October 26, 2009

Implementing Self-Directed Learning

By Sandeep Devabhakthuni, PGY1 Pharmacy Practice Resident, University of Maryland Medical Center

Self-directed learning is basically the process in which an individual matures from a dependent learner in a highly structured environment (often a classroom) to an independent learner with the motivation to continuously self-monitor and self-manage his/her learning process. In the healthcare setting, the recent paradigm shift to evidence-based medicine requires the engagement of healthcare professional students in self-directed learning. Typically, healthcare professional schools design academic curriculums that will at minimum prepare students to become competent practitioners. While I learned a tremendous amount of information that will serve me well in my clinical practice, I realized that the program of study I completed was designed to help me achieve the minimum competencies needed to be a general practitioner. Despite having just graduated with a Doctor of Pharmacy degree, I recognize there are several ways I can improve myself. Thus, I am a big proponent for self-directed learning because I want to become a highly competent healthcare provider.

Self-directed learning is an effective (even essential) method for training healthcare professionals. But how do we motivate students to become self-directed life-long learners? Specifically, is there a need for more guidance during the didactic portion of the curriculum before expecting students to perform self-directed learning activities during their experiential learning rotations? At the University of Maryland School of Pharmacy (UMSOP), Huynh et al considered this issue by investigating the impact of advanced pharmacy practice experiences (APPEs) on student’s readiness for self-directed learning (Am J Pharm Educ. 2009; 73(4): 65-72).

In this investigation, the authors followed pharmacy students over the course of their last year in the Doctor of Pharmacy curriculum in order to assess their readiness to engage in self-directed learning activities. During their third year before starting APPEs, pharmacy students from were invited to complete a questionnaire consisting of 2 sections: the Self-Directed Learning Readiness Scale (SDLRS) and a baseline characteristics survey. A score of 150 or greater on the SDLRS instrument was correlated with a high level of readiness for self-directed learning. After completing the required APPEs, the pharmacy students were asked to complete the SDLRS instrument again. The data from the post-APPE questionnaire was compared to the results of the pre-APPE questionnaire.

The authors reported that 77 (64%) and 80 (67%) students completed the questionnaire in the third and fourth year, respectively. Of these respondents, only 46 (38%) matched pairs completed the questionnaire in both years. From the baseline characteristics analysis, none of the characteristics such as age, gender, pre-pharmacy coursework, postgraduation plans, or leadership experiences had an impact on the SDLRS score. The overall mean SDLRS score for the pharmacy students who completed the questionnaire in the third year and fourth year were 157 ± 21 and 162 ± 21, respectively. No difference was found in the mean scores on the SDLRS for students in their third and fourth years (p > 0.05), regardless of using all student data or only matched pairs (i.e., same student before and after completion of APPEs) data.

To be honest, I was not entirely surprised that the impact of APPEs on the student’s readiness for self-directed learning was minimal. Pharmacy students need to be ready to engage in self-directed learning before they begin their experiential learning rotations. If the student does not have the expectation of performing self-directed learning during the APPEs, the student will struggle during his/her last professional year. Teaching students to engage in self-directed learning during the APPEs is probably too late. The students need to be aware of the need for self-directed learning before they apply the process during APPEs. The fact that the APPEs have a minimal impact on the student’s readiness supports this observation. Instead, the purpose of the APPEs is to provide the pharmacy student opportunities to engage actively in self-directed learning. Thus, it is crucial to provide guidance to the pharmacy students before APPEs on how to successfully engage in self-directed learning activities during APPEs.

At the time of the investigation, the authors reported that the pharmacy students at the UMSOP were not provided explicit instruction regarding how to conduct self-assessments or engage in reflective learning. The good news - most students demonstrated a high readiness for self-directed learning at baseline before beginning their APPEs. The focus should shift to helping students applying self-directed learning skills during their APPEs. In other words, preceptors should evaluate whether students successfully engage in self-directed learning activities. By giving feedback regarding the quality of these self-directed activities, students will learn how to self-evaluate and take steps to improve their knowledge and skills when they begin their practice as pharmacists.

[Editor's Commentary: Why are some people more successful in their professional lives then others? What keeps some people "on top" of their field for many years? Is it strictly a matter of internal motivation? An intrinsic personality trait? An inherent need to understand the world? Intellectual curiosity? Or is self-directed learning a learned behavior? A set of skills, habits, and attitudes learned by observing other successful people in our lives (e.g. parents, role models). Can these skills, habits, and attitudes be taught in school? Few of us have received explicit instruction about how to "be" a self-directed learner. Not surprisingly, students who are admitted to schools of pharmacy are very bright and successful. It seems likely that one of the ingredients for their success is their ability to independently recognize gaps in knowledge and skills ... and engage in self-development activities to close these perceived gaps. Indeed, the "best and brightest" often become involved in research projects (or "special projects" or "independent study") during their years in pharmacy school and pursue residency or fellowship training after graduation. And yet, these are the individuals who are most competent and best prepared to entry practice without doing a residency or fellowship. Is the ability to successfully engage in self-directed learning an intrinsic quality or a learned behavior? Is it nature or nurture? An age old debate. -S.H.]

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