Action Learning through a Medical Mission Trip

by Julie Pauly, Pharm.D. Candidate, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University

Action learning requires individuals to take ownership of their decisions by solving real-life problems with reflection on the results. First described by Reg Revans in 1982, action learning principles were developed for businesses and other organizations as a means for employee development, team-building, problem solving, and quality improvement. There are learning opportunities in encountering the unknown. According to Leonard and Marquardt, action learning has educational implications, where students can enhance not only foundational knowledge, but leadership and team-building skills.¹

Action learning is simply “learning by doing” where an individual within a “set” or group reflects upon her/his role, while gaining the aid or advice not only from a facilitator but also peers.² Each group must establish their own rules and structures that determine norms of behavior and how they will complete complex tasks. Action learning is best applied when standard solutions to problems are unavailable and past experiences can guide decisions. This lack of fixed procedure creates a “highly situational” learning environment, where application of knowledge and strategy must be catered to the environment in which the student is serving. While action learning can be risky because it requires empowering individuals to take on tasks they may feel ill prepared to perform, there also comes a high gain in productivity in this “learning by doing” concept.

A medical mission trip embodies the action learning principles. This type of learning environment fosters the “learning by doing” mentality by providing learners with opportunities to execute and manage patient care, but also use their didactic education to “practice” with patients who have diverse needs.

In May of 2014 the Gregory School of Pharmacy took a group of pharmacy students on a medical mission trip to Honduras for a week of service to the people of Siguatepeque. I served as one of four fourth year clerkship students; each relying on one another for completing tasks and ensuring a smooth trip.  As a collective, we were responsible for managing the medication inventory, packing, and distribution of medications to be taken on the trip, as well as organizing the medications before and after each clinic day.  We were also responsible for scheduling the other student team members and facilitating their activities at each of the clinic stations.  This type of dynamic enhanced our understanding of what “team-building” really meant, learning the worth of those individuals who step up and do their part, as well as empowering those who needed to pull their weight. The preceptors served as “facilitators,” where they guided the clerkship students if questions arose but gave us full autonomy in the execution of the plan. These responsibilities gave the clerkship students an opportunity to develop their administrative, management, and leadership skills — skills that are very important for any working professional.

In addition, the clerkship students, under the supervision of the preceptors, had the privilege of interviewing patients to address their medical complaints. We were encouraged to share our view of the diagnosis and recommend treatment strategies that included lifestyle modification and medication(s) available from our limited formulary. More than 100 individuals lined up each day to be seen by our team.  We got plenty of practice!  Each day our interactions with patients became more refined, and each new experience reinforced our confidence.  According to Gifford, obtaining experience in this manner is superior to traditional teaching methods.  I agree!  Indeed my learning was far beyond what I’ve experienced in any “traditional” classroom or even experiential learning setting.  Perhaps because I was given more autonomy and everyone was relying on me.  My knowledge, critical thinking, and confidence as a clinician was accelerated.

As action learning requires, a degree of uncertainty needs to be present.  Koo describes the concept of uncertainty as “how to ask appropriate questions in conditions of risk, rather than to find the answers to questions that have already been precisely defined by others.”³  As a clerkship student, I was required to consider the difference in culture and norms in Honduras compared to my life in the United States.  Moreover, the medications and tools available to us in Honduras were very limited.  Thus applying my knowledge of standard “guideline” recommendations was not possible. We had to learn how to deliver the best possible care using the limited resources we possessed. Every decision had to carefully weigh what was best for the individual patient in front of us as well as the needs of everyone.  We had to ration our limited supplies.  We lacked extensive diagnostic tools and this made it very challenging when addressing patient complaints; I had to reflect on my knowledge of disease states to make decisions that were still at the highest standard of care. Thinking back on the experience, I am grateful for this uncertainty — the lack of well-defined ways to practice.  I know as a clinician we will be called to think outside the box.  Even in the United States, things don’t always have well-defined answers.

Another facet of action learning is reflecting on what was learned and how you will use your new knowledge and skills in the future.  This requires a personal inquiry regarding what is important when carrying out your role and responsibilities.  It was important for me to reflect upon my interactions with my peers and preceptors to gauge how best to approach any given situation. At the end of each day (and even as I write this), I reflected on the interactions I had with patients. I now have a deeper understanding of what it meant to be invested in a patient and maintaining compassion. Kindness and being available to a patient — truly listening to their concerns — goes a very long way if you want to give your best to a person.

I feel action learning is an ideal for training healthcare professionals. Hands-on practice in situations that do not have well-define answers gives the blossoming healthcare student the skills and experiences needed for their future role as a professional.  This type of “learning by doing” is often achieved through post-graduate residency programs; but this needs to be part of our professional degree programs too.

In order for action learning to work effectively, there must be willing expert facilitators who invest time and energy in their students. The facilitator must make certain that all learners have meaningful “doing verses watching” practice experiences, where the student takes the lead under a watchful eye. A group “set” must also be responsible for working together. However, some individuals may not wish to fully participate in this type of learning environment or accept this level of responsibility. Facilitators must encourage engagement and help manage group dynamics. A facilitator would also have to assist with problem-solving by help students reason through a situation and acknowledge that multiple answers may be available.

Is action learning appropriate for learners at all levels of education? Action learning requires us to generate our own knowledge through action, using our past knowledge as a foundation.  Therefore, it may not be appropriate for younger students, say those in middle or high school. Action learning also requires an internal reflective inquiry and this may be challenging to younger students.

Action learning has limitations too. If all learners in the group are not committed to the learning experience, the group will suffer. Action learning also requires an actively engaged facilitator, which may prove challenging while also managing other job responsibilities. Lastly, there are site-specific limitations and state laws that govern the scope of an intern’s practice responsibilities, thus giving students a high degree of autonomy is not always possible.

In conclusion, the application of action learning principles in higher education is incredibly powerful and this method of teaching should used when educating healthcare professionals. My mission trip experience is a model of action learning put into practice.

References

1. Leonard, H.S. and Marquardt, M.J. The evidence for the effectiveness of action learning. Action learning: Research and practice. 2010. Pg. 7, 2, 121-136.
2. Gifford J. Action Learning: Principles and Issues in Practice. Institute for Employment Series. May 2005.
3. Koo L. Learning Action Learning. Journal of Workplace Learning. 1999. 11(3):89.
4. Marquardt M. Action Learning and Leadership. The Learning Organization. 2000. 7(5): 233-241.