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
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
- 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.
- Gifford J. Action Learning: Principles and Issues in Practice. Institute for Employment Series. May 2005.
- Koo L. Learning Action Learning. Journal of Workplace Learning. 1999. 11(3):89.
- Marquardt M. Action Learning and Leadership. The Learning Organization. 2000. 7(5): 233-241.
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