Adult learning theorists such as Malcolm Knowles (Knowles, Holton & Swanson, 2005) and Stephen Brookfield (1986) emphasise that adults learn differently than children. They maintain that any educational programme aimed at adults should be focused first on the learner, rather than on instructional design. Knowles defines the teaching approach of andragogy (andros being Greek for man) as being separate from that of pedagogy (pedo, Greek root word for child). Knowles introduced his andragogy model in the early 1970s, building on the work of Dewey (1933) and Lewin (1951) among others. In it he describes a number of core adult learning principles which he argues
Phase 1: September - December 2006 Framing the project
• Establishment of 2006-07 Memorandum of Understanding (MOU) • Assessment of EBP
learning interests and needs
• Four individual interviews with available Sunnyview staff • One group interview with
remaining staff and students
Phase 2: April - August 2007 Introductory EBP sessions
• Designed and conducted six 90 minute EBP skill development sessions with Sunnyview therapists and students
Phase 2 (cont.): September - December 2007 Journal club sessions
• Establishment of 2007-08 Memorandum of Understanding (MOU) • Faciliatated three 90
minute sessions with Sunnyview therapists involving the critical appraisal of the research literature on selected topics Phase 3: January - June 2008 Responding to change sessions
• Designed and conducted three 90 minute sessions with Sunnyview therapists on challenges arising while integrating change over a professional career
24
must be addressed in all adult learning situations. They include (Knowles, Holton & Swanson, 2005, p. 3):
1. Learner‟s need to know (why, what and how)
2. Self-concept of the learner (autonomous, self-directing) 3. Prior experience of the learner
4. Readiness to learn (life related)
5. Orientation to learning (problem centred, contextual)
6. Motivation to learn (intrinsic value, personal/ professional payoff)
Knowles et al. underline the need of learners to „own‟ the learning process in order to feel empowered. By owning they mean that the adult learners should be given
opportunities to share control over the learning strategies. When adults are treated as collaborative partners in the learning, not only is the „need to know‟ addressed, but the process appeals to a self-concept based on being independent learners. As much of the literature emphasises, EBP involves a commitment to lifelong, self-directed learning. Knowles et al. (2005) note the importance of integrating the learner‟s prior experiences, a founding principle that has long been espoused by many educational theorists
(Argyris, 1982; Boud & Griffin, 1987; Dewey, 1933; Kolb, 1984; Schön, 1987). Savery and Duffy (1996) also argue the need of learners to own the learning process by
providing learning opportunities that are experiential and problem-solving in nature. Schön (1987), a learning theorist frequently cited in the health education literature, analysed the experiential basis of professional problem-solving. He theorizes about how professionals, through reflecting on past experiences, seek to interpret professional questions or conundrums (reflection-on-action). Schön maintains that professionals subsequently seek additional information (research, opinions of colleagues) which they integrate into their thinking. When professionals later find themselves in a similar situation they re-consider the applicability of the new knowledge (reflection-in-action). Schön‟s theory is commonly cited in the clinical therapy literature over the past 15 years as an explanatory framework for clinical reasoning (Brown, Esdaile & Ryan, 2003; Higgs, 1995; Schell & Schell, 2008).
25
Like Schön, Kolb (1984) encourages reflective learning. His theory of experiential learning describes a cycle comprised of four stages which are followed in sequence if successful learning is to take place. These stages are:
Concrete experience (doing/ having an experience)
Reflective observation (reviewing/ reflecting on the experience) Abstract conceptualisation (concluding/ learning from the experience) Active experimentation (planning/ trying out what one has learned)
I find both the Schön and Kolb models very relevant to EBP teaching and learning. Both emphasise the role of reflection in learning. As noted previously in the discussion of definitions of EBP in the occupational therapy literature, EBP is seen as “just one of
the tools of reflective practice” (Taylor, 2007, p.2). Additionally, the experimentation
stage of Kolb‟s model requires that the learner apply what has been learned. EBP learning, following his model, would involve implementing problem-solving strategies that educate for capability (Fraser & Greenhalgh, 2001).
On examining the adult learning theory literature in greater depth, I became aware that most of the above-cited theorists were anchoring their ideas in a contructivist
epistemology. Epistemology is concerned with how we know what we know. The American educator John Dewey (1933) was a constructivist, as were educational psychologists Vygotsky and Piaget. Piaget‟s theories of child development are
commonly taught in occupational therapy curricula. Both Vygotsky and Piaget maintain that children learn to know as they engage with the world around them and seek to make sense of it by creating meaning (Tryphon & Vone, 1996). Constructivism, then, focuses on the meaning-making of the human mind (Crotty, 1998). When this meaning- making takes into consideration the larger social context it is referred to as social constructivism, or, more commonly, simply constructionism5. Intuitively, the logic of
5
Constructionism is an epistemological stance oftentimes invoked by qualitative researchers. It has its roots in the philosophical writing of Heidegger and Husserl among others. Constructionism is embodied in many theoretical perspectives such as phenomenology and critical inquiry. Positivists maintain that by using appropriate methods of inquiry we can arrive at an accurate and certain knowledge of an objective truth. Constructionists, however, believe that “all knowledge, and therefore all meaningful reality as
such, is contingent upon human practices, being constructed in and out of interaction between human beings and their world, and developed and transmitted within an essentially social context” (Crotty,
2009, p. 47). Therefore, in the constructionist view, meaning is not discovered, but is rather constructed. In contrast to a positivist, a constructionist maintains that our world, including its objects, is
indeterminate. Our world contains potential meanings, but the actual meanings are constructed by us humans. We do this during the process of engaging with the world in our attempt to interpret and make
26
anchoring the therapists‟ learning (i.e. constructed meanings about EBP) in their understandings about their [clinical] experiences appealed to me as one well familiar with the writing of Schön and Kolb. Much has been written in the adult learning literature which supports such a premise (Argyris, 1982; Boud & Griffin, 1987; Fish & Coles, 1998; Knowles, Holton & Swanson, 2005; Savery & Duffy, 1996). All of these theorists emphasise that learning is ideally grounded in life experiences which
themselves take place within social contexts.
Savery and Duffy (1996) propose eight constructivist instructional principles that enable individuals to elicit meaning from their learning experiences (pp. 17-25):
1. Learning activities should be tied to a larger task or problem.
2. The learner should be facilitated in feeling ownership of the overall problem or task.
3. The task should be authentic in the sense that it has real world relevance for the learner.
4. The task and the learning environment should be such so as to reflect the complexity of the environment in which the learners will be expected to function at the end of the learning.
5. The learner should also have ownership of the process used in tackling the task or problem.
6. The learning environment should challenge the learner‟s thinking.
7. The learner should be encouraged to test existing knowledge / experiences against alternative views/ experiences.
8. Reflection should form an important part of the learning process.
sense of it. At the same time, we are born into a time and space-framed world of meaning that is bestowed upon us by our culture. And it is not just our thoughts that are constructed, our emotions are also.
Consequently, from the constructionist viewpoint, meaning (or truth) is neither objective nor subjective. Rather, all human knowledge is merely a plausible way of viewing our world; there is no one „true‟ way of seeing things. Even scientific knowledge is just one particular form of constructed knowledge designed to serve specific purposes. On an ontological level, constructionism does not deny that the world can exist without a human mind (e.g. dinosaurs probably existed millions of years ago), but maintains that
meanings without a mind do not exist (it was humans who gave dinosaurs a name, attributed to them the associations we make about them).
Constructivism is somewhat different from constructionism, though the constructivist epistemology is grounded in that of constructionism. The proponents of constructivism are to be found particularly in social psychology and education. Constructivism focuses on “the mean-making activity of the individual mind [whereas] constructionism focuses on the collective generation and transmission of meaning” (Crotty, 2009, p. 58) such as an entire culture.
27
These instructional principles guided me in developing learning strategies for the Sunnyview EBP sessions detailed in the programme handbook (Crausaz, 2007a). The learning activities were linked to EBP skill development. The proposed tasks, such as engaging in journal club discussions, were authentic as described by Savary and Duffy (1996). As the learning took place within the actual service where the therapists worked as a team, everyday enablers and constraints to engaging in EBP were frequently
discussed.
The education literature in the health professions, in congruence with the constructivist educational literature cited above, also underlines the importance of contextual learning. In the health professions, the criteria for an effective learning environment highlight the importance of facilitating the transfer of what is learned to what is practised. For
example, in occupational therapy pre-qualification education there is a long tradition of what is termed work-integrated learning (clinical placements). In post qualification education, the emphasis is on fostering what Brown, Esdaile and Ryan (2003, p. 220) term a “learning workplace culture”. Dillenbourg (1999) stresses the role of the group in fostering such a learning workplace culture. He envisions colleagues learning from each other by working together on the same objective; each group member is a potential source of information. Dillenbourg credits group process with creating both a sense of ownership and empowerment. Hammel, Finlayson, Kielhofner, Helfrich and Peterson (2001) emphasise the importance of situated learning where: 1) knowledge is acquired in context; 2) learning involves social interactions with collaborative problem solving of specific issues. Welch and Dawson (2006) maintain that practice-based collaborative learning of EBP skill acquisition, involving an entire team, serves as a catalyst to increasing therapists‟ confidence in consuming research and in exploring the transition towards being an evidence-based practitioner. It was this literature that inspired me to initially orient my efforts to encourage research utilisation by therapists through a service-based educational approach.
Hence, the adult learning literature re-enforced my conviction, grounded in my past experiences as a facilitator of short continuing education courses between1990 and 2005, that the learning of practising clinicians should incorporate their prior experience and include experiential learning tasks focused on problem-solving. I was also aware that in working with the entire Sunnyview occupational therapy team I would need to
28
address the differing EBP skill needs and attitudes of novice to expert therapists. Dysart and Tomlin‟s (2002) research demonstrates that it is the most experienced therapists who regard research evidence to be the least relevant to their clinical practice. Hence, I felt the grounding of new EBP knowledge and skills in the therapists‟ clinical
experiences would be the shortest route to bridging the much criticised theory-practice divide; a bridging to be primarily accomplished through reflective practice as advocated by many scholars (Argyris, 1982; Boud & Walker, 1990; Fish & Coles, 1998; Higgs & Jones, 2000; Kolb, 1984; Schon, 1987). The learning strategies employed during the six 1 ½ hour EBP skill development sessions with the Sunnyview therapists in April to August 2007 were designed with the intention of doing just that (Appendix 2). Additionally, the literature impressed upon me the importance of learners owning the learning process by having their say in the learning strategies being employed. This was accomplished through the Sunnyview therapists and myself collaboratively deciding the content and learning activities of each session. In this way, their need to know a specific body of knowledge was addressed in a manner meant to enable self-directed learning. However, the literature also highlights challenges to encouraging self-directed learning. In the paper Putting evidence-based occupational therapy into practice: A programme
of collaborative task-based learning (Crausaz, 2007b) I debate at length whether a
constructivist learning environment is, in fact, something of a chimera. If it is assumed that teachers are the knowers who craft content and learning processes, are they really supporting a collaborative search for meanings? In the role of the expert I still had the strongest voice in what the learners should be learning and how. Tennant (1986), in his criticism of Knowles‟ work, maintains that there are only emasculated self-directed learners as any strategies to aid the transition of learners from being dependent to being more self-directed are necessarily paternalistic and manipulative. Tennant develops his position even further by arguing that Knowles (and by extension many constructivist learning theorists) gives too much guidance for structuring the processes to be adhered to in any educational setting by stating “why should self-directed learners follow the
processes advocated by Knowles? Surely the imposition of a process can be just as restrictive and alienating as the imposition of content?” (p. 115). Tennant laments the
use of learning contracts as they “commence with a diagnosis of personal deficits [...]
there is the prescription to define „deficits‟ in relation to the needs of social institutions”
29
In my collaboration with Sunnyview, the therapists self-identified their EBP knowledge and skill deficits and they decided on the learning activities in which they wished to engage to address those deficits. However, through my work with them, as I discuss below, I came to appreciate the limitations of not insisting that learners demonstrate more self-direction and not imposing minimal engagement in the learning processes, even if it meant my assuming what Tennant would consider a manipulative role. Hence I feel that Tennant‟s criticisms are over-stated. As Savery and Duffy (1996) emphasise, a learning environment is one where learners reflect on their existing knowledge and challenge their own and each other‟s thinking. If the learners do not set the bar this high, perhaps it is the role of the teacher to actively support them in doing so, even if Tennant would consider such an approach paternalistic. This encouragement should probably be done from the outset, when learning aims and objectives are first being articulated. As I was only beginning to construct my understanding of how best to frame EBP educational opportunities, the Sunnyview collaboration gave me an opportunity to learn from my mistakes, before undertaking the main study.