[The following notes were generated by Sandra Haudek, PhD.]

The Spring 2022 IAMSE Webinar Seminar Series, titled “To Infinity and Beyond: Expanding the Scope of Basic Sciences in Meeting Accreditation Standards” finished with its fifth seminar on Thursday, March 31, 2022, titled “Strategies for Incorporating Self-Directed Learning into Basic Sciences Education”. In this session, Samara Ginzburg, Dean for Education and Associate Professor of Medicine and Science Education, and Joanne Willey, Chair of the Department of Science Education, both from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, presented strategies to promote the development of self-regulated learning skills needed for students to become self-directed.

Dr. Ginzburg started this interactive session by asking the audience to picture a colleague who practices self-directed learning (SDL). Throughout the session, she asked the audience questions about their behaviors and compared the audiences’ answers to published data. 

Dr. Willey stated that the literature is full of information on student characteristics and their relationship to SDL. However, they did not find studies with information on the understanding of SDL by faculty. Therefore, they conducted a national survey of medical educators designed to assess faculty needs on their understanding of SDL [1,2]. Specifically, do faculty value SDL for medical students? Are faculty familiar with strategies documented to promote SDL? They found that of the 350 undergraduate medical educators who responded, ~95% believed that SDL is essential for medical student success. However, when asked what, in their opinion, SDL encourages, answers were multifaceted. Among those, the team identified three layers: (1) highest layer: life-long learning values, self-reflection, curiosity, motivation, goal setting, and better equipped to meet challenges; (2) middle layer: better prepared for the classroom and clinical responsibilities, peer teaching, team-based skills; and (3) lowest layer: improving academic performance, communication skills.

Dr. Ginzburg continued by stating the actual definition as published by her team [3]. She explained that her institution’s curriculum is grounded on SDL with 12 years of experience. Self-directed learning is “a construct that embodies the process elements associated with self-regulated learning as well as the characteristics of the learner and the culture of the learning environment.” The concepts include three separate areas that have to fall together: (1) learner characteristics (motivation, curiosity, resilience); (2) the culture of the learning environment (assessment, resources, values, hidden curriculum); and (3) the self-regulated learning cycle. The latter is intrinsic to the entire SDL process and, although this process is innate to some personalities, it has to be learned and practiced by most faculty. The cycle encompasses planning, learning, assessing the knowledge to identify gaps, and adjusting behaviors to close these gaps.

LCME gives another definition (element 6.3) which is similar to those from other educational regulatory bodies for health professions schools. Educators need to make sure students know how to self-assess their learning, how to independently analyze, identify, and synthesize the relevant information (learning of the cycle), how to appraise the credibility of resources, and ensure that students receive feedback on their information-seeking skills. LCME asks to do this as a unified sequence, meaning altogether as part of the same learning activity. This element has driven many changes in curricula across the country to include SDL.

Dr. Willey continued by reviewing data from her national survey study [1,2]. In their study, her team created questions for medical educators addressing three SDL strategies: (1) Cognitive strategies, which make the material more accessible (e.g., what do you do to help students understand, relate to, and digest the material?). (2) Metacognitive strategies, which increase the ability to set goals, self-assess, and adjust. (3) Emotional & motivational strategies, which address learner attributes and culture of the learning environment. They found that faculty were overall familiar with the metacognitive and emotional & motivational strategies to promote SDL, but were much less comfortable with cognitive strategies despite having the most control over them as they teach. To highlight their findings, Dr. Willey posed several of their study questions to the audience and, after analyzing the polls, discussed the audience’s overall responses compared to the national overall responses.

To highlight the different question types, Dr. Ginzburg discussed Charles Grow’s model of staged SDL from the general education literature (1990s). In this model, Dr. Grow considers a student to pass through different levels of self-direction. A student starts as a dependent, becomes interested, then involved, and then self-directed. The student functions on different levels depending on the content; they may be on a higher level in one area but a lower level in another area. In his model, Dr. Grow also considers the role of the instructor from being an authority/coach, to motivator/guide, to facilitator, to consultant/delegator. Thus, as the student progresses through these levels, the faculty should also adjust their roles. Ideally, the instructor matches, or near matches, the level of the student. A mismatch, or severe mismatch, should be avoided.  If an instructor works with a group of students, the instructor should find the overall best level, accepting that one student may be a severe mismatch; the latter student is best helped by one-on-one meetings. The faculty’s task is to practice how to recognize and meet the learners on their level, as well as take learners step-by-step from one level to the next.

Dr. Willey explained that individuals usually stick to the same question type during their teaching. However, with practice, faculty may move between question types on purpose, depending on the students’ levels and environment. The type of questioning drives what happens before, during, and after an SDL session. She illustrated how faculty can covert a recall question into an analysis question, then into a synthesis question, based on work from the Stanford Faculty Development Program, Leland Stanford University (1998). Faculty should also be able to encourage students to rephrase their questions from the first level to higher-level questions to generate discussion and practice scaffolding. (1) Recall questions (what?) probe for basic facts and require prior knowledge or experience. Recall questions do not generate much discussion but engage learners in some form before the session. (2) Analysis and synthesis questions (how?) require learners to demonstrate deeper understanding, create context into which individual pieces of data fit, and apply deductive reasoning and logic to answer questions. Analysis questions generate reasonable discussions in advance, during, and after the SDL session. (3) Application questions are complex and require integrating different materials, but generate robust discussions. Application questions require preparation, highly stimulating discussions, and continue to impact after the SDL session.

The presentation lasted 45 minutes. Drs. Ginzburg and Willey then responded to questions from the audience: How do the cognitive, metacognitive, and motivational strategies discussed differ from learning versus SDL? How can you integrate the concepts you discussed to be used to meet LCME, which requires faculty feedback on citations? Does SDL affect team performance? Do you believe that Montessori students have an advantage?

1. Lim YS, Lyons VT, Willey JM. Supporting Self-Directed Learning: A National Needs Analysis. Med Sci Educ. 2021 Apr 6;31(3):1091-1099. doi: 10.1007/s40670-021-01278-y. eCollection 2021 Jun. PMID: 34457952
2. Lim YS, Lyons VT, Willey JM. Supporting Self-Directed Learning: Development of a Faculty Evaluation Scale.Teach Learn Med. 2021 Oct 13:1-10. doi: 10.1080/10401334.2021.1977136. Online ahead of print. PMID: 34645314
3. Ginzburg SB, Santen SA, Schwartzstein RM. Self-directed Learning: a New Look at an Old Concept. Med Sci Educ. 2020 Oct 20;31(1):229-230. doi: 10.1007/s40670-020-01121-w. eCollection 2021 Feb. PMID: 34457877 Free PMC article.

[The following notes were generated by Sandra Haudek, PhD.]

The Spring 2022 IAMSE Webinar Seminar Series, titled “To Infinity and Beyond: Expanding the Scope of Basic Sciences in Meeting Accreditation Standards” continued with its fourth seminar on Thursday, March 24, 2022, titled “Towards Integrated Medical Education: Getting the best out of interdisciplinary teacher teams and leaders”. In this session, Mirjam oude Egbrink, Professor of Implementation of Educational Innovations and Vice Dean Education, and Stephanie Meeuwissen, an internal medicine resident, both from Maastricht University Medical Centre in the Netherlands, presented their research on interdisciplinary teacher teams working on integrated medical education.

Dr. Egbrink started by summarizing the shifting landscape of healthcare due to increased medical knowledge and technology and the increased presentation of patients with multiple chronic diseases that all together require a higher level of complexity and a growing need for collaboration between different health care professions. To address this shift, the Maastricht University Faculty of Health Medicine and Life Sciences has implemented an interdisciplinary, problem-based curriculum for undergraduate students. In contrast to traditional discipline-specific curricula, they organized their integrated curriculum by thematic case-based blocks, each 4-10 weeks long, in which students engage in small-group sessions focusing on relevant healthcare-related to real-life problems to stimulate meaningful and deep learning. Each thematic block includes contributions from a series of disciplines. Since these topics include basic, social, and clinical sciences, the educators who develop and organize these individual blocks need to come from different disciplines. At Maastricht University, these groups of teachers are called Planning Groups and consist of 3-5 faculty from different departments, including a team leader. With over 50 departments and over 300 blocks, this involves a complex organization.

Until recently, there was no data on how these Planning Groups functioned, how team members worked together, and how integrated and meaningful the content was. Therefore, Dr. Egbrink and her team studied the following questions: 1) How do interdisciplinary teacher teams function when working on an integrated curriculum? 2) How does their teamwork influence the quality of education? 3) What are important factors influencing team functioning? 4) How can we promote the successful functioning of interdisciplinary teacher teams?

Dr. Meeuwissen continued by asking, “What makes a successful team?” The answer is not self-evident as any team, not just medical teams, are complex and prone to conflicts. Literature on management sciences and business is rich in information about team learning. Team success depends on how members interact with each other. Team learning depends on how the team builds upon each other’s knowledge and experience. Team learning behavior depends on sharing information among team members in an open and respectful environment that leads to co-construction of content that further evolves to constructive conflict management. Constructive conflict is about the negotiation of different experiences, perspectives, and knowledge not leading to a conflict but agreement. Team learning influencing factors are based on individual (personal), team (interpersonal), and organizational knowledge, skills, and attitudes. Team learning outcomes and innovation are also better in high-level team learning [1].

When Dr. Meeuwissen’s team surveyed the faculty participating in the Planning Groups, they identified three different team approaches [2]. (1) Fragmented Team (“Hangout”): Team members shared their discipline but did not work with each other’s experience or build upon each other’s expertise. (2) Framework-guidance Team (“Distribution Center”): Team members built on each other’s knowledge and stayed outcome-centered. The team leader was more in charge of the different perspectives. (3) Integrated Team (“Melting Pot”): Teams worked well together, incorporated members’ knowledge, skills, and attitudes. The team leader and members together created student-centered education. When Dr. Meeuwissen measured the quality of education as perceived by students, they found that fragmented teams scored lowest in organization, structure, and learning effects. By contrast, the integrated teams scored highest in all aspects (organization, structure, learning effects, and cohesion). Team members confirmed these results since members of integrated teams were most satisfied with their work. They concluded that different team approaches produced varying levels of outcomes. An integrated team approach should be encouraged as they demonstrated the highest team learning levels.

Dr. Meeuwissen then discussed enabling and inhibitory factors that influenced interdisciplinary teacher team functioning [3]. They found several personal characteristics and team dynamics that influenced their respective team approach. (1) In the fragmented team, personal alignment was dominant, including members’ attributes, tendencies, and motivation. In essence, members in these teams did not align with the educational philosophy of integration, rather emphasized discipline-center education. (2) In framework-guided teams, team leadership was evident since leaders and members had a vision, took responsibility, and regularly reflect on their work. (3) Integrate teams, in addition to team-leadership attributes, also incorporated organizational processes like decision-making.

To investigate “What makes a successful team leader?”, Dr. Meeuwissen and her team observed (interactions and written correspondence) and interviewed select teams over a year [4]. She found that success was associated with the team leader’s inclusiveness behavior. Such inclusiveness included coordinating, explicating, inviting, connecting, and reflecting. The team leaders were on task, knew exactly what was going on, were mindful of deadlines, knew the different backgrounds, personalities, capabilities, and emotional states of all team members, gave clear and explicit directions and made sure each member was heard and contributed to the work. In return, team members’ participated actively, spoke up, and even mimicked the leader’s inclusiveness. In alignment with the literature, her results indicated a paradigm shift in health professions’ education leadership.

Lastly, Dr. Meeuwissen discussed how they set up a faculty development program on leadership identity formation for interdisciplinary teacher team leaders [5]. They used the method of Design-Based Research, which anchors on theoretical principles: competence-based learning, workplace learning, learning by doing, small-group learning, and tailor-made learning. The leader identity development process is an iterative, collaborative & continuous process that integrates knowledge, broader views on leadership, application, and reflection.

Dr. Meeuwissen summarized that leadership is an important asset that determines the culture and structure of the organization, a leader identity program can convert teachers’ views on leadership, thoughts on education and leadership are important to change behavior, all teams are groups but not all groups are teams, and that soft elements of interdisciplinary teams can have hard consequences for education.

The presentation lasted 35 minutes. Drs. Egbrink and Meeuwissen then responded to many questions from the audience: if there was a difference in team behaviors between individuals of different demographics. How did you determine which team falls into which category? Did you make any interventions when you found a low-performing team?

1. Meeuwissen, S.N.E., Gijselaers, W.H., Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. When I say… team learning. Medical Education. 2020;54(9):784-5.
2. Meeuwissen, S.N.E., Gijselaers, W.H., Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. How teachers meet in interdisciplinary teams: hangouts, distribution centers and melting pots. Academic Medicine. 2020;95(8):1265-73.
3. Meeuwissen, S.N.E., Gijselaers, W.H., Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. Working beyond disciplines in teacher teams: teachers’ revelations on enablers and inhibitors. Perspectives on Medical Education. 2021;10(1):33-40.
4. Meeuwissen, S.N.E., Gijselaers, W.H., van Oorschot, T.D., Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. Enhancing Team Learning through Leader Inclusiveness: a One-Year Ethnographic Case Study of an Interdisciplinary Teacher Team. Teaching and Learning in Medicine (2021);33(11).
5. Meeuwissen, S.N.E., Gijselaers, W.H., de Rijk, A.E., Huveneers, W.J.M, Wolfhagen, I.H.A.P., oude Egbrink, M.G.A. When Theory Joins Practice: Teachers’ Leader Identity Development in Health Professions Education. Medical Teacher (2021). Published online. doi:10.1080/0142159X.2021.2015532