Role of Family Physicians in Implementing Asthma Self-Management Programs

The reality of everyday asthma care differs substantially from guidelines. The fact that better possibilities for asthma care do not result in better outcomes remains an enigma and harms professional pride. Patient self-management has been presented as a tool to improve outcome of care. Based on published work thus far, it can be concluded that self-management of asthma can be beneficial from both the family physicians' and the patients' perspective and, under certain conditions, proves to be an efficient method of incorporating both interests. Health professionals play an important role in implementing self-care, but several barriers should be solved first: attitudes of health professionals and patients need to shift towards shared responsibilities and be patient-centered and organization of care should change accordingly. As reviewed in this article, the typical features of self-management of asthma may provide the means to overcome these barriers.Asthma, Patient education

A Philosophical Discussion of the Support of Self-Regulated Learning in Medical Education: The Treasure Hunt Approach Versus the (Dutch) “Dropping” Approach

Issue: Many current educational approaches are intended to cultivate learners’ full (learning) potential by fostering self-regulated learning (SRL), as it is expected that those learners with a high degree of SRL learn more effectively than those with a low degree of SRL. However, these attempts to foster SRL are not always successful. Evidence: We considered complexities related to fostering self-regulated learning by use of an analogy. This analogy was based on two (Dutch) children’s games: the treasure hunt (children can find a “treasure” by following directions, completing assignments and/or answering questions) and the dropping (pre-teens are dropped in the woods at nighttime with the assignment to find their way back home). We formulated four interrelated philosophical questions. These questions were not formulated with the intention to provide clear-cut answers, but were instead meant to evoke contemplation about the SRL concept. During this contemplation, the implications of definitional issues regarding SRL were discussed by use of the first question: What are the consequences of the difficulties to explicate what is (not) SRL? The second question (How does SRL relate to autonomy?) touched upon the intricate relationship between SRL and autonomy, by discussing the role of social interaction and varying degrees of instruction when fostering SRL. Next, a related topic was addressed by the third question: How much risk are we willing and able to take when fostering SRL? And finally, the importance of and possibilities to assess SRL were discussed by the fourth question (Should SRL be assessed?). Implications: From our contemplations it has become clear that approaches to foster SRL are often insufficiently aligned with the experience and needs of learners. Instead these approaches are commonly defined by contextual factors, such as misconceptions about SRL and lack of leeway for learners. Consequently, we have used principles that apply to both treasure hunts and droppings, to provide guidelines on how to align one’s approach to foster SRL with the educational context and experience and needs of learners