Defenbaugh, Nicole L, PhD

Dostal, Julie, MD

Garufi, Linda, MD, MEd

Hansen, Susan E, MA

Mathieu, Susan S, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Family MedicineTracking the Trajectory of Resident LearningThrough the Lens of Self-Determination Theory.Susan E. Hansen MALehigh Valley Health Network, Susan_E.Hansen@lvhn.orgNicole L. Defenbaugh PhDnicole.defenbaugh@lvhn.orgSusan S. Mathieu MDLehigh Valley Health Network, Susan_S.Mathieu@lvhn.orgLinda Garufi MD, MEdLehigh Valley Health Network, Linda_C.Garufi@lvhn.orgJulie Dostal MDLehigh Valley Health Network, Julie.Dostal@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/family-medicinePart of the Family Medicine CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHansen, S. E., Defenbaugh, N. L., Mathieu, S. S., Garufi, L. Dostal, J. (2018, May). Tracking the Trajectory of Resident Learning Throughthe Lens of Self-Determination Theory. Poster Presented at: STFM Society of teachers of Family Medicine, Washington, DC.References:1.  Baglia, J., Foster, E., Dostal, J., Keister, D., Biery, N., & Larson, D. (2011). Generating developmentally appropriate competency assessment at a family medicine residency. Family Medicine, 43(2), 90-98. 2.  Cleveland, H. (1982). Information as Resource. The Futurist: 37–39.3.  Foster, E., Biery, N., Dostal, J., & Larson, D. (2012). RAFT (Resident Assessment Facilitation Team): supporting resident well-being through an integrated advising and assessment process. Family Medicine, 44(10), 731-734. 4.  Keister, D. M., Larson, D., Dostal, J., & Baglia, J. (2012). The radar graph: the development of an educational tool to demonstrate resident competency. Journal of Graduate Medical Education, 4(2), 220-226. doi: 10.4300/JGME-D-11-00163.15.  Knowles, M.S. (1984). Andragogy in Action. Applying modern principles of adult education, San Francisco: Jossey Bass. 6.  Kusurkar, R., & ten Cate, O. (2013). AM last page: Education is not filling a bucket, but lighting a fire: self-determination theory and motivation in medical students. Academic Medicine: Journal of the Association of American Medical Colleges, 88(6), 904-904. doi: 10.1097/ACM.0b013e3182971e067.  Nothnagle, M., Anandarajah, G., Goldman, R.E., Reis, S. (2011). Struggling to be self-directed: Residents’ paradoxical beliefs about learning. Academic Medicine: Journal of the Association of American Medical Colleges; 86(12):1539–1544. 8.  Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1): 68-78. http://dx.doi.org/10.1037/0003-066X.55.1.689.  Schumacher, D.J., Englander, R., Carraccio, C. (2013). Developing the master learner: Applying learning theory to the teacher, the learner and the learning environment. Academic Medicine: Journal of the Association of American Medical Colleges; 88(11): 1635-1645.10.  Ten Cate, O.Th.J., Kursurkar, R.A., Williams, G.C. (2011). AMEE Guide No. 59:  How self-determination theory can assist our understanding of the teaching and learning processes in medical education. Medical Teacher, 33:961-973. doi: 10.3109/0142159x.2011.595435. © 2018 Lehigh Valley Health NetworkAcknowledgements:The Dorothy Rider Pool Health Care Trust for providing funding support for the innovations and examination of them through this study.The authors would like to thank Will Miller, MD, for editorial insights; Nancy Gratz, MPA, PCMH-CCE, and Staci L. Morrissey, BS, for their support with data analysis; and Carol Varma for poster design. The authors also express appreciation to the faculty, residents, and graduates of the Lehigh Valley Family Medicine Residency Program for engaging in the work of transforming medical education. Early PGY1 End of PGY1End of PGY2End of PGY3GROUPCompetenceFeeling overwhelmed and uncertain in their new roles, residents seek external assessment of their clinical competency. They focus on the challenges of an unfamiliar educational process as they discuss their fears about preparing for the boards and making decisions independently about patient care. Seeing the upper-year residents at work stokes their anxiety as they recognize that soon they will be expected to perform at that level. “I don’t feel comfortable with a lot of what I know, or confident in seeing someone and saying this is what’s going on.” AutonomyThe opportunity to find their own paths attracted these learners to the residency, but they soon realize they will need help navigating the expectations and realities of their new environment.  They are eager to be able to make decisions independently, both in the clinic and about their educational plans, and have high expectations for themselves. In describing their approach to learning, they express both appreciation for and frustration with the resources they can access.“Since its learner driven, it takes a lot more initiative than we’re used to.” Relatedness In Progress  Motivation Level TBD  INDIVIDUALCompetenceThe resident voices areas of need and articulates ownership in a process to improve knowledge.“I’m mostly interested in kind of trying to identify, em, rashes and different kinds of lesions and how to effectively communicate what I see because,  I mean, I can’t even tell you how many times I’ve gone over macular pap and whatever and it’s just not sinking [in].” AutonomyResident embraces opportunity to select learning opportunities experiences and discusses process for choices made. Resident initiates and develops a visit to a patient education center and makes deliberate choices to fill perceived gaps in medical knowledge.                                                                                                                                                                                                                                                              “I think that would be a good foundation for my further interest and, em, knowledge component of diabetes.”    Relatedness Resident feels welcomed into the community by others and sees opportunities for forging relationships. While “feeling some anxiety about working with specific attendings,” resident recognizes ability to learn from them despite discomfort. Stressors include relying too much on others.  Motivation Level TBD  RADAR GRAPHMotivation Level TBD  Family Medicine Residency Program, Lehigh Valley Health Network, Allentown, PennsylvaniaTracking the Trajectory of Resident Learning Through the Lens of Self-Determination TheorySusan E. Hansen, MA; Nicole L. Defenbaugh, PhD; Susan S. Mathieu, MD; Linda Contillo Garufi, MD, MEd; Julie A. Dostal, MDIntrinsic Motivation: Desire to propel oneself toward learning outcomesAutonomy:   Choice and authority in decisionmakingCompetence: Ability to achieve mastery in subject matterRelatedness: Connection to and feeling of value within learning communityComponents of Self-Determination TheoryStage 3:Identification of emergent themes by PGY levelPI and 2 study team members per PGY level independently identify themesConsensus by group on themes for each PGY level, by SDT componentStage 2:Operationalization of Self Determination TheoryAssignment of AL codebook to components of SDTand stratification of results by PGY levelStage 1: Adult Learning CodebookOperationalization of Adult Learning and coding of source data to appropriate child & grandchild nodesPURPOSEThis study describes the trajectory of graduate medical learners’ development as internally motivated (activated) learners over a 3-year training period within a residency program designed to support the development of the autonomy, relatedness and competency.BACKGROUNDSelf-Determination Theory has been proposed as a model to support the development of adult learning in medical education (Olle et al., 2011). Previous work (Nothnagle et al., 2011) has indicated that family medicine residents needed to develop confidence in their self-directed learning skills and required support and residency culture and structural changes to develop these skills. The Lehigh Valley Family Medicine Residency Program, as part of the Preparing the Personal Physician for Practice (p4) national demonstration project of innovation in family medicine residency training, restructured its curriculum to support residents in acquiring and applying the principles of adult learning. These changes included the addition of an individualized longitudinal curriculum, active participation in a community of practice beginning in year 1, a tailored advising and assessment process (Resident Assessment Facilitation Team, or RAFT), and focus on lifelong learning skills in periodic formative and summative assessments (Baglia et al., 2011; Foster et al., 2017; Foster et al., 2012; Keister et al., 2012).METHODOLOGYThis retrospective mixed-methods study analyzes qualitative and quantitative data collected from 56 family medicine residents enrolled in our program in academic years 2009-2015. We seek to describe the trajectory of self-directed learning across the 3-year residency training period. Results of each data set will be compared side-by-side to determine whether the qualitative and quantitative data at specific training intervals illustrate similar patterns. QUANTITATIVE ANALYSISRadar graphs are used to track the progression of residents at each PGY level in attaining competency in lifelong learning skills (Keister et al., 2012). The study team will operationalize the assessed behaviors to the components of Self-Determination Theory. Composite radar graphs of all lifelong learning observable behavior scores for each PGY level will be analyzed to determine whether motivation levels can be assigned using only this numerical data. •  3,695 individual scores representing the 3-year training period of 19 residents who graduated in academic years 2012-2014•  Scores assigned by clinical preceptors and other faculty who observed the residents during family medicine inpatient service, outpatient continuity site care, didactic sessions or in a RAFT meeting.•  3 composite radar graphs depicting mean frequency of observed behaviors at each PGY levelRESULTS•Review identified themes•Consensus creation of PGY-level descriptor statement for each SDT component•Identification of exemplar quotes•Results to full team for member checkingSubgroup for aggregated resident data set analysis•Review identified themes•Consensus creation of PGY-level descriptor statement for each SDT component•Identification of exemplar quotes•Results to full team for member checkingSubgroup for individual resident data set analysisIdentification of motivation status at each PGY level•  How should we incorporate original quotes from the data sources?•  What do you want to know about the process for assigning levels of motivation?• What is confusing or not clear? THEORETICAL FRAMEWORKThe data analysis will be done from an adult learning (andragogy) theoretical perspective, based on the principals outlined by Malcolm Knowles (1984), focused on the development of intrinsic motivation, as described by Self-Determination Theory.    COMPLETED STEPS     NEXT STEPS                  QUALITATIVE ANALYSISWe explore the qualitative data on two levels of analysis – the aggregated cohort of residents enrolled from 2009 to 2015 and a case study of an individual learner. •  Aggregated Resident Data Set: 24 focus group transcripts from PGY-level cohorts at four intervals (after orientation in PGY1 and end of each of the 3 training years)•  Individual Learner Data Set: Transcripts of 7 RAFT sessions, 7 educational SOAP (Subjective, Objective, Assessment and Plan) notes presented at these sessions and the summary statements written by the resident for the educational communityQUESTIONS FOR DISCUSSION

Tracking the Trajectory of Resident Learning Through the Lens of Self-Determination Theory.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1527&context=family-medicine

Tracking the Trajectory of Resident Learning Through the Lens of Self-Determination Theory.

Abstract

Similar works

Full text

Available Versions

Lehigh Valley Health Network: LVHN Scholarly Works