Assuring Meaningful Learning Using Evidence based Strategies Cary - - PDF document

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Training Adult Learners: Training Techniques

Assuring Meaningful Learning Using Evidence‐based Strategies

Cary Kreutzer, EdD, MPH, RD July 10, 2014

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Objectives

Learning – Assessment – Delivery - Evaluation – Organization

• Understand & connect neuroscience and learning
• Apply the Model of Information Processing and define

strategies using the model to promote learning

• Create lesson plans ‐ define, organize and structure
• Create learning objectives using the Taxonomy for

Learning, Teaching and Assessing (Anderson, LW & Krathwohl, D.R., 2001)

• Understand & apply evaluation tools to assess

audience training needs, solicit feedback on instruction & delivery, prepare for future education

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Training Adult Learners: Training Techniques

Patient & Group Education

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Impetus: The Joint Commission

• Standard PC.02.01.21: The hospital effectively

communicates with patients (care, tx, sevice). – Hospital identifies pt. oral and written communication needs – Hospital communicates in care, tx. & svcs. That meets the pts. Oral and written communication needs. Standard RI.01.01.03: The hospital respects patient’s rights to receive info in a manner he/she understands.

The Joint Commission. (2010). The Joint Commission: New and Revised Standards and EPs for Patient‐Centered Communication, Accreditation Program: Hospital, Pre‐publication Version. The Joint Commission, Oakbrook Terrace, IL.

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Training Adult Learners: Training Techniques Impetus: Healthy People 2020 Health Communication & Health Information Technology Objectives

• HC/HIT 1. Improve the health literacy
• f the population.
• HC/HIT 2. Increase proportion who

report providers have satisfactory communication skills.

• HC/HIT 3. Increase proportion of

people who report providers always include them in decision making.

• HC/HIT 13. Increase social marketing in

health promotion programs (health depts., schools of public health)

Impetus: Health Literacy

• Health literacy, the essential backbone of informed patient

engagement (Howard Koh, MD, MPH, Assistant Secretary for Health at the Department of Health and Human Services, Feb 2013).

• ~ 12 percent of Americans have the skills necessary to

navigate the health care system, leaving the majority of Americans at‐risk for unnecessary hospital admissions and readmissions, medication errors, and failure to manage their health conditions effectively.

• Health care providers often assume that patients understand

what they are told unless they indicate otherwise.

Program for International Assessment of Adult Competencies (PIAAC), Literacy, Numeracy, Problem Solving, nces.ed.gov.

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Training Adult Learners: Training Techniques

American Medical Association Research & Video Series – Health Literacy

• Language
• Reading
• Numeracy

In 1998, the American Medical Association (AMA) became the first national medical organization to adopt policy recognizing that limited patient literacy affects medical diagnosis and treatment. American Medical Association’s Video on “Low Health Literacy: You Can’t Tell by Looking”

http://www.youtube.com/watch?v=cGtTZ_vxjyA

Impetus: Nutrition Care Process (Academy of Nutrition & Dietetics, 2003)

Essentials of the Nutrition Care Process include the following:

• Step 1: nutrition assessment to determine nutrient adequacy,

health function, and behavioral status

• Step 2: nutrition diagnosis to determine the etiology, cause,

and contributing risk factors

• Step 3: nutrition intervention to implement the evidence‐

based action or medical nutrition therapy appropriate to the condition

• Step 4: nutrition monitoring and evaluation to review and

measure ongoing progress related to the established goals of intervention

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Training Adult Learners: Training Techniques

IDNT Reference Manual NCP Step 3: Nutrition Intervention

• Food and/or Nutrient

Delivery

• Nutrition Education
• Nutrition Counseling
• Coordination of Nutrition

Care

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Nutrition Education

• Content (E‐1)

– Instruction or training intended to lead to nutrition‐related knowledge.

• Application (E‐2)

– Instruction or training intended to lead to nutrition‐related result interpretation or skills.

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Training Adult Learners: Training Techniques

Define Nutrition Education vs. Counseling

• Information dissemination (Educ)
• Active vs. passive (Educ)
• Learner gains knowledge and skills &

education is effective if learner integrates new knowledge into everyday life (Educ)

• Counseling encompasses behavior and

motivation, self‐efficacy, readiness to change

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Learning Influences

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Person Behavior Environment

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Training Adult Learners: Training Techniques

Why are learning styles so popular?

• What is your opinion about learning styles

– Visual – Auditory – Kinesthetic

• Pashler (2008) “We conclude therefore, that at

present, there is no adequate evidence base to justify incorporating learning styles assessments into general educational practice”

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Index of Learning Style Questionnaire

For each of the 44 questions below select either "a" or "b" to indicate your answer. Please choose only one answer for each question. If both "a" and "b" seem to apply to you, choose the one that applies more frequently. 1.I understand something better after I (a) try it out. (b) think it through. 2.I would rather be considered (a) realistic. (b) innovative. 3.When I think about what I did yesterday, I am most likely to get (a) a picture. (b) words. 4.I tend to (a) understand details of a subject but may be fuzzy about its overall structure. (b) understand the overall structure but may be fuzzy about details. 5.When I am learning something new, it helps me to (a) talk about it. (b) think about it.

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• Visual
• Auditory
• kinesthetic

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Training Adult Learners: Training Techniques

Your experience as a learner

• Think back to college or high school

– What teaching strategies did the instructor offer that supported OR did not support your learning – What learning strategies did you utilize that supported OR did not support your learning

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Short-term Sensory Store

Visual Input

Memory Loss Memory Loss

Rehearsal

Working Memory Long-term Memory

Storage

Retrieval Attention

Elaboration Organization

Auditory Input

Model of Information Processing: How knowledge is stored in Long Term Memory

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Training Adult Learners: Training Techniques

Short‐term Sensory Store Working Memory Long‐term Memory Capacity Large Small Large Duration Very Short:

Visual=1 second or less Auditory=2 ‐ 3 seconds

5 ‐ 20 seconds Indefinitely long

Learning Capacity and Duration Making Information Meaningful

Making Information Meaningful Organization

• I mpose order and

connections in new information

Elaboration

• Expand on existing

schemas – Scaffolding -

Zones of proximal development (Vygotsky, 1978)

Activity

• Put learner in the most

active role possible in making connections and information meaningful

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Training Adult Learners: Training Techniques

Kurt Fisher, PhD, Professor, Harvard School of Education

• http://www.learner.org/courses/neuroscience
• Unit 5 Dynamic Skill Development
• Neuroscience in the Classroom
• Dynamic Skill Scale

Levels of learning – action, representation, abstraction Sensory + motor = representation

Additional videos and curriculum can be used for training – funded by Annenberg Foundation

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Understanding the importance

• f prior knowledge ‐ Schemas

Read the following passage and see how much you remember afterwards.

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Training Adult Learners: Training Techniques

The procedure is actually quite simple. First you arrange things into different groups depending on their makeup. Of course, one pile may be sufficient, depending on how much there is to do. If you have to go somewhere else due to lack of facilities that is the next step, otherwise you are pretty well set. It is important not to overdo any particularly endeavor. That is, it is better to do too few things at once than too many. In the short run this may not seem important, but complications from doing too many can easily arise. A mistake can be expensive as well. The manipulation of the appropriate mechanisms should be self-explanatory, and we need not dwell on it here. At first the whole procedure will seem complicated. Soon, however, it will become just another facet of life. It is difficult to foresee any end to the necessity for this task in the immediate future, but then one can never tell.

Rote vs. meaningful learning

• Simple repetition
• Keeps info in WM,

but does not necessarily transfer to LTM

• Passive learning
• Recognizing

similarities

• Constructing

personal meaning

• Encoding in LTM
• Active learning

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Training Adult Learners: Training Techniques

Instructional Techniques for Selecting ‐to decrease cognitive load

• Selecting = helping the

learner pay attention to the relevant information

• Objectives
• Pre‐questions
• Post‐questions
• Highlighting

Instructional Techniques for Organizing‐ to move information to long term memory

• Organizing = helping the

learner build an

• rganized structure (also

called scaffolding) –Outline –Headings –Pointer words –Graphic

• rganizer

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Training Adult Learners: Training Techniques Instructional Techniques for Integrating – also helps move information to long term memory

• Integrating = helping

the learner connect what it presented to what they know and practice –Case studies –Worked examples

Ways to Provide Guidance

• Scaffolding
• Modeling
• Questioning
• Feedback
• Worked example then
• wn work
• Small chunks of

information

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Training Adult Learners: Training Techniques

How do we reduce cognitive load?

• Human mind is limited in it’s ability to process

information we do a lot of focused learning, what we are able to scaffold decreases our cognitive load.

• Example: If I give you 3 seconds to review and

memorize the following letters (all same) which would be easier, why?

• WO UIB MES LUS A
• WOU IBM ESL USA

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David Myers – Make Things Memorable

• SQ3R – Survey, Question, Read, Retrieve, Review
• Trying and failing = improved learning
• Recall and retrieval boosts the connection of new ideas

with long‐term memory

• Difficulty and challenge is desirable
• Make the ideas your own, the more actively you

participate improved learning

http://www.youtube.com/watch?v=rFIK5gutHKM&feature=youtu.be SQRRR is a reading comprehension method named for its five steps: survey, question, read, recite, and review. The method was introduced by Francis Pleasant Robinson in his 1946 book Effective Study, based on principles documented in the 1930s.

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Training Adult Learners: Training Techniques

Read Attentively, Summarize and Review (RASR)

• University of Florida
• 44 healthy adults, 60‐75 years old
• Reading information, put in your own works

(summarize), requires processing information and sorting the relationship between pieces of information.

• Participants who summarized aloud remembered

more detail than those who just re‐read. Combining with a post‐test had greatest benefit for memory after 24 hours.

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The Lesson Plan

• Objectives covered in the presentation
• Assign pre‐reading
• Provide syllabus or outline for learning –

highlight key words, provide vocabulary list

• Build in discussion or activities to check

for understanding

• Involve the audience and their expertise

as much as possible

• Evaluate & REFLECT

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Training Adult Learners: Training Techniques

Lesson Plan

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Writing objectives

Incorporate both the kind of knowledge to be learned (knowledge dimension) and the process used to learn (cognitive process), allowing for clear, focused objectives and assessments

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Anderson & Krathwohl (2001) – Revised Bloom’s Taxonomy

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Training Adult Learners: Training Techniques

Learning Objectives

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Blooms Taxonomy – Cognitive Process Dimension

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Ambrose, S.A., 2010, pp.246

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Training Adult Learners: Training Techniques

Education Strategies

• Use a medically trained interpreter if necessary:

– For those who do not speak English well, they may also not be able to read English. – Ensure that all language access services, including translation, are in plain language.

• Ask open‐ended questions:

– Elicit cultural beliefs and attitudes: “Tell me about the problem and what may have caused it.”

• Check for understanding:

– Use the “teach‐back” method: Have the person restate the information in his or her own words. Clarify if Pt. can’t remember and allow them to teach back again

• In the classroom use technology – clickers, Poll Everywhere

Keep it Simple… Check for Understanding

• Keep it Simple:

– Using simple language and defining technical terms – Breaking down complex information into understandable pieces – Organizing information so the most important points come first – Building on information the individual already knows

• Check for Understanding:

– Discuss, ask questions, written, projects, tests – Don’t Say… Any Questions? Or Did you get that?

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Training Adult Learners: Training Techniques

Explaining Info and Instructions Clearly

• Repeat
• Provide Examples
• Be Specific
• Back up with

written/visual instructions

• Ask about learning

preference

Kirkpatrick 4 Levels of Evaluation

• Level 1: Reaction
• Level 2: Learning
• Level 3: Behavior
• Level 4: Results

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Level 1 Level 2 Level 3 Level 4

Kirkpatrick, D.L. (2006). Seven Keys to Unlock the Four Levels of

• Evaluation. Performance Improvement, 45(7), p. 5-8.

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Training Adult Learners: Training Techniques

Evaluation

• NO More smiley face evaluations
• How will they use the information
• What are two strategies they learned that they can

apply to practice tomorrow?

• What are two things that were new that they

learned?

• Was the instructor able to adequately answer

questions?

• Was the information presented in a clear and
• rganized manner?
• Did the instructor present recent evidence?

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Continue to Evaluate and Define Audience Education Needs

• Use the input from student evaluations to

improve your future performance – always EVALUATE and REFLECT

• Update your materials to keep current
• Continue to improve your knowledge on the

subject matter

• Reflect on your success or challenges and

note changes needed in future

• Record presentation and watch, self‐critique
• Watch other presenters and make notes of

effective teaching strategies used

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Training Adult Learners: Training Techniques Teaching self‐efficacy of award winning professors (Morris & Usher, 2011)

• Using Bandura’s (1986) social‐cognitive theory and self‐efficacy

(SE).

• Teacher SE defined as beliefs in one’s capabilities to organize and

execute the course of action required to produce given attainments (Bandura, 1997). Findings: Self‐efficacious instructors plan & organize more

• effectively. More likely to seek out and use engaging instructional
• strategies. Put forth greater effort in motivating students. More

resilient when faced by obstacles than are teachers with low SE. However, early career professors lacked the instruction for effective education and are instead “thrown in the fire”. Recommend: CE training, mentors/role models, seek feedback on their performance to support continual improvement

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CDC Health Communications

The June issue of Health Communication Science Digest (HCSD or Digest) is now available at http://www.cdc.gov/healthcommunication/ScienceDigest/index.html In the Digest this month several authors report research on new media in health

• communication. Some look at the role of social media in health campaign

effectiveness (Avery & Lariscy; Friedman, et al.), others examine emerging uses of Facebook and Twitter in public health (Arcia, Ki & Nekmat; Lachlan, et al.; Rudat, et al.), and one paper details how audience feedback via new media alters organizational behavior (Lee, et al.). Evidence that health messaging impacts audience perceptions where delivered via new media (Paek, et al.; Saguy, et al.; Stavrositu & Kim) or multiple channels (Agaku & Ayo-Yusuf; Jensen, et al.) is also outlined. The use of fear appeals in health message design (Panic, et al.; Popova), health literacy (Chen & Feeley; Rubin, et al.; Verkissen, et al.), and social marketing strategies (Evans, et al.; Pringle, et al.) are the focus of several papers. And, the role of interpersonal communication in health campaign effectiveness is discussed by others (Hendricks, et al.; Kim). Please remember that you can access all issues of the “Health Communication Science Digest” series online via the searchable Health Communication Science Digest Archive. Subscribe to this and other CDC publications: http://www.cdc.gov/subscribe.html

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Training Adult Learners: Training Techniques

Take Home Points

• Know your audience – tailor to their literacy‐level,

current knowledge & allow individual to construct personal meaning

• Decrease cognitive load with handouts, outlines &

worked examples

• Involve your audience, check for understanding, test &

re‐test, provide opportunities to practice skills

• Scaffold, zones of proximal development, move

information to long‐term memory

• Evaluate, reflect, revise and seek mentoring & role

models

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References

• Ambrose, S. A., Bridges, M. W., DiPietro, M., Lovett, M. C., & Norman, M. K. (2010). How

learning works. San Francisco: Jossey‐Bass.

• Anderson, L.W., & Krathwohl (Eds.). (2001). A Taxonomy for learning, teaching, and assessing:

A revision of Bloom's taxonomy of educational objectives. New York: Longman.

• Epstein, J. L. (1989). Family structures and student motivation: A developmental perspective.

In C. Ames & R. J. Sternberg (Eds.). Teaching thinking skill: Theory and practice (Vol. 3, pp. 259‐295). San Diego: Academic Press.

• Kirkpatrick, D.L. (2006). Seven Keys to Unlock the Four Levels of Evaluation. Performance

Improvement, 45(7), p. 5‐8.

• Mayer, R. E. (2011). Applying the science of learning. Boston, MA: Pearson Education.
• Morris, D.B. & Usher, E.L. (2011). Developing teaching self‐efficacy in research institutions: A

study of award winning professors. Contemporary Educational Psychology, 36: 232‐245.

• Pashler, H. McDaniel, M., Rohrer, D. Bjork, R. (2008). Learning Styles: Concepts and
• Evidence. Psychological Science in the Public Interest. Vol 9(3) pp.103‐119.
• Rogalski, Y., Altmann, L.J.P., Rosenbek, J.C. (2014). Retrieval, practice and testing improve

memory in older adults. Aphasiology, 28(4), April.

• Schunk, D. H., Pintrich, P. R., & Meece, J. L. (2008). Motivation in Education: Theory, Research

and Applications. Third Edition. Englewood Cliffs, NJ: Prentice Hall. ISBN 0‐13‐228155‐4.

• Vygotsky, L. (1978). Mind in society: The development of higher psychological processes.

Cambridge, MA: Harvard University Press.

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