Lifelong Learning and Reflective Practice
Esther de Groot1 and Nicole J.J.M. Mastenbroek2
1Julius Center for Health Sciences and Primary Care, Utrecht University, The Netherlands
2Faculty of Veterinary Medicine, Utrecht University, The Netherlands
The work of veterinarians has changed tremendously in recent decades and will be subject to change in the future. To meet the new demands of their profession and keep up their expertise, veterinarians need to engage in continuing professional development (CPD) and use opportunities for lifelong learning (LLL), both formal and informal (Larkin, 2010; Lee, 2003; Laal and Salamati, 2012). Lifelong learning leads to an enriching life of self-fulfillment and is positively related to mental wellbeing in veterinarians (Laal and Salamati, 2012; Mastenbroek et al., 2014). Learning will need to take place on an ongoing basis, individually and in interaction with others (Dale, Pierce, and May, 2013). Therefore, not surprisingly, preparation for LLL is – and has been (see Box 27.2.), an important goal in many (veterinary) curricula (Jaarsma, 2009).
Preparing for Lifelong Learning
Lifelong learning is not easy for professionals such as veterinarians, and they experience different barriers to participation in CPD (de Groot et al., 2012; Dale, Pierce, and May, 2010; Moore, 2000). Thus, veterinary professionals ought to become aware of the importance of LLL from the start of their education. They need to acquire the knowledge, the attitudes, and the skills necessary for development of their LLL competencies after graduation. To ensure that veterinarians will be involved in LLL, some people focus on accreditation of formal CPD (May, 2012; Caple, 2005), but we will focus on competencies for and beliefs about LLL, following the advice of Stephen Billett not to confuse lifelong learning with lifelong teaching (Billett, 2010). In this chapter we will explore what competencies veterinarians need for LLL on their own and with others, consider how to develop these during the curriculum, and propose strategies to enhance learning beyond veterinary curricula.
Lifelong learning is a concept that refers to “activities a person performs throughout their life to improve their knowledge, skills, and competence in a particular field” (Koper, 2007, p. 71). Many competencies necessary for LLL have been described, from which we will address the following two categories: autonomous competencies, necessary to manage one’s own self-directed learning; and relational competencies, being able to interact and learn in social interaction within heterogeneous groups.
Within LLL, reflective practice is an essential component. Reflective practice is about learning from one’s experience; understanding one’s personal beliefs, attitudes, and values; and linking new to existing knowledge (Mann, Gordon, and MacLeod, 2009). It is not only a cognitive, individual, and internalized activity, but also highly social (de Groot et al., 2013; de Groot et al., 2012; McArdle and Coutts, 2010). Therefore, reflective practice asks for learning conversations that are critical through the exploration of options, assumptions, and evidence (de Groot et al., 2012). In discussing individual learning and learning in social interaction, we align with two major perspectives on learning: learning as an individual activity of acquiring knowledge and skills; and learning as participation in learning communities (Sfard, 1998).
For reflective practice, veterinarians need competencies in self-directed learning (SDL). SDL is necessary to construct knowledge on your own and collaboratively at the workplace. Because the goal of LLL is “equipping people with skills and competencies to continue their own ‘self-education’ beyond the end of formal schooling” (Candy, 1994, p. 15), we consider SDL to be a prerequisite for LLL. Veterinary schools should help students to become self-directed learners.
Knowles (1975, p. 18) defines SDL as “a process in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes.” Self-directed learning (SDL) differs from self-regulated learning (SRL); in SDL the learning task is always defined by the learner, while in SRL the learning task can be generated by the teacher. Self-directed learning clearly provides a crucial role for the learner at the outset of the learning task (Loyens, Magda, and Rikers, 2008). In a curriculum with tight-set outcomes, SDL’s premise of full autonomy regarding learning tasks is challenging to implement.
How to Become a Self-Directed Learner
Readiness to Learn
Students entering veterinary education will differ in the way they learn, which depends largely on characteristics such as intelligence, personality, and former learning experiences, but also on their – often implicit – beliefs about knowledge and knowing (personal epistemology; Hofer and Pintrich, 2002). Such beliefs drive behaviors. It makes all the difference to learning whether (see Box 27.3) an individual believes that knowledge is something received from others; that problems are solvable and answers can be right or wrong; or, at the other end of the spectrum, that knowledge is constructed on what one already knows, and develops through experience and reflection on experiences (Hofer and Pintrich, 2002). Students engaging in SDL should be aware of their own epistemological beliefs, and how these beliefs influence their learning. For example, when participants in a group discussion have a relativist understanding, where “all opinions are equally right” (Kuhn, 1999, p. 23), group discussion will not become a valuable learning experience or an opportunity for knowledge-sharing (Weinberg, 2015).
Since not all students entering a course will be familiar with the concepts of SDL and reflective practice, these concepts require explicit explanation regarding their meaning, the competencies required, and how they can be learned. Various skills and attitudes toward learning are required for successful SDL, for example the abilities to:
- diagnose their own learning needs realistically;
- take the initiative in making use of resources (i.e., teachers and peers as resources for diagnosing learning needs or as facilitators or helpers, as well as learning materials appropriate to different learning objectives);
- translate learning needs into learning objectives (Knowles, 1975).
However, most of all students require an adequate self-concept as a nondependent and self-directed person.
Learning objectives are motivating, especially for learners with a goal-oriented learning orientation (Teunissen and Bok, 2013). Learning objectives direct learning activities; achieving objectives is perceived as a successful (learning) experience that raises self-efficacy. Once learners have diagnosed their learning needs and translated these into learning objectives, they formalize them by making a personal development plan. In formal training, the preparation of development plans is often a joint process between student and mentor.
Engaging in the Learning Process
Students need to understand themselves as learners in order to understand their needs as self-directed learners. These needs concern, for example, the instructional methods they prefer for gathering and processing information. Do they prefer active or reflective learning, verbal or visual explanations? They need to understand their own learning preferences because SDL requires a deep approach to learning. Understanding themselves as learners means that they know what learning resources they need. As women now dominate student enrollment in veterinary education all over the world, it is relevant to examine the consequences for teaching, learning, mentoring, professional development, and leadership. Male and female students might have different ways of knowing and learning. Research focusing on women’s development and ways of knowing reveals that women prefer a less authoritarian and more person-centered learning environment, and supports the adoption of student-centered approaches to teaching and learning in veterinary education (Taylor and Robinson, 2009).
Evaluating learning should not be confused with assessment only, although summative assessments can be valuable for evaluation of the acquisition of knowledge (i.e., exams, case reports, or essays) or mastering specific skills (i.e., objective structured clinical examinations). Evaluating learning in an SDL context involves evaluation of progress, for example by seeking feedback of peers, colleagues, or faculty members and subsequently reflecting on the feedback gathered. Self-reflection includes examining assumptions, beliefs, and emotions regarding learning and learning objectives. It is one of the most important and at the same time most difficult aspects of SDL.
The aforementioned strategies for the development of SDL call for curricula that allow for authentic learning experiences, such as longer clinical placements or extramural education, where students integrate theory into real-life practice and learn teamwork competencies through socialization. Here, in the workplace, they will have authentic practice experiences on which to reflect and become reflective practitioners.
Reflective practice is an increasingly important aspect of CPD. Reflective skills and reflective practice seem to be essential for continuing personal and professional development in young veterinarians (Mastenbroek et al., 2015). Reflective practice enables individuals to look back on, learn, and improve their own practice. Since the obligation to keep their knowledge and skills up to a professional standard is part of the implicit social contract that health professionals have with society, it needs no further explanation that helping students be prepared for reflective practice must be part of the veterinary curriculum.
Schön (1983) argues that it is impossible for professionals to possess all the knowledge and skills required to solve problems in each and every complex situation they face every day. Despite this, professionals have to act and while acting use reflection. Schön (1983) called this type of reflection reflection-in-action, in contrast to reflection-on-action, which is reflection in which professionals engage after they have solved the problem and look back on their decisions.
Many descriptions of reflective practice exist, and often they are intermingled with terms such as reflection, reflective thinking, and critical reflection (Brookfield, 2009). Differences between these concepts are related to the focus of the reflection: whether reflection should be on your own behavior, on assumptions guiding your behavior, or on power structures at play in the workplace, which affect how the work is being done. In this chapter, we will look at reflective practice as deep approaches to learning and meaning-making in the workplace or during authentic learning situations within the curriculum.
Reflection-on-action helps to make subsequent meaning of complex situations and enables professionals to learn from experience. The inclination to and ability for reflection appear to vary across individuals and across contexts in which individuals practice (see Box 27.4). Nevertheless, the ability for reflective practice seems to be amenable to development provided that the learning environment is encouraging, for example by supervisors’ behaviour. Curricular interventions (see Box 27.5), aimed at promoting reflection and reflective practice, are now being incorporated in veterinary undergraduate curricula, even though the evidence to support and inform these interventions and innovations is limited.
How to Support Learning of Lifelong Learning Competencies in (Veterinary) Medicine
The main methods for preparing students for LLL are the use of portfolios, mentoring, and learning from consulting the research literature. As reflection is an essential skill in the process of SDL, and as we know that this is a competency that has to be developed through training, it is important to guide educators in structuring the development process.
Learning with Portfolios
To support the learning of reflective practice and SDL, portfolios are frequently used. A portfolio serves as an outline for independent study, a letter of intent, and a tool to aid in the evaluation of achievement. Knowles (1975) describes how, in the design of a learning portfolio that serves in the achievement of SDL skills (he used the term “learning contract”), one should include learning objectives, learning resources, and strategies to be used, evidence of accomplishment, and criteria and means of validating evidence. To be effective:
- The design of the portfolio should be tailored to the intended purpose.
- Portfolios should best be introduced in curricula where learning in authentic situations is a key feature.
- Conditions must be met that facilitate successful introduction of portfolios, such as teacher and student support and commitment by educational leaders (van Tartwijk et al., 2007).
Portfolios in veterinary education may have a focus primarily on formative assessment or on summative assessment (Mossop, 1991). A learning portfolio that contributes to LLL competencies should include reflective writing in action, on action, and for action, which makes the design complex. And even with a well-designed learning portfolio, an active and committed teacher (mentor) is indispensable (Driessen et al., 2005).
A mentor is a more experienced adult who helps a less experienced individual learn to navigate the world of work through career-related and psychosocial support (Kram, 1985). In veterinary medicine, professionals have recognized the importance of mentoring students, since the recruitment and retention of students appear to be difficult (Niehoff, Chenoweth, and Rutti, 2005). In a study on mentoring within the veterinary world, mentors’ behaviors aimed at career development and socioemotional support appeared to be positively related to the perceived effectiveness of the relationship. Mentors developed trusting relationships with their protégés by encouraging and reinforcing them, accepting them as competent professionals, helping them attain desired positions, and providing appropriate challenges (Niehoff, Chenoweth, and Rutti, 2005). Mentors may also function as role models. When reflective practice or SDL is supported by portfolios, several studies show that stimulating and guiding reflection on portfolio issues through mentoring was even more important than the portfolio use itself (Bok et al., 2013; Mann, Gordon, and MacLeod, 2009; Driessen et al., 2005).
Learning from Evidence-Based Practice
Practicing evidence-based veterinary medicine is an opportunity for veterinarians to keep their knowledge up to date, because in the literature they will find recent knowledge from their domain. Therefore, they have to (learn to) search for and judge the literature during their studies (Cockcroft and Holmes, 2004). As an example, to enhance veterinary technology students’ research capabilities, a teaching program has been described where students worked in self-selected dyads to author a scientific case report, based on authentic cases from their clinical practice. This approach was reported to be an enjoyable and valuable learning experience, and not only contributed to writing and presentation skills, but helped students to become more fully formed professionals (Clarke et al., 2013).
In veterinary practice much of the learning takes place in social interaction: veterinary professionals learn during their interactions with patient owners, during dyads with students on extramural placements and in learning groups, within their own practice, or with professionals from other practices (May and Kinnison, 2015; Scholz, Trede, and Raidal, 2014). Nevertheless, studies about (lifelong) learning of veterinarians rarely pay attention to communities, disregarding the collaborative nature of their work (Scholz, Trede, and Raidal, 2014; de Groot et al., 2012). Learning groups may have different goals and different names. A broad division could be made between groups where discussion has their personal and professional development, management, and communication in mind (Mastenbroek et al., 2015), and groups where discussions are primarily set up to keep their veterinary knowledge up to date and to solve problems in the veterinary domain that occurred in their clinical practice (de Groot et al., 2012). The latter are often called learning communities or communities of practice.
The concept of communities of practice, introduced by Etienne Wenger (1998), has transformed from a model about a master with apprentices, to a model focusing on the interaction between individuals, toward a knowledge management concept (Cox, 2005). We consider the second the most attractive kind of learning communities for veterinarians: small groups to share and create knowledge about their profession collaboratively. Participants in these communities should be active in their learning process and engage in collective inquiry.
Critically Reflective Dialogs in Communities
Learning in communities is potentially valuable, but it has to be ensured that learning in communities does not only socialize people into existing practices, but helps them innovate and observe their work in a critically reflective manner (de Groot et al., 2012). Essential behaviors in such learning communities are asking for feedback, challenging groupthink, critical opinion-sharing, research utilization, and openness about mistakes (de Groot et al., 2012). In order to become valuable contributions to LLL, communities need organizational support (Jang and Ko, 2014), and they require a moderator who asks reflective questions and enables members to critically reflect on their learning process (see Box 27.6). And finally, the groups should be heterogeneous but not too heterogeneous (van Knippenberg, de Dreu, and Homan, 2004). When the background of participants is too diverse, they lack common ground for an in-depth discussion, while when it is too similar, there is a risk of confirmation bias and groupthink.