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Robyn Wearner
INTE 7100
July 13, 2014
Professional Learning within a Research Project
Background
Self-Management Support (SMS) is a best practice approach to chronic disease management. SMS is
defined as the collaboration between the patient and care team in where the patient sets goals to
improve their condition(s) and the care team supports the patient in their effort to adopt lifestyle
behaviors that will have a positive impact on their health.
We know SMS is difficult for family practices to implement a workflow and to satisfy the requirement
and/or document the best practice care provided. Due to strains on physician time, the workflow
should involve staff. Professional learning for SMS and related areas are provided for the clinicians and
staff.
Opportunities
Team-based care is a focus in healthcare. As in education, in order to meet the needs of many, it may
be necessary to enlist the support of others in the care of one. The potential impact of the
collaboration between a patient and their healthcare team—setting goals to manage chronic disease—
has been shown to be an effective approach in patient care and health. (Battersby, 2010)
A saying that seems to arise often is, “Have Everyone Work to the Highest Level of Their Licensure”.
Although the words are spoken, I am not sure if audiences are questioning how to make this happen or
what it actually means at the practice level. There are credentialed or licensed positions to be sure and
it is good to be thinking about what their work entails and what they do, including their professional
learning requirements or options. But there is also a significant portion of medical staff professionals
that are not licensed with organizations that outline their professional learning needs. For example,
medical assistants (MA) are trained to draw blood and take vital signs but the professional role itself can
vary widely and impact team performance and patient health. A gap in asking the MA to work at their
highest level of licensure is 1) not possible because they are not formally defined or too narrowly
defined and 2) another ubiquitous saying “if you’ve seen one practice, you’ve seen one practice”. Each
medical practice operates differently, with different expectations of this role. Therein lays a problem
and opportunity to open discussion about what roles to be performed in the given workplace setting.
This clarity about what to do and who should do it is quite often missed or overlooked under the
demands of day-to-day operation in a medical practice. The example serves to demonstrate there are
gaps in professional learning in the context of a family medicine practice.
This report aims to describe and assess professional learning in family medicine practices participating in
a research project with some perspective as a research team member. My role is to provide trainings
and facilitate discussion about how to implement new processes to support SMS. I will introduce the
concept of Self-Management Support to the entire staff and provide opportunities for them to learn
about it in the context of their work setting.
The goals of the professional learning for clinicians and staff are to:
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Participate in SMS trainings, including activities within and outside of training hours;
Engage the concept of SMS, regardless of professional role in the practice;
Discuss the current and ideal states in relation to SMS;
Plan for implementing SMS within the work setting and;
Transformational learning, at least for Group 3 practices that receive all trainings, tools and
coaching.
The goals of the professional learning for the research team:
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Engage in audience in the concept of SMS professional role in the practice;
Facilitate discussion about the current and ideal states of SMS;
Employ strategies that encourage transformational learning, at least for Group 3 practices that
receive all trainings, tools and coaching and;
Utilize strategies to maximize social learning theories.
Planned Intervention
This research project is studying three arms of SMS implementation; each of the randomized groups (1,2
or 3) receive varying levels of training, access to web-based tools and facilitation or coaching for
implementation efforts. The practice level intervention was designed to learn how professional
learning (for all clinicians and staff) may or may not impact uptake of process to adequately address SMS
with patient populations. Ultimately the goal is for transformational learning within groups that are
generally not self-directed learning environments.
Professional Development
By way of in-person professional learning events using Microsoft PowerPoint presentations, the
following trainings have been designed to situate the learner for the purpose of the research study and
the concept being explored. Each practice receives the first 2 training sessions therefore they are the
focus of the assessment.
SMS
Patient
Engagement
SMS, Part 2
Coaching
Key behavioral elements to managing chronic disease are diet, physical activity, smoking, selfmonitoring, medication adherence, alcohol, mood and stress. These elements are a theme throughout
the trainings and participants are invited to complete surveys and actions plans to internalize the
process, both as a patient and a healthcare team member. The SMS and Patient Engagement trainings
use a variety of mechanisms to encourage active audience participation and engagement. (Ironically,
many of the same principles we explore with practice groups in the patient engagement session about
their patients, we also indirectly exploring with them as researchers and their capacity to engage in the
concept.) In brief, examples of activities that ascribe to theory and best practice are outlined below.
SMS
training activities
Patient Engagement
training activities
•Complete goal setting sheet
•Cognitive and reflective learning theories
•Practice in goal setting (completed alone, for self)
•Complete health assessment
•Complete inteactive action planning activity
•Social learning theories
•Role play in dyads (may chose self as one role)
Applicable learning theories that relate or align with this work are numerous. To mention a few, there
are links to cognitive learning theories, reflective and transformational learning theories, and each of the
social learning theories that Harris (2011) outlines in her chapter on workplace education. A variance
from much of the literature and theories reviewed is that the settings have a range of learners from
required to voluntary as well as significant knowledge base differences. Given the group format training
design as well as the average number of roles in each training session, social learning theories,
particularly the social cognitive and social cultural learning theories are relevant to these learning
events.
As a research team member, we will gain knowledge about the space we have created for a method of
fostering of low and high road transfer (Harris, 2011). This learning will involve the learner fusing SMS
skills into practice until they become automatic (low road transfer) and possibly reaching a point of
reflection where the transfer of knowledge and skill is used in other situations (high road transfer). Early
learning indicates that, for some, the process of mindful reflection and analysis is of great value to the
continuous change and improvement processes being felt in healthcare. Learning applications such as
role play, dyad action planning, process mapping in the context of their workflows, etc. are incorporated
in the learning events.
Professional learning within primary care environments is typically not self-directed, especially for nonmedical learning. As a professional learning practitioner, the sessions I deliver adhere to three principles
that Knowles (1996) identifies as crucial application for adult learning; an understanding of why, an
application from which to apply or a task to perform and, an opportunity to problem solve and put the
learning to immediate use in their workplace setting. The “what and whys” of SMS are discussed and
provided, interactive activities are utilized to maximize the concept first hand and the problem of
integration into their setting is explored.
Use of technology
The training sessions were created with the intent to share knowledge through the conventional use of
slide sets. While I consider it a stretch to call the projection of slide sets as use of technology, I believe
they may qualify because aside from bullet point content, there are also uses of images, such as screen
shots of the sites and tools created for the audience. I believe that technology has not been used as
effectively as it could be within the existing slide sets. The use of video and images could help to
significantly reduce the number of slides that exceed the commonly regarded 6X6 rule of 6 lines and 6
words on each line on a slide.
On the practice level, interface with technology ranges from minimal to significant in the research
project and this is based on the randomized groups. Web-based sites and tools are available to all
practices but extended features and the professional learning community is expanded in groups 2 and 3.
The research practice coach serves as a conduit for sharing and linking practices with resources and
additional peer-to-peer support.
Inquiry and Recommendations
Have the trainings been designed to adequately address the range of learners in the audience? Largely,
the content of training material and the design and flow of trainings meets the needs of the research
team. There are not concerning gaps except for the lack of tie in for the staff that are not receiving
credit for the trainings. Their leadership asks for their participation but it is not explicitly stated by
leadership or trainers that they could be using this training material in the future. The research team
can infer this possibility but cannot state this to further engage in the training.
However, upon providing the trainings and completing an assessment, the slide decks are text heavy
and could be enhanced or modified to become more effective professional learning presentations. I
recommend rewording content to reduce the number of words and incorporating one video to
demonstrate SMS in action. These changes are likely to yield greater engagement and possibly greater
understanding of the concept in general.
My capacity as a research team member is to help these groups with professional growth and
development is elevated by taking a close look at what we are doing and assessing for adult learning
theory integration. Using the assessment results as a guide, I can suggest modifications to the team that
would encompass the variety of learners into these professional learning events. Done well, the
trainings could become more engaging to the audience while also providing challenging and meaningful
opportunities for clinicians and staff to learn.
References:
Battersby, M., (2010) Twelve Evidence-Based Principles for Implementing Self-Management Support in
Primary Care. The Joint Commission Journal on Quality and Patient Safety. Volume 36 Number 12.
Harris, I.B., (2011) Conceptions and Theories of Learning for Workplace Education. Extraordinary
Learning in the Workplace, Volume 6, pp 39-62
Knowles, M. (1996). Adult Learning. In Robert L. Craig (Ed.), The ASTD Training and Development
Handbook (pp. 253-264). NY: McGraw-Hill.