1. The Learning Coach: Using Electronic Portfolios to Promote Self-Directed Learning in Residency Melissa Nothnagle, MD, Marcia Smith, PhD, Paul George, MD Department of Family Medicine Alpert Medical School of Brown University

2. Learning Objectives Identify strategies for teaching self-directed learning to residents Address the challenges of self-directed learning in residency programs Describe methods to evaluate self-directed learning in residency

3. Self Directed Learning What is self-directed learning? Also known as self-regulated learning Active, goal-directed, self-control of behavior, motivation, and cognition for academic tasks (Pintrich)

4. One model of self-directed learning A learner-driven process: Diagnose Learning Needs Formulate Learning Goals Identify Learning Resources Select and Implement Learning Strategies Evaluate Learning Outcomes Knowles, 1975

5. Need for SDL in residency Learning environment in residency – Lack of learner control over process – Focus on doing, not reflecting Heterogeneity of learners – Preparation, study skills, motivation, culture Foundation for lifelong learning skills

6. (How) do your residents engage in self- directed learning?

7. Learning Coach Model Guidance needed to develop skills in self- assessment, goal setting and reflection Dedicated time Trusting and collaborative environment – No evaluation, confidential One-on-one, to address individual needs of heterogeneous learners Westberg, Jane and Jason, Hillard. Fostering learner’s Reflection and Self Assessment. Family Medicine: 1994; 278-282.

8. Meetings with coach Monthly one-hour meeting Goal-setting – Monthly goals, long-term goals Reflections EBM tutorial – Complementary skill for lifelong learning

9. Electronic Portfolio Purpose: tool for reflection “MyFolio” program (within E*Value) Imports all evaluation data Procedure logs Residents may upload presentations & projects Spaces to record goals and reflections during coaching meetings

10. Coach Motivator Facilitator Consultant Dependent Interested Involved Self Directed Learner Teacher Adapted from Grow, G. Teaching Learners to be self directed. Adult Education Quarterly, Vol. 41, No. 3, pp. 125-149.

11. Strategies for success Funding: HRSA grant Gradual implementation – First year: program design and getting buy-in – Second year: implementing coaching with one class, electronic portfolios – Third year: expanding to 2 nd and 3 rd year residents Time carved out of rotations – no outside work required of residents

12. Our program evaluation Quantitative – Self-ratings: goal-setting, reflection, ability to manage own learning – Coach ratings after each meeting Qualitative – Interviews with residents and faculty about learning culture, self-directed learning skills – Portfolio analysis

13. Coach’s rating form After each session, coach rates resident’s: – Ability to set or modify goals – Ability to reflect on own practice Additional notes recorded: – Quality/quantity of resident reflections – Achievement of short term goals from prior months – Attitude/motivation

14. Goal-setting ability: Mean scores over time Coaching session Mean score Generalized linear mixed model to test for linear trend: p<0.0001

15. Reflective ability: Mean scores over time Mean score Coaching session Generalized linear mixed model to test for linear trend: p<0.0001

16. Small Group Discussion How could you promote self-directed learning among your residents? – Goal setting – Reflection on learning

17. Next steps Transfer coaching role to advisors in 3 rd year – Residents comfortable with portfolio, help faculty gain comfort Qualitative analyses