Effective Education for Patients Julie-Anne Regan University of Chester

How People Really Learn ‘Ripples’ model of learning Phil Race BSc PhD PGCE FCIPD SFHEA NTF Visiting Professor, Assessment, Learning and Teaching Leeds Metropolitan University

My aim for today To help you to focus on the patient learning experience rather than the teaching method; What the patient is doing rather than what you, the CR practitioner, is doing.

Race’s Ripple Model asserts there are seven factors underpinning successful learning – in any context We are going to concentrate on the first five of those today

2 1 3 Prepare to jot down your answers to the second second parts of each of four questions – no more than six words or so. 4

1: How do you learn well? Think (don’t write anything yet) of something that you’re good at, something that you know you do well. How did you become good at it? Write a few words in box 1.

Most people’s views... ]practice ]trial and error ]having a go ]repetition ]experimenting

2: What makes you feel good? Think of something about yourself that you feel good about. How can you know it is good? What’s your evidence to support this feeling? Write a few words in box 2.

Most people’s views... ]feedback ]other people’s reactions ]praise ]gaining confidence ]seeing the results

3: What can go wrong? Think of something that you’re not good at, perhaps as a result of a bad learning experience. What went wrong, and whose (if anyone’s) fault it may have been? Write a few words in box 3.

Most people’s views... ]did not really want to learn it ]could not see the point ]bad teaching ]could not make sense of it

4: And if there isn’t a ‘want’? Think of something that you did learn successfully, but at the time you didn’t want to learn it. What kept you going, so that you did indeed succeed in learning it? Write a few words in box 4.

Most people’s views... ]strong support and encouragement ]did not want to be seen not able to do it ]needed to do it for what I wanted next

Five of the factors underpinning successful learning learning by doing learning from feedback wanting to learn needing to learn making sense - ‘getting one’s head round it’… ‘digesting’

Ripples on a pond…. Wanting/ Needing Doing Feedback Making sense

Cornerstones of learning Wanting = curiosity Needing = commitment Doing = competence development Making sense = contestation Feedback = communication

Smarter teaching - tuning in everything we do, when we teach, to these five factors. You can always consider the other two at a later date!

Patient centred teaching Strive to enhance our patients’ want to learn; Help patients to develop ownership of the need to learn; Keep patients learning by doing, practice, trial- and-error, repetition; Ensure patients get quick and useful feedback – from us and from each other; Help patients to make sense of what they learn. There is a degree of overlap in these factors.

How we can help our patients to learn more effectively, efficiently, and enjoyably… We can strive to enhance our patients’ want to learn… Making learning fun to get them involved in their learning; Pointing out why we’re teaching it, and why they’re learning it; Health Belief Model (see Becker and Rosenstock for example). HBM.docHBM.doc Models of behaviour change (see Bandura; Skinner; Azjen; Prochaska and DiClemente.) Stage of Change.docStage of Change.doc

How we can help our patients to learn more effectively, efficiently, and enjoyably… We can help patients to develop ownership of the need to learn; Identifying their realistic life (health) goals; Using those goals to plan relevant learning activities; Explaining how the learning will be useful to them for achieving those goals; Making sure the patient understands the consequences of not learning, as well as the benefits of the learning. The discussion about ‘want’ is relevant here too

How we can help our patients to learn more effectively, efficiently, and enjoyably… We can keep our patients learning by doing, practice, trial-and-error, repetition; Keeping them learning actively in our rehabilitation sessions; Helping patients to feel good about learning through mistakes. Make rehabilitation a safe learning environment; Bringing learning to life and life to learning – learning must continue between sessions; Opportunities for feedback; Different learning tasks for different groups- eg use of technology enhanced learning.

How we can help our patients to learn more effectively, efficiently, and enjoyably… We can ensure patients get quick and useful feedback – from us and from each other; Making sure they get feedback quickly enough while they still care about it; Help them to recognise feedback from their own bodies indicating positive outcomes/progress; Helping them to get a great deal of feedback from each other by using peer support within the group; Working with significant others to impress the importance of feedback.

How we can help our patients to learn more effectively, efficiently, and enjoyably… We can help patients to make sense of what they learn… Explaining to them how we got our heads around complex ideas in the past; Making it OK for the light not yet to have dawned; Know your patients – people learn at different paces, some may need smaller steps and more repetition than others; Consolidating what they have learned by putting them into the position of helping others to learn – family, friends, other patients.

Thank You What about the ‘grabber’?