Tomorrow's Pharmacist October 1999 p27-29
Edited by Pamela Mason

Continuing education

Continuing education and lifelong learning: how many hurdles do we have to jump?

By Jennifer M. Archer, MSc, MIPD

Gone are the days when gaining a degree signalled the end of learning. The rapid pace of change means that no one can afford to stand still anymore. Which hurdles will you need to jump to maintain your professional standards and personal development needs?

Life long learning is the general term used to describe the learning that we all experience after leaving full time education. Although it is accepted that we gain learning at all stages of life, in our early years this could be termed as "guided" or "formal" learning. Such learning is generally structured in design using syllabuses and curriculums to form the frameworks in which we learn, with the requirement to attend a regular place of learning. Lifelong learning includes the ability to gain some form of credit to demonstrate the development of knowledge and skill to others, as well as the important aspect of learning for personal satisfaction. Dictionary definitions state that a professional is someone "displaying a high level of competence and skill". Most of us have already demonstrated that we have successfully jumped a number of hurdles - either by passing examinations, finals, the preregistration year, or by other learning activities which are more practically orientated, for example, completing projects, assignments and practical demonstrations.
In the case of pharmacy students or graduates like yourselves, whatever format the learning took, you probably did not let the hurdles become barriers to learning and you will have become a "professional" who practises (or will shortly have the opportunity to practise) pharmacy. Your ongoing progress and ability to continue to jump hurdles to maintain the standards of a professional will require you to take personal responsibility for your own learning and develop a plan for continuing professional development (see page 61 аа).

Continuing education

Continuing education is part, but only part, of the CPD process and focuses on knowledge, skills, information and attitudes. The European Universities Continuing Education Network (EUCEN) defines continuing education as "any form of education, vocational or general, resumed after an interval following the continuous initial education." Continuing education may include:

Education for full time mature students (those starting an undergraduate course at the age of 21 or over and other courses at the age of 25 or over)
Liberal adult education
Part time degrees and diplomas
Post experience vocational education courses, including staff development
Open access courses.

How are you going to maintain your knowledge, skills and remain up to date in pharmacy practice?
Accepting that we cannot know everything all of the time is not easy. To quote Charles Handy, "in an uncertain world, where all we know for sure is that nothing is sure, we are going to need organisations that are continually renewing themselves, reinventing themselves, invigorating themselves. These are learning organisations, the ones with the learning habit." This philosophy is probably not questioned very much as we complete the early part of our secondary education. The route we take is set down in a given curriculum by subject area, with everyone completing the basics, until the choice of GSCEs has to be made or we pursue a similar level educational development programme. Nowadays, however, with the introduction of the national curriculum developments, a considerable degree of self- learning is encouraged. The learning this offers may be helping to change our attitude in this area.

Learning styles

Could this be the point where we start to consider our continuing education? We may not recognise that this is what we are doing. We are identifying which hurdles we can jump best, we begin to recognise the style and environment in which we like to learn and by what we would prefer to learn - which often is the trigger for selecting our career pathway.
Dr Michael Kirton, an occupational psychologist and researcher, says that we develop our preferred learning style when we are 13 years old. This may help to explain why, to learn a similar item of knowledge or skill, some of us like to read information whereas others would rather complete a practical task. Therefore, recognition of what we personally prefer helps us to adapt and to work within other learning styles, so that we can benefit from every learning opportunity presented and so continue to maintain our cycle of continuing education. Some anecdotal research suggests those who can develop their learning styles are probably quicker at jumping the hurdles.
Two other researchers, Kolb and Honey, have explored the way in which we learn and how we change depending on our learning experiences and the situations in which we find ourselves. One example of this that I am sure you will be familiar with is moving from school to university. Regularly involved in small group teaching of about 12 students studying biology, you are encouraged to be active and participative. Arriving at university you find yourself joining a very large group of 90 students for a lecture on pharmacology, which conveys much information but has a very passive learning style with little interaction and relies on your own self motivation and a willingness to learn. Again, this and other changes to our learning experiences require us to make a dedicated commitment to our own continuing education, particularly if the next hurdle identified is to be jumped successfully.

Methods of CE

The ways in which continuing education can be undertaken are numerous. Examples include joining a group of learners with common learning objectives, attending a workshop, a lecture, a discussion or debate, participating in a news group on the internet or in study groups. Individual learners negotiate their own learning to meet their individual learning objectives and choose routes such as distance learning, computer assisted learning (CAL) programmes, audio and video programmes and the use of auditing processes. All learning opportunities use a variety of learning methods.
One method currently being used in the development of many programmes for health care professionals is problem based learning (PBL), which is student/learner focussed. A small number meet, typically for three two-hour meetings to work on one patient case. During these meetings pages of information are given out on a patient case. At the first meeting, the history of the present illness/complaint is given to members of the group, all of whom are required to read the information and determine a list of learning issues (questions that they feel they must answer in order to understand the case). Once they are satisfied they have completed these for the first page, a second page is issued - usually the past medical history. No attempt to answer the learning issues takes place during the meeting. Answering the learning issues takes place between meetings by the members of the group on an individual basis. They can use the library, textbooks, on line databases - anything they wish. To support the process, a facilitator asks the group members questions that make them think about what is going on.

Reflection

Another very useful method, which you can develop for yourselves, is reflective practice. It allows us to learn from our every day experiences and helps to identify specific learning needs (see panel).
Another model worth exploring is Driscoll's structured reflection model. It frames similar questions in a different format and may be preferred by some. During our lives, we are continually being provided with challenges and opportunities, workloads and deadlines. According to Driscoll, "adults are continually acquiring new skills and knowledge in familial, recreational and occupational settings. Adults cannot help but acquire new skills and knowledge as they proceed through life, and it would be a highly perverse individual who managed to shield him of herself from all those circumstances and life changes which necessitate the development of new competencies." This includes the way in which we are provided with education and support to learn the knowledge and skills, practical application, the do's and don'ts, to approach learning with the right attitude and implement the learning to best effect to meet the needs we identify.
Some of us find these processes relatively easy, and, like the hurdles to be jumped, we want the height to be increased at regular intervals, with the reward that we can move forward to the next standard or level (eg, "A" levels to a place at university, or a BPharm to an MSc). Others wish the hurdles could be lowered a little and the distance to be travelled reduced to enable them to go at a pace they can manage, both in terms of ability and the time available in which to complete the activity.
Yet, even with these hurdles to jump, we generally still strive to achieve the best outcome we can in whatever we do for our employers, peers, clients, family and friends. So what can and do we do for ourselves to help us motivate ourselves to deliver this? What is the best "stretch and fit" for you as an individual to meet your own learning needs? (Stretch and fit is a term used in management to identify what is required and the development of a strategy to meet this requirement).
The focus of everyone's continuing professional development (of which continuing education is one element) is quality of learning, flexibility, applicability and relevance. To quote David Blunkett, "to cope with rapid change and the challenge of the information and communication age, we must ensure that people can return to learning throughout their lives". The government's White Paper, "The new NHS: a first class service, quality in the new NHS" states that "lifelong learning is an investment in quality. The NHS must keep pace with the changing world, with medical advance, with fast changing new technologies and approaches to patient care. Greater public awareness of these advances has created increased expectations of what the NHS can deliver."

Model for structured reflection

1. Phenomenon
- Describe experience
2. Causal
- What essential factors contributed to this experience?
3. Context
- What are the significant background factors to this experience?
4. Reflection
- What was I trying to achieve?
- Why did I intervene?
- What were the consequences of my actions for: Myself, the patient/family, for the people I work with?
- How did I feel about this experience when it was happening?
- How did the patient feel about it?
- How do I know how the patient felt about it?
- What factors/knowledge influenced my decisions and actions?
5. Alternative actions
- What other choices did I have?
- What would be the consequences of these other choices?
6. Learning
- How do I now feel about this experience?
- Could I have dealt better with the situation?
- What have I learned from this experience?

Conclusion

The move from being a university undergraduate to a preregistration trainee again provides a new challenge, the chance to develop continuing education opportunities and learning experiences, thus enabling the continuing education cycle to progress. Using knowledge and skills in practice, in a setting that involves both patients and other health care professionals, will enable you to confirm the use and understanding of learning gained currently and in the past. It identifies new learning gaps and, as a result, further learning needs to be met. Some of these will require the undertaking of some continuing education.

Mrs Archer is assistant director (direct learning) at the Centre for Pharmacy Postgraduate Education, Manchester

Tomorrow's Pharmacist October 1999 p27-29 Edited by Pamela Mason

Continuing education