1	The adult learning process Andrew G. Lee, MD Professor of Ophthalmology, Neurology, and Neurosurgery Director of Graduate Medical Education New Educational Initiatives Associate Program Director of Ophthalmology University of Iowa Hospitals and Clinics
2	Objectives Define adult learning principles & process Doctor = Latin root (teacher) Use real world examples to illustrate key points Dreyfus model of expertise Ericsson deliberate practice model Role of mentorship in resident education process
3	Adults learn differently from kids Pedagogy (kids) One-way teaching Learner passive Structure hidden Lecture format Impersonal (class) Little application Summative feedback Andragogy (adults) Two-way learning Learner active (self reflect) Structure pre-defined Interactive format Personalized (individual) Application of skills Formative Feedback
4	Adult learning is active Help learner to learn “how to learn” Inspire life long learning (process not event) Check learner progress over time Engage learner in learning process Provide formative & summative feedback
5	Adult learning Adults need to know WHY they are learning something new (motivation) Self directed learning Needs assessment driven Prior experiences make learning experience more meaningful (context) Application in “real world”
6	Practice what we preach Short reflection-interactive exercise How did you learn to do a new task? (playing an instrument, dance, sport) Take 1 minute & tell your neighbor A brave soul should come forward & tell the group their story Take 30 seconds to reflect on process of adult learning
7	Key elements of learning examples Learning in stages (Dreyfus model) Practice (Ericsson model) Passionate mentor
8	Paradigm Shift The Dreyfus model of skill acquisition Stages of competence Novice Beginner Advanced beginner Proficient Expert
9	The Dreyfus model for Evaluation using defined behavioral anchors Stages of competence Novice Prep, Drape, Anesthesia Beginner Capsulorhexis, wound design Advanced beginner One handed techniques Proficient Two handed techniques Expert < 15” case
10	Old accreditation model “Minimum numbers” Procedure Class I Class I + III Cataract 45 75 Strabismus 10 15 Cornea 0 5 Glaucoma laser 5 10 Glaucoma filter 5 10 Retina/vitreous 3 10 Other retinal 10 10 Oculoplastics 15 25 Globe trauma 4 6 Class I: Direct supervision by faculty Class III: Resident first assistant
11	Paradigm shift: Ericsson model Wet lab practice Capsulorhexis (small parts of cases over and over again until comfortable) Do one part of an otherwise perfect case Keep practicing within Dreyfus stage until ready to proceed to next level Opposite of minimum numbers accreditation model (may move to next stage after n = 2 or 200)
12	Mentorship can work both ways
13	What is the most important part of my job in academics? Clinical care? Education (Mentorship)? Research?
14	How did four Iowans save one billion lives worldwide?...and what does this have to do with education?
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16	Norman Borlaug Born, Crestor, Iowa (1914) Won Nobel Peace Prize (1970) Wheat/corn hybrids in arid climates But that’s not the cool part
17	But…no Borlaug without Henry Wallace Born: Adair County, Iowa 1888 Iowa State College at Ames 1910 High-yielding strains of corn 1913 Secretary of Agriculture (FDR) 1933 Vice President of United States 1940 Interred Glendale Cemetery, Des Moines
18	Henry Wallace 1940, Henry Wallace: vacation in Mexico Wallace noted yield of corn was much lower than his native Iowa Idea - start an agriculture experimental station like Iowa Rockefeller foundation funded Pioneer Hi-bred International (1926)
19	The Mexico Agricultural Station Borlaug selected for agricultural station in Mexico started by Henry Wallace Wheat & corn hybrids in arid climates Norman Borlaug single-handedly prevented worldwide famine & saved an estimated one billion lives! But that’s not the cool part…
20	Who influenced Henry Wallace As a child (his father was a Iowa State dairy professor), Henry Wallace used to take walks with a student at ISU named ….George Washington Carver “His (Carver’s) faith in me aroused in me a natural instinct to excel and deepened my appreciation of plants in a way I can never forget.”—H. Wallace
21	George Washington Carver Born a slave Orphaned in infancy Mother kidnapped by slavers Couldn’t get an education because of the color of his skin Started formal school at age 12
22	Who helped Carver? First black student at Simpson College (Iowa) studying art & piano Etta May Budd was his art professor Helped him find gardening odd jobs Encouraged him to study plants Helped admit to Iowa State (1894) where her father was Professor/Chair of Horticulture Carver => First black student & first black teacher at Iowa State before his amazing career at Tuskegee
23	The Peanut story (Tuskegee) 325 products from peanuts >100 products from sweet potatoes Carver never made nor sought any money for his discoveries
24	George Washington Carver Declined a $100K/yr salary ($1 million today) Tuskegee annual salary ($1K) Total lifetime earnings $73K Started foundation (1943) at death ($60K)
25	How four Iowans saved One Billion lives Norman Borlaug Henry Wallace George Washington Carver Etta May Budd
26	Why am I telling you this story?... You might not be a Norman Borlaug You might not be a George Washington Carver You might not even be a Henry Wallace But you can be an Etta May Budd!
27	Now what is the most important part of your job? Clinical care Research Education (mentorship)
28	Summary Define adult learning principles & process Encourage change in your teaching & assessing paradigms (Dreyfus/Ericsson) Emphasize evolving role of mentorship in resident education process (Borlaug)
29	Thanks for your time & attention