Assessing Affective Learning

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Assessing Affective Learning

• Reconstructing the art of medicine?

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Aims Outcomes

• Identify 3 broad approaches to characterising
  affective learning from the literature
• Be aware of the range of forms of assessment
  associated with these approaches
• Have the opportunity to reflect on the fit
  between these approaches and assessment methods
  and your own practice, interests and teaching
  /learning situation.

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First things

• What do you understand by the term affective
  learning?
• What issues would you identify with respect to
  assessment of that learning?
• Bring to mind a specific example of
  problems/issues you would like to think about in
  this session.

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The cautionary tale of Prof A., Mr. B. and the
morbidity book.

• Please read the story and then consider these
  questions
• In 1965, what factors might have accounted for
  the difference in the responses of Prof A and Mr
  B?
• In 2005, what learning outcomes might be
  important to include in Prof. As PDP?

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Whos got the power?
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Facing Fallibility?

• The conspiracy between doctors their patients
  to pretend that medicine is a perfect science
  rather than an imperfect art has had a profound
  effect on the culture within medicine.
• This impacts on the wellbeing of doctors, the
  doctor patient relationship and patient safety
  and litigation. (Anthony 2005)

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Q. Does affective Learning depend on affective
environment/context?

• Empathy in medical students. (Spencer, 2004,
  Hojat et al 2004)
• Consultant burnout (Maslachs Burnout
  Inventory emotional exhaustion,
  depersonalisation, perceived personal
  accomplishment) and compassion fatigue

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Affective Learning

• Affective pertaining to affections, emotional
• Affection affecting mental state, emotion,
  disposition (towards), goodwill, love, bodily
  state due to any influence, malady, disease, mode
  of living, property, quality, attribute
• Affective domain of educational objectives The
  behaviour required in this domain involves the
  demonstration of feelings, emotions and attitudes
  towards other people, ideas or things.

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Figure 2.2 Major Categories in the Affective
Domain (Reece Walker 2000)
Characterising Total behaviour consistent with
internalised values
Increasing Difficulty
Organising Committed to set of values as
displayed by behaviour
Valuing Displays behaviour consistent with single
belief or attitude in situations where not
forced to obey
Responding Complies to given expectations by
reacting to stimuli
Receiving Aware of, passively attending certain
stimuli. For example listening
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http//www.nwlink.com/donclark/hrd/bloom.html
Affective Domain Affective growth in feelings or
emotional areas (Attitude)
Receiving willingness to hear, selected
attention Responding active participation,
motivation Valuing the worth a person
attaches to a particular object, phenomenon or
behaviour, ranging from acceptance to
commitment Organising creating a unique
value system. The emphasis is on comparing,
relating synthesising values Internalising
The behaviour is persuasive, consistent,
predictable, and most importantly
characteristic of the learner
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Approaches to affective learning

• Product dimensions of professional competence
  (Epstein Hundert 2002)
• Process components/attributes of a professional
  conversation or physician/patient interaction
  (Stewart 2001, Kalamazoo 1 (2001) 2 (2004),
  ACGME (2005), MMC (2005)
• Empirical studies in a range of fields which have
  seemingly convergent findings

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Emerging empirical evidence base (1)
Interpersonal Factors

• Education psychosocial aspects of
  teacher-learner relationships (Vaughn Baker
  2004)
• Psychotherapy process-outcome research (APA
  Taskforce Empirically Supported Relationships
  2002)
• Better clinical outcomes are associated with
  better physician-patient communication. (Stewart,
  1995)
• Good (ie effective) and poor communication
  styles can be identified through discourse
  analysis. (Roberts et al 2003)

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Emerging empirical evidence base(2) Complexity

• Educational
• - In education we privilege the complicated
  ignore the complex (as in biological self
  organising systems) ACGME, Zimmerman (2005)
• Affective Neuroscience
• - basic emotion systems (Panksepp)
• - principle of neurobiological
  intersubjectivity (Schore 1994)

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Affective Neuroscience

• Panksepp 1998 Based on studies with primates
  which reveal basic intrinsic emotional systems
  which are
• Developed in response to environmental
  possibilities and challenges
• Encoded in specific emotional neural circuits
  (seeking, rage, fear, panic)
• Associated with major emotional operating systems
  generating well organised behaviour sequences

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Environmental drivers for emotional development
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Basic emotion systems
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Teaching/Learning (1)
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Teaching/Learning (2)
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Mind-Brain-Body attachment bond
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Reconstructing the art of medicine?
Science, Technology the Art of Medicine (Tauber
1993) It is not just a case of the physician
treating the patient as a whole man, but rather
one of the physician himself as a whole man
dealing with the patient as a whole
man Bridging the Heart Mind Community as
device for linking cognitive and affective
learning. (Hall 2005) In every class I teach, my
ability to connect with my students, and to
connect them with the subject, depends less on
the methods I use than on the degree to which I
know and trust my selfhood and am willing to
make it available and vulnerable in the service
of learning (Palmer 1998)
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Assessment methods and formats

• Assessment methods of capturing information for
  the purposes of identifying, measuring, tracking
  and promoting affective learning.
• Approachltgtmodelltgtmethods/formats
• Please refer to the table Mapping Assessment
  Methods given in the handout. Which of the
  assessment methods/formats described are already
  familiar and which are new to you? Are any of the
  issues you identified earlier addressed here?

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Building Effective Therapeutic Relationships

• Observation checklist
• Patient-rated process (eg Session Rating Scale)
  outcome (Outcome Rating Scale)
• Joint clinical assessment appointments tailored
  to stage, interests learning requirements of
  learners
• Focus on developing support in learning
  environment at all levels ie faculty,
  curriculum, learning materials and relating to
  individual learners
• ?organisational change?!

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How we assess affective learning will be
influenced by

• Our task / practice
• (telling /showing /growing)
• Our model (directive product / constructive
  process / developmental)
• Our setting / context (national specialty
  professional structures local organisation)

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Approaches to Professional Regulation 1

• Evidence based
• www.bemecollaboration.org
• Rules based
• Determined through
• ethical / legal process
• (?after Shipman)

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Approaches to Professional Regulation 2

• Public opinion based
• Determined through public consensus
• (?feasible/desirable)
• Self-Regulation
• Top down GMC
• www.gmc-uk.org/policy_planning/draft_consultation.
  pdf
• Bottom up Local Learning Communities / faculties

General Medical Council
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Models of Learning Community (Hall,2005)

• Therapeutic
• Marketing / consumer accountability
• Civic
• Truth
• reality is a web of communal relationships and
  we can know reality only by being in community
  with it.

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Natures most powerful signal
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Bottom-up development