I have been a big fan of BJ Fogg for going on two years now since I first met him at a conference at Stanford in the summer of 2011. In my opinion, Dr. Fogg’s work on behavior change has the ability to significantly impact much of what we know about medical education and practice improvement. And the more time I have spent studying the natural learning actions and engineering the ArcheMedx learning architecture model, the more it seems that Dr. Fogg’s work is critical to understanding why the CME community continues to struggle to have the impact that is so desperately needed. (You can learn much more about Dr. Fogg behavior change model here.)
The basic premise of the natural learning actions model is that adult learners, and perhaps clinicians more specifically, rely on a series of behaviors that serve as the foundational elements of the ‘cognitive’ learning process. These learning actions include note-taking, setting reminders, searching related content, and social learning. From our research it seems that these learning actions become almost habitual in that the learners rarely, if ever, think about the actions themselves. And it seems that the fact that these actions are so often taken without awareness is not a good thing…not by a long shot.
As we learn more about the natural learning actions it appears that very little thought or effort is put into refining one’s natural learning actions over time. Ask 100 learners if they have ever thought about how to make their note-taking more efficient or effective and 90-95% will say no. (Perhaps worse yet, ask 100 educators if they have ever attempted to support the four natural learning actions as a means of supporting learning, and 95-99% will say no.)
In the end we are left with a scenario where each learner relies on their own patched together approach to leverage a cluster of actions that they rarely if ever think about and, for this reason, maybe the challenges within the CME community should be no surprise? Simply put: developing and delivering more and more content won’t work. And putting all of our eggs in the cognitive learning theory basket won’t work either. We MUST structure the content in medical education so that the learning actions are encouraged AND supported.
But surely some CME is effective and many times learning does take place, right? Absolutely. And this is where Dr. Fogg’s work comes in to play.
If a learner is critically motivated to learn than the lack of an efficient and effective learning architecture to support the natural learning actions can be overcome. As Dr. Fogg would suggest, when motivation is high, almost anything is possible (see the figure above). But when learners are not motivated to that ‘critical’ degree, then the lack of a robust architecture to support their natural learning actions undermines their ability to learn. Simply put: when a simple model for note-taking, reminders, search, and social learning is not available, then learning just ain’t simple.
So what’s the takeaway? Though we do not have great data to suggest how often learners are critically motivated to learn such that they can overcome each and ever hurdle of ‘educational inefficiency’ that stands before them, experience would suggest that this is a very rare occurrence – a ‘critically motivated’ learner is the exception and not the rule. Most of our learners most of the time need our help to learn, they need the act of learning to be simplified and they need the learning experience to be structured.
What I learn from Dr Fogg is that educators must see, as part of their professional obligation, a responsibility to simplify learning and to structure the learning experience…and our team at ArcheMedX will continue to work to this very end. It is our belief that the simpler, structured models of learning are the surest path to achieve the changes that are so desperately needed in the lifelong learning of healthcare professionals.
