This is the FINAL installment!  Check out all 9 previous chapters! Stay tuned for the official launch this fall.  Your reviews and feedback have helped to make this a better product.  Here are links to the previous chapters in this series: Zone of Proximal Development; Transformative Learning Theory; Spaced Repetition Theory; Self-Determination Theory; Organizational Learning; Dreyfus Model of Skill Acquisition; Digital Natives; Deliberate Practice and, Constructive Developmental Framework

Action Learning

Authors: Holly Caretta-Weyer (@holly_cw); Jennifer Mitzman (@Mitzman_EMPEM); Geoff Jara-Almonte  (@gjaraalmonte)

Editor: Michael Gottlieb (@MGOTTLIEBMD)

Main Authors or Originators: Reginald Revans

Other important authors or works: Revans RW. Action Learning. Manag Decis. 1983;21(1):39-50.

Part 1:  The Hook

Tom, a new chief resident, is excited to begin his third year of emergency medicine residency. He feels very honored and humbled to have been selected by the program leadership, his peers, and the nursing staff as chief. He has always worked hard, done well on his yearly in-training exam, and excelled clinically. Tom is now looking forward to the new challenges that will arise in his new role.

At his first chief resident meeting with the program director, Dr. Jones, she challenges Tom and his two co-chiefs to think about the legacy they want to leave on the residency. Tom thinks to himself, “Legacy? I’m just happy they picked me! What could I possibly do that would outlive my time here that would have lasting impact and meaning for the program?” Tom decides to think on this in the coming weeks and makes plans to discuss this further with his program director and co-chiefs.

Later that week, Tom is sitting in the back of the room at the weekly Wednesday didactic conference. They are halfway through the usual four hours of lecture when Tom looks around and notices that his co-residents are all either asleep, finishing charts, or texting on their phones. Almost none of them are paying attention!

“Ugh.” Tom thinks to himself. “I’m bored too and would love to be charting or sleeping, but I’m supposed to be setting an example.” He then thinks, “There has to be a better way to convey the necessary core content during didactic conference without putting all of the residents to sleep!” Maybe there is some way to improve the conference situation and leave that chief resident legacy after all…

Part 2:  The Meat

Overview

Action Learning Theory was initially described in the 1940s by Reginald Revans. Initially it was applied in the coal mines but took off in the business world as a corporate strategy in the 1990s.1 Action Learning Theory challenged the traditional paradigm in which educators or field experts asked questions of their learners and then judged those responses based upon their own fund of knowledge. Instead, the coal miners working daily on projects were deemed to be the experts.2 Utilizing a group-think practice, they discussed projects and formulated questions in real-time based on the problems faced. They then worked through solutions by pooling their prior experiences and thinking creatively.

Background

Action Learning Theory requires two key components for success. Revans defined the first as programmed knowledge. In medical education, we would consider this to be the ‘fund of knowledge’. This is the required foundational knowledge of pathophysiology and disease processes required of a medical professional. This has historically been acquired through traditional methods, such a reading or attending lectures. The second component critical to his theory is questioning insight. This is where new problems are solved using prior experience and creative thought.

One of the earliest healthcare applications of this theory took place in London as part of the hospital internal communications project in which 10 large hospitals participated. This project recognized inter-departmental communication as a huge obstacle in patient care and developed and instituted multidisciplinary hospital leadership teams comprised of physicians, nurses, and administrators, which today we recognize as the standard hospital leadership.3

Medical education has taken many steps forward in integrating Action Learning into the curricula. Team-based and problem-based learning workshops now abound in medical schools as primary teaching modalities. Residency programs routinely utilize methods such as simulation, small group discussions, and social media to increase residents’ active learning. One school even instituted body painting to integrate Action Learning Theories into the anatomy curriculum.4

Modern takes or advances

Several other authors have elaborated on Revans’ Theory of Action Learning. A critical review of the field identified three ‘camps’ of Action Learning described as the scientific, experiential, and critical reflection models.5 One of the critiques of the original work of Revans and others was an absence of a reproducible framework with which to operationalize Action Learning.  This was supplied by Marquandt who suggested six key concepts that allowed organizations to more easily understand and implement the ideas of Action Learning.6

It is important to differentiate Action Learning, as conceived by Revans and elaborated on by McGill and Beaty, Mumford, Marsik and Pedler, from active learning. The idea of active learning has permeated undergraduate and graduate medical curricula, and indeed was seen as a necessary imperative to improving medical education as early as the 1980s.7 This term generally conceives of any activity which requires students to ask questions or perform activities that encourage the construction of new knowledge based on prior knowledge or experience – as opposed to activities which seek to transmit knowledge or facts to learners.8,9

Action Learning – as classically described – has commonality with active learning, but critical differences exist. Action Learning is founded around a task that is complex, difficult, and accompanied by some degree of risk. Revans described this as the “risk imperative” – believing that interrogation of participants’ beliefs could not occur if they were indifferent to the outcome.10 In contrast to some types of active learning, Action Learning necessarily occurs in a closed group or ‘set’ and, while individuals in the set may each have their own unique problem to work on, learning occurs via the interaction between members of the set.

Some authors have sought to understand the educational value of Action Learning by placing it in conversation with the five major schools of adult learning as categorized by Merriam and Caffarella and applied to medical education by Torre and colleagues. They draw important conceptual links between elements of Action Learning (the problem, the set, a reflective inquiry process, power to take action, commitment to action, and action learning coach) and schools or theories of learning to describe the various ways in which steps of the Action Learning process promotes learning.11

Other authors have begun to develop experiments in Virtual Action Learning (VAL). Two published examples include both graduate-level and professional courses offered in an online platform, one at a university and the other provided internally for federal employees.12,13  Both made use of an online asynchronous communication platform for the members of the set to communicate and facilitate peer to peer learning. Both studies identified improved learner satisfaction in the Action Learning group. Other authors have investigated Action Learning in virtual avatar-based environments (eg, Second Life).14

Other examples of where this theory might apply in both the classroom & clinical setting

Action Learning was not conceptualized with classroom learning or didactics in mind. The focus is on identifying real-world, work-based problems to stimulate the desire to learn, coupled with the expectation that learners are empowered to act with accompanying real-world consequences. Therefore, this limits the applicability of Action Learning to classroom, theoretical, or purely didactic settings. Nevertheless, some medical education activities employ many elements of Action Learning in their design.

In medical education, problem-based learning (PBL) and simulation activities reflect many of the tenants of Action Learning. In PBL, small groups of learners are paired with a tutor and given a scenario or ‘trigger’, which prompts the identification of a set of learning objectives and allows the learners to gather and apply the new knowledge. In these cases, learning is centered on finding a solution to the problem posed by the trigger.15 These activities incorporate many of Revans’ assumptions of Action Learning including ‘learning is cradled in the task’, ‘urgent problems or enticing opportunities provide the spur for learning’, ‘action and feedback’, ‘learning with and from each other’, and ‘the facilitator role’.10

Simulation activities, particularly those that are interdisciplinary with a focus on improving logistics, institutional processes, and communication or cooperation between various hospital groups, may also exemplify the key components of Action Learning if designed with this in mind. For example, if an institution decided that trauma patients were not receiving blood in a timely manner, a multidisciplinary team made of physicians, nurses, pharmacists, laboratory technologists, and blood bank personnel might come together to develop a solution. They may decide to run simulated trauma cases with structured debriefing sessions to determine critical steps in the blood-delivery process choosing one team member to guide debriefing and facilitate the identification of important learning tasks. They would likely recognize that the time required to administer blood was the cumulative result of uncertainties and protocols in multiple specialties and departments, and develop and test new protocols developed from these critical insights.6

Annotated Bibliography of Key Papers

Marquardt MJ, Revans RW. Action learning in action: Transforming problems and people for world-class organizational learning. Davies-Black Pub., 1999.

Original works on Action Learning by Revans did not contain clear instructions or steps for others to utilize this process in their own environments.  This is one of the reasons for multiple ‘camps’ within the umbrella of Action Learning and the proliferation of activities and interventions labeled ‘Action Learning’ that bear little resemblance to the original process. Marquardt attempted to provide a template to allow others to operationalize Action Learning by six key concepts that could be readily applied to individual situations.

Eason K. Action learning across the decades. Leadership in Health Services. 2017;30(2):118-128.

This paper explores the usage of action learning in healthcare, specifically how to engage key stakeholders in complex health systems.

Marsick VJ, O’Neil J. The many faces of action learning. Management learning 30.2 (1999): 159-176.

This review article compares and contrasts the three major camps of Action Learning: scientific, experiential, and critical reflection. The authors identify key proponents or developers of each of the camps and identify relative strengths and weaknesses. They also attempt to reconcile the disparate camps by identifying key components of each that adhere to the general philosophy of Action Learning.

Marquardt M, Waddill D. The power of learning in action learning: a conceptual analysis of how the five schools of adult learning theories are incorporated within the practice of action learning. Action Learn Res Pract. 2004;1(2):185–202.

This manuscript attempts to expand upon the conceptual frameworks that underlie Action Learning. Prior literature on Action Learning had limited discussion of the relevance to underlying conceptual frameworks. The authors attemtpt place the key steps of the Action Learning process in conversation with five major educational theories, and identify ways in which components of those theories may inform the practice of Action Learning.

Limitations

There is lack of consensus on what types of activities and interventions can be properly described as Action Learning, which complicates the development and assessment of a robust body of literature in support of this theory.5,16 The body of literature on Action Learning consists primarily of case studies, with a relative paucity of literature investigating learner-centered outcomes.16

Action Learning requires an appropriate problem for participants to address. It must be a pragmatic, real-world, workplace-based stimulus, and participants must be empowered to make real change (with accompanying risks) to address the problem. Learning that occurs is in service of identifying solutions to the given problem, and is not directed toward a specific learning objective per se. If course directors have specific knowledge, skills, or attitudes that they have decided participants should cover or master by the end of the session, these may be only partially covered (or missed entirely) if participants do not identify those topics as relevant to the problem at hand.

Action Learning requires collaboration and cooperation between learners. Careful attention to group dynamics is required. Action Learning demands a group member whose sole focus is on facilitation of group interaction and the learning process. Performance of learners both within and between groups may be quite variable depending upon group dynamics and the skill of the facilitator.

Part 3:  The Denouncement

Tom and his co-chiefs sit down and discuss solutions to didactic conference boredom at-length. After a quick literature search, they come upon Action Learning Theory. The focus on identifying a real-world, work-based problem to tackle and empowering the residents to make decisions and act with real-world consequences appeals to the chiefs. Maybe they really can leave a meaningful legacy by improving the didactic conference using Action Learning! They decide to present this as a solution to their program director.

Dr. Jones sits down across from the chiefs for lunch. He says “I heard you had an idea for your chief resident legacy! Lay it on me.”

Tom and his co-chiefs present the principles behind Action Learning Theory. Dr. Jones nods as the team describes their plan. Once the plan is presented, Dr. Jones is intrigued yet skeptical. “How are you going to get the faculty to buy in? It sounds like it is going to take a lot of faculty time…”

Tom responds, “That’s the beauty – we are going to use Team-Based Learning, so that we only need one facilitator for each session. Additionally, TBL inherently requires that residents come in with some shared knowledge base in order to tackle real-world, workplace-based problems and their associated consequences. This should achieve buy-in because no one wants to look dumb in front of their peers on the readiness assessments. Then, they have to apply that knowledge to tough problems that they will encounter in the ED! We can even add a level of complexity with systems-based problems to address some of those less often addressed competencies.”

Dr. Jones sits back and looks at the chiefs. “Well that’s one heck of a legacy team! Let’s get started putting these cases together.”

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References

1. Revans RW. Action Learning. Manag Decis. 1983;21(1):39-50.
2. Keys L. Action learning: Executive development of choice for the 1990s. J Manag Dev. 1994;13(8):50–56.
3. Eason KD. Action learning across the decades: case studies in health and social care settings in 1966 and 2016. Leadersh Health Serv. 2017;30(2).
4. Jariyapong P, Punsawad C, Bunratsami S, Kongthong P. Body painting to promote self-active learning of hand anatomy for preclinical medical students. Med Educ Online. 2016;21(1):30833.
5. Marsick VJ, O’Neil J. The many faces of action learning. Manag Learn. 1999;30(2):159–176.
6. Marquardt MJ, Revans RW. Action Learning in Action: Transforming Problems and People for World-Class Organizational Learning. Davies-Black Pub.; 1999.
7. Association of American Medical Colleges. Physicians for the Twenty-First Century. GPEP Rep. 1984.
8. Michael J. Where9s the evidence that active learning works? Adv Physiol Educ. 2006;30(4):159–167.
9. Michael J, Modell HI. Active Learning in Secondary and College Science Classrooms: A Working Model for Helping the Learner to Learn. Routledge; 2003.
10. Revans R. ABC of Action Learning. Gower Publishing, Ltd.; 2011.
11. Marquardt M, Waddill D. The power of learning in action learning: a conceptual analysis of how the five schools of adult learning theories are incorporated within the practice of action learning. Action Learn Res Pract. 2004;1(2):185–202.
12. Waddill DD. Action e-learning: An exploratory case study of action learning applied online. Hum Resour Dev Int. 2006;9(2):157–171.
13. Curtin J. Action learning in virtual higher education: applying leadership theory. Action Learn Res Pract. 2016;13(2):151–159.
14. Wagner C, Ip RK. Action learning with Second Life-A pilot study. J Inf Syst Educ. 2009;20(2):249.
15. Wood DF. ABC of learning and teaching in medicine: Problem based learning. BMJ. 2003;326(7384):328.
16. Cho Y, Marshall Egan T. Action learning research: A systematic review and conceptual framework. Hum Resour Dev Rev. 2009;8(4):431–462.