For the fourth year, we are collaborating with the ALiEM Faculty Incubator Program to serialize another volume of Educational Theory made Practical. The Faculty Incubator program a year-long professional development program for educators, which enrolls members into a small, 30-person, mentored digital community of practice (you can learn more here); and, as part of the program, teams of 2-3 participants author a primer on a key education theory, practically linking the abstract to practical scenarios.  

They have published their first and second e-book compendium of this blog series and you can find the Volume 3 posts here (the e-book is in progress!) As with the previous iterations, final versions of each primer will be complied into a free eBook to be shared with the health professions education community. 

Your Mission if you Choose to Accept it:

The ALiEM Faculty Incubator Program would like to invite you to peer review each post. Using your comments, they will refine each primer. No suggestion is too big or small – they want to know what was missed or misrepresented. Whether you notice a spelling or grammatical mistake, or want to suggest a preferred case scenario that better demonstrates the theory, they welcome all feedback! (Note: The blog posts themselves will remain unchanged.)

This is the third post of Volume 4! You can find the previous posts here: Cognitive Load Theory and Epstein’s Mindful Practitioner.

Joplin’s Five-stage Model of Experiential Learning

Authors: Mark Keuchel (@mkeuchel); Al’ai Alvarez (@alvarezzzy) ; Curtis Knight

Main Authors or Originators: Laura Joplin

Part 1: The Hook

The interns had an upcoming simulation module on placing central lines. A small group of them decided to show up early to play around with the equipment and see if they can practice on their own. Each of them had either seen one done or got to place one during medical school. Everyone had an idea of what they need to do and each one felt comfortable practicing the steps without the assistance of an instructor giving them direct feedback.

John grabbed the syringe and attempted to cannulate the internal jugular in the mannequin. He kept on poking the neck and was getting frustrated.

Recalling some steps for when she did it, Jill took over, and started telling John her version of how it should be done, unsuccessfully.

Jim read out loud the steps emailed for their asynchronous learning as Jill continued to attempt with the cannulation.

Everyone was feeling frustrated without the teacher.

Part 2: The Meat

Overview

Dr. Laura Joplin’s theory suggests that all learning is experiential. According to Joplin’s theory, a person learns from “experiencing” and interacting with the subject. Dr. Joplin felt that experiential learning programs had two main responsibilities to the learner:

1. Provide an experience
2. Provide a reflection period on that experience.

These two phases of learning are joined in the “action-reflection” cycle. According to Joplin, the simple provision of an experience by itself is not sufficient for learning; a learner’s reflection on the action is of critical importance.

The five-stage model describes an experiential learning strategy that combines the following stages:

1. Focus
2. Action
3. Support
4. Feedback
5. Debrief

Feedback and support are critical throughout the process from the moment of initial action up to the conclusion of the learning experience. This framework gives educators a model to be deliberate in strengthening the experiential nature of their course design, highlighting that it is the educator’s responsibility to provide a learner-centered education.

Background

Joplin’s 5-stage model was created to be intentionally simple and define learning but is not a learning theory itself. The model is organized around a ‘hurricane-like cycle’ emphasizing a challenging action in between focusing and debriefing. These ‘action-reflection’ cycles are differentiated from experience alone by incorporating a reflection process. The application of the cycles can be in either a ‘maxi’
or ‘mini’ scope, depending on the intent of the project; the cycle can focus on large-scale course design or a brief teaching moment or insight.

The first aspect of the model is the focus stage. It is here that the educator identifies the task and the attention of the learner becomes engaged. The educator is tasked to shine light to a specific topic to help orient the learner. The education must also be cautious not to be too specific that may push learners to tunnel-vision and impede unplanned learning. The focus stage is an important aspect in aligning the learner’s attention to the educator’s goals. Actions in the focus stage depend on the type of activity to be performed. A focus stage may be as simple as verbally discussing the goals or may be more involved such a reviewing an article before an action.

Second is the action stage. This stage of the model surrounds the learner in direct confrontation with an often-unfamiliar situation requiring the learner to engage in problem solving. The inherent stress of the situation gives the learner an “experiential” learning. Active learning is key facilitated by participation rather than passively reading or watching a video. The learner must be given “responsibility” in the learning process, such a component that is absent in textbooks where the author decides the sources. The learning difficulty must be appropriate to the learner and is the responsibility of the educator. By actively engaging the learner, the brain is considered “on” where the new information can be processed and retained.

While it is the learner’s responsibility to take action, the most important aspect to the experiential learning is the educator’s support and feedback to the learner’s action. When the learner feels supported, they will have the motivation to continue to try. Providing support allows the learner to take on risks that advances the education experience. Feedback gives the learner reflection, such as personal interactions, knowledge base, and techniques needed to advance. The more specific the feedback, the better the learner is able to improve in the next attempt or stage. Both support and feedback encourage a growth mindset. Joplin emphasizes that a distinction should be made between what the educator holds true and what may be more consistent to the medical community as a whole.

The debrief process allows the learning climate to be recognized, examined, dissected, and evaluated. It cements the learning experience, accounting for personal perception and beliefs. Debrief occurs internally, as well as an experiential education debrief, and includes reflection of actions undertaken and the next steps. A well constructed debrief helps accelerate the learning experience.

Modern takes or advances

The intentional aspect of Joplin’s 5-stage model of experiential learning requires time and work that may not always be feasible in the clinical setting. Moreover, there is a generational difference in perception of teaching and learning. Because Joplin’s model can be applied in a “maxi” and “mini” scope, it is easily translatable in a busy shift. Knowing the five stages is important, and deliberate signposting of these steps may help learners better appreciate the process. Here’s how:

1. “Let’s focus your attention to the way you’re holding the syringe.” [focus]
2. “I’m going to give you feedback on what I’m seeing you do, and how it may affect the success of your venous cannulation.” [reflection: feedback]
3. “I’m going to give you a more specific feedback. I’m noticing your angle is to steep. How can you optimize this to allow the wire to thread easily?” [specific feedback, challenging]
4. “I like how you’re stabilizing your hand as you advance the guidewire through the needle. It helps prevent kinking of the wire.” [specific support]
5. “That’s great. You’ve advanced the wire successfully, and I’m noticing that you’re holding the wire carefully so as not to lose it. How do you want to proceed?” [debrief]

In a “maxi” application of Joplin’s model, consider the process of training as a team for SimWars competition. A group of residents are either picked or volunteer to represent the department. Each one has a specific skill set needed for success, yet team cohesion is a very important characteristic of a winning team. A deliberate focus on developing this sense of teaming is a must. As the team practices on different crisis resource management, the team must reflect upon the efficiency and effectiveness of communication styles. Support must exist to intentionally address this aspect of the team, and support needs to happen often. The feedback must also be specific regarding the delegation of roles, the practice closed-loop communication and feedback on appropriate tone and delivery of orders. For every iteration, each of these areas must be addressed for improvement, including highlighting of successful tasks achieved. Ultimately, the 5-stages are repeated using multiple sources of feedback; support and challenging occur as the team advances. Once ready, the team will have shown a well-rehearsed, cohesive implementation of crisis management. A final debrief is critical in order to further emphasize areas for improvement and celebrate successful aspects of the implementation.

Simulation in medical education utilizes Joplin’s five-stage model of experiential learning. Here are examples of simulation literature that support this practice:

a. For undergraduate medical education: Vic Brazil’s Live Die Repeat model
b. For graduate medical education: Mayo Clinic’s The Live Die Repeat model

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

Another example for the use of Joplin’s 5-stages is on giving framework for residents as teachers model. By clearly defining the steps in successful learner-centered teaching, a junior teacher (residents) are able to be deliberate in their approach to teaching. Not only will they gain experience in mastery of the topics they are teaching, they will also apply the metacognition of effective teaching styles.

Annotated Bibliography of Key Papers

Joplin, Laura.  On Defining Experiential Education. Journal of Experiential Education. 1981;4(1):17-20.²

This paper introduces the idea of the 5-stage model of experiential learning.  Her model is organized around a “hurricane-like cycle” emphasizing a challenging action in between focusing and debriefing while being surrounded by feedback and support.

Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Upper Saddle River, NJ: Prentice Hall.³

This book by Kolb built upon earlier work and lead him to believe that knowledge acquisition was obtained through “transformation of experience.”  His theory had 4 stages in a cyclical pattern: concrete experience, reflective observation, abstract conceptualization, and active experimentation. This is an interesting theory that overlaps and augments the work of Joplin, and is worth comparing and contrasting.reference

Limitations

Joplin’s 5-stage model is clear, deliberate and learner-centered – but teacher intensive. The time requirement and effort required for preparing adequate experiences and creating the feedback and debriefing to match the initial experience is not to be taken lightly.

In order to be effective, Joplin’s five-stage model requires time and intentionality. On shift teaching using Joplin’s model may not be feasible as the patient may not feel comfortable undergoing several iterations of the procedure. From a learner’s perspective, learning from this technique can be exhausting, thereby defeating the point of a learner-centered teaching. It is important to cultivate buy-in from the learner, and acknowledging the feedback fatigue induced by rapid cyclones of observation and feedback at the beginning of the process is key. Frequent check-ins are important, and the teacher must create a supportive learning climate for the learner to work independently with less meta-intrusions.

Part 3: The Denouement

The group of interns realized that experience alone is not effective in learning how to place central venous catheters. They needed an instructor to tell them what they were doing right and what they were doing wrong. When the teacher arrived, using Joplin’s 5-stage model, she provided a deliberate method for reflection on each step of the cycle to encourage them to develop mastery for each step of the process. The key here is not to simply be lucky with cannulating the vein. It also emphasized the need for an experienced teacher to help guide the process and solidify technical skills for each step. The teacher offered individualized support for each learner. Specific feedback was given in the moment along with appropriate corrective actions. The teacher provided support for successful completion of each task. At the end of the workshop, each of the learner felt confident about their skills, and was able to demonstrate mastery of the procedure. A debriefing session followed to discuss scenarios and offer troubleshooting tips. Simulation workshop is a great way to teach procedural skills, especially using Joplin’s five-stage model of experiential learning.

Don’t miss the fourth post in the series, coming out Tuesday, February 18, 2020!

PLEASE ADD YOUR PEER REVIEW IN THE COMMENTS SECTION BELOW

References

1.Andreasen, R. J., & Wu, C. (1999). Study abroad program as an experiential, capstone course: A proposed model.Journal of International Agricultural and Extension Education, 6(2), 69- 78.

2. Joplin, Laura.  On Defining Experiential Education. Journal of Experiential Education. 1981;4(1):17-20.

3. Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Upper Saddle River, NJ: Prentice Hall.

4. Torock, J. L. (2009). Experiential learning and cooperative extension: Partners in non-formal education for a century and beyond. Journal of Extension [On-line], 47(6) Article 6TOT2. Available at: http://www.joe.org/joe/2009december/tt2.php

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