Adult Learning Theory with K2P CEO Mary Ellen Beliveau
Mary Ellen Beliveau, MEd, is the co-founder and chief executive officer of Knowledge to Practice. As CEO, she sets the strategic direction of the company including developing new market strategies, innovating products and services for different medical disciplines and ensuring measurable results for both clients and K2P’s business operations.
Mary Ellen is an impassioned visionary in the world of continuing medical education. Her vision is both inspired and grounded by over 20-years of experience innovating postgraduate medical education curriculum, including as Chief Learning Officer (CLO) at the American College of Cardiology and as a CLO consultant to Dana Farber Cancer Institute, and Executive Vice President of Specialty Sciences at Pri-Med.
What exactly is heutagogy?
Heutagogy is the most contemporary adult learning theory; its greatest applicability is for highly educated, expert learners. The concept is that once you’re postgraduate, out in the field, you want to be able to assemble just the content you need when you want it. No one size fits all course will do this.
However, if the curriculum is perennially evergreen, comprehensive with quick, easy access such that each individual easily configures the content that is relevant to their patient population and practice setting, this delivers high learning outcomes. If learners are given this type of control over their learning curriculum, and they receive CME and MOC while they are doing it, they get deeply stimulated and engaged and acquire the confidence to bring immediate change to their practice and provide better patient care.
So, heutagogy is for individuals who understand the complexities of their practice and practice setting, desire to stay on the cutting edge, and have the agency to configure content applicable to and for their patient population. Think of it like Spotify, configuring playlists that you enjoy.
How does CME based on this idea differ from traditional CME?
The traditional CME model is more of a “put in your hours, check the box, take the exam” kind of process and the focus is all about maintaining licensure and credentials. In fact, often, the material being taught is several years behind the contemporary practice. Heutagogy is more about being clear on your personal needs, and having the power and ability to build learning experiences that professionally develop you based on your goals, rather than a generic national standard–requiring individuals to be competent in areas that are not relevant to their specific patient profiles and practice setting. It’s learning in order to gain mastery in areas you need to understand, but also in areas, you find intellectually stimulating and customizing the curriculum to fit your needs.
Unfortunately, we still have an antiquated approach to licensure and certification, which is still firmly based on a pedagogical model, where someone else is telling me what I need to know. And that imposed structure is the same regardless of the patient population I treat, whether I work in a rural, urban, or suburban setting, whether my patients belong to an underserved minority group, or are more complex.
How does Knowledge to Practice manage those differences?
I look at it as our job as educators to provide physicians the opportunity, in an objective way, to understand the competencies as they’re defined, but then within those areas allow them to self-assess where they need more learning in order to:
- Provide the care their patient populations need
- Satisfy their own intellectual curiosity and meet their professional development desires
The idea behind CurrentMD Cardiology is to design a large enough library of content, in small mirco bytes, that keeps pace with the rate of development such that learners can choose what information they want to learn to maintain their licensure, but mostly enable them to deliver the very best and most contemporary care to their patients.
But how do I, as a physician, know what I don’t know?
Most physicians are, by nature, caretakers, it’s how they are woven. As part of their Hippocratic Oath they promise to stay current and continually develop and refine their knowledge, skills and attitudes. But being aware of personal gaps is a challenge, particularly since physicians are trained to be autonomous. In fact, their job requires them to be decisive at the bedside, which means confidence is essential, and being vulnerable is especially difficult. The implications are they help with objective self-assessment.
At K2P, we evolve our platform and design our content, through a deep awareness of practice settings, patient populations, and practice gaps along with the understanding of new disease states, and the development of drugs and devices. We then map the required essential sciences that are foundational to new concepts being mastered that can act as foundational or remediation depending on the individual. We design our information architecture such that each nugget can be uniquely compiled (heutagogy) into a personally meaningful curriculum and traversed at the appropriate time and desire of the learner.
We have our core curriculum, continually updated and maintained, and we have our commitment to keeping pace with the field. We offer micro-learning opportunities and self-assessments, and we cover major conferences and other big events. Our goal is to take the pressure of timely consumption of medical journals off our learners and enable them the agency to prioritize and access what is most meaningful to their personal professional development.
We’ve been studying how physicians learn best and what their needs are for more than 7 years now, deeply researching these things, so I feel like we’ve made some headway in understanding how to best enable each learner a personally meaningful experience.
How does it differ from andragogy?
It’s not really a difference, but more of an extension of Knowles’ Theory of Andragogy. Knowles defined andragogy in 1980, he identified the 6-8 core principles that differ between pedagogy (learning of a child) and andragogy (how an adult learns).
Andragogy is the art and science of adult learning, it describes the way in which adults need to be able to self-direct and define what they need to learn, have access to it and then move their learning forward. Heutogogy takes andragogy to the next level, stating that they want the ability to configure their own curriculum by piecing relevant content together in a way such that they can achieve their professional goals. In order to achieve this ability, adult learning theory must inform the:
- Platform design
- User experience
- Information Architecture
- Instructional design
What they need is a technology platform that allows them to create a personalized curriculum that is living and breathing, both aligned and supporting their professional development goals.
The orthogonal approach that we use to design our information architecture, which we spent more than two years researching and developing, does exactly this. It recognizes all the different use cases and which types of physicians need to access which areas and make it all clear and accessible so people can navigate, self-direct, and access quickly. [We have a blog post explaining this idea in more detail.]
The heutagogy part expands upon these 6 principles and requires us to trust and respect that providers have the ability to configure a “smart” curriculum and will continually engage and change behaviors if we are able to deliver this to them effectively.
Delivering pre-defined one-size-fits-all courses has proven to deliver no change to practice and just doesn’t work for people who are motivated, expert, and especially time-starved. As well, high-stakes exams aligned with generic/national standards that do not reflect actual competencies that are relevant to specific geographies and disease state heat maps, practice settings, or practice types, are adding to burnout and frustration for our providers. We want to empower them, and let them engage in continuing medical education in a manner that supports their professional development goals with the agency to find what is stimulating to them and important to their patients.
How might this look on the ground?
At present, we don’t align continuing medical education to specific areas of quality lack in any way, even though we know that quality is often poor and remarkably variable. But this needs to be done while respecting physician autonomy and professionalism.
Let’s consider Don Moore’s Taxonomy. It works like a staircase and essentially takes Bloom’s Taxonomy and adjusts it to specifically align with medicine provider professional development learning stages.
Observation is an essential part of the performance and continual improvement, but we have not effectively been able to accomplish this in a streamlined manner. I think the oversight of physician competency should be local, healthcare systems should have this responsibility, not a medical specialty board. I believe Medical Specialty Boards should focus on first-time certification, but the baton should be passed to health systems for recertification because that is where observation can happen in a meaningful way without creating extra work by the provider. This will also align professional development with the key KPIs of the healthcare system. In this way, development is happening in line with care and truly drives behavior change.
So, say it’s heart failure. The administrators can look and see, wow, we don’t have good trends in heart failure and we’re going to get some big fines from the government. And they know that there are four new compounds coming out this year, so they can then ask their staff to spend 2 or 3 of their 25 or 50 hours of yearly CME time on heart failure, completing activities that will close the gap, and they will recognize this education is essential in ambulatory, acute, and patient observation settings, and not limited to the education of the cardiologist.
How is CurrentMD Cardiology designed to do this?
On CurrentMD Cardiology we provide you with a menu of short talks by true experts and you can pick what you want to learn. We’ve spent a lot of time and effort figuring out how to provide great teaching in the most relevant and effective ways, and I think we’ve developed, and continue to develop, a learning platform that is not just a reference tool that serves up CME. It fits a gap in the market–between Up-to-Date, where you can look up an answer, and a Board Review product.
You can also choose how and when you want to learn because our platform is so agile, with every activity available on multiple devices and in multiple formats. So, I don’t have to spend 2 hours at night fast-forwarding through a tedious podium talk. I can see what’s offered and grab a 10 or 20-minute talk on, say, advanced heart failure to understand how to manage the patient I just saw. And I can do this in the car during my drive to the hospital, on the treadmill, or whatever.
Actually, we have a new talk on hypertension in pregnancy that provides a perfect example. We posted that activity in late July. It was recorded by Odayme Quesada, MD, a real expert on the topic, and is only about 20 minutes long. Within just a few weeks of it going up on CurrentMD Cardiology, it was viewed hundreds of times, so we’re obviously filling a need with these smaller, bite-sized topics.
It sounds like you really enjoy your job.
I do. As you can hear, I’m anxious for people to move away from the sage on the stage and recognize what we have to give providers to keep them intellectually stimulated and practicing at the top of their license–understand what they need to treat their patients but also maintain a firm grasp on the broader field.