1.Self-Directed Learning Theory

What are some important underlying beliefs about self directed learning?

• Learners “construct” their own knowledge based on what they already know
• Knowledge construction is active, not passive – experience is an important factor
• Reflection – creation of meaning and conceptualization from experience – is an integral part of learning – happens both during and after an experience
• Learners make judgments about when and how to modify their knowledge
• Role of adult (such as CME) teacher is to facilitate learning process, not transmit knowledge
• Motivation to learn is complex but internal motivators are more likely to result in successful learning than external forces (e.g. desire to improve practice, network with others or validate current practice vs. need to acquire CME credits, recreational benefits)
• Independent and self-directing – typically have their own personal goals and objectives for learning which may be different than the stated course objectives
• Individuals have different and preferred ways of learning and processing information
• Active rather than passive learning strategies are more likely to beeffective

2. What are the major stages of change?（Lasted 4 D model)

Prochaska: stages of “readiness” to change (developed to explain the process of overcoming addictions)

• Pre-contemplation – may be aware of other alternatives, but no perceived need to change or interest in changing – cons outweigh pros of changing
• Contemplation – recognize a problem exists, willing to consider benefits and barriers to change, thinking about making a change but no commitment to action
• Preparation – convinced benefits outweigh barriers and have a plan to make changes
• Action – change is implemented, using strategies to prevent relapse
• Maintenance – change is sustained, efforts made to sustain change

(Prochaska 1992; Prochaska 1995)

3. What factors influence doctors’ ability to change clinical behaviours?

I think: many factors influence doctors’ motivation and ability to use their new knowledge and skills gained through a CME program. If we want to facilitate transfer of knowledge into practice, maybe the CME programs should encourage participants to identify factors influencing ability to use new knowledge and skills – both barriers and supports. Besides I think there are lot of factors influencing performance may be a characteristic of the doctor, their practice, the health system, the patient, or intrinsic to the activity (e.g. cost, risks, benefits) or situation (triggers to action e.g. patient presentation/availability, patient demand, reminders – practice systems, other health professionals, health system).

Medical care in Taiwan is both very similar and significantly different than care in the United States. In Taiwan, we have some are practice-related (e.g. organizational priorities of a group practice, attitudes of staff) or health-system-related (e.g. organizational priorities of the local or regional system, attitudes towards traditional roles and hierarchies of health professionals, value place on inter-professional collaboration) but seldom from patient-related (e.g. patient motivation, which will influence by a wide variety of predisposing factors). Maybe the reason is: the doctor-patient relationship differs significantly and cultural differences abound in even the most modern health care settings.