3 The Continuum of Learning
Placing IPE Objectives with the Continuum of Learning
As students move through their professional education and into practice, there are often different expectations of the depth and skill level with which they engage with interprofessional learning. Learning objectives reflect these expectations. Dalhousie’s continuum of learning activities for health professional education, informed by Bloom’s taxonomy (Krathwohl, 2002), Miller’s (n.d.) pyramid of clinical competence, conceptualizes this continuum in three parts:
- Exposure: Explore interprofessional competencies (concepts, values, contexts, and practice skills).
- Immersion: Apply interprofessional knowledge and skills, analyze interprofessional concepts.
- Integration: Use and adapt interprofessional knowledge and skills in practice, translate knowledge, seek new knowledge, and act for change.
Learning objectives should reflect at what stage on the learning continuum the participants are expected to engage in learning. This will inform what actions are articulated in the objective.
Dalhousie created a table which blended several educational concepts to create a shared understanding and language to better understand the type and depth of IPE along the continuum learning (Dalhousie University, 2017). The document brought together principles from revised Bloom’s taxonomy (Krathwohl, 2002) and Miller’s modified pyramid (Cruess et al, 2016) as well as the U of A continuum of learning level of IPE activity [NewTab] interaction as described by the University of Alberta.
Bloom’s taxonomy describes 6 levels of learning students progress through as they increase their comprehension of material (remember, understand, apply, analyze, create and evaluate; Miller, n.d.). The levels begin with a focus on grasping the content, and end with a focus on being confident enough in the learned material to share it with others (Miller, n.d.). Each level contains a bank of verbs associated with what a student should be able to do at each level (see tables below; Dalhousie University, 2017).
Miller’s modified pyramid assesses clinical competence across 5 levels of learning: “knows”, “knows how”, “shows how”, “does” and “is” (Cruess et al., 2016; Miller, 1990). In the first stage, “knows”, students are given objective assessments like quizzes and exams that test their knowledge, which is considered the base of becoming a healthcare professional (Blazar et al., 2022; Cruess et al., 2016; Miller, 1990). This occurs at the same time as the stages remember and understand in Bloom’s taxonomy (Dalhousie University, 2017). Next, in the “knows how” stage, participants develop competence with the material, allowing them to successfully complete healthcare simulations (Blazar et al., 2022; Cruess et al., 2016; Miller, 1990). This corresponds to Bloom’s stages understand and apply (Dalhousie University, 2017). “Shows how” occurs when the student is assessed in real-life or simulated situations and can apply the material they have learned in class (Blazar et al., 2022; Cruess et al., 2016; Miller, 1990). This occurs in the apply, analyze and create stages of Bloom’s taxonomy (Dalhousie University, 2017). Finally, in “does”, students are evaluated on their ability to work on their own as healthcare professionals (Blazar et al., 2022; Cruess et al., 2016; Miller, 1990). The creation and evaluation stages of Bloom’s taxonomy show “does” (Dalhousie University, 2017).
These four levels of Miller’s original 1990 pyramid were revised because researchers realized that being competent as a healthcare professional was not only about learner actions (“doing”), but it was also about professional beliefs and attributes (“being”). Therefore, a fifth (and highest) level “Is” was added to represent professional identity. Professional identity encompasses the beliefs, values, qualities and attitudes a student should possess (and wants to possess) as a healthcare professional. (Cruess et al., 2016)
Read More: Assessments to use to evaluate professional identity
Based on ideas from Cruess et al. (2016)
Professional Self Identity Questionnaire [NewTab] (Crossley & Vivekananda-Schmidt, 2009)
Repertory Grids [NewTab] (Madill & Latchford, 2005)
Professional Role Orientation Inventory [NewTab] (Bebeau et al., 1993)
Professional Identity Essays [NewTab] (Bebeau & Monson, 2011)
The continuum of learning activities was based off of the University of Alberta’s Interprofessional Learning Pathway Competency Framework [NewTab] which consists of 3 phases of learning: exposure, immersion and integration (see Figure 2; Dalhousie University, 2017; University of Alberta, 2013). Each phase is described below, along with its corresponding stages of Bloom’s taxonomy.
Figure 5: illustration noting overlaps of Bloom’s Taxonomy (colours), Miller’s pyramid (grey) and the U of A Continuum of Learning Activities (white)
In the exposure stage, students “[e]xplore interprofessional competencies (concepts, values and contexts; practice skills)” (Dalhousie University, 2017). Examples of behaviours students show while in the exposure stage include: practicing effective communication skills, recognizing obstacles impeding collaboration, and identifying the similarities and differences between health professions (University of Alberta, 2013).
The exposure stage corresponds to the remember and understand stages of Bloom’s taxonomy.
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Remember |
Students can pull important information from their memory (Miller, n.d.).
Verbs: “arrange, define, describe, duplicate, identify, know, label, list, match, memorize, name, order, outline, recognize, relate, recall, repeat, reproduce, select, state, examine, locate, quote, tabulate, tell, copy, discover, enumerate, listen, observe, omit, read, recite, record, retell, visualize” (Dalhousie University, 2017) |
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Understand |
Students demonstrate comprehension of material through putting the content in their own words (Miller, n.d.).
Verbs: “explain, describe, illustrate, classify, convert, defend, describe, discuss, distinguish, estimate, explain, express, extend, generalize, give example(s), identify, indicate, infer, locate, paraphrase, predict, recognize, rewrite, review, select, summarize, translate, interpret, compare, differentiate, associate, contrast, demonstrate, relate, restate, ask, cite, discover, group, judge, observe, order, report, represent, research, show, trace, transform” (Dalhousie University, 2017) |
Students in the immersion stage “[a]pply interprofessional knowledge and skills; analyze interprofessional concepts, values, and contexts” (Dalhousie University, 2017). This could be demonstrated by problem-solving communication issues, analyzing team hierarchies, and using tools in clinical practice (University of Alberta, 2013).
The immersion stage corresponds to the apply and analyze stages of Bloom’s taxonomy.
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Apply |
Students can use the information they have learned to complete activities (Miller, n.d.).
Verbs: “apply, compute, construct, change, choose, demonstrate, discover, dramatize, employ, illustrate, interpret, manipulate, modify, operate, practice, predict, prepare, produce, relate, schedule, show, sketch, solve, use, write, calculate, experiment, complete, paint, teach, report, act, administer, articulate, chart, compute, determine, develop, establish, examine, explain, interview, judge, list, record, simulate, transfer” (Dalhousie University, 2017) |
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Analyze |
Students can link the information they have learned to prior information and experiences (Miller, n.d.).
Verbs: “analyze, categorize, compare, contrast, separate, apply, change, discover, choose, compute, demonstrate, dramatize, employ, illustrate, interpret, manipulate, modify, operate, practice, predict, prepare, produce, relate, schedule, show, sketch, solve, use, write, classify, distinguish, infer, explain, select, connect, differentiate, discriminate, divide, order, point out, prioritize, subdivide, survey, advertise, appraise, breakdown, calculate, conclude, correlate, criticize, deduce, devise, diagram, dissect, estimate, evaluate, experiment, focus, organize, outline, plan, question, test” (Dalhousie University, 2017) |
Students in the integration stage “[u]se and adapt interprofessional knowledge and skills in practice; translate knowledge; seek new knowledge; act for change” (Dalhousie University, 2017). This can be shown by seeing and using the strengths of other team members, making changes to improve collaboration, and promoting knowledge translation (University of Alberta, 2013).
The integration or practice ready stage corresponds to the create and evaluate stages of Bloom’s taxonomy.
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Create |
Students show their comprehension of material by creating their own outputs (Miller, n.d.).
Verbs: “create, design, hypothesize, invent, arrange, assemble, categorize, collect, combine, comply, compose, construct, create, design, develop, devise, explain, formulate, generate, plan, prepare, rearrange, reconstruct, relate, reorganize, revise, rewrite, set up, summarize, synthesize, tell, write, substitute, compile, generalize, integrate, organize, prepare, produce, role play, adapt, anticipate, choose, collaborate, express, facilitate, imagine, infer, intervene, justify, make, manage, negotiate, originate, propose, report, schematize, simulate, speculate, structure, solve, support, test, validate” (Dalhousie University, 2017) |
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Evaluate |
Students can assess how effective materials are (Miller, n.d.).
Verbs: “create, design, hypothesize, invent, arrange, assemble, categorize, collect, combine, comply, compose, construct, create, design, develop, devise, explain, formulate, generate, plan, prepare, rearrange, reconstruct, relate, reorganize, revise, rewrite, set up, summarize, synthesize, tell, write, substitute, compile, generalize, integrate, organize, prepare, produce, role play, adapt, anticipate, choose, collaborate, express, facilitate, imagine, infer, intervene, justify, make, manage, negotiate, originate, propose, report, schematize, simulate, speculate, structure, solve, support, test, validate” (Dalhousie University, 2017) |
For more examples of skills demonstrated by students in the Exposure, Immersion and Integration stages, visit the Interprofessional Learning Pathway Competency Framework [NewTab].
Summary
- There are many different pedagogical approaches to IPE. Many share similar elements that support active learning to allow students to learn about, with, and from each other in order to meet the criteria to be considered for interprofessional education.
- Learning objectives should align with the pedagogical approach being used. They often indicate the objective of developing particular IPE competencies and specify how this will occur.
- The pedagogical approach and learning objectives for the IPE event inform each other and support how the IPE event is designed and facilitated.
