Knowles, M.S. (1975). Self-directed learning: A guide for learners and teachers. New York, NY: Cambridge, the Adult Education Company

Tough, A.M, (1967). Learning without a teacher. Toronto: Ontario Institute for Studies in Education. The adult’s learning projects: A fresh approach to theory and practice in adult learning. Austin, TX: Learning Concepts.

Brockett, R. G., and Hiemstra, R. (1991). Self-direction in Adult Learning: Perspectives on Theory, Research and Practice. London: Routledge.

Caffarella, R.S. and O’Donnell, J.M. (1989). Self-directed learning. Nottingham: Department of Adult Education, University of Nottingham.

Candy PC (1991). Self-Direction for Lifelong Learning. A Comprehensive Guide to Theory and Practice. San Francisco, CA: Jossey-Bass.

Grow, G.O. (1991). Teaching learners to be self-directed. Adult Education Quarterly, 41, 125- 149.

Long, H. B. and Associates (1988). Self-directed learning: Application and theory. Athens, GA: University of Georgia, Department of Adult Education.

Long, H. B., Oklahoma Research Center for Continuing Professional and Higher Education & North American Symposium on Adult Self-Directed Learning. (1989). Self-directed learning: Emerging theory & practice. Norman, OK: Oklahoma Research Center for Continuing Professional and Higher Education, University of Oklahoma.

Merriam, S. B., and Caffarella, R. S. (1991). Learning in adulthood. San Francisco and Oxford: Jossey-Bass Publishers.

While Joe’s assessments in the areas of professionalism and interpersonal communication are always outstanding, his marks in medical knowledge and patient care are just, well, average. Joe was disappointed to learn that he had only scored in the 30th percentile on his annual in training examination.

He meets with his program director (PD) to brainstorm for ways to improve his medical knowledge and in training examination scores. His PD tells him, “You’re doing everything right Joe! You always show up to conference and get 100% on the weekly reading quizzes!” Joe knows he is doing everything “right,” but he is frustrated by his results.

Every Wednesday, he sits through the same series of lectures he has experienced the last three years of his residency. He can sometimes even predict what slide is coming next! Joe participates in all of the required residency activities and feels like he knows everything. However, despite knowing everything at conference, he feels like he doesn’t know anything when he is working clinically. He is often stumped, not knowing which test to order next or what the diagnosis is. He felt even worse when he got his in training exam results.

Joe shows up to work one day and is so frustrated when he doesn’t know what medications to use for a patient requiring procedural sedation. Joe decides to ask one of his friends from the anesthesia residency program for advice.

In the setting of rapidly evolving knowledge, Malcolm Knowles argues that the main purpose of education is to provide learners with the “skills of inquiry” rather than the knowledge itself. Knowles offers self-directed learning (SDL) as an essential skill to maintain human competence.¹

Self directed learning occurs when learners¹:

1. Take initiative to diagnose their learning needs, with or without the help of others
2. Formulate learning goals
3. Identify human and material resources for learning
4. Choose and implement appropriate learning strategies
5. Evaluate learning outcomes

A similar definition for SDL, offered by Hiemstra, is any study form in which individuals have primary responsibility for planning, implementing, and evaluating the effort.²

Knowles distinguishes SDL from traditional teacher-directed learning on several bases. Self-directed learners’ internal motivation for learning develops from life tasks or problems.¹ Learning is problem-centered, rather than subject centered.¹ Knowles emphasizes that the learner’s motivation is an essential feature of SDL; self-directed learners may benefit from teacher-centered learning, but the self-directed learner enters the experience with a different fundamental attitude.¹ In general, however, the role of the teacher in SDL is to dialogue with learners, secure resources, evaluate outcomes, and promote critical thinking.²

The first parts of SDL, “diagnosing” one’s learning needs and formulating learning goals, requires a learner to assess their personal knowledge deficits (the difference between the desired skills and knowledge and their current skills and knowledge).¹ Therefore, self-assessment is a key concept when discussing SDL.

Some of the concepts inherent to self-directed learning have existed for centuries, with “self-study” being an important concept in the learning of Socrates, Plato, Aristotle, Alexander the Great, Caesar, Erasmus, and Descarte.²

In the 1920s, Lindeman laid the foundation for many of the core elements of self-directed learning.³ Rather than SDL, Lindeman refers to these elements in the context of “Adult Education.” Lindeman makes several assumptions in his work, including that adults are “self-directing” and are motivated by “needs and interests that learning will satisfy.”^3,4

In 1961, Houle performed a study of 22 subjects and divided each into subgroups, one being the learning-oriented learners who “make decisions in life in terms of the potential for growth which they offer.”⁵ Knowles and others feel that the discovery of learning-oriented learners was an important concept in the discovery of self-directed learners.⁴

Carl Rogers offered the concept of student-centered learning in 1969, with the observations that “the sense of discovery…and comprehending [associated with learning] comes from within.”^6,7 The learner evaluates “whether [the learning] leads toward what he wants to know.”^6,7 In 1971, Tough observed that the majority of learning projects are “planned by the learner himself, who seeks help and subject matter from a variety of acquaintances, experts, and printed resources.”⁸

In 1973, Malcolm Knowles laid the foundation for his future work on SDL with his book The Adult Learner: A Neglected Species.⁴ Here, he popularized the term “andragogy” to refer to the concepts and assumptions inherent to the education of adult learners. In this work, he describes a mature learner’s desire to be self-directing, identifying one’s own readiness to learn and organizing learning around life problems (motivations).⁴ He also emphasizes the need for lifelong education to maintain competence. He describes the skills of lifelong learning, many of which parallel the fundamentals of SDL.

A more formalized definition for of SDL emerged in 1975 when Knowles published a book entitled “Self directed learning: A guide for teacher and learners”.¹

In 1977, Lucy Guglielmino developed a Self-Directed Learning Readiness Scale (SDLRS), a self-report Likert scale to measure one’s readiness for SDL.⁹ Additionally, Oddi developed a 24-item continuous learning inventory.¹⁰ These two instruments have been widely used in many future studies on SDL.

As the concept of SDL evolved, several authors offered further contributions (Brockett and Hiemstra, Long, Candy, Caffarella and O’Donnell, Grow, Merriam and Caffarella, among others).^11-17 For example, Grow theorizes that a learners mature through stages to ultimately become a self-directed.¹⁴ During the first stage, the learner is completely dependent on the teacher for learning and in the last (fourth) stage, a learner is a master of SDL. Other authors provide conceptual models for SDL. For example, the Brockett and Hiemstra provide a conceptual framework for SDL, distinguishing between SDL (instructional method processes) and learner self-direction (personality characteristics) in their personal responsibility orientation (PRO) model.¹¹

Knowledge has grown exponentially over the last century. As early as 1930, Alfred North Whitehead stated that “we are living in the first period of human history for which [the] assumption [that major cultural changes take longer than a lifespan] is false…today this time-span is considerably shorter than that of human life.”⁴ This idea rings even more true in the current era of technology and information sharing.

One of the core fundamentals of SDL is that learners “identify human and material sources for learning.”¹ While this action could have been difficult to achieve before the widespread dissemination of textbooks and online resources, the current environment is one rich with human (albeit virtual) and material sources for learning. Learners have a variety of open access journals, digital textbooks, blogs, podcasts, free open access medical education (FOAM), and massive open online courses (MOOCS).^18-22 Thus, the fundamentals of SDL are extremely well-suited for the modern era.

Within medicine, guidelines for SDL are present at all stages. Continuing medical education relies upon motivated self-directed learners to maintain competence within the health care system; undergraduate and graduate medical education programs also require curricula to ensure that learners are self-directed. The Liaison Committee for Medical Education (LCME) standard 6.3 states: “The medical curriculum [should include] self-directed learning experiences and time for independent study to allow medical students to develop the skills of lifelong learning. Self-directed learning involves medical students’ self-assessment of learning needs; independent identification, analysis, and synthesis of relevant information; and appraisal of the credibility of information sources.”²³

Many medical schools meet this requirement in the form of problem-based learning (PBL). PBL engages learners in many of the fundamentals of SDL. According to Barrows, PBL encourages students to “improve on their knowledge base to keep contemporary in their eventual field of medicine and to provide appropriate care for new or unique problems they may face in their work. This is self directed learning.”^24,25

Within graduate medical education, the need for SDL is found within the Accreditation Council for Graduate Medical Education (ACGME) core competency: practice based learning and improvement (PBLI). PBLI requires that residents “demonstrate the ability to investigate and evaluate their care of patients, appraise and assimilate scientific evidence, and continuously improve patient care based on constant self-evaluation and life-long learning.”²⁶

The ACGME allows emergency medicine residencies to provide up to 20% of didactic education in the form of “individualized interactive instruction,” a term previously referred to as “asynchronous learning.” While asynchronous learning is not synonymous with SDL, many of the components of SDL are necessary for successful participation in asynchronous curricula.²⁶

Individualized interactive instruction (III) is more rigorous than the catchall term “asynchronous learning,” which literally means that the learning occurs asynchronously. III requires that the learning activity is monitored for resident participation, overseen by faculty, monitored for effectiveness, and has an evaluative component.²⁷ Asynchronous and III curricula are best carried out with the use of a learning management system (LMS), such as blackboard, schoology, or canvas. An LMS can organize and curate resources for learners, as well as provide a platform for self-assessment and discussion among learners. However, if the instructor is choosing the instructional strategies and learning resources, then such asynchronous learning is not really “self-directed.”

An important question in the context of SDL is how learners should identify the appropriate human and material resources for learning. In the era of teacher-centered instruction, a student had to trust the instructor as the reputable information source. With the current abundance of materials available to learners, it may be difficult to distinguish between credible and inaccurate materials. Resources such as the Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) review content to ensure accuracy and provide a “stamp” of approval.²⁸

Knowles, M.S. (1975). Self-directed learning: A guide for learners and teachers. New York, NY: Cambridge, the Adult Education Company

Regarded by many as the original major contribution to self-directed learning, Knowles describes the fundamentals of self-directed learning and distinguishes between teacher-directed and self-directed learning.

Tough, A. (1971). The Adult’s Learning Projects: A Fresh Approach to Theory and Practice in Adult Learning. Toronto: OISE.

Tough interviewed over 50 individuals from many different social classes. He determined that the average person completes approximately 8 learning projects per year, totaling 700-800 hours, with the majority of these projects being chosen by the learner themselves.

Houle, C.O. (1961). The inquiring mind. Madison: University of Wisconsin Press

Houle performed a study of 22 subjects. He determined that the subjects fell into three categories: goal-oriented, activity-oriented, and learning-oriented. The latter group provided some basis for self-directed learning.

Norman GR (1999). The adult learner: a mythical species. Acad Med 74(8):886-9.

Norman casts doubt on many of the tenets of self-directed learning, including self-assessment and a learner’s ability to create educational goals.

Inherent to the SDL process is the ability to perform accurate self-assessment. Norman and Eva and Regehr report that humans are inherently bad at this skill of self-assessment, bringing this construct of SDL into question.^29-33 One’s own perceptions of one’s knowledge and skills are fraught with the Lake Wobegon effect.³⁴  Dunning and Kruger suggest that a person’s incompetence masks his/her ability to recognize his/her own incompetence.²⁹

Intriguingly there is no one accepted definition of self-assessment, as it means many different things to different people. Per a systematic review on self assessment, the definitions of “self-assessment” were not available in most studies, with the majority of studies set out to determine the ‘accuracy’ of self assessment in terms of quantitative comparisons with external measures or ‘expert’ ratings.³⁵

Eva and Regehr take the definition of self-assessment into a broader territory than just an “ability” by splitting this idea into three separate pedagogical strategies. ³³

1. Self directed assessment seeking: Using data from invited feedback and other external sources to direct personal improvement.
2. Reflection: Deliberate exploration of elaborating one’s understanding of the problem on has face or is facing rather than simply trying to solve it, i.e. trying to understand why a patient’s health state deteriorated in the way it did.³³
3. Self Monitoring: Personal judgment of one’s ability versus awareness, in the moment, of whether or not the current situation is going well; “slowing down when one should” or “knowing when to look something up” or “knowing when to ask for help.” ³³

Self directed learning also requires that learners formulate their own learning goals; this idea is also fraught with difficulty. Norman argues that learners, especially in medical education, must have significant guidance on what to learn; learners may still successfully choose how they learn it (directed, self-learning).³⁰

Ever since introducing this curriculum, Katie feels much more confident during her shifts. Before she felt so overwhelmed by all the knowledge out there, but now she feels more comfortable in finding the right places to look for answers.

Joe is excited to bring this idea back to his PD in emergency medicine. He schedules a meeting for the following Wednesday after conference. His program director loves the idea, but wants to make sure it will count for conference credit.

Joe looks on the Council of Residency Directors (CORD) website and finds that the activity may qualify for individualized interactive instruction. Joe learns that if the activity is monitored for participation, overseen by the faculty, monitored for efficacy, and has an evaluative component it will qualify. Joe knows that the first two parts are easy to achieve, but doesn’t know how he will accomplish the last two. Joe and his PD meet again and decide to include a question about the new conference component on the annual program evaluation (APE). Also, the program director will review and evaluate all of the residents’ clinical question worksheets.

Joe can’t wait to tell his colleagues about the new conference addition!