Adopting Self-Directed Learning in Continuing Professional Education: Physicians and Architects

(Gary J. Confessore, Sharon J. Confessore)

Chapter Four


Overcoming Resistance to Self-Direction in Adult Learning

Roger Hiemstra and Ralph G. Brockett (Editors)

New Directions for Adult and Continuing Education

Number 64, Winter 1994

Jossey-Bass Publishers

Ralph B. Brockett, University of Tennessee, Knoxville, EDITOR-IN-CHIEF

Alan B. Knox, University of Wisconsin, Madison, CONSULTING EDITOR


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Various aspects of self-directed learning have been accepted as a continuing professional education alternative for practitioners of medicine in Canada and of architecture in the United States.

Adopting Self-Directed Learning in Continuing Professional Education: Physicians and Architects

Gary J. Confessore, Sharon J. Confessore

In order to understand the nature and sources of resistance to self-directed learning within professions, it is essential to differentiate between the participation of adults in education within general contexts and within professional contexts. Hence, this chapter provides a cursory review of some concerns in both contexts. It also describes two separate but related projects that have introduced self-directed learning alternatives into mandatory continuing professional education systems: physicians and surgeons in Canada, and architects in the United States.

An Overview of Participation in Adult Education

Houle's (1961) work is generally credited with having given rise to a flood of scholarly works on participation in adult education. Over the years, some of these studies have focused on characteristics of the individual, such as learning styles and motivation (Boshier, 1971; Burgess, 1971), while others have focused on "attractors" and "deterrents" affecting participation (Aslanian and Brickell, 1980; Cross, 1981; Scanlan and Darkenwald, 1984). In general, both study types represent efforts to predict which individual adults are most likely to participate in continuing education activities.

In a related genre, studies have been conducted to assess the role workplace challenges and opportunities play in individuals' learning activities. These include Carnevale and Gainer (1989), Marsick and Watkins (1990), and McGill, Slocum, and Lei (1992). Other studies directly concerned with

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self-directed learning in the workplace include Confessore and Confessore (1993), Foucher (1993), and Guglielmino, Guglielmino, and Long (1987).

More central to the present chapter's concerns are works of those who have studied continuing learning activities of professionals. These include, among a great many others, Gross (1976), in pharmacy, and Hughes and others (1973) in medicine, law, theology, and social welfare. These works differentiate professionals from others in a variety of ways. Most are concerned with principles and techniques of presenting new information to professionals within the context of their status as adult learners. This includes accounting for individual learning styles, human and physical resources, and attractors and deterrents to participation. Two works in continuing medical education (Fox, Mazmanaian, and Putnam, 1989; Fox, 1991) and two by Schön (1983, 1987), who worked closely with architects, have been particularly influential in contributing to a reduction of resistance to self-directed learning in both fields. However, all four studies differ from those mentioned earlier in that they proceed from certain assumptions associated with professional status, although there does not appear to be one canonical definition of the term professional.

We believe much of the demand for formalized, even mandatory systems of continuing professional education, and consequently some resistance to self-directed learning, is rooted in the evolving view of professionals held by society. Hence, the issue of professionalism will be considered in the next section.

What Is a Professional?

One important effort to provide an authoritative definition of the term professional, especially as it relates to educational concerns, was produced by Schein in 1970 as part of a series sponsored by The Carnegie Commission on Higher Education. He prefaced his list of ten criteria with the following caveat:

Efforts at a clear definition of the concept of professionalism have had a long history. The problem of definition derives from our attempt to give precision to a social or occupational role that varies as a function of the setting within which it is performed, that is itself evolving, and that is perceived differently by different segments of society. Furthermore, the concept of the professional cannot be defined by any single criterion. Different sociologists have given different weights) to different criteria, but all have agreed on the necessity to use a multiple criterion definition. . . . [p.8]

Taken as a whole, Schein's criteria reflect what seems to have been an expectation of society that once an individual achieved professional status he or she retained it for the remainder of an active career. None of his criteria point to an expectation that professionals have a need to continue learning during the course of an active career. However, his assertion that professions are "evolving" and are "perceived differently by different segments of society" seems to reflect his concern that professional status in modern society was already under assault from external forces.

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Schein's criteria for defining a profession are useful for purposes of this chapter because the expectation can be inferred, on the part of both professionals and society, that professional status is not to be questioned by those outside the profession throughout the period of an active career. No doubt many older citizens recall attributing something like Schein's criteria to clergy, physicians, and, perhaps, to lawyers until some forty years ago. Yet by 1970 there was already a well-documented inclination of society toward distrust of professionals. This inclination may have been stimulated by increased general awareness of personal and consumer rights, or by a greater sense of egalitarianism. However, it was most certainly magnified by a general awareness of the "knowledge explosion" and the realization that a professional's claim to possess specific, advanced knowledge could only be made in light of evidence that professional education was ongoing and effective (Curry, Wergin, and Associates, 1993).

In the midst of these complex forces, individual practicing professionals must attempt to balance their own motivations and insights with those of the public they are assumed to serve. Governments or regulatory bodies also are assumed, at least by the public, to be responsible for ensuring, in effect, that professional conduct comports with Schein's criteria and public trust.

The Professions Respond

It is somewhat ironic that by responding to such pressures and criteria through implementation of mandatory systems of professional education, professions have reasserted the positions that only professional peers should judge professional performance, that professionals possess a specialized body of knowledge and skills acquired during a period of lifelong learning, and that self-governing professional associations should define standards of education for continuing licensure. In the drive to mandate continuing professional education, the issues of objectivity, professional detachment, and mutual trust between the client and the professional seem to have remained unaddressed, along with the issue of the professional's potential self-interest.

As mandatory continuing education was implemented, the systems gravitated toward the bureaucratic convenience of counting credits rather than toward quality assurance. Continued licensure has been too often predicated on the number of hours spent in approved seminars or symposia rather than on evidence of actual learning. There has not been sufficient regard for where or how material was learned or whether it was likely to contribute to improved practice.

Mandatory continuing professional education systems have failed to establish in the public's mind that the primary motivation for professionals to continue learning is to improve their practice rather than to maintain their privileged status. This failure, more than anything else, seems to have been at the core of resistance to self-directed learning in the professions. Fortunately, as much as a decade ago, the literature began to include the very understanding that would cut this Gordian knot.

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Schön's Concept of the Reflective Practitioner

Schön (1983) argues that we are in need of "inquiry into an epistemology of practice" that begins with the assumption "that competent practitioners usually know more than they can say. They exhibit a kind of knowing-in-practice, most of which is tacit. Nevertheless, starting with protocols of actual performance, it is possible to construct and test the models of knowing. Indeed, practitioners themselves often reveal a capacity for reflection on their intuitive knowing in the midst of action and sometimes use this capacity to cope with the unique, uncertain, and conflicting situations of practice" (pp. viii-ix).

In effect, Schön asserted that professionals develop the skills and habits of reflecting on any unfolding evidence of consequences (effects) stemming from actions taken (causes) as an integral dimension of the flow of practice, in order to function autonomously. Hence, his term "the reflective practitioner." By taking as his point of departure the synergistic interaction of practical competence and professional artistry, he laid a foundation for understanding that the unique and dynamic nature of any individual's practice is the best point from which to determine learning relevance. In part, Schön's paradigm (1983) of reflection-in-action is a practical response to Schein's assertion (1970) that one of the hallmarks of any professional is an "ability to take a convergent knowledge base and convert it into professional services that are tailored to the unique requirements of the client system" (p. 45; italics in original). It is this notion that connects the nature of professionalism with reflection-in-action, and ultimately with the natural condition of self-directed learning among professionals. Although training for the professions inculcates a common knowledge or skill set, as soon as an individual engages in the professional activity of diagnosing and responding to specific needs of client cases that present themselves, the individual's practice becomes differentiated from that of others.

Schön (1983) attributes this effect to the fact that each case presents at least one of three features that prevents practice from becoming routine. These are uniqueness, conflict, and ambiguity. Hence, even within the context of a fairly narrow specialization, a professional obligation to tailor service to client requirements continually compounds the differences between one person's practice and another's. In the process of framing and reframing questions in an effort to understand the unique circumstances of each client, the reflective practitioner embarks on a road toward understanding or learning that becomes less and less amenable to support by generalized educational systems.

Self-Directed Learning as an Integral Function of Continuing Professional Education

In the area of continuing medical education, Fox (1991) agrees with much of Schön's concept of the reflective practitioner as descriptive of physicians. He reports, "Physicians I have talked to about this support the notion that in every

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case there is some aspect that is either unique, conflicted, or ambiguous" (p. 164). He also notes the motivation among physicians to change aspects of their practice is most often rooted in a passion to do a better job. This passion does not arise as a matter of feeling less competent than they should be. Rather, it reflects a desire to be as competent as they can be with regard to practice as they experience it (Fox, Mazmanaian, and Putnam, 1989).

Central among their findings, Fox, Mazmanaian, and Putnam (1989) report that it is changes in the lives and practice of physicians that precipitate the need to learn. This finding runs contrary to the traditional assumption that changes in practice follow episodes of learning. It also sheds a very different light on assumptions regarding motivational elements of traditional instructional designs.

Learning from practice is only a small part of the change physicians report. Most is accomplished by a process of self-directed learning in which "the overall plan is under the control of the physicians, even though many of the educational activities and resources used in the plan are developed by others. The pattern of formal and informal resources is what the learner controls, not necessarily the teaching or learning experience" (Fox, 1991, p. 156). In fact, change through learning among physicians involves reading, discussions with colleagues, and involvement in formal continuing professional education programs, in that order.

Similar distributions of learning activities are reported for several professions. Several researchers have focused on the issue of improved professional performance as differentiated from the accumulation of grades, credit earned, or hours of instruction endured (Benfield and others, 1977; Cervero and Rottet, 1984).

Overcoming the Resistance

Recently, two major continuing professional education projects have been undertaken with the expressed intention of incorporating Schön's (1983) reflective practitioner concept and the findings of Fox, Mazmanaian, and Putnam (1989). First was the Royal College of Physicians and Surgeons of Canada, who commissioned the Maintenance of Competency Project (MOCOMP). Within two years after that the American Institute of Architects commissioned the American Institute of Architects Continuing Education System (AWCES) project. Initial surveys of the membership of both professional associations yielded evidence that members were regularly engaging in self-directed learning activities in response to their need to improve practice. These learning activities were usually viewed as unrelated to formal continuing education. Many members were concerned that direct linking of documented traditional forms of continuing education with relicensure would not necessarily yield the desired evidences of improved practice. Moreover, in both surveys it was clear practitioners felt the existing system of continuing education did not address their unique and most pressing learning needs. Although almost none used the

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term, most called for a system that would grant full faith and credit for various forms of self-directed learning.

Addressing these concerns constituted a substantial departure from the status quo and required a comprehensive effort to identify and overcome resistance to change. Two critical elements of resistance were identified and efforts to overcome them were mobilized. The first was the momentum of past practice and the bureaucracy that had grown up around it. Each professional association had staff and policies empowered to support only traditional forms of continuing professional education. These activities represented a substantial source of income to the association. In order to overcome resistance to self-directed learning, it was necessary to disassociate issues of quality assurance from issues of centralized control. It also suggested the need for mechanisms to maintain an adequate stream of income. The second was the institutionalization of learning alternatives that responded to commonalties rather than differences in practice. Adapting to individual differences required educating the leadership and members regarding the validity of self-directed learning activities as measured in terms of improved practice. It also required development of systems by which self-directed learning can be recognized, recorded, and valued by the professional association.

A strategy of communication and education was undertaken by way of existing communications networks at the national, regional, and local levels. Using the results of surveys, both the leadership and the members were made aware of the extent to which they were already relying on self-directed learning activities as an important source of continuing professional education. In addition, information sessions and instructional materials were developed to assist the leadership and the members in their efforts to recognize and capitalize on opportunities to meet their unique learning needs. These materials included specific guidelines for organizing and conducting self-directed learning projects. As a result, a system was established that provided ways to meet unique individual needs while satisfying the association's need to validate learning among its members.

As yet untested is the argument that loss of income through provision of formal continuing professional education would be adequately offset by increased membership fees. This position is predicated on the assumption that membership in the professional association is valued in the context of the assurance that appropriate continuing professional education has been undertaken and accredited. To the extent that self-directed learning activities are seen as responsive to the unique needs of the practitioner, and are validated by the association, the value of membership will be enhanced in the eyes of individual practitioners. The result is an anticipated increase in membership income that will offset the loss associated with reductions in formally provided programs.


In order to overcome resistance to self-directed learning, leaders of the MOCOMP and AWCES projects undertook a strategy of long-term and pro-

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fession-wide education designed to disseminate information regarding (1) the need for change in the continuing professional education system, (2) a full understanding of the historical antecedents of the existing system of continuing professional education, (3) the underlying construct of learning as it manifests itself among practicing professionals, and (4) the mechanisms by which incorporation of self-directed learning activities can satisfy the real need for change in practice rather than for renewal of license. However, the larger issue has been the establishment of an understanding that continuing professional education practices must link continued learning to improved practice. When that connection is made, the appropriateness of self-directed learning among professionals becomes self-evident and much resistance to self-direction is overcome.


Aslanian, C. B., and Brickell, H. M. Americans in Transition: Life Changes as Reasons for Adult Learning. New York: College Entrance Examination Board, 1980.

Benfield, W. R., Rosenbluth, S. A., Ryan, M. R., and Smith, M. C. "Detection of Early Warning Signs of Cancer by Community Pharmacists: An Evaluation of Training on Professional Behavior." American Journal of Pharmaceutical Education, 1977, 41, 23-28.

Boshier, R. W. "Motivational Orientations of Adult Education Participants: A Factor Analytic Exploration of Houle's Typology." Adult Education, 1971, 21, 3-26.

Burgess, P. "Reasons for Adult Participation in Group Education Activities." Adult Education, 1971, 22, 3-29.

Carnevale, A. P., and Gainer, L. J. The Learning Experience. Washington, D.C.: American Society for Training and Development and U.S. Department of Labor, 1989.

Cervero, R. M., and Rottet, S. "Analyzing the Effectiveness of Continuing Professional Education: An Exploratory Study." Adult Education Quarterly, 1984, 34, 135-146.

Confessore, S. J., and Confessore, G. J. "The Extent and Nature of Employee-Initiated Learning in the Workplace." Proceedings of the National Research Conference on Human Resource Development. College Station: Department of Educational Human Resource Development, College of Education, Texas A&M University, 1993.

Cross, K. P. Adults as Learners: Increasing Participation and Facilitating Learning. San Francisco: Jossey-Bass, 1981.

Curry, L., Wergin, J. F., and Associates. Educating Professionals: Responding to New Expectations for Competence and Accountability. San Francisco: Jossey-Bass, 1993.

Foucher, R. "Factors Affecting Organizational Policies on Self-Directed Learning." Paper presented at the 7th International Symposium on Self-Directed Learning, West Palm Beach, Fla., Jan. 1993.

Fox, R. D. "New Research Agendas for CME: Organizing Principles for the Study of Self-directed Curricula for Change." Journal of Continuing Education in the Health Professions, 1991, 11, 155-167.

Fox, R. D., Mazmanaian, P. E., and Putnam, R. W. Changing and Learning in the Lives of Physicians. New York: Praeger, 1989.

Gross, S. M. "Demographic Study of the Relationship of Continuing Pharmaceutical Education to Selected Attitudinal- and Competence-Related Criteria." American Journal of Pharmaceutical Education, 1976, 40, 141-148.

Guglielmino, P. J., Guglielmino, L. M., and Long, H. B. "Self-Directed Learning Readiness and Performance in the Workplace: Implications for Business, Industry, and Higher Education." Higher Education, 1987, 16, 303-317.

Houle, C. O. The Inquiring Mind: A Study of the Adult Who Continues to Learn. Madison: University of Wisconsin Press, 1961. (Updated edition now available from the Research Center for Continuing Professional and Higher Education, University of Oklahoma, OCCE/200 McCarter Hall, Norman, OK 73037

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Hughes, E. C., and Others. Education for the Professions of Medicine, Law, Theology, and Social Welfare. New York: McGraw-Hill, 1973.

McGill, M., Slocum, J., and Lei, D. "Management Practices in Learning Organizations." Management Dynamics, Summer 1992, pp. 5-16.

Marsick, V. J., and Watkins, K. E. Informal and Incidental Learning in the Workplace. London: Routledge, 1990.

Scanlan, C. S., and Darkenwald, G. G. "Identifying Deterrents to Participation in Continuing Education." Adult Education Quarterly, 1984, 34, 155-166.

Schein, E. H. Professional Education: Some New Directions. New York: McGraw-Hill, 1970. Schön. D. A. The Reflective Practitioner. New York: Basic Books, 1983.

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Gary J. Confessore is professor of higher education administration in the Graduate School of Education and Human Development at George Washington University, Washington, D.C.

Sharon J. Confessore is assistant professor of human resource development in the Graduate School of Education and Human Development at George Washington University, Washington, D.C.

June, 2001

-- Return to Roger Hiemstra's opening page

-- Return to the Overcoming Resistance to Self-Direction in Adult Learning Contents page

-- Go to Editor's Notes, Chapter One, Chapter Two, Chapter Three, Chapter Five, Chapter Six, Chapter Seven, Chapter Eight, Chapter Nine, Chapter Ten, Chapter Eleven or The Index.