1. Fox’s Study of Physicians (1989)
• Found change preceded learning, rather than
CME initiated change
• Found blurring between personal and
environmental forces for change in
physicians
• Found 10 discreet forces for change

2. Forces for change that resulted in learning
(Fox et al.)
• Curiosity
• Desire for personal well-being
• Desire for financial well-being
• Stage of career
• Competence
• Clinical environment
• Relationships with medical institutions
• Relating to others in the profession
• Regulations
• Family and community

3. Three Conclusions - Fox et al. Study

4. Jarvis Characterization of Learning
from Experience (Paradoxes of
Learning -1992)
• Non Learning
• Non-Reflective Learning
• Reflective Learning

5. Non Learning
• Presumption - the typical response to the world
and the basis of most social living experiences;
a trust that the world will not change
• Non-consideration - a variety of reasons that
people do not respond to a learning situation
• Rejection - some people have an experience,
but reject the possibility of learning from it

6. Non-Reflective Learning
• Preconscious Learning - what Marsick and
Watkins called incidental learning; occurs at the
edge of consciousness or periphery of vision.
Knowledge is vague and has not become
conscious knowledge
• Skills Learning - training; learning that occurs in
an action mode of experience
• Memorization - most common meaning of term
“learning” - authoritative knowledge is learned in
order to be reproduced

7. Reflective Learning
• Contemplation - process of thinking about an
experience and coming to a conclusion;
behaviorists didn’t consider this learning
• Reflective Skills Learning - often called reflective
practice. Schön called it reflection-in-action.
• Experimental Learning - theory tried out in
practice

8. Jarvis has argued that the mind, the
self, and our identity as individuals
are all socially constructed and
learned through experience
People who have similar experiences
may have similar perspectives on the
world - this gives rise to concepts of
group consciousness, such as class
or gender consciousness