Learning from Experience

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Clinical Improvement and Learning Models for Effective Action

Experiential Learning

The commonest learning model in clinical improvement is the Plan –Do Study-Act (PDSA) cycle, derived from the statistical process control movement, led by W.Edwards Deming. Deming described the System of profound knowledge as consisting of four parts,

  • appreciation for a system,
  • knowledge about variation,
  • theory of knowledge and
  • psychology.

In the education field, Kolb’s experiential learning is a common approach that has been adapted to learning from clinical experience.

Single and Double Loop Learning

In the professional management field, Schon and Argyris have described single and double loop learning, which has been adopted by systems thinkers and modelers

Other Learning Models

Addition of Kolb’s experimentation and reflection, which can be both real and virtual experiments, including mental, game-playing or computationally aided simulations Insight 616

This includes adding Argyris’s differences in Espoused theory and theory in use, including defensive reasoning and discussability. Note single loop correctable errors can’t be identified in advance and in practice we use a mixture of both loops. We also have the concepts of Puzzles or Questions (objects of enquiry) and the fallibility of detectors and indicators (Brunswik’s lens, both believing is seeing and the presence of noise and the effects of the context and the actions of others, self-confirming attribution error. This can be extended to Aygyris’ concepts of organizational defences. And it fits with Peirce’s methods of inquiry (abduction, deduction and induction), but that will be taken up later in a more philosophical discussion. Finally detecting similarities and differences as in Korbzybski’s semantic differential and practice enactment of repetitions and distinctions and Klein’s macrocognition and flexecution.

Questions & Comments to Geoff McDonnell
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