Category Archives: Formative

Still looking for an ethical way to assess “lifelong learning”

Medical school accreditation process requires that institutions document that medical students develop the skills for “lifelong learning”.  As other standards of the section require that you answer precisely the question that is asked, I found this topic particularly challenging.  “Lifelong” requires that the assessment occurs at the end of life.   Otherwise, you may have been a learner for three-quarters of your life, and this is not lifelong.  One option would be to assess learning capability and then immediately “dispatch” the individual, providing a data point that indeed reflects lifelong learning.  Even as my caffeine titers swing wildly from under- to over-caffeinated, this approach seems unlikely to pass the Institutional Review Board.  In fact, submission of the application may result in my developing a close relationship with individuals with behavioral clinical expertise.

When reaching an impasse, return to the original question. Revisiting the Liaison Committee on Medical Education (LCME) element # 6.3, the title is actually “Self-Directed and Lifelong Learning”.  So, there may be an opening – focus instead on Self-Directed Learning.  The accreditation documents helpfully provide an expanded description

“The faculty of a medical school ensure that the medical curriculum includes self-directed learning experiences that 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; appraisal of the credibility of information sources; and feedback on these skills from faculty and/or staff.”

Part of the quandary is rooted in the shift of professional education from information acquisition to the development of competencies.  Competencies are much better aligned with professional behaviors, and include aspects of knowledge, skills, and attitudes.  Among the competency domain buckets, self-directed learning is more appropriately identified as a skill and an attitude.

Conversation with a friend (pre-pandemic) indicated that a transposition of the phrase would be useful, and that “directed self-learning” is a more appropriate goal for professional school.  Each institution has a desired set of learning outcomes – the curriculum for the faculty must guide the students so that the skill of independent learning focuses on the knowledge content that must be learned.

The first component in the LCME expanded definition of the element is “…self-assessment of learning needs.”  Assessing this is a challenge – if a learner does identify a gap, you as the facilitator can check off that box.  More challenging is a situation when you recognize a learning need and the learner does not.  To get to check off that box, you have to use open-ended questions to probe the learner’s current state of awareness and lead them on a voyage of self-discovery.  It is indeed a challenge, but the ability to self-identify gaps is an essential characteristic of a professional.  While the journey is a challenge, the creation of the list of learning objectives as an outcome is nice, tangible, and easy to assess.

The second component is more straight-forward “…independent identification, analysis, and synthesis of relevant information.”  Finally, I get to return to my comfort zone – information.   Acquiring information as proof that you know how to acquire information is one logical outcome that is easy to assess.  Assessment of the ability to synthesize that information with other relevant information gets more obscure, and ultimately requires a value judgment.  Overall, still doable.

The third component is “appraisal of the credibility of information sources”.   After establishing a few boundaries (such as “Cite Wikipedia and I will hold you up for public shaming”), learners progressively master when to use texts, professional society position papers, clinical research studies and meta-analyses to obtain the appropriate type and depth of information.  That box is checked.

The concluding component “feedback on these skills”, returns the focus to assessment.   To document this, you have to do an assessment on assessment, or a meta-assessment.  And as evidence both that knowledge alone is not enough and that the ability to appraise the credibility of sources is needed, a Bing search produced over 1 billion web hits for the term “meta-assessment”.  Google Scholar was a little more selective returning only 1,290 results.  None of which I intend to read.

We now live in a world where knowledge gaps are no longer perceived as a problem.  For example, what if I wanted to go to Vermillion South Dakota and did not know how to get there?  The knowledge gap is unimportant as long as I know a successful strategy to remedy that gap.  Apple maps now becomes my new best friend.  Even in 2022, knowledge does still matter.  A keyboarding or spelling error can send (and has sent) travelers in interesting directions.  An individual needs to realize when they are headed in the wrong direction.

So, the “lifelong” adjective remains a non-starter in terms of assessment.  Directed self-learning, however, is a needed goal as we prepare professionals for the challenges that await them.


Robert G. Carroll earned his Ph.D. in 1981 from the Graduate School of Biomedical Sciences of the University of Medicine and Dentistry of New Jersey-Newark. Following a 3 year post-doc at University of Mississippi Medical Center in Jackson, he moved to East Carolina University in 1984 as an Assistant Professor of Physiology. He is currently Professor of Physiology at the Brody School of Medicine at East Carolina University and the Associate Dean for Medical Education.

Rob is the past chair the Education Committee for the American Physiological Society, and currently chairs the Education Committee of the International Union of Physiological Sciences. He was editor of the journal “Advances in Physiology Education” from 2008-2013.

Robert G. Carroll, PhD.

Professor of Physiology

Associate Dean for Medical Student Education

Brody School of Medicine at East Carolina University

Greenville NC USA