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LIFELONG LEARNING
613
Education Techniques for
Lifelong Learning
Lifelong Learning in the
21st Century and Beyond1
Jannette Collins, MD, MEd
TEACHING
POINTS
See last page
Lifelong learning is now recognized by educators, governing bodies,
accreditation organizations, certification boards, employers, thirdparty payers, and the general public as one of the most important
competencies that people must possess. Promoting lifelong learning
as continuous, collaborative, self-directed, active, broad in domain,
everlasting, positive and fulfilling, and applicable to one’s profession as well as all aspects of one’s life has emerged as a major global
educational challenge. Meeting this challenge will require changes
in the way teachers teach and learners learn, as teachers take on a
more facilitative role and learners take more responsibility for setting goals, identifying resources for learning, and reflecting on and
evaluating their learning. For physicians, this will require less dependence on traditional educational venues, such as passive continuing
medical education activities, and greater participation in self-assessment, peer assessment, evaluation of performance in practice, documentation of practice-based learning and improvement activities, and
learning at the point of care. Radiologists in an academic setting are
exposed to multiple opportunities for practicing lifelong learning, such
as teaching others, participating in multidisciplinary conferences and
journal clubs, and engaging in research. All radiologists can participate in self-audits and group audits of performance and become active participants in national radiology societies, where they can learn
from each other. Participation in the American Board of Radiology’s
Maintenance of Certification program reflects a commitment to actively engage in lifelong learning and is one way of demonstrating to
the general public a commitment to maintaining competence.
©
RSNA, 2009 • radiographics.rsnajnls.org
Abbreviations: ACGME = Accreditation Council for Graduate Medical Education, CME = continuing medical education, MOC = Maintenance of
Certification
RadioGraphics 2009; 29:613–622 • Published online 10.1148/rg.292085179 • Content Codes:
1
From the Department of Radiology, University of Wisconsin Hospital and Clinics, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI
53792-3252. Received July 10, 2008; revision requested August 5 and received August 7; accepted August 13. The author has a book contract with
Lippincott Williams & Wilkins. Address correspondence to the author (e-mail: jannette.collins@healthall.com).
See also the editorials by Bisset and Bresolin (pp 623–624) and Buchmann and Greenberg (pp 625–626) in this issue.
©
RSNA, 2009
614
March-April 2009
The great enemy of the truth is very often not the lie—
deliberate, contrived and dishonest—but the myth—
persistent, persuasive and unrealistic.
John F. Kennedy,
Yale Commencement Address, 1962
I don’t think much of a man who is not wiser today
than he was yesterday.
Abraham Lincoln
Introduction
Learning occurs throughout life (1). Education
cannot be envisioned as a finite thing, a “preparation” for life, but must be viewed as a part of life
itself (2). People can no longer view the end of
compulsory education with relief or value freedom from educational obligation more highly
than the continuation of intended learning (3).
As recently as the 1980s, education was not
universally approached as a lifelong process (4).
Except to maintain certification, most people did
not have a conscious attitude about being lifelong
learners (4). Malcolm S. Knowles, the “father of
adult learning,” predicted in 1980 that lifelong
learning would become the organizing principle
of all education (4), and now the term lifelong
learning is part of everyday conversation in educational parlance (4). Presently, there are education
departments with the title Lifelong Learning,
university appointments such as Director of
Lifelong Learning, and university courses on lifelong learning.
Lifelong learning has emerged as one of the
major challenges for the worldwide knowledge
society of the future. A variety of events support
this claim: (a) 1996 was the “European Year
of Lifelong Learning”; (b) the United Nations
Educational, Scientific and Cultural Organization
(UNESCO) included “Lifetime Education” as
one of the key issues in its planning; and (c)
the G7-G8 group of countries named “Lifelong
Learning” as a main strategy in the fight against
unemployment (5). The importance of preparing students to become lifelong learners has
received widespread attention by professional organizations such as the Association of American
Medical Colleges (6) and the Liaison Committee
on Medical Education (7), and developing life-
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long learning habits has been a consistent recommendation in virtually all proposals for medical
education reform (8).
The original physician covenant, the Oath of
Hippocrates, addresses the teaching of medicine to willing pupils: “I will regard his sons as
my brothers and teach them the science, if they
desire to learn it, without fee or contract. I will
hand on precepts, lectures, and all other learning to my sons, to those of my master, and to
those pupils duly apprenticed and sworn, and to
none other” (9). There is no mention of furthering one’s education for the good of the patient.
Despite this, the altruistic manner of the oath implies a level of self-improvement that submits the
physician to continued learning (10).
In 1996, the Institute of Medicine began focusing on problems ranging from education of
healthcare personnel to healthcare delivery. The
initial report, To Err Is Human: Building a Safer
Health System, uncovered a flawed system in
which medical errors resulted in 44,000 patient
deaths per year (11). In response to this report,
the American Board of Medical Specialties voted
to adopt a change in the recertification process of
their member boards. What resulted was a program called Maintenance of Certification (MOC)
that required continuous certification, rather than
episodic certification, and included the following
four components: professional standing, lifelong
learning and self-assessment, cognitive expertise,
and evaluation of performance in practice (12).
Although not an outcomes measure, MOC
provides a process to document physician commitment to lifelong learning and to reassure the
public. MOC is not a universal requirement.
Data from a survey sent to representatives of
radiology societies in 34 countries indicated that
only nine of 23 responding countries (39%)
required radiologists to renew their certificates
(13). Most (78%) required continuing medical
education (CME), but only 22% required selfassessment programs for renewal of certification.
In addition to public accountability, the importance of lifelong learning is reflected by the
explosion of information. The Space Age has become the Information Age. Experts estimate that
knowledge doubles every 3 to 10 years, depending
on the field of study (4). The number of medical
clinical trials rose from 500 annually in the 1970s
to more than 10,000 in the late 1990s (14).
RG ■ Volume 29 • Number 2
An operational environment of mass markets,
simple products and processes, slow change, and
certainty has been replaced by customer orientation, complex products and processes, rapid and
substantial change, uncertainty, and conflicts (5).
In today’s competitive global marketplace, lifelong
earning demands lifelong learning (4). In the past,
hard work and loyal service led to a secure future.
Today, employers and third-party payers place a
premium on those who continually acquire skills
and knowledge and who have the resilience and
flexibility to adjust to the evolving needs of the
global labor market. Thus, the ability to engage in
lifelong self-directed learning is the single most important competence that people must possess (15).
This article focuses on the definition of lifelong learning, the differences between lifelong
learning and “traditional learning,” the traits
and skills of lifelong learners, barriers to lifelong
learning, and strategies for radiologists to engage
in lifelong learning.
Lifelong Learning: A Definition
Despite the emphasis placed on physicians’
lifelong learning, no universally accepted definition has been proposed (16). In late 1997, the
Commission for a Nation of Lifelong Learners,
made up of leaders in business, labor, education,
government, and philanthropy, presented its recommendations in “A Nation Learning: Vision for
the 21st Century” (17). The Commission defined
lifelong learning as “a continuously supportive
process which stimulates and empowers individuals...to acquire all the knowledge, values, skills
and understanding they will require throughout
their lifetimes...and to apply them with confidence, creativity, and enjoyment in all roles, circumstances, and environments.”
This definition emphasizes lifelong learning as
(a) continuous (it never stops); (b) supportive (it
isn’t done alone); (c) stimulating and empowering
(it’s self-directed and active, not passive); (d) incorporating knowledge, values, skills, and understanding (it’s more than what we know); (e) spanning
a lifetime (it happens from our first breath to our
last); (f) applied (it’s not just for knowledge’s
sake); (g) incorporating confidence, creativity, and
enjoyment (it’s a positive, fulfilling experience);
and (h) inclusive of all roles, circumstances, and environments (it applies not only to our chosen profession, but to our entire life) (4).
Collins
Lifelong Learning
and Traditional Learning
615
Lifelong learning is more than adult education,
which often is restricted to providing people with
opportunities to engage in (school-like) learning
activities during their adult life (5). The challenge
for lifelong learning is to fundamentally rethink
learning, teaching, and education for the information age in an attempt to change mind-sets.
Lifelong learning involves and engages learners of
all ages in acquiring and applying knowledge and
skills in the context of authentic, self-directed
problems (5). By integrating working and learning, people learn within the context of their work
on real-world problems.
Models of education based on the work of
B. F. Skinner and F. W. Taylor are inadequate
for the lifelong learning needs of the 21st century (5). There is not a scientific, best way
to learn and work because real problems are
ill-defined. Thinking, doing, and learning are
integral to one another and not separate activities. Understanding is partial, and situated; total
coverage is impossible. Much knowledge is tacit
(unspoken) and relies on tacit skills. Thus, all relevant knowledge cannot be explicitly articulated.
The learner’s involvement in goals setting is
a prerequisite to motivated and self-regulated
learning (18,19). Goal setting implies the personal commitment of the learner and is an
integral part of learning in life. The learning is
rewarding because the learner is in the process
of realizing his or her goals. In traditional learning, motivation is often lacking because students
are not involved in goals setting. Learning goals
are often unclear to students and seem to have
no clear relation to life goals. Students are often
not compelled to feel that these are their goals,
but rather those of the teacher, the school, or
society. The goals are fixed and predetermined,
providing students with little or no chance of
involvement.
Traditional learning tends to motivate by extrinsic rewards, such as praise from the teacher
or others, grades, or financial compensation. As
a result, students can develop a dependency on
praise, leading to feelings of insecurity and nondevelopment of task motivation (20).
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March-April 2009
Learning flows from a variety of activities, for
example, observing how other people do something, discussing with others, asking someone,
looking up information, trying something for
oneself and learning from trial and error, and
reflecting on all the previous activities (20). The
mental activities involved in learning may be divided into four categories: (a) social interaction,
(b) processing verbal and other symbolic information, (c) direct experience, and (d) reflection.
Learning in real life usually combines activities
from different categories and is always interwoven with the sociomaterial world. In contrast,
traditional school learning tends to focus mainly
on one type of activity, processing symbolic
information.
Evaluation of learning in life is directed toward
achieving life goals. Evaluation is not an end
product, but leads to renewed orientation, other
learning activities, or a change in goals (20). The
learner decides if and why the gained knowledge
and skills were satisfactory. At school, the teachers and administrators decide on the criteria and
also decide whether the students have satisfied
the criteria or not. Traditionally, criteria are often related to the learning goals, but not to life
goals. In real life, learners decide on the type of
activities in which to engage, often with input
from others, but the final responsibility is with
the learner. In traditional learning, most of the
regulating is done by the teacher and educational
system. This makes learning look like a neat,
step-by-step procedure, from the beginning of the
book to the end, from the start of the program to
the examination. Learning processes in real life
are much less predictable and straightforward.
Traits and Skills
of Lifelong Learners
Lifelong learning is largely self-directed learning.
Hammond and Collins (21) describe self-directed
learning as “a process in which learners take the
initiative, with the support and collaboration of
others; for increasing self- and social awareness;
critically analyzing and reflecting on their situations; diagnosing their learning needs with specific
reference to competencies they have helped identify; formulating socially and personally relevant
learning goals; identifying human and material
resources for learning; choosing and implementing appropriate learning strategies; and reflecting
on and evaluating their learning.” This humanistic
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Table 1
Traits and Skills of Lifelong Learners
Traits
Curious
Venturesome and creative
Innovative in practice
Resourceful
Motivated to learn
Confident in ability to learn from others, share
what they know, and accept feedback
Willingness to make and learn from mistakes
Persistent
Flexible in thinking
Interdependent and interpersonally competent
as well as independent and self-sufficient
Methodical and disciplined
Logical and analytical
Reflective and self-aware
Adaptable to changing healthcare needs
Responsible and accountable for work
Skills
Well-developed communication skills
Self-directed learning skills
Information-seeking and retrieval skills
Higher-order thinking skills
Metacognitive skills (skills for “thinking about
thinking”)
Able to develop and use defensible criteria for
evaluating learning
Able to work as a change agent
Able to share good practices and knowledge
characterization of self-directed learning implies
a sense of social awareness and responsibility,
self-actualization, and the acceptance of personal
responsibility for one’s own learning (22).
An individual’s learning potential and the
development from novice to expert depend on
the development of expertise in learning to learn
(knowing what and how to learn), having access to
a relevant knowledge base to build on, and being
motivated to learn. When competency in a domain
increases, the learner begins to develop his or her
own domain-related goals, chooses and employs
more adequate strategies, and shows increasing
ability to operate independently (20). An expert
does not only possess a vast amount of domain
knowledge, but is also expected to contribute
knowledge to the domain. The expert’s motivation
comes from strong internal goals (23), such as a
desire for personal growth, capitalizing on existing knowledge to supplement professional competence, and ensuring accountability for practice
through renewed clinical competence (24).
RG ■ Volume 29 • Number 2
Table 2
Suggested Learning Activities
Participate in conventional learning update activities such as professional meetings, journal clubs,
or self-study programs
Participate in distance learning and virtual universities; access online libraries and remote databases for sponsored independent learning
Develop new skills with experiential training, such
as in technology or communication
Enhance leadership skills as a volunteer in professional associations
Find a mentor to be coach, teacher, and support
team member
Take coursework, or work toward an advanced
degree
Read and reflect on reading, independently or with
peers or a mentor
What teaching, learning, and knowledge
each mean is learned by experience in the social
context. Significant others (eg, teachers, parent, peers) model what learning is. If students
have come to see knowledge as factual “objective truth,” they will not be inclined to adopt a
critical and constructive attitude toward learning
(20). Learning is an active, goal-oriented, cumulative, and constructive activity, in which prior
knowledge plays an important role in hindering
or facilitating further learning (25). A prerequisite for learning is to activate and make explicit
prior concepts that are relevant to the topic and
process of learning. Without this prerequisite, the
learning will result in inert knowledge and lack
transfer to other situations (20).
Attributes common among lifelong learners
relate to an ability and willingness to be selfcritical, self-correcting, and flexible in thinking
and acting (Table 1) (4,22,26). Lifelong learning
is attitudinal—that one can and should be open
to new ideas, decisions, skills, or behaviors. Skills
for lifelong learning relate to the need to acquire,
process, and transfer knowledge. Lifelong learners need to be able to determine what they need
to learn and how to make and carry out a learning plan. They need to know how to locate appropriate information, evaluate its quality, organize
it, and use it effectively. They need to be critical
and creative thinkers, problem solvers, and decision makers, and they need to practice regular
self-reflection.
Collins
617
An abundance of adult learning research supports the role of experience and reflection in
continuing education (27–31). Personal reflection
allows learners to uncover gaps in knowledge and
skills that form the basis of learning goals. Steps
to lifelong learning can be articulated as (a) reflection, (b) setting goals, (c) assessing knowledge
and skills, (d) creating a learning plan, (e) putting
the plan into action, and (f) evaluating and refocusing. Several activities that can be incorporated
into a learning plan are described in Table 2 (4).
An important lifelong learning skill is the ability to use evidence at the point of care. Medical
students, residents, and practitioners build an
extensive database of clinical experience and
medical knowledge. Like any database, though, it
can grow out-of-date. Regularly reflecting on decisions and practices will stimulate clinical questions. Answering these clinical questions by using
valid, relevant information will keep a database
up-to-date.
A simple method is to record questions that
cannot be answered immediately. Then, make
a commitment to answer at least one or two of
the most compelling questions each week (32).
The ideal evidence-based physician will critically
reflect on his or her practice on a regular basis,
asking whether there is a better way to do things.
The physician will then answer the questions
generated by a process of critical reflection using
relevant, valid information, rather than anecdote
or opinion, whenever possible. The evidencebased practice movement set out primarily to
improve healthcare, but its aims provide an excellent model for learning from practice (33).
Although CME has been used for decades as
the major venue for physician education, there
is little evidence that participation in CME improves patient care or outcomes (34,35). Newer
forms of CME, such as reminders, outreach visits, opinion leaders, multifaceted activities, and
patient-mediated interventions, have been demonstrated to alter outcomes and improve patient
care (35–38). Unfortunately, these more effective
forms of education are the minority of CME
offered (10). The majority of CME consists of
didactics, which lead to a passive form of learning
and do not seem to fit the method in which most
adults actively learn; that is, learner-centered and
active educational programs (10).
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March-April 2009
The Accreditation Council for Graduate
Medical Education (ACGME) requires that
residents be able to “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 lifelong learning”
(39). Further, residents are expected to develop
skills and habits to meet the following goals:
(a) identify strengths, deficiencies, and limits in
one’s knowledge and expertise; (b) set learning
and improvement goals; (c) identify and perform
appropriate learning activities; (d) systematically
analyze practice by using quality improvement
methods, then implement changes with the goal
of practice improvement; (e) incorporate formative
evaluation feedback into daily practice; (f) locate,
appraise, and assimilate evidence from scientific
studies related to their patients’ health problems; (g) use information technology to optimize
learning; and (h) participate in the education of
patients, families, students, residents, and other
health professionals (39).
Self-assessment is a required component of
residency training and MOC (39,40). Davis et
al (41) focus on self-assessment as the ability of
physicians to perform “self-rating” or use “selfaudit” with a goal of generating summary judgments of their performance to determine their
own learning needs and find resources to meet
them. When a gap is discovered through selfassessment or self-audit, it seems to have more
salience than one exposed by someone else (42).
However, physicians have a limited ability to accurately self-assess, and a number of
studies found that the worst accuracy in selfassessment is seen among physicians who were
the least skilled and the most confident (41,43).
Physicians are especially deficient in self-assessment that involves reflection in action (ie, assessment based mostly on past experiences and
beliefs). These results are consistent with those
found in other professions (41). Further, these
findings are independent of level of training, specialty, the domain of self-assessment, or manner
of comparison (41). This reinforces the observation by Eva and Regehr (43) that an accurate
judgment of performance cannot be made without standard measures based on credible data.
Thus, guided self-assessment should be incorporated at the earliest stages of medical training
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Table 3
Self-Assessment Strategies
Effective self-assessment should be based on a
clear understanding of what healthcare professionals actually do in their practice
Self-assessment should include measures of knowledge and reasoning but also of other domains
(behaviors, skills, processes of care, outcomes)
The individual learner should regularly obtain
external validation of his or her self-assessment
activities, both by using feedback and comparative data from other physicians with like practices
and by sharing results with peers
Improvement activities including CME should be
selected in part on the basis of the results of selfassessment
as an essential professional skill, and this skill
should be honed throughout medical training.
New initiatives and formats are needed to assist
the self-assessment process and to more accurately promote and assess broader domains of
competence such as professionalism and lifelong
learning. Such measures include the promotion
of learning portfolios, documenting practicebased learning and improvement activities, creating less general and more detailed learning and
practice objectives, and addressing the general
competencies espoused by the ACGME (41).
The use of self-assessment for professional development must ultimately involve review of performance in real settings or assessment at work.
For this reason, MOC includes a mandatory evaluation of performance in practice. Evaluation of
practice performance requires a broad view, and
relevant data must be compiled from numerous
sources (eg, medical records, claims data, patient
registries, ancillary laboratory and pharmacy
data, patient surveys). Guidelines for effective
self-assessment are outlined in Table 3 (44).
Barriers to Lifelong Learning
Certain obvious issues, such as lack of motivation, time, and adequate resources, can interfere
with an individual’s success as an independent
adult learner. In addition, more subtle problems,
such as a lack of awareness of knowledge deficit,
personal reluctance to change, ambivalence, and
group mentality, can also be significant barriers
to positive educational change (45). Skills must
be developed, and efforts must be undertaken
RG ■ Volume 29 • Number 2
Table 4
Strategies of Lifelong Learning for the
Radiologist
Use input from peers and seniors to identify learning needs
Keep a personal portfolio and record learning
events
Seek feedback on performance from others
Use evidence at the point of care
Teach others
Keep a to-learn list
Always have something to read
Participate in research
Actively participate in local and national organizations
Actively participate in local multidisciplinary conferences
Follow up on difficult cases
Audit performance and improve performance
through self-correction
for learners to develop a positive attitude, enjoyment, and motivation toward learning because no
one will engage in processes and attitudes during
their whole life for goals and objectives that they
do not like (5).
Medical students face obstacles toward lifelong learning before they even enter medical
school, as the American educational culture often
promotes passive rather than active learning (46).
In fact, Wilcox (47) reported that only 13% of
college professors responding to a survey were
supportive of self-directed learning. Thus, the
majority of medical students in their preclinical years learn through the same didactic lecture format used in undergraduate coursework.
Individual learning experiences and support
should improve as the six core competencies are
integrated into medical education (10).
Learning often comes from confusion, problems, the uneasy realization of lacking adequate
skills and knowledge, and discomfort (48).
Learning means change and change implies
risks. Therefore, learning asks for the courage to
take risks (20). At least temporarily, the learner
needs a certain amount of tolerance of uncertainty. However, people differ in their tolerance
of uncertainty. People with a strong certainty
orientation (a low tolerance of uncertainty) tend
to stick to what they (believe to) know and do
not like to investigate what is unknown to them.
On the other hand, uncertainty-oriented people
Collins
619
feel challenged by new, contradictory information
and unclear situations (20). Traditional learning environments often reduce uncertainty for
students as much as possible. The structure and
curriculum organization tend to afford a kind of
certainty (about what to do and when) that is seldom seen in real life.
Lifelong learning needs to occur at the point
of care, but clinical questions often go unanswered because of a lack of convenient access to
reference materials at the point of care, insufficient time to search for information, and the
challenge of formulating an answerable question
(49). Further, the paternalistic view of physicians
as all-knowing might make them afraid to admit
that they do not know everything and less likely
to critically appraise their current practices. Such
phrases as “this is the Michigan [or Harvard,
or Duke] way” and “We’ve always done it this
way, and my patients do fine” further undermine
a willingness and ability to critically reflect on
practice (32). Adult learning theory suggests that
physicians will learn best when learning is in the
context of patient care, answers their question,
is directly applicable to their work, and does not
take too much time (50). Two characteristics that
predict whether physicians will seek and find an
answer to a clinical question are the urgency of
the problem and their confidence that they will
find an answer (51).
Radiologist as Lifelong Learner
There are multiple strategies to help radiologists
develop a habit of lifelong learning (Table 4).
Teaching is the best way to learn. Radiologists
learn what they teach and there are many opportunities for radiologists to teach, especially in
academic settings. Many people organize work
with to-do lists. A to-learn list can be used to record problems or ideas that stimulate learning.
Another lifelong learning strategy is always having
something to read, whether it’s a journal article or
textbook or online material. Although it doesn’t
have the impact of point-of-care learning, keeping
abreast of current medical information can stimulate one to look at and think differently about
one’s work and, in some cases, want to learn more.
The scope of continuous learning should include well-established practices (eg, computed
tomography [CT], magnetic resonance [MR]
imaging, positron emission tomography [PET]),
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March-April 2009
newer technologies (eg, CT perfusion, MR spectroscopy, vascular ultrasound), and those on the
forefront of radiology (eg, molecular imaging,
optical imaging, infrared spectroscopy) as well
as topics that are not typically considered within
the traditional domains of radiology (52). Such
topics include health economics, finance, ethics,
healthcare policy, medical informatics, Web design, neuropsychology, nanotechnology, communication, and education.
Radiologists can join organizations that bring
people together who can learn from each other.
Most radiologists belong to one or more national
radiology societies, but there are also local opportunities such as teaching academies, institutional
journal clubs, and other institutional groups that
bring together individuals with common interests.
Getting involved in research is a way to solve problems with valid and reliable solutions and contribute to the bank of knowledge from which everyone
can benefit. The steps involved in research require
examining problems analytically and being creative
in searching for solutions. Radiologists can utilize
My CME Action Plan, which is available on the
Radiological Society of North America (RSNA®)
Web site. This Internet-based tool is designed to
help members identify their CME needs in their
particular areas of practice.
Radiologists can become actively involved in
local multidisciplinary conferences (eg, tumor
board, hepatobiliary conference, morbidity and
mortality conference). Reviewing the cases presented at such conferences and participating in
the discussions of such cases with a diverse group
of healthcare professionals is not only a way to
enrich one’s understanding of medicine, but it
also encourages relationship building and fosters a “community of learners” that continues to
function outside of conferences. Keeping a list of
cases to follow up on is another strategy of lifelong learning. Following up cases with uncertain
findings or management pathways is valuable in
that the learning is highly relevant and likely to
result in long-term educational gains. These cases
can be shared with colleagues, who can provide
additional insight into how to approach the case.
Observing how others respond to a situation
can reinforce an existing perspective or open up
a different one (53). It is up to the individual to
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examine and question his or her routines and
interpretations. Formal audits can provide data
on self-performance, with the potential to compare one’s performance with those of others (eg,
cancer detection rate, false-positive and falsenegative biopsy statistics, nodule detection rate,
procedure complication rate). Every radiologist
makes errors in perception, interpretation, or
procedural technique. These errors may be recognized by colleagues. Encouraging colleagues to
bring this to his or her attention allows a radiologist to take advantage of an opportunity to be
self-critical and self-correcting. Because radiologists won’t always recognize when a diagnosis is
obvious, yet they don’t suggest the diagnosis, it’s
important to have external feedback.
Conclusions
Lifelong learning is now recognized by educators,
governing bodies, accreditation organizations,
certification boards, employers, third-party payers, and the general public as one of the most important competencies that people must possess.
Promoting lifelong learning as continuous, collaborative, self-directed, active, broad in domain,
everlasting, positive and fulfilling, and applicable
to one’s profession as well as all aspects of one’s
life has emerged as a major global educational
challenge. Meeting this challenge will require
changes in the way teachers teach and learners
learn, as teachers take on a more facilitative role
and learners take more responsibility for setting
goals, identifying resources for learning, and reflecting on and evaluating their learning.
For physicians, this will require less dependence on traditional educational venues, such as
passive CME activities, and greater participation
in self-assessment, peer-assessment, evaluation of performance in practice, documentation
of practice-based learning and improvement
activities, and learning at the point of care.
Radiologists in an academic setting are exposed
to multiple opportunities for practicing lifelong
learning, such as teaching others, participating
in multidisciplinary conferences and journal
clubs, and engaging in research. All radiologists
can participate in self-audits and group audits
of performance and become active participants
in national radiology societies, where they can
learn from each other. Participation in MOC
reflects a commitment on the part of the learner
RG ■ Volume 29 • Number 2
to actively engage in lifelong learning and is one
way of demonstrating to the general public a
commitment to maintaining competence.
Take-Home Points
1. Learning is not finite, but a lifelong process.
2. The importance of lifelong learning is recognized by the American Board of Radiology
(ABR) (and all medical specialty boards), the
ACGME, the Liaison Committee on Medical
Education, the Association of American Medical
Colleges, and numerous other national educational organizations.
3. MOC provides a process to document physician commitment to lifelong learning and to
reassure the public of this commitment.
4. Lifelong learning is continuous, collaborative, self-directed and active, broad in scope, everlasting, positive and fulfilling, and applicable to
work and all aspects of life.
5. Learner involvement in goals setting, acquisition of knowledge, self-assessment, and
self-reflection reflects a change from traditional
education.
6. Self-assessment must include a review of
performance in real-life settings including those
at the workplace.
7. Learners must acquire necessary skills to
become effective lifelong learners; these skills
must be incorporated at the earliest stages of
medical training as essential professional skills,
and these skills should be honed throughout
medical training and practice.
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RG
Volume 29 • Number 2 • March-April 2009
Collins et al
Lifelong Learning in the 21st Century and Beyond
Jannette Collins, MD, MEd, et al
RadioGraphics 2009; 29:613–622 • Published online 10.1148/rg.292085179 • Content Codes:
Page 614
Education cannot be envisioned as a finite thing, a “preparation” for life, but must be viewed as a part
of life itself (2).
Page 615
The Commission defined lifelong learning as “a continuously supportive process which stimulates
and empowers individuals...to acquire all the knowledge, values, skills and understanding they will
require throughout their lifetimes...and to apply them with confidence, creativity, and enjoyment in
all roles, circumstances, and environments.”
Page 616
Lifelong learning is largely self-directed learning.
Page 617
Attributes common among lifelong learners relate to an ability and willingness to be self-critical, selfcorrecting, and flexible in thinking and acting (Table 1) (4,22,26).
Page 620
Because radiologists won’t always recognize when a diagnosis is obvious, yet they don’t suggest the
diagnosis, it’s important to have external feedback.