Using Self-Directed Learning to Combat Information Overload in Oncology Fellowship

Jill Gilbert, MD

I do and do not envy today’s learner. As I was completing my quarterly questions for the American Board of Internal Medicine’s Maintaining Certification program, I was struck by how much has changed since I finished my fellowship in 2001. At that time, paclitaxel was the big discovery, and non–small cell lung cancer (NSCLC) treatment was anchored in how best to rearrange the traditional chemotherapy deck chairs. To be fair, that was an important and groundbreaking study that set the standard for how we treated NSCLC at that time. But the field has rapidly progressed. Now, we have immunotherapy and molecularly targeted agents (and further sub-targeted therapy), among others. And don’t even get me started on the hematologic malignancies. I trained in the days of melphalan and prednisone for multiple myeloma. Look how far we have come!

These discoveries are tremendous news for our patients. However, as a learner and the steward of such advances, the oncologist is responsible for knowing and applying the data. I envy the ability to offer treatments that were not available before, to provide greater hope based on data. To stay afloat, I had to figure out what my learning style is as an adult learner. Unless you went to an educationally progressive kindergarten through 12th grade and college programs, the approach to learning is generally one-size- fits-all. Maybe that worked when the volume of new information was limited. But the amount of hematology/oncology-related data we encounter and the speed at which we encounter them is truly unprecedented. Moreover, the ability to assimilate and apply the huge amount of data in real time remains paramount as lives are dependent on our ability to be educationally facile.

Adult learning theory is a framework that explains how adults learn differently from children.1 It emphasizes self-directed learning, experience-based instruction, and the intrinsic motivation that drives adults to learn. It recognizes that adults bring a wealth of experience to the learning process and are motivated by practical, problem-solving needs.

Key Principles of Adult Learning Theory:

Self-directed learning

Adults prefer to take ownership of their learning, setting their own goals and identifying their learning needs.

Experience-based instruction

Adults learn best when they can relate new information to their previous experiences and apply it to real-world situations.

Relevance and practical application

Adults are motivated by learning things that are directly relevant to their lives and work, and they prefer to learn skills they can immediately use.

Intrinsic motivation

Adults are more likely to engage in learning when they are internally motivated to do so, such as by a genuine need to know or a desire for personal or professional growth.

Readiness to learn

Adults are motivated to learn when they perceive a need for new information or skills directly relevant to their current life circumstances or goals.

Orientation to learning

Adults tend to be task-oriented or problem-centered in their approach to learning, focusing on applying knowledge to real-world situations.

Here is how adult learning plays out in my life.

1. I do not learn from lecture-style presentations. Throughout my life, learning occurred from the experience of taking notes or using a highlighter to underline key items in textbooks. I am a visual learner and linking a highlighted color or my notes’ handwriting allows me to visualize the material in a way that is different from how it is presented. I am not a podcast or audiobook person. My attention span is too short, and audio is clearly not visual.

2. I remember the learning associated with cases. When I am in the clinic and need to look something up, I will use a web-based review platform. This is fast and provides the data, but it also provides key references. To link the new data with the clinical scenario, I will read the key paper from the references section on my own time. Then, the new knowledge is linked to a case, and I will remember this for the next patient I see.

3. My intrinsic motivation remains at the forefront of my learning. When I am burned out, I have to remember why I do this. My motivation is to improve the survival and quality of life for patients with cancer. Lifelong learning is a pact with our patients. How do you learn? Although a hematology/oncology fellowship program teaches a particular method, adult learning means you can adapt the current format to your learning style. Use insights and reflection to identify what types of tools have helped you over your lifetime of learning.

Reference

1. O’Neill E. What is adult learning theory? LearnUpon Blog. Accessed May 6, 2025. bit.ly/4jL9NXw