Capturing the Range of Learning:

Implications for Disaster Health in a

Resource Constrained Future

Authors:

Brian A. Altman, PhD 

Kandra Strauss-Riggs, MPH

Kenneth W. Schor, DO, MPH

December 2012
1

Capturing the Range of Learning: Implications for Disaster Health in a Resource Constrained

Future

Altman BA, Strauss-Riggs K, Schor KW. Capturing the range of learning: Implications for 

disaster health in a resource constrained future. National Center for Disaster Medicine and 

Public Health. December 2012.

Abstract

Building and maintaining necessary disaster-related learning by health professionals, amidst an 

environment of resource constraint, is challenging. This article suggests the value of Coombs 

and Ahmed’s three interrelated “modes of education” (formal, nonformal, and informal) in 

considering disaster health learning and linkages to performance. Implications of this 

conceptualization are: drawing on the full range of formal, nonformal, and informal modes, 

fostering learning outside of classes and training sessions, appropriately encouraging informal

means to facilitate learning, and including questions about the mode of learning in evaluation. As 

resources for disaster health education and training become more constrained, resilience is 

increased if we focus on what learning is necessary to achieve performance, and then facilitate 

multiple paths to that learning, including informal learning options which are less resource 

intensive. Thus, the development of competent disaster health professionals is less vulnerable to 

the vicissitudes of budget and time.

As we speak with our partners, it is clear that resource constraint is a matter of discussion and 

concern within the disaster medicine and public health community. This issue is illustrated by 

the title of the February 2012 Public Health Preparedness Summit, “Regroup, Refocus, Refresh: 

Sustaining Preparedness in an Economic Crisis.”

1 Competent performance by health 

professionals prior to, during, and after disaster events can reduce morbidity and mortality and

strengthen the health security of the nation. Consequently, one focus of concern is building and 

maintaining the necessary disaster-related learning by health professionals amidst limited 

resources. Finding ways to achieve needed learning within a resource constrained environment 

enhances resilience for the disaster health workforce.

In the health professions, learning has been largely viewed as occurring in either an education or 

training setting. Much debate occurs around this dualistic view, especially when new knowledge 

or programs must be institutionalized in the professional health workforce. It is not our intent to 

define education or training within the realm of disaster health knowledge. Rather, this paper 

argues that such a bifurcated view of education or training does not offer the full range of

options presented by another perspective. A learning perspective that is more inclusive of the 

adult experience may be particularly timely in our emerging era of dwindling preparedness 

resources. As resources become scarce, leaders become more focused on learning outcomes and 

the performance effects of the learning intervention.
2

The inclusive perspective in Coombs and Ahmed’s three interrelated “modes of education” 

(formal, nonformal, and informal)2,3 provides a useful way of understanding vectors through 

which learning for performance

4 takes place. Their conceptualization avoids a narrow focus on 

completion of training sessions, and illuminates additional paths to achieve necessary learning. 

Formal education refers to the familiar educational system of schools and grade levels, including 

university. In formal education, grades are given and degrees are granted.

3 Nonformal

education, by contrast is “organized, systematic, educational activity”

2, p. 8 but takes place outside 

of the usual school system. Examples of nonformal education would include educational 

programs in the community, training in the workplace, and continuing professional education 

programs. Informal education “is the lifelong process by which every person acquires and 

accumulates knowledge, skills, attitudes and insights from daily experiences and exposure to the 

environment”

2, p. 8 and would include speaking with colleagues and reading journals and other 

reference materials.

Mode Definition Disaster Health

Examples

Formal the familiar

educational system of 

schools and grade 

levels, including 

university

professional degree

programs

Nonformal “organized,

systematic, 

educational activity”

2, 

p. 8 but takes place 

outside of the usual 

school system

continuing

professional education 

programs, workplace 

training

Informal “the lifelong process

by which every 

person acquires and 

accumulates 

knowledge, skills, 

attitudes and insights 

from daily 

experiences and 

exposure to the 

environment”2, p. 8

speaking with

colleagues; reading 

journals, lessons 

learned and after 

action reports;

experience with actual 

disasters; participating 

in drills, exercises, 

hotwashes

Table 1. Coombs and Ahmed’s three interrelated “modes of education” (formal, nonformal, and

informal)

2,3 with disaster health examples

Table 1 provides examples of these three modes in the disaster health field. The modes are 

interrelated, and a case could be made that a drill conducted in the workplace with a specific 

educational intent might be nonformal rather than informal. Rather than providing a strict 

classification scheme, the value of Coombs and Ahmed’s typology is in reminding us that all 

three forms of education are at play over the course of an individual’s career. In particular, it
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helps us to remember that much learning occurs through informal means, which has been 

described empirically.

5 From a performance perspective, the mode through which the learning 

occurs is not as important as that it occurs. Thus, it is critical to overtly value all three modes of 

learning, especially for disaster health and particularly when resources are increasingly 

constrained.

Figure 1 illustrates these paths to disaster health learning for performance. Education and 

training efforts that result in learning are an approach to enhance performance.

4 Performance 

during exercises and actual disaster events can indicate prior learning by health professionals, 

suggest needs for additional learning, and serve as informal learning for future performance. 

Performance is itself a source of learning via a connection back through the informal mode. 

Learning related to disasters may also have benefits in the day-to-day performance of health 

professionals, as indicated by the dashed arrow. For example, it is logical to propose that

interpersonal and planning skills learned in a disaster preparedness context may offer benefit to 

performance in more routine contexts as well.

Figure 1. Paths to Disaster Health Learning for Performance

Thinking of these three modes through which learning can take place suggests the following four 

implications for the disaster health community. First, as a community we should draw on the full 

range of formal, nonformal, and informal modes to achieve the necessary disaster health learning 

and performance. Second, those in educational or leadership positions should foster learning 

outside of classes and training sessions (e.g., capturing and sharing learning from experience, 

providing online and hard-copy resource materials, encouraging mentoring conversations,

keeping a learning journal). Training courses are not the only way to resolve learning needs. 

Third, in areas other than required certifications and mandated training, when limited time and 

financial resources constrain more programmatic education and training efforts in disaster health, 

we can encourage informal means to facilitate learning. We can provide resources and structures 

to enable informal disaster health learning that is integrated with, rather than separate from,

health professionals’ day jobs.
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Finally, evaluation should assess learner performance. Evaluation should also include how 

learning for the performance occurred. A question such as “How did you learn to do that?” 

inquires about the mode or modes through which learning for a particular performance took 

place. The follow up “How can we bring that same learning to others?” gathers opinions of how 

that learning could be replicated. These two questions provide insight into the learning process 

for particular performance, which can inform efforts to promote similar learning for others such 

that the competency and capability of the disaster health workforce is enhanced. Such questions

do not replace evaluation of a particular training event (i.e. “What did you learn from the training 

session?”) but rather provide suggestions on how to draw from the full range of modes to

promote learning for performance.

For example, suppose an organization needs to enhance performance in some components of 

disaster preparedness. Typically, the organization would develop or purchase a program of 

training courses to teach the knowledge and skills necessary for achieving the preparedness 

performance targets. In this case though, there are little time or financial resources available. 

The organization feels stuck. However, other options exist. For instance, organizational leaders 

could identify which of their current personnel have the knowledge and skills necessary and ask 

them to informally share their knowledge with colleagues. The success of this learning effort 

will be in the preparedness performance by personnel. Evaluation should include asking those 

individuals how they learned what to do. Future preparedness efforts should work to replicate 

that learning with other staff, and maintain it among all personnel. Learning should emphasize 

practicing within a scope of care.

Emphasizing a range of modes to enable disaster health learning offers a learning 

countermeasure to resource constraint. As resources for disaster health education and training 

become more constrained, resilience is increased if we focus on what learning is necessary to 

achieve performance, and then facilitate multiple paths to that learning, including options which 

are less resource intensive. Thus, the development of competent disaster health professionals is 

less vulnerable to the vicissitudes of budget and time.

We are not aware of empirical studies which assess how use of informal learning for disaster 

health preparedness and response amidst resource constraint translates to performance. This area 

should be a priority for future research. We encourage the disaster health community, and other 

elements of the medical education community experiencing resource constraint, to explore how a 

full palette of learning modes can open up formerly “invisible”

5 p. 659 learning options. When 

financial or time resource limitations constrain some approaches, other paths can emerge.

References

1. Public Health Preparedness Summit 2012 Anaheim February 21-24.

http://www.phprep.org/2012/. Accessed April 3, 2012.

2. Coombs PH, Ahmed M. Attacking Rural Poverty: How Nonformal Education Can Help, 

a research report for the World Bank prepared by the International Council for 

Educational Development. Baltimore: Johns Hopkins; 1974.

3. Merriam SB, Caffarella RS, Baumgartner LM. Learning in Adulthood: A Comprehensive

Guide. 3rd ed. San Francisco: Jossey Bass; 2007.
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4. Swanson RA, Holton EF, III. Foundations of Human Resource Development. 2nd ed. San

Francisco: Berrett-Koehler; 2009.

5. Sargeant J, Mann K, Sinclair D, Ferrier S, Muirhead P, van der Vleuten C, Metsemakers 

J. Learning in practice: Experiences and perceptions of high-scoring physicians. Acad 

Med. 2006; 81(7):655-660.