Adult Learning Theories and Their Application in Medicine
There are several theories that explain the learning process in adult. Each of them focuses in one or several characteristics of adult learners and may be suitable for a specific group or occasion. Each theory is based on some principles and assumptions. Knowles’ Adult Learning Theory is the one that fits best for developing an online learning model for ALTUM Health. On the other hand, there are some points coming from other theories and models that can be used for specific situations and participants. Some important learning theories are the followings:
Social cognitive theory acknowledges the interactive or social aspect of learning. The influence of the environment plays an important role in this theory.
Reflective practice is paying attention to the practical values and theories which inform everyday actions. This theory states that new information is interpreted in the light of past knowledge and experience.
Transformative learning relays on change of frames of reference by critically reflecting on assumptions and beliefs and consciously making and implementing plans that bring new ways of definition.
Self-directed learning is based on the fact that much of the knowledge is context-dependent and subject to a self-assessment of needs.
Experiential learning (Kolb’s theory) is a structured stage of the learning cycle, which includes performing a task, reflecting upon that task with input from others, identifying areas where improvement could be made, and readjusting in some way before a new cycle.
Constructivism says that people construct their own understanding and knowledge of the world, through experiencing things and reflecting on those experiences (Brockett, 2018).
Malcolm Knowles’ Adult Learning Theory – Andragogy
Malcolm Knowles was an American educator. He popularized the use of the term Andragogy as a synonym to adult education. According to Malcolm Knowles, andragogy, a Greek word meaning man-leading, is the art and science of adult learning. In comparison to that, we have pedagogy, which is child-leading.
Assumptions and Principles:
Knowles made 5 assumptions about the characteristics of adult learners:
- Self-Concept: Adult’s Self-concept moves from being dependent to being self-directed. Adults need to be involved in the planning and evaluation of their instruction.
- Adult Learner Experience: Adults accumulates a growing amount of experience that becomes an increasing resource for learning. Experience is the basis for learning activities.
- Readiness to Learn: The readiness to learn becomes oriented to the tasks of social roles. As a result, the adult’s orientation toward learning shifts from subject- centred to problem-centred. Adults are most interested in learning subjects that have immediate relevance and impact on their job or personal life.
- Orientation to Learning: For adults, time perspective changes from one of postponed application of knowledge to immediacy of application.
- Motivation to Learn: As a person matures the motivation to learn shifts from external to internal (Hartree, 1984).
Domains of Learning:
Medical education is based on three interrelated domains:
Knowledge (cognitive) domain: Knowledge can be defined as a background of facts and interactions between facts that should lead to an understanding of the material being learned.
According to Bloom’s taxonomy, there are six levels within the cognitive domain, from the simple recall or recognition of facts, as the lowest level, through increasingly more complex and abstract mental levels, to the highest order which is classified as evaluation.
Skill (Psychomotor) Domain: Skill is the capacity that is acquired by systematic and sustained effort to smoothly and adaptively perform complex activities. This domain has been revised over years by Dave, Harrow, and Simpson. In Simpson taxonomy, the focus is on the progression of mastery of skill from observation to the invention.
Attitude (Affective) Domain: Attitude is a learned predisposition to respond in a consistently favourable or unfavourable manner with respect to a given object. Krathwohl’s affective domain taxonomy is probably the best-known taxonomy in this domain. It is based on to the principle of internalization which refers to the process whereby a person’s affect toward an object passes from a general awareness level to a point where the affect is internalized and consistently guides or controls the person’s behavior (Anderson, 2001).
Application of theory
Educators in medicine should make sure that their program is consistent with the principles of adult learning. Many programs still follow the pedagogical model. Although it may be appropriate for some adult learners, there is much evidence that adults learn better from educators who apply andragogy. Adults cannot simply act as passive receivers of the expertise and knowledge of someone else. To fully comprehend and use new information and skill in the future, they should have a different level of engagement than what is required by younger learners. They need to feel supported within their education framework and they must be allowed to bring their own experience. For adults, autonomy is important and they should be given clear direction about the standards and objectives and then they can be allowed to manage their learning process (Taylor, 2013).
Despite being an important component, reflection is left out of Knowles’ concept of adult learning.
It is an important difference between adult learning and child learning (pedagogy) theories and can enhance adult learning by increasing motivation to learn.
Learning Styles
The educator should be familiar with different styles of learning in adults. When teaching methods are matched to the needs of the individual learner, that learner is more likely to understand, recall and use new information. The three major learning styles are as the followings:
Visual: These learners prefer to see the process demonstrated in a step-by-step way. They benefit from video demonstrations and from lectures that focus on watching an expert perform a task. They also tend to use traditional class notes more effectively than others.
Auditory: These learners are most effective when they listen to a process or concept being described. They benefit most from a traditional lecture. Participating by actively asking questions may help them learn better. They gain advantages from recording each lecture.
Kinesthetic: Kinesthetic learners learn best by performing tasks. This is true even if they have not quite mastered the concepts and need to use trial and error. They can use either of the other learning styles as a secondary tool, but will benefit the most from project-based learning (Overview of learning styles ,n.d.).
Teaching Strategies
There are several teaching strategies that can be used in adult learning context.
Presentation: This strategy demands that teachers are active participants in the learning process.
The physical, cognitive, and emotional expectations of the students are not as great as those placed on the teacher. Evidence suggests that the presenting strategy alone is much less effective in changing behavior than activities such as case discussion.
The Enabling Strategy: This strategy needs a experienced teacher who has the desire to be involved with students. Methods such as problem-solving projects and discussions belong to this strategy. Students are engaged in activity which is generally centered on a problem to be solved.
The Exemplifying Strategy: In this strategy, students learn from watching a model and imitating it.
Facilitation strategies: This strategy is based on principles such as voluntary participation, mutual respect, collaborative spirit, action and reflection, critical reflection, and self-direction (Teaching Strategies, n.d.).
E-learning in Medicine
E-learning platforms are being utilized by many medical schools. It is as effective as conventional models and can be used to foster self-directed learning. The gradual shift towards e-learning is seen as a catalyst for applying adult learning theory, which will see more medical educators taking on the role of facilitator and assessor of competency. Medical educators are continuing to engage with e-learning in an effort to come up with innovative approaches. Furthermore, in online programs, the material can be updated in a timely manner to ensure delivery of the most up to date content to trainees.
E-learning has several benefits from which the followings are the most important ones:
Variety of programs and courses: No matter what students study, they can find the courses or programs they need online.
- Lower total costs: Online programs prove a more affordable option than traditional colleges.
- More comfortable learning environment: As there are no physical class sessions, students listen to lectures and complete assignments with no need to fight traffic, leave work early for class, or miss important family time.
- Convenience and flexibility: Online courses give students the opportunity to plan study time around the rest of their day.
- More interaction and greater ability to concentrate: Online courses offer shy or more reticent students the opportunity to participate in class discussions more easily than face-to-face class sessions.
- Career advancement: Students can take online courses and even complete entire degrees while working.
- Avoid commuting: Students in online courses can always attend by participating in discussion boards or chat sessions.
- Improve in technical skills: Even the most basic online course requires the development of new computer skills, as students learn to navigate different learning management systems and programs. The participation skills students learn within their online courses translate to many professions, including creating and sharing documents, incorporating audio/video materials into assignments, and completing online training sessions (Dumford,2018).
There are some reports that claim students who take online courses, are less likely to engage in collaborative learning, student-faculty interactions, and discussions with diverse others, compared to their more traditional classroom counterparts. The students with greater numbers of online courses also reported less exposure to effective teaching practices and lower quality of interactions (Dumford,2018). This disadvantage will be partially solved by the application of
the principles of adult learning theories. Furthermore, newer online platforms that provide many different ways for the trainees to engage in collaborative learning and interactivities.
References:
Dumford, A. D., & Miller, A. L. (2018). Online learning in higher education: Exploring advantages and disadvantages for engagement. Journal of Computing in Higher
Education, 30(3), 452-465. doi:10.1007/s12528-018-9179-z
Hartree, A. (1984). Malcolm Knowles’ Theory of Andragogy: A Critique. International Journal of
Lifelong Education, 3(3), 203-210. doi:10.1080/0260137840030304
Overview of learning styles. (n.d.). Retrieved from https://www.learning-stylesonline.
com/overview/
Taylor, D. C., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11). doi:10.3109/0142159x.2
Teaching Strategies. (n.d.). Retrieved from https://www.edutopia.org/topic/teaching-strategies
What is value-based healthcare? (2019, January 10). Retrieved from
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