How Adults Learn

Peter J. Fabri, M.D.Professor of Surgery

Associate Dean of Graduate Medical Education

University of South Florida Health Sciences Center

Organic Chemistry 1966

I couldn’t understand it So I memorized it Every night I would rewrite my lecture

notes from the beginning of the semester It went this way for 4 months One morning it made sense and from

that day on I could learn

Childhood Learning

Rote memory Repetition Testing as feedback Gathering building blocks Vertical and additive?

Adult Learning

Conceptual Contextual ContinuousHorizontal and integrated?

Learning Theories

Many talented educators have developed theories to explain the processes of

the human mind. Are they correct? Maybe in part. Then why use them? Because they provide a structure that

helps us understand how to teach and glues together the episodes of learning.

Four Learning Theories

Bloom’s Taxonomy Gardner’s Theory of Multiple

Intelligences Gagne’s Theory of Conditions of Learning Dreyfus Process of Learning

Why is medical education different now? How much to learn?

– Until recently, the amount of relevant clinical knowledge was finite and knowable.

– The rate of knowledge expansion is now exponential.

Where do we learn?– The traditional teaching ward provided opportunity

for continuity, integration, and interaction.

– The modern teaching clinic is fragmented, episodic, and discontinuous.

In the past, core knowledge could be learned in medical school.

An intern or resident was an apprentice, mastering a set of skills.

Once learned, the knowledge was thought to suffice for life.

Today, medical education is a continuous, lifetime commitment to learning while working

Why is medical education different now?

In the past, the physician was the unchallenged captain of the team.– led by authority– individual superstar with a team of helpers– learned in elite isolation

Today, the physician is a senior member of a multidisciplinary team.– leads by example– one of many talented team members– learns in an integrated and interrelated system

Why is medical education different now?

Learning on the Wards

The Osler model Large wards; long hospitalizations All diseases are likely to be represented

in all phases. Under the direction of a master, an

individual is able to observe the full spectrum of a disease and its treatment.

Learning in the Clinic

Fragmented and episodic Never see the whole picture Little continuity Requires an educational model to “glue”

the pieces together

Modern “Tools”

Competency-based education Lifelong learning Continuous improvement Evidence-based Medicine Clinical guidelines Maintenance of competence

Coaches vs. Teachers

A teacher is an individual who tells the students what, when and how to

learn, then tests to see if they have learned.

A coach provides context, direction, motivation, and leadership,

evaluating progress along the way.

Cognitive Domain- KnowledgeBloom’s Taxonomy

knowledge

comprehension

application

analysis

synthesis

evaluation

Psychomotor Domain- SkillsBloom’s Taxonomy

observing

preparing

performing/aided

acting

facility

Affective Domain- AttitudesBloom’s Taxonomy

paying attention

participating

valuing

value system

adopting outlook

Multiple Intelligences

Learning is composed of multiple sensory and intellectual inputs

--sound, sight, smell, etc.

The greater the number of inputs attached to a particular idea, the greater the retention of the information.

Some individuals learn better orally, some visually, some kinesthetically, some by combinations.

8 Multiple Intelligences

Linguistic (word smart) Logical-mathematical (number

smart) Spatial (picture smart) Kinesthetic (body smart) Musical (music smart) Interpersonal (people smart) Intrapersonal (self smart) Naturalistic (nature smart)

Gagne- Conditions of Learning

There are several types or levels of learning. Each type requires a different type of

instruction, and has different conditions. Five major categories of learning:

– verbal, intellectual skills, cognitive strategies, motor skills, attitudes

Prerequisites to learning for each level

Gagne- 9 instructional events gaining attention (reception) informing re objectives (expectancy) recalling prior learning (retrieval) presenting stimulus (selective perception) providing guidance (semantic encoding) eliciting performance (responding) providing feedback (reinforcement) assessing performance (retrieval) enhancing retention and transfer (generalization)

Gagne- Principles

Different instruction is required for different learning outcomes

Events of learning operate on the learner in ways that constitute conditions of learning

The specific operations that constitute instruction are different for each type

Learning hierarchies define what intellectual skills are to be learned and a sequence of instruction

Skill AcquisitionDreyfus model (1980)

novice advanced beginner competent proficient expert master

3rd year studentgraduating studentchief residentboard eligible (+2years)5-10 years practice?

Common Misbeliefs

Everyone wants to learn Everyone learns the same way Everyone learns at the same rate Once learned, knowledge is forever Memorized information can be used Everyone can integrate knowledge

Summary

The “apprenticeship” model is rapidly being replaced by adult learning

– Competency based

– Objectives driven

– Consistent evaluation methods

Summary 2

Different learners require different learning methods and assistance

Learning is hierarchical and increases in complexity and interrelatedness

Learning requires prerequisite knowledge and/or experience

Varied learning opportunities and experiences enhance retention

Something learned may not be able to be used!

Conclusion

If you want to be involved in adult learning, you need to try to understand the intricacies of adult learning.

The traditional notion that everyone learns at the same speed, in the same way, with the same outcome must be reassessed and methodologies modified.