How Adults Really LearnHow Adults Really Learn

Linda Larson Carr, PhDLinda Larson Carr, PhDAcademic SpecialistAcademic Specialist

Office of Learning & TeachingOffice of Learning & Teaching

UA College of Medicine UA College of Medicine

Phoenix CampusPhoenix Campus

Next Next Clinical Teaching Clinical Teaching

session is …session is …

Thursday, February 17Thursday, February 17

“Dealing with Non-Succeeding “Dealing with Non-Succeeding Learners: Lessons Learned”Learners: Lessons Learned”

Welcome!Welcome!

• Please introduce yourself.Please introduce yourself.

• What aspect of learning do you find most What aspect of learning do you find most intriguing?intriguing?

OROR

• What question would you like answered?What question would you like answered?

ObjectivesObjectives

• ExplainExplain the principles of adult learning and the principles of adult learning and the differences between pedagogy and the differences between pedagogy and andragogy.andragogy.

• Identify and explainIdentify and explain four critical elements of four critical elements of learning that must be addressed to ensure learning that must be addressed to ensure that students learn effectively and efficiently.that students learn effectively and efficiently.

• DescribeDescribe relevant educational models for relevant educational models for adult learners.adult learners.

What is Learning?

AverageRetentionRates of

Instructional Methods

Pedagogy vsAndragogy

Characteristicsof

Learners

Challengesre. Learning?

What is learning?What is learning?

““Learn to Play Tennis” ExerciseLearn to Play Tennis” Exercise

Lecture(5%)

Reading(10%)

Audiovisual (20%)

Demonstration (30%)

Discussion Group (50%)

Practice By Doing (75%)

Teach Others / Immediate Use of Learning (90%)

Bethel, Maine: National Training Laboratories (1960s)Bethel, Maine: National Training Laboratories (1960s)

Average RetentionAverage RetentionRate after 24 hoursRate after 24 hours

Pedagogy vs. AndragogyPedagogy vs. Andragogy

PEDAGOGYPEDAGOGY

• The art and science The art and science of teaching childrenof teaching children

ANDRAGOGYANDRAGOGY

• The art and science of The art and science of helping adults learnhelping adults learn

• Term introduced in Term introduced in 1968 by Knowles1968 by Knowles

Characteristics of LearnersCharacteristics of Learners

ADULT LEARNERSADULT LEARNERS

• Problem-centeredProblem-centered• Results-orientedResults-oriented• Self-directedSelf-directed• Often skeptical about Often skeptical about

new informationnew information• Seek relevancySeek relevancy• Accepts responsibility Accepts responsibility

for own learningfor own learning

YOUTH LEARNERSYOUTH LEARNERS

• Subject-orientedSubject-oriented• Future-orientedFuture-oriented• Often depend on adults Often depend on adults

for directionfor direction• More acceptingMore accepting• Often train for unclear Often train for unclear

futurefuture• Often dependent on Often dependent on

othersothers

What are the pressures to find new and efficient ways of learning?

Challenges of Clinical TeachingChallenges of Clinical Teaching

• Too little time availableToo little time available

• Conflicting time pressures on Conflicting time pressures on teachers and learnersteachers and learners

• Lack of teacher observation Lack of teacher observation of learner’s workof learner’s work

• Lack of teacher probing learner’s Lack of teacher probing learner’s knowledge and reasoningknowledge and reasoning

“Academic medicine is in crisis across the world. Medicine's capacity to research, think, and teach is collapsing just at the time when science, social trends, and globalisation are offering great opportunities—and threats.

BMJ  2003;327:1001-1002 (1 November), Editorial

What do we need to What do we need to know about know about

adultadult learning? learning?

Goalsfor

Learning

How the BrainWorks

Implicationsfor

Teaching

What isLearning?

How to EnhanceLearning

Goals for Higher EducationGoals for Higher Education

Goals for higher education Goals for higher education now transcend transmitting now transcend transmitting knowledge to helping knowledge to helping students develop students develop cognitive cognitive structures, skills, strategies, structures, skills, strategies, and motivationand motivation for continued for continued learning and problem solving.learning and problem solving.

(McKeachie, et al., 1986)(McKeachie, et al., 1986)

How Do We Understand How Do We Understand Learning Today?Learning Today?

• Humans actively create their knowledgeHumans actively create their knowledge• Knowledge is not passively receivedKnowledge is not passively received• Previous knowledge shapes new Previous knowledge shapes new

knowledgeknowledge• New knowledge shapes subsequent New knowledge shapes subsequent

knowledgeknowledge

(Joint Task Force on Student Learning, 1998, (Joint Task Force on Student Learning, 1998, Powerful Partnerships: Powerful Partnerships: A Shared Responsibility for LearningA Shared Responsibility for Learning, , http://www.aahe.orghttp://www.aahe.org))

Learning is not a spectator sport.Learning is not a spectator sport. Students do not Students do not learn much just by sitting in class listening to learn much just by sitting in class listening to teachers, memorizing prepackaged assignments, teachers, memorizing prepackaged assignments, and spitting out answers.and spitting out answers.

They must They must talk talk about what they are learning, about what they are learning, writewrite about it, about it, relate it to past experiencesrelate it to past experiences, and , and apply itapply it to to their daily lives. They must their daily lives. They must make what they learn make what they learn part of themselves.part of themselves.

- Arthur W. Chickering and Zelda F. Gamson - Arthur W. Chickering and Zelda F. Gamson “Seven Principles for Good Practice,” AAHE “Seven Principles for Good Practice,” AAHE Bulletin 39:3-7, March 1987 Bulletin 39:3-7, March 1987

Learning is enhanced when Learning is enhanced when learners are asked to …learners are asked to …

• State the information in their own wordsState the information in their own words• Give examples of itGive examples of it• Recognize it in various guises and Recognize it in various guises and

circumstancescircumstances• See connections between it and other facts See connections between it and other facts

or ideasor ideas• Foresee some of its consequenceForesee some of its consequence• State its opposite or converseState its opposite or converse

MetacognitionMetacognition

• DefinitionDefinition: thinking about : thinking about thinking.thinking.

• Planning, monitoring, and Planning, monitoring, and evaluating thinking evaluating thinking processes.processes.

• Good learners engage in Good learners engage in more metacognitive more metacognitive activities than poor activities than poor learners.learners.

“…“…The most important single The most important single factor influencing learning is factor influencing learning is what the learner already what the learner already knows. Ascertain this and knows. Ascertain this and teach him accordingly.”teach him accordingly.” (D. Ausubel, 1968)(D. Ausubel, 1968)

Barriers to LearningBarriers to Learning• Low self esteemLow self esteem• Unwillingness to ask for Unwillingness to ask for

helphelp• Lack of confidenceLack of confidence• Low/uncertain motivationLow/uncertain motivation• Inattentiveness or lack of Inattentiveness or lack of

attendance/participationattendance/participation• Under-developed study Under-developed study

skillsskills• Poor listening skillsPoor listening skills

• Anxiety or fear of Anxiety or fear of insecurityinsecurity

• Inadequate knowledgeInadequate knowledge• Low expectations of Low expectations of

selfself• Domestic, financial or Domestic, financial or

personal worriespersonal worries• Physical, mental, or Physical, mental, or

health conditionshealth conditions• Specific learning Specific learning

difficultiesdifficulties

Implications?Implications?

• Need to shift the focus from Teaching to LearningNeed to shift the focus from Teaching to Learning• Need to use techniques that help students create Need to use techniques that help students create

meaning meaning • Both faculty and students become LEARNERSBoth faculty and students become LEARNERS

>

How the Brain WorksHow the Brain Works

Teaching to the BrainTeaching to the Brain

• Emotions are a key in learning.Emotions are a key in learning.• An enriched learning environment is An enriched learning environment is

primary. We must expect more.primary. We must expect more.• Problem solving must be a way of Problem solving must be a way of

classroom life.classroom life.• The “big picture” is important.The “big picture” is important.• Finally, work to eliminate threats.Finally, work to eliminate threats.

(“ (“The Teaching Professor,”The Teaching Professor,” June/July 1999) June/July 1999)

2626

How to Enhance Learning?How to Enhance Learning?(Entwistle, 1992)(Entwistle, 1992)

STUDENT STUDENT CharacteristicsCharacteristics

DEEP APPROACHDEEP APPROACH - Previous knowledge of topics - Previous knowledge of topics - Perceived relevance of info - Perceived relevance of info - Intrinsic interest in subject - Intrinsic interest in subject - Study skills - Study skills

SURFACE APPROACHSURFACE APPROACH - Fear of failure - Fear of failure - Anxiety - Anxiety - Reliance on memorization - Reliance on memorization - Extrinsic motivation - Extrinsic motivation

DEPARTMENTDEPARTMENT Influences Influences- Matching content to previous- Matching content to previous knowledge knowledge- Good teaching- Good teaching- Opportunities for individual - Opportunities for individual choice choice- Study skills training & support- Study skills training & support

- Short- answer & MCQs- Short- answer & MCQs- Heavy workload & overloaded- Heavy workload & overloaded curricula curricula- Spoon-feeding through - Spoon-feeding through handouts handouts- Lack of relevance or choice- Lack of relevance or choice

Epidemiology of MislearningEpidemiology of Mislearning(L Shulman)(L Shulman)

• AmnesiaAmnesia

• FantasiaFantasia

• InertiaInertia

Evaluateown

learning

Formulate own

learningobjectives

Diagnoseown needs

Mutual planningof methods/

content

Establish aneffective learning climate

Identify/devisestrategies for

using resources

Support inlearning plans

AdultLearningTheory

(Knowles)

A closer look …A closer look …applying educational theory applying educational theory

in practicein practice

Self directedlearning

Self directedlearning

Reflectivepractice

Reflectivepractice

Construc-tivism

Construc-tivism

Self efficacy

Self efficacy

Self directed learningSelf directed learning

• Organizing teaching and Organizing teaching and learning so that learning is learning so that learning is within the learners’ controlwithin the learners’ control

• A goal towards which A goal towards which learners strive so that they learners strive so that they become able to accept become able to accept responsibility for their own responsibility for their own learninglearning

Self efficacySelf efficacy

• Bandura posits that people’s Bandura posits that people’s judgments of their own ability to judgments of their own ability to deal with different situations is deal with different situations is central to their actionscentral to their actions

• These judgments may or may not These judgments may or may not be accuratebe accurate

• 4 sources: performance 4 sources: performance attainments, observations of attainments, observations of others, verbal persuasion, and others, verbal persuasion, and physiological statephysiological state

Self efficacy – Self efficacy – roles for the teacherroles for the teacher

• Modeling or demonstrationModeling or demonstration• Setting a clear goal or image of the desired Setting a clear goal or image of the desired

outcomeoutcome• Providing basic knowledge and skills needed Providing basic knowledge and skills needed

as the foundation for the taskas the foundation for the task• Providing guided practice with corrective Providing guided practice with corrective

feedbackfeedback• Giving students the opportunity to reflect on Giving students the opportunity to reflect on

their learningtheir learning

ConstructivismConstructivism

The primary idea of constructivism is The primary idea of constructivism is that learners “construct” their own that learners “construct” their own knowledge on the basis of what they knowledge on the basis of what they already know. This theory posits that already know. This theory posits that learning is active, rather than passive, learning is active, rather than passive, with learners making judgments about with learners making judgments about when and how to modify their when and how to modify their knowledge.knowledge.

Teacher’s roleis a

FACILITATOR

Learning based

on priorknowledge

Activelearning

Is key

Reflective practiceReflective practice

• Schon’s work based on a Schon’s work based on a study of many study of many professionsprofessions

• Formal theory often not Formal theory often not useful to solve real life useful to solve real life problemsproblems

• Professionals automatic Professionals automatic ways of practicing ways of practicing (“zones of mastery”)(“zones of mastery”)

Knowingin action

Reflection in

action

Information seeking

Solveproblem

Zoneof

Expertise

Surprise

Patient encounter

Schőn’s Model of Reflective Practice

Knowingin action

Reflection in

action

Information seeking

Solveproblem

Zoneof

Expertise

Surprise

Client encounter

Reflection after the

eventInformation

seeking

Enhancement of practice

•Do I feel good about my management of this case? If so, why:

•Do I feel uncomfortable about my management of this case? If so, why:

•Do I need new information, skill or attitude to manage this case better? If so, what specifically do I need?

•Did I learn anything new while managing this case? If so, what specifically did I learn?  

A Tool for Reflecting on Practice

My Learning Diary:My Learning Diary: Record what’s new to you and Record what’s new to you and check off progress with learning in the right-hand columncheck off progress with learning in the right-hand column

NOTESNOTES 1.1. “ “ What is the What is the new messagenew message here and how does it fit with here and how does it fit with my existing knowledge or my existing knowledge or experience?experience?

2.2. What What questionsquestions do I have? “What do I have? “What if” questions help me to “ make if” questions help me to “ make sense” of the new conceptsense” of the new concept

3.3. Do I need Do I need more informationmore information to to answer my questionsanswer my questions

4.4. I need to I need to validatevalidate my my understanding of this new understanding of this new conceptconcept

5.5. I need to I need to visualizevisualize how I can use how I can use this information in other areas of this information in other areas of my study or practice”my study or practice”

The Context

of Clinical

Education

▼Rounds- Journal clubs- Tumor Boards

▼Team learning

▼Practice reflection

▼Mentors

▼AsynchronousCommunication

▼Informationsources

▼National links with peers

▼Outcome data-Patient surveys- Utilization studies- Practice reflection- Corporate memory

Paradigms in LearningParadigms in Learning(Penchion D. 1999. Editorial BMJ. May 8)(Penchion D. 1999. Editorial BMJ. May 8)

OLD ParadigmOLD Paradigm

• Finite amount of knowledge to be Finite amount of knowledge to be absorbedabsorbed

• Experts are recognized by Experts are recognized by knowing what they should knowknowing what they should know

• Learning starts by contacting an Learning starts by contacting an authorityauthority

• Uncertainty is discouraged and Uncertainty is discouraged and ignorance avoidedignorance avoided

• Experts have knowledge—they’re Experts have knowledge—they’re on TOPon TOP

NEW ParadigmNEW Paradigm

• It is not possible to absorb all It is not possible to absorb all knowledge on a subjectknowledge on a subject

• Experts are recognized by knowing Experts are recognized by knowing what they don’t know and knowing what they don’t know and knowing how to manage ithow to manage it

• Learning starts in practiceLearning starts in practice (Balance (Balance E-B, tacit knowledge and learning E-B, tacit knowledge and learning from mistakes)from mistakes)

• Legitimizing uncertainty and Legitimizing uncertainty and learning by learning by questioninquestioningg

• Experts find solutions—they are on Experts find solutions—they are on TAPTAP

Small Group ActivitySmall Group Activity

Case 1: Orientation to a clerkshipCase 1: Orientation to a clerkship

Case 2: Patient safety trainingCase 2: Patient safety training

Case 3: Transitional year trainingCase 3: Transitional year training

Apply principles of adult learningApply principles of adult learning

Where do we go from here?Where do we go from here?

What does changing What does changing the paradigm from the paradigm from teaching to learningteaching to learning imply about my role as imply about my role as a teacher? My a teacher? My learners’ roles?learners’ roles?

Tonight’s Gallery of LearningTonight’s Gallery of Learning

• New knowledge or New knowledge or ways of knowing …ways of knowing …

• New or renewed New or renewed interest in …interest in …

• Continued questions Continued questions about …about …

• The muddiest point:The muddiest point:

• What will I keep the What will I keep the same?same?

• What will I do more of ?What will I do more of ?• What will I do less of?What will I do less of?• What I will stop doing?What I will stop doing?• What I will do differently What I will do differently

and how will I do it?and how will I do it?• What I will add is …What I will add is …

In conclusion …In conclusion …

We may not fully understand how adults We may not fully understand how adults learn, but what we do know is that the learn, but what we do know is that the capacitycapacity and and potentialpotential of individuals is of individuals is breathtaking! Educators have the privilege breathtaking! Educators have the privilege to develop that capacity and help learners to develop that capacity and help learners reach their potential by applying adult reach their potential by applying adult learning theories, such as learning theories, such as self directed self directed learning, self efficacy, constructivism, learning, self efficacy, constructivism, andand reflective practice.reflective practice.

Please completePlease complete

Participant Feedback Form.Participant Feedback Form.Thank you!Thank you!

Tell Tell me and I’ll forget;me and I’ll forget;

Show Show me and I may remember; me and I may remember;

Involve Involve me and I’ll understand.me and I’ll understand.

Chinese Proverb Chinese Proverb