How Adults Really Learn

1. How Adults Really Learn Linda Larson Carr, PhDAcademic SpecialistOffice of Learning & Teaching UA College of Medicine Phoenix Campus

2. Next Clinical Teaching session is … Thursday, February 17“Dealing with Non-Succeeding Learners: Lessons Learned”

3. Welcome! • Please introduce yourself. • What aspect of learning do you find most intriguing?OR • What question would you like answered?

4. Objectives • Explain the principles of adult learning and the differences between pedagogy and andragogy. • Identify and explain four critical elements of learning that must be addressed to ensure that students learn effectively and efficiently. • Describe relevant educational models for adult learners.

6. What is learning? “Learn to Play Tennis” Exercise

7. Average RetentionRate after 24 hours Bethel, Maine: National Training Laboratories (1960s)

8. PEDAGOGY The art and science of teaching children ANDRAGOGY The art and science of helping adults learn Term introduced in 1968 by Knowles Pedagogy vs. Andragogy

9. ADULT LEARNERS Problem-centered Results-oriented Self-directed Often skeptical about new information Seek relevancy Accepts responsibility for own learning YOUTH LEARNERS Subject-oriented Future-oriented Often depend on adults for direction More accepting Often train for unclear future Often dependent on others Characteristics of Learners

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

11. Challenges of Clinical Teaching • Too little time available • Conflicting time pressures on teachers and learners • Lack of teacher observation of learner’s work • Lack of teacher probing learner’s knowledge and reasoning

12. “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

14. What do we need to know about adult learning?

16. Goals for Higher Education Goals for higher education now transcend transmitting knowledge to helping students develop cognitive structures, skills, strategies, and motivation for continued learning and problem solving. (McKeachie, et al., 1986)

17. How Do We Understand Learning Today? • Humans actively create their knowledge • Knowledge is not passively received • Previous knowledge shapes new knowledge • New knowledge shapes subsequent knowledge (Joint Task Force on Student Learning, 1998, Powerful Partnerships: A Shared Responsibility for Learning, http://www.aahe.org)

18. Learning is not a spectator sport. Students do not learn much just by sitting in class listening to teachers, memorizing prepackaged assignments, and spitting out answers.They must talk about what they are learning, write about it, relate it to past experiences, and apply it to their daily lives. They must make what they learn part of themselves.- Arthur W. Chickering and Zelda F. Gamson “Seven Principles for Good Practice,” AAHE Bulletin 39:3-7, March 1987

19. Learning is enhanced when learners are asked to … • State the information in their own words • Give examples of it • Recognize it in various guises and circumstances • See connections between it and other facts or ideas • Foresee some of its consequence • State its opposite or converse

20. Metacognition • Definition: thinking about thinking. • Planning, monitoring, and evaluating thinking processes. • Good learners engage in more metacognitive activities than poor learners.

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

22. Low self esteem Unwillingness to ask for help Lack of confidence Low/uncertain motivation Inattentiveness or lack of attendance/participation Under-developed study skills Poor listening skills Anxiety or fear of insecurity Inadequate knowledge Low expectations of self Domestic, financial or personal worries Physical, mental, or health conditions Specific learning difficulties Barriers to Learning

23. Implications? > • Need to shift the focus from Teaching to Learning • Need to use techniques that help students create meaning • Both faculty and students become LEARNERS

24. How the Brain Works

25. Teaching to the Brain • Emotions are a key in learning. • An enriched learning environment is primary. We must expect more. • Problem solving must be a way of classroom life. • The “big picture” is important. • Finally, work to eliminate threats. (“The Teaching Professor,” June/July 1999)

26. STUDENT CharacteristicsDEEP APPROACH - Previous knowledge of topics - Perceived relevance of info - Intrinsic interest in subject - Study skillsSURFACE APPROACH - Fear of failure - Anxiety - Reliance on memorization - Extrinsic motivation DEPARTMENT Influences- Matching content to previous knowledge- Good teaching- Opportunities for individual choice- Study skills training & support- Short- answer & MCQs- Heavy workload & overloaded curricula- Spoon-feeding through handouts- Lack of relevance or choice How to Enhance Learning?(Entwistle, 1992)

27. Epidemiology of Mislearning(L Shulman) • Amnesia • Fantasia • Inertia

29. A closer look …applying educational theory in practice

31. Self directed learning • Organizing teaching and learning so that learning is within the learners’ control • A goal towards which learners strive so that they become able to accept responsibility for their own learning

32. Self efficacy • Bandura posits that people’s judgments of their own ability to deal with different situations is central to their actions • These judgments may or may not be accurate • 4 sources: performance attainments, observations of others, verbal persuasion, and physiological state

33. Self efficacy – roles for the teacher • Modeling or demonstration • Setting a clear goal or image of the desired outcome • Providing basic knowledge and skills needed as the foundation for the task • Providing guided practice with corrective feedback • Giving students the opportunity to reflect on their learning

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

36. Reflective practice • Schon’s work based on a study of many professions • Formal theory often not useful to solve real life problems • Professionals automatic ways of practicing (“zones of mastery”)

37. Patientencounter Knowing in action Zone of Expertise Reflection in action Surprise Information seeking Solve problem Schőn’s Model of Reflective Practice

38. Client encounter Knowing in action Zone of Expertise Reflection in action Surprise Information seeking Enhancement of practice Solve problem Reflection after the event Information seeking

40. A Tool for Reflecting on 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?

41. NOTES “ What is the new message here and how does it fit with my existing knowledge or experience? What questions do I have? “What if” questions help me to “ make sense” of the new concept Do I need more information to answer my questions I need to validate my understanding of this new concept I need to visualize how I can use this information in other areas of my study or practice” My Learning Diary:Record what’s new to you and check off progress with learning in the right-hand column

42. The Context of Clinical Education • Rounds • Journal clubs • Tumor Boards • Information • sources • National links with peers • Team learning • Practice reflection • Outcome data • -Patient surveys • - Utilization studies • Practice reflection • Corporate memory • Mentors • Asynchronous • Communication

43. OLD Paradigm Finite amount of knowledge to be absorbed Experts are recognized by knowing what they should know Learning starts by contacting an authority Uncertainty is discouraged and ignorance avoided Experts have knowledge—they’re on TOP NEW Paradigm It is not possible to absorb all knowledge on a subject Experts are recognized by knowing what they don’t know and knowing how to manage it Learning starts in practice (Balance E-B, tacit knowledge and learning from mistakes) Legitimizing uncertainty and learning by questioning Experts find solutions—they are on TAP Paradigms in Learning(Penchion D. 1999. Editorial BMJ. May 8)

44. Small Group Activity Apply principles of adult learning Case 1: Orientation to a clerkship Case 2: Patient safety training Case 3: Transitional year training

45. Where do we go from here? What does changing the paradigm from teaching to learning imply about my role as a teacher? My learners’ roles?

46. New knowledge or ways of knowing … New or renewed interest in … Continued questions about … The muddiest point: What will I keep the same? What will I do more of ? What will I do less of? What I will stop doing? What I will do differently and how will I do it? What I will add is … Tonight’s Gallery of Learning

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

49. Please complete Participant Feedback Form. Thank you!

50. Tell me and I’ll forget;Show me and I may remember; Involve me and I’ll understand. Chinese Proverb Thank You!