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How Adults Learn - University of Pittsburgh

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How Adults Learn
Peter J. Fabri, M.D.
Professor of Surgery
Associate Dean of Graduate Medical Education
University of South Florida Health Sciences
Organic Chemistry 1966
 I couldn’t understand it
пЃµ So I memorized it
пЃµ Every night I would rewrite my lecture
notes from the beginning of the semester
пЃµ It went this way for 4 months
пЃµ One morning it made sense and from
that day on I could learn
Childhood Learning
пЃµ Rote memory
пЃµ Repetition
пЃµ Testing as feedback
пЃµ Gathering building blocks
пЃµ Vertical and additive?
Adult Learning
пЃµ Conceptual
пЃµ Contextual
пЃµ Continuous
пЃµHorizontal and integrated?
Learning Theories
пЃµ Many talented educators have developed
theories to explain the processes of the
human mind.
пЃµ Are they correct? Maybe in part.
пЃµ Then why use them?
пЃµ 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
 Gagne’s Theory of Conditions of Learning
пЃµ Dreyfus Process of Learning
Why is medical education different now?
пЃµ How much to learn?
– Until recently, the amount of relevant clinical
knowledge was finite and knowable.
– The rate of knowledge expansion is now
пЃµ Where do we learn?
– The traditional teaching ward provided
opportunity for continuity, integration, and
– The modern teaching clinic is fragmented,
episodic, and discontinuous.
Why is medical education different now?
пЃµ In the past, core knowledge could be learned
in medical school.
пЃµ An intern or resident was an apprentice,
mastering a set of skills.
пЃµ Once learned, the knowledge was thought to
for life.
пЃµ Today, medical education is a continuous,
lifetime commitment to learning while
Why is medical education different now?
пЃµ 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
пЃµ 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
Learning on the Wards
пЃµ The Osler model
пЃµ Large wards; long hospitalizations
пЃµ All diseases are likely to be represented
in all phases.
пЃµ Under the direction of a master, an
individual is able to observe the full
spectrum of a disease and its
Learning in the Clinic
пЃµ Fragmented and episodic
пЃµ Never see the whole picture
пЃµ Little continuity
 Requires an educational model to “glue”
the pieces together
Modern “Tools”
пЃµ Competency-based education
пЃµ Lifelong learning
пЃµ Continuous improvement
пЃµ Evidence-based Medicine
пЃµ Clinical guidelines
пЃµ Maintenance of competence
Coaches vs. Teachers
пЃµ A teacher is an individual who tells the
students what, when and how to learn,
then tests to see if they have learned.
пЃµ A coach provides context, direction,
motivation, and leadership, evaluating
progress along the way.
Cognitive Domain- Knowledge
Bloom’s Taxonomy
Psychomotor Domain- Skills
Bloom’s Taxonomy
Affective Domain- Attitudes
Bloom’s Taxonomy
adopting outlook
value system
paying attention
Multiple Intelligences
пЃµ Learning is composed of multiple
sensory and intellectual inputs
--sound, sight, smell, etc.
пЃµ The greater the number of inputs
attached to a particular idea, the greater
the retention of
the information.
пЃµ Some individuals learn better orally,
some visually, some kinesthetically, some
by combinations.
8 Multiple Intelligences
пЃµ Linguistic (word smart)
пЃµ Logical-mathematical (number
пЃµ Spatial (picture smart)
пЃµ Kinesthetic (body smart)
пЃµ Musical (music smart)
пЃµ Interpersonal (people smart)
пЃµ Intrapersonal (self smart)
пЃµ Naturalistic (nature smart)
Gagne- Conditions of Learning
пЃµThere are several types or levels of learning.
пЃµ Each type requires a different type of
instruction, and has different conditions.
пЃµ Five major categories of learning:
– verbal, intellectual skills, cognitive strategies,
motor skills, attitudes
пЃµ Prerequisites to learning for each level
Gagne- 9 instructional events
gaining attention (reception)
пЃµ informing re objectives (expectancy)
пЃµ recalling prior learning (retrieval)
пЃµ presenting stimulus (selective perception)
пЃµ providing guidance (semantic encoding)
пЃµ eliciting performance (responding)
пЃµ providing feedback (reinforcement)
пЃµ assessing performance (retrieval)
пЃµ enhancing retention and transfer
Gagne- Principles
пЃµ Different instruction is required for
different learning outcomes
пЃµ Events of learning operate on the
learner in ways that constitute conditions
of learning
пЃµ The specific operations that constitute
instruction are different for each type
пЃµ Learning hierarchies define what
intellectual skills are to be learned and a
sequence of instruction
Skill Acquisition
Dreyfus model (1980)
пЃµ novice
пЃµ advanced beginner
пЃµ competent
пЃµ proficient
пЃµ expert
пЃµ master
пѓ©3rd year student
пѓ©graduating student
пѓ©chief resident
пѓ©board eligible (+2years)
пѓ©5-10 years practice
Common Misbeliefs
пЃµ Everyone wants to learn
пЃµ Everyone learns the same way
пЃµ Everyone learns at the same rate
пЃµ Once learned, knowledge is forever
пЃµ Memorized information can be used
пЃµ Everyone can integrate knowledge
 The “apprenticeship” model is rapidly
being replaced by adult learning
– Competency based
– Objectives driven
– Consistent evaluation methods
Summary 2
пЃµ Different learners require different
learning methods and assistance
пЃµ Learning is hierarchical and increases in
complexity and interrelatedness
пЃµ Learning requires prerequisite knowledge
and/or experience
пЃµ Varied learning opportunities and
experiences enhance retention
пЃµ Something learned may not be able to be
пЃµ If you want to be involved in adult
learning, you need to try to understand
the intricacies of adult learning.
пЃµ The traditional notion that everyone
learns at the same speed, in the same
way, with the same outcome must be
reassessed and methodologies modified.
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