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 пЃµ I couldnвЂ™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 пЃµ BloomвЂ™s Taxonomy пЃµ GardnerвЂ™s Theory of Multiple Intelligences пЃµ GagneвЂ™s Theory of Conditions of Learning пЃµ Dreyfus Process of Learning Why is medical education different now? пЃµ How much to learn? вЂ“ Until recently, the amount of relevant clinical knowledge was finite and knowable. вЂ“ The rate of knowledge expansion is now exponential. пЃµ Where do we learn? вЂ“ The traditional teaching ward provided opportunity for continuity, integration, and interaction. вЂ“ 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 suffice for life. пЃµ Today, medical education is a continuous, lifetime commitment to learning while working Why is medical education different now? пЃµ In the past, the physician was the unchallenged captain of the team. вЂ“ led by authority вЂ“ individual superstar with a team of helpers вЂ“ learned in elite isolation пЃµ Today, the physician is a senior member of a multidisciplinary team. вЂ“ leads by example вЂ“ one of many talented team members вЂ“ 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 treatment. Learning in the Clinic пЃµ Fragmented and episodic пЃµ Never see the whole picture пЃµ Little continuity пЃµ Requires an educational model to вЂњglueвЂќ the pieces together Modern вЂњToolsвЂќ 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 BloomвЂ™s Taxonomy evaluation synthesis analysis application comprehension knowledge Psychomotor Domain- Skills BloomвЂ™s Taxonomy facility acting performing/aided preparing observing Affective Domain- Attitudes BloomвЂ™s Taxonomy adopting outlook value system valuing participating 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 smart) 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: вЂ“ 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 (generalization) пЃµ 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 пѓ©? 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 Summary пЃµ The вЂњapprenticeshipвЂќ model is rapidly being replaced by adult learning вЂ“ Competency based вЂ“ Objectives driven вЂ“ 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 used! Conclusion 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.