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It is important, however, that the linkages are precise rather than general Stein et al. Elaboration and knowledge acquisition. Refinement is the act of sifting and sorting through the information to retain those elements that make sense. Finally, restructuring is the development of new knowledge maps schemata which arguably allow one to become an expert or demonstrate expertise Norman et al. Expertise in medicine and surgery.

The processes of acquiring new knowledge, relating it to what is already known and developing new understanding is complicated and difficult but educators can help the learners by providing advance organisers Ausubel Ausubel D. There are two types of advance organisers: models and metaphors, which we will consider later, and scaffolding. Scaffolding refers to the structural things that teachers do to guide learners through the teaching and learning material.

They are necessary because the sheer volume and complexity of knowledge to be acquired often leaves the learner standing on the threshold in a state of liminality , rather than stepping into the world of learning.


It is easy to underestimate the problem of liminality. It is described well by Ray Land Land et al. Threshold concepts and transformational learning. We need someone to lead us over the threshold, introduce us to the new ideas, and probably explain some of the language Bernstein Bernstein B. Pedagogy, symbolic control and identity: Theory, research, critique. As we start to build our knowledge and understanding, we need to have some idea of where things fit, how they fit together, and some idea of how the individual pieces are part of a greater whole.

Scaffolding includes programme level organisers, which are dependent on both the content and the context in which it is being learned. Programme organisers include the syllabus, lectures, planned experiential learning and reading lists.

Most commonly, these days scaffolding includes providing learners with a list of intended learning outcomes. It is important to remember that it also includes the induction that students receive when they enter the programme or a new clinical environment. Learning outcomes can be further refined using Bloom's taxonomy Bloom et al. Taxonomy of educational objectives: The classification of educational goals. Handbook I, Cognitive domain. A taxonomy for learning, teaching and assessing: A revision of Bloom's taxonomy of educational objectives.

In Figure 2 , Bloom's taxonomy is shown in the pyramid itself, and Anderson's development of it in the side panels. Bloom's taxonomy, after Atherton Atherton JS , Learning and teaching; Bloom's taxonomy [Online]. Figure 2. Learning outcomes, therefore, should be associated with verbs, rather than lists of things to learn. The difficulty with the model is highlighted by the differences between Bloom and Anderson's model. In reality, the elements of the pyramid are arranged in a cycle. Evaluation leads to developing a new idea which is then applied, analysed, evaluated and so on.

Bloom's original work led to several variants. The pyramid is important, because in training students for the healthcare professions it is essential to remember that the outcome of training is intended to be a graduate who can take their place in the workforce Action. Knowledge is the foundation of the pyramid — but not the pyramid itself. Miller's pyramid after Miller Miller GE. Figure 3. In a structured learning environment new knowledge is sufficiently similar to the existing knowledge to allow its relevance to be perceived. A more challenging condition applies in real life, when the relevance of information is often far from apparent.

The JoHari window, a graphic model of interpersonal awareness. UCLA , Proceedings of the western training laboratory in group development. Figure 4. Two things are immediately apparent from this construction — namely that discussion between individuals will increase the amount of practical knowledge, and that some things remain a mystery until we talk to someone else with a different range of knowledge or understanding.

What is an Adult Learning Theory?

It follows that the more diverse a learning group's membership is, the more likely the individuals within the group are to learn. Before we look at the ways in which we can assist learning, there are two other considerations; both of which relate to the way that the learner thinks about knowledge. The approaches to learning of students in a traditional and in an innovative problem-based medical school. Learning styles and approaches: Implications for medical education. There is a real and active debate about whether learning styles are fixed or flexible, and the extent to which they are determined by the context Coffield et al.

It does seem clear that some learners prefer to work towards a deep understanding of what they are learning; others prefer to acquire the facts, a term known as surface learning. A moment's reflection will show that each can be an appropriate strategy. It is important to know normal blood gas values or electrolyte levels and this surface learning triggers appropriate clinical action. However, to sort out a patient with acidosis requires a deeper understanding of how the various physiological systems interact.

The ability to be strategic about the sort of learning we engage in is important. But it can be affected by the assessment system. So, if an assessment system tests for recall of facts, then the successful learner will employ surface learning.

Andragogy – Adult Learning Theory (Knowles)

If the system rewards deep thought, understanding and reasoning, then the successful learner will aim for that. Recognising the different styles is important, as most lectures will appeal more to surface learners and extended project work will appeal more to deep learners. Some subject material actually needs to be known and rapidly recalled blood gas values, electrolyte levels , while other material needs to be deeply understood to allow appropriate interventions coping with acid base disturbances, or circulatory shock.

Together with this change in focus comes a greater confidence with coping with uncertainty. This work was based on a relatively able, affluent and homogenous population of undergraduates and was subsequently extended by Perry's colleagues to a wider cross section of society. They Belenky et al. Women's ways of knowing: The development of self, voice and mind. Belenky and colleagues also extended the scale beyond receiving and understanding knowledge, to being co-constructors of knowledge Belenky et al. Some recent work by Maudsley Maudsley G. Doctor of Medicine. There are two explanations for this paradox, one is that the learners tend towards more strategic learning styles in order to cope with the demands of the assessment system; the alternative explanation is rather more complex and relates to the business of becoming a new member of the profession.

The process of learning new things is not just about acquiring knowledge surface learning , it includes being able to make sense of it, and hopefully making use of it. But being able to do these things means that you have to acquire an understanding of where things fit. A novice stands at the threshold, not quite knowing what to expect, and sometimes not even knowing what they are supposed to be looking at. This is a state of liminality, and the learner needs to have some threshold concepts so that they can move further Land et al.

Frequently the difficulty is in the vocabulary or the way that language is used Bernstein Bernstein B. Threshold concepts and troublesome knowledge: An introduction. The role of the teacher is to help the learner over the threshold, and, as discussed above, help them until it starts to make sense. If we follow Wenger's arguments Wenger Wenger E. It will be clear by now that there are several different theories about, and approaches to, learning. In the section that follows we introduce a model that encapsulates them and can be used to structure, plan and deliver successful learning experiences.

We propose that there are five stages in the learning experience, which the learner needs to go through. The learner and the teacher will have particular responsibilities at each stage.

We shall outline the model first, describe the responsibilities and then discuss each element in greater detail. All learning starts with the learner's existing knowledge, which will be more or less sophisticated in any given domain Figure 5.

What is Adult Learning Theory?

A proposed model of adult learning. The dissonance phase exists when the learner's existing knowledge is challenged and found to be incomplete. The challenge can be internal, when a learner is thinking things through, or it can be external, provided by a teacher or patient. There are several things that influence whether the learner will engage with the dissonance phase. These include the nature of the task, the available resources, the motivation of the learner, and the learner's stage of development and their preferred learning style.

It ends with the learner reflecting and determining their personal learning outcomes.

9 Tips To Apply Adult Learning Theory to eLearning - eLearning Industry

During the refinement phase, the learner seeks out a number of possible explanations or solutions to a problem elaboration , and through completing tasks, research, reflection and discussion refines the new information into a series of concepts which are, for the learner, new. The organisation phase is where the learner develops or restructures their ideas to account for the increased information they have acquired. There are at least two elements to this: reflection in action, where the learner tests and re-tests hypotheses to makes sense of the information and the organisation of the information into schemata which for the learner, at least make sense.

The feedback phase is arguably the most crucial, as it is where the learner articulates their newly acquired knowledge and tests it against what their peers and teachers believe. The feedback will either reinforce their schema, or oblige the learner to reconsider it in the light of new information. During the consolidation phase the learner reflects upon the process they have undergone, looking back over the learning cycle and identifying what they have learned from it, both in terms of increasing their knowledge base, but also in terms of the learning process itself reflection on action.

During each of these phases, we propose that there are specific roles for teachers and learners. The model that we have given here shows that there are a number of ways in which applying the model can help in the design of learning activities, whether in one-to-one discussions, small group work, seminars or large lectures.

The same principles apply to planning curricula, at short course, module or programme level. Whether working with an individual learner, or planning a major programme, the educator needs to recognise that the learner needs to move through a cycle, in order to truly understand and learn. We also need to be explicit that educator and learner have specific responsibilities at each stage of the learning process.

The key to success as an educator is probably providing the advance organisers. We need to know what we want the learner to learn, and how it fits into the greater scheme. That means that we must have clearly defined outcomes, at the appropriate levels of one of the modifications of Bloom's taxonomy Figure 2. We may need a student to gain new knowledge, apply their knowledge or create a new hypothesis, for instance.