Images in Academic Medicine

Learning process and how adults learn

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Ravi Prakash, Neha Sharma1, Uma Advani1

Department of Medicine, SMS Medical College and Hospital, 1Department of Pharmacology, SMS Medical College,
Jaipur, Rajasthan, India
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Abstract Learning is a process of changing behavior of learner. Teaching–learning process lasts the entire life span
of each individual. Adult education is the intentional systematic process of teaching and learning by which
person who occupies adult role acquires new value, attitude, knowledge, skill, and discipline. Art and
science of helping adults in learning is called andragogy. Adult learners are autonomous, self‑directed,
reluctant to learn new things, and they focus mainly on immediate implementation of knowledge. The
theories to explain adult learning are conditioning theory, theory of connectionism, and cognitive theory.
Adult learning knowledge in medical education helps to keep update for recent advances in different fields.
To improve teaching–learning, the principles of adult learning should be applied like active involvement
of learner by allowing debate and challenge of ideas using audience response system technique. The adult
learner should always be motivated and reinforced by positive feedback. Adults are usually goal oriented;
so, we should always relate learning to participant’s goal.
The following core competencies are addressed in this article: Medical knowledge, Practice-based learning
and improvement, Professionalism, Systems-based practice.

Keywords: Adult learning theories, andragogy, principles of adult learning

Address for correspondence:

Dr. Uma Advani, Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan, India.
E‑mail: [email protected]
Received: 27.08.2018, Accepted: 10.12.2018

INTRODUCTION acquire, renew, upgrade, or complete knowledge, skill,

and attitude for functioning effectively in a constantly
Learning is a process of changing behavior of learner. changing science.[2] “A teacher can never truly teach,
Learning results in some modification, relatively unless he is still learning himself.” For a medical
permanent change in the way of thinking, feeling, and teacher, learning is a lifelong commitment. Dynamic
doing of the learner. Learning can be both an emotional status of medical knowledge today is to keep update
and intellectual process.[1] Teaching–learning process
for recent advances in different fields like to gain
lasts the entire life span of each individual. There are
hands‑on experience in various advancing techniques,
some basic differences between children and adult
for example, laparoscopic surgery, laser surgery, and
learning process. Adult learning allows an adult to
in vitro fertilization techniques.[3]

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DOI:
10.4103/IJAM.IJAM_41_18 How to cite this article: Prakash R, Sharma N, Advani U. Learning process
and how adults learn. Int J Acad Med 2019;5:75-9.

© 2019 International Journal of Academic Medicine | Published by Wolters Kluwer - Medknow 75

 Prakash, et al.: Adult learning

In medical education, the plenty of attention given Table 1: Difference between pedagogy and andragogy
to “what is said” but often little consideration is Pedagogy Andragogy
given to “how it is said.” The purpose of teaching is It is identified as art and science
Art and science of helping adults in
of teaching children learning
not mere dispensing of information but to develop It is formal and value learning It is co‑operative and value learning
learning habits.[2] Medical educators must be aware of that is put on them that is relevant in everyday life
Learners are dependent and Learners are independent of
several assumptions about adult learners. They must directed by dictation of teachers and teacher acts as a
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understand that adults learn differently than children teachers facilitator, who aids adults to
and that individual differences in learning style should become self‑directed learners
Learners are intrinsically Learners are intrinsically motivated
be seen not as an obstacle but as an opportunity while motivated through grades as motivation extrinsically is
designing programs for adult learners.[4] Evaluation is external by difficult. Evaluation is mainly by
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teachers with tests self‑assessment

Limited teaching as learners are Limitless teaching as learners have
There are different categories of adult learners such inexperienced own experience which can be
as (1) self‑directed learners: they plan, conduct, and used as a resource
assess their own learning, (2) goal‑oriented learners: Usually 50 min lecture modality Learning modalities specify
is used to cover teaching outcome, in addition to theoretical
on enrolling in a course, usually they know what goal material, mainly theoretical knowledge, practical application
they want to attain, (3) activity‑oriented learners: knowledge is given and problem‑solving exercises are
also given
they learn more readily with various activities, Learning is cumulative and linear Learning is nested and interactive
and (4) learning‑oriented learners: they must see a with transfer of knowledge with construction of knowledge
reason for learning something; learning has to be from faculty to students and skills
applicable to their work or other responsibilities to
be of value to them.[5,6] of knowledge. For example, medical student should
be encouraged to participate in debate, questioning,
ADULT LEARNING
case solution, and seminar presentation and set the
basis for research activities. Many educators and
Adult education is the intentional systematic process of
psychologists have contributed to the development of
teaching and learning by which person who occupies
various theories to explain the processes of the human
adult role acquires new values, attitude, knowledge,
mind.[10,11] Are they correct? May be partly. Then why
skill, and discipline. “Pedagogy” and “andragogy,”
use them? Because they provide a structure that helps
both these words are derived from Greek words.
us to understand how to teach and glues together the
“Peds” from “paid” meaning “child” and “agogus”
episodes of learning.
meaning “leader of.” “Andra” means “man” not
“boy.”[4] Andragogy means the explanation of adults, THEORIES OF ADULT LEARNING
motivation and disposition to learning.[7] There are
differences in teaching–learning process in children Conditioning theories
and adults. The characteristic data obtained as a result It explains learning process in terms of stimuli
from various researchers[4‑7] have been summarized and response. Any event a person can perceive is
in Table 1. called as a stimulus and the reaction of a person is
called as response. Operant conditioning involves
CHARACTERISTICS OF ADULT LEARNERS reinforcement of a spontaneously emitted response
or behavior. For example, in a class, if a student
Adult learners are autonomous, self‑directed, and emits correct response (operant) to an open query,
always expect respect and equal status. “The difficulty reinforcement occurs if teacher rewards him/her by
lies not so much in developing new ideas as in escaping a smile or a nod or by appreciation words. Similarly,
from old ones.” They focus mainly on immediate undesirable operant like making noise in the class
implementation of knowledge and are reluctant to can be negatively reinforced by the teacher. Thus,
learn new things.[8] It is wrong to presume that all desirable behavior can be selectively strengthened
the information transmitted to the students are always and undesirable behavior can be selectively weakened.
learnt and since that does not happen, a lot more
information is to be transmitted so that something will Theory of connectionism (Thorndike)
be learnt.[9] Adult has a deep need to be self‑directed; It explains learning in terms of the formation and
the teacher therefore engages in inquiry with student strengthening of bonds or neural connections between
to awaken interest rather than searing as an oracle stimuli and responders, with the following four laws:

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 Prakash, et al.: Adult learning

a. Law of readiness: Stimuli response bond is ready process.[15] It can be done by small group discussion or
to act and gives satisfaction. If do not act, it causes by interactivity in large group. Encourage participants
annoyance to be resources to you and to each other.
b. Law of exercise: Exercise strengthens learning (law
of use) while lack of exercise weakens a learning (law Feedback
of disuse) Establish a climate which is conducive to feedback,
could stop twice in the lecture, and ask questions to
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c. Law of effect: Learning is stamped in if the effect

is satisfying while learning is stamped out if effect discuss response. Training should be designed in such
or outcome is annoying a way that it covers approximately one‑third part to
d. Law of belongingness: Inter‑related acts are learnt presentation and two‑third part to application and
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more easily than a collection of unrelated acts. In feedback. The use of audience response system (ARS)
medical education, integrated modular learning will technology can be an effective teaching tool that
be more useful by explaining topic all points of view. encourages active learning in a lecture format. ARS
lecture format can increase knowledge gained from
Field/cognitive theory lectures.[16,17]
Learning is not simply an addition to existing complex
pattern or cognitive structure in mind, but it is Rebound effect of evaluation
reconstructing of existing pattern or cognitive field to Students usually learn for the sake of examinations.
make it better organized: more meaningful and clearer. Therefore, regular tests or objective‑structured
questions or quiz can be used for better learning by
Learning modules asking questions on what we want them to learn.[18,19]
Various teaching–learning modules have been described;
these help in building up of concepts and understanding Learning modalities
of lesson. Inquiry training model uses steps of scientific Learning is composed of multiple sensory and
problem solving for learning and understanding a topic. intellectual inputs such as sound, sight, and smell.
In medical education, physicians of tomorrow are Some individuals learn better orally, some visually,
taught by teachers of today with curricula of yesterday. some kinesthetically, and some by combinations.
It is better to manage change than to manage inertia. Learning begins with a new experience which may
Computer‑assisted learning and the integration of be by seeing, touching, tasting, smelling, hearing, or
e‑learning into medical education can catalyze the shift feeling. More effective the learning experience (also
toward applying adult learning theory.[12,13] depends on teacher), the better is the learning.

PRINCIPLES OF ADULT LEARNING The stimulation of sensory receptors will influence

learning. Based on this, different types of learners
To improve teaching–learning, it should be made have been identified such as (1) visual learners:
active by applying principles of adult learning.[14] It is they prefer print material, learn best by reading or
like “A Beacon in the Night,” as it provides guidance responding to visual cues such as chalkboard/overhead
to medical educators. transparencies, (2) auditory learners: they prefer
listening, lecturing works best for them, (3) tactile
Relevance
learners: they like to manipulate objects, laboratory
Learning is better with subject matters of immediate
or hands‑on methods are most appropriate for them,
relevance. If it is for long‑term goal, students should
and (4) kinesthetic learners: like to learn through
be properly motivated.
experiential activities; they prefer simulations,
Keep it interesting exploratory activities, and problem‑solving.A
Complex matter should be made simple using suitable simulator and the simulated clinical experiences
examples and anecdotes and by making it learner provide the opportunity to meet the needs of learners
centered: contextual with use of more photos, images, like multiple objectives with multiple learners.
or videos. Retention improves as students see the results of
their actions. Experiential learning gives time to
Active involvement facilitate critical thinking, diagnostic reasoning, and
There should be active involvement of the learner; problem‑solving.[20,21] Studies show that varying study
he/she should be active contributor to the educational methods and materials will improve retention and

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 Prakash, et al.: Adult learning

recall of information and enhance learning experience. involvement of learners and degree of initial learning.
The “learning pyramid,” sometimes referred to as More easily if learners can relate it to their past
the “cone of learning,” developed by the National experiences, they are sequential learners. As per saying
Training Laboratory, suggests that most students “You cannot pour fresh tea in a cup full of stale tea,”
only remember about 10% of what they read from the application of knowledge depends on factors such
textbooks but retain nearly 90% of what they learn as association with known information, its similarity,
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through teaching others. The learning pyramid model and degree of original learning.
suggests that some methods of study are more effective
than others and that varying study methods will lead Reinforcement
to deeper learning and long‑term retention. People Positive reinforcement is done by encouraging
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generally remember 10% of what they read, 20% of correct mode of behavior and performance. It can be
what they hear, 30% of what they see, 50% of what given in the form of effective feedback by peers and
they hear and see, 70% of what they say, and 90% of encouraging participation and teacher.[30] In case of
what they say as they do a thing. Hence, there is no negative reinforcement, we have to be careful; it should
doubt that technical devices have greater impact and be restricted to formative assessment results only.
dynamic informative system.[22,23]
Transference
Hear it, see it, say it, do it, and teach others to improve Ability to use information, its implementation, and
retention. There is more effective retention if more application of knowledge is transference. Hence, first
than one training method is used[24‑26] as shown in remember, then understand, and at the end, apply the
Table 2. learnt knowledge.

COMPONENTS OF LEARNING CONCLUSION

Important components of learning are motivation, Good teaching–learning practices should be followed
reinforcements, retention, and transference.[27‑29] whether teaching is conducted in the classroom,
clinic, or hospital. It requires time: time to instruct,
Motivation observe, and assess the students and also time for
Good eye contact, smiles, and active listening skills self‑reflection and time for our own professional
such as nodding always help to motivate students. development. Purpose of teaching is not mere passing
In addition, certification by reputed or recognized on information but develop lifelong learning habit
authority and promotion or admission to higher making it an enjoyable process. Encourage participants
studies will motivate adult learners. Like saying “You to be resources to faculty and to each other. Allow
can lead the horse to water but you cannot make debate, questioning, and challenge of ideas in adult
him drink,” a good motivator can produce thirst in learning. Relate learning to participant’s goal with
learners. Use of role models by medical educators has active involvement of adult learners.
a major impact on learners. Mediocre teacher tells,
good teacher explains, superior teacher illustrates Financial support and sponsorship
while exceptional teacher inspires. Nil.

Retention Conflicts of interest

The greater the number of inputs attached to a There are no conflicts of interest.
particular idea, the greater the retention of the
Ethical conduct of research
information. Factors which affect retention are active
Not applicable - This is a review article.
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