Internal Medicine

Adult Learning

Adult LearningIntroduction

It is now recognised that adult learning differs from the learning of children, and that educational programmes for adult learners have to be based on a different set of premises. In particular, the conventional “classroom” and its activities are frequently inappropriate for adult learners.

Priniciples of Adult Learning

As set forth by Malcom Knowles, adult learning differs from children’s learning in that it explicitly recognises that adults:

1. Are autonomous and self-directed. Teachers must actively involve adult participants in the learning process and guide participants to their own knowledge rather than supplying them with facts.

2. Have prior experience and knowledge. They need to connect learning to this knowledge/experience base. This is particularly relevant to our registrars.

3. Are goal-oriented. The adult learner has a clear idea why he or she wishes to learn something -in the case of a registrar, so that he or she can manage their patients more confidently, pass a professional exam, and become a specialist physician. Learning has to be clearly important to reaching this goal to be of value to them.

4. Are relevance-oriented. Learning has to be applicable to their work to be of value to them. Though some will enjoy learning for the sake of learning, many will find this boring or frustrating.

5. Are practical, focusing on the aspects of a lesson most useful to them in their work.

6. Need to be shown respect. Our registrars in particular are both biologically and socially adult: thy leave work at the end of the day to take up the role of husband, wife, father, mother. They respond poorly to any form of patronisation or adult-child transaction.

Adapted from: Lieb S.


Andragogy (adult education), as opposed to pedagogy (child education, is learning theory specifically for adults. It emphasizes process more than content and makes the following assumptions about the design of learning:

1. Adults need to know why they need to learn something.

2. Adults need to learn experientially.

3. Adults approach learning as problem-solving.

4. Adults learn best when the topic is of immediate value.

These principles are directly relevant to our teaching. Clearly the best time for a registrar to learn about a complex subject like the interpretation of arrhythmias on ECG is when he or she is working in the cardiac unit, and not as arbitrarily rostered as part of a learning programme for the first Wednesday in May, a time when he or she happens to be rotating through Nephrology. In contrast, while working in the cardiac unit:

  • The practical significance of the learning is immediately clear. (The registrar may well have encountered such an ECG in the CCU that same week.)
  • Learning to recognise the ECG while actually trying to save a life in the CCU is true experiential learning, and the experience is unlikely to be forgotten.
  • It is clearly a form of problem-solving.
  • It is clearly of immediate value.
© R J Hift

Proceed to Active learning