Andragogy

In the book The Adult Learner by Knowles, Holton III, and Swanson (2015), the theory of andragogy is proposed and explained. Pedagogy, or the way children are taught and how they learn, is described first. Pedagogy is based on the assumption that the teacher is the instiller of knowledge and that children are the receivers. The teacher is the single responsible party for education. The authors state that teachers of children must thoroughly understand how children learn and what techniques are necessary for them to get the most out of their education. Knowles et al. (2015) felt that expertise, though a different kind, is required when teaching adults as well. The teacher assumes the role of facilitator and provides a safe environment for adult learners to participate in more active, self-directed learning.

Knowles et al. (2015) six primary assumptions include the following:

The need to know: The teacher determines what children need to know, but adults are used to making their own decisions, prioritizing their goals, and determining what is the best use of their time. To have adults “buy-in” to education, they need to know what will be taught, why it is essential, and how it will benefit them in their daily life. On the flip side, they need to understand the ways they will be disadvantaged if they do not learn the content or skill (Knowles et al., 2015). Like most adult activities, learning is most successful for adults if they are encouraged to share in choosing which learning strategies will be utilized.

Adults have experience: Children come to a classroom with a lack of life experiences, and they must be assisted in learning how to file or consolidate the new material they learn. Careful scaffolding must be supplied by the teacher to allow the student to progress. Knowles et al. (2015) contrast this with adults who have a lifetime of experience. By its nature, this leads to much greater heterogeneity in the adult classroom. Knowles et al. (2015) said that effective adult learning requires the ability to tap into these experiences as a resource and make learning an experience in itself. A lifetime of expertise contributes to an adult’s self-concept. The authors feel that ignoring this expertise devalues the adult learner. Adult learners may not need careful scaffolding of knowledge. They can consolidate or make mental models and file information with their lifetime of experiences (Knowles et al., 2015).

The learner’s self-concept: Knowles et al. (2015) point out that adults have developed the ability and responsibility to make their own decisions, which leads to their autonomy. This ability to make decisions and the consequences of the choices they make lead to their developing self-concept. To have another tell them what they need to learn and how they would learn it best is antithetic to this. According to Knowles et al. (2015), sometimes adults are used to the learning experiences being what they remember from grade school, and frequently they will assume the passive role of “learner.” Helping adults understand that they need to apply the same decision-making abilities that they use in their life to their education helps them move from dependent to self-directed learners (Knowles et al., 2015). On the flip side, denying a self-directed adult the ability to make decisions on how they learn best will thwart learning as well.

Readiness to learn: Knowles et al. (2015) stress that the learning experience is the richest and most beneficial for an adult when it is timed, when an adult is ready to learn it. Adults understand that knowledge can be powerful and can help them in their social and work life. For this reason, they are more inclined to participate in learning that contributes to their personal or work goals. Pratt (1988) provided a model explaining why adults may be comfortable and self-directed in their learning in one circumstance, but require direction and support in another.

Orientation to learning: Knowles et al. (2015) feel that adults want to learn how to complete a task or to solve a problem instead of learning organized by subjects. In addition to timing the learning well, it needs to be practical and to have real-life applications. Studies have shown that people learn math concepts best when they are taught in terms of everyday math problems, and language is best absorbed if the learner is taught the words that they will need in their daily life (Knowles et al., 2015).

Motivation to learn: Knowles et al. (2015) say that adults can be motivated to learn something from a motivator outside of themselves, but the most influential motivators are internal. Concepts like improving self-esteem, quality of life, and job satisfaction are strong motivators for adults. Putting andragogy into practice requires preparation, though a different kind than teaching children. Adult learners must be told what they can be expected to learn, as well as realistic expectations of how they will learn the content and then apply it.

Andragogy in Practice

Knowles et al. (2015) stress that a climate must be collaborative, respectful, and warm. Adults must be welcomed into learning and must feel that they are safe. Adults learn best if they are motivated to learn, and the content is timely and applicable to real life. To develop the content, the learner and instructor should collaborate on what needs to be taught, the needs to be addressed, and the objectives of the course. Learning activities must be active, experiential, and logically sequenced. Finally, the course must be evaluated by both the instructor and the learners on how well it meets the learner’s needs.

If learning for adults is structured in this way, it can lead to better retention as well as completion rates for adult classes. If instructors structure a lesson as a collaborative experience and assume the role of co-learners seeking feedback and encouraging two-way communication, they are more likely to be successful as an instructor (Knowles et al., 2015).

Applying the Principles to Giving Feedback

Need to know: Medical students need to understand how to provide and receive feedback. On a recent survey completed by both faculty and students, the ability to give and receive feedback was one of the top learning goals identified. Students need to understand how to provide appropriate feedback to their instructors, realize that receiving feedback is how they will grow in their clinical skills, and learn effective decision-making skills.

The student’s evaluations, which strongly contribute to their success or failure at obtaining the residency of their choice in the specialty they desire, depending on their ability to evaluate and learn from feedback successfully. Explaining to the medical students how faculty and students contributed to choosing the topic will help get buy-in for participation. Students are told that it was a mutual decision on what objectives were selected, and careful consideration was made that they are relevant and essential to their medical student career.

Learner’s self-concept: Medical students are adult learners. They are responsible for their own lives and learning. Their patients will depend on their medical knowledge and clinical decision-making skills. They are autonomous and feel comfortable that they know what they need to learn. Ask students to think of a previous experience where their inability to give or receive feedback effectively was detrimental to their home or work life. This question will help them see why it is essential for them to learn more about feedback, its purposes, communication styles, and under what terms feedback should be given.

Role of learner’s experience: We have all received feedback throughout our life. We have a wealth of knowledge to draw on when considering when feedback was given effectively and when it failed miserably. Case studies are used for students to draw on their experiences, incorporate their new knowledge, and evaluate how they will give feedback in the case study scenario. An assessment at the end of the training video will review the technique so that all learners are prepared to participate in the case studies.

Readiness to learn: Students have been provided feedback in the way of grades throughout their educational careers. This practice continues through medical school. The need to score high on their exams as well as have excellent clinical skills summaries motivate students to learn how to both give and receive feedback well. A student who is resistant to feedback and does not want to improve or change or one that provides inappropriate feedback to their preceptors will not only run the risk of scoring low on their clinical assessments but also be a danger to patients.

Orientation to learning: Explaining the strong correlation between improvement in their clinical skills and their clerkship comments or evaluations and then subsequently their Medical School Performance Evaluation should provide a strong external incentive to want to learn how to give and receive feedback effectively. The desire to improve communication skills, deliver bad news, and encourage growth and change in their future patients will provide internal motivation to learn how to provide feedback in a way that strengthens relationships.