MEDICAL EDUCATION

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Notes for the Primary Care Teachers
HOW DO ADULTS LEARN?

SK Kwa FRACGP, FAFPM
International Medical University, Seremban, Malaysia

Address for correspondence: Assoc Prof Kwa Siew Kim, International Medical University, Jalan Rasah, 70300 Seremban, Malaysia. Tel: 06-7677798, Fax: 06-7677709, Email: siewkim_kwa@imu.edu.my
Kwa SK. How do adults learn? Malaysian Family Physician. 2007;2(1):25-26

Introduction
It is the professional responsibility of Family Doctors to train the next generation of physicians. This can be daunting to novice mentors because until recently, learning how to teach has never been in the medical curriculum. The problem is made more challenging when the learners are adults. In order to be an effective mentor, you will have to thoroughly understand your learners. This paper aims to provide information on the special characteristics of adult learners and its implications on teaching-learning.¹ The term “andragogy” was first introduced by the educationist Malcolm Knowles who defined it as the “art and science of helping adults to learn”. Box 1 lists the special characteristics on which the principles of adult learning are based. ²

Box 1: Special characteristics of adult learners

CHARACTERISTICS OF ADULT LEARNERS

Independent and self-directed

Adult learners are independent and self-directed and will decide on what they want to learn. Unfortunately, when placed in a learning environment some immediately revert back to their traditional pedagogical roots of passive dependency and expect ‘spoon feeding’ from the teacher.  This paradox prevents them from acquiring lifelong learning3. The solution is to teach them how to “fish” by applying modern learner-centred approaches (problem based learning, outcome based learning, guided discovery learning) and teaching them how to source for learning materials.^2,3 Keeping a portfolio can identify knowledge and skills gaps and assist in monitoring progress of their continuing professional development.  Adult learners, with the guidance of the mentor, can prepare a curriculum based on their own learning needs.

Self-motivated
Motivation to learn comes from extrinsic and intrinsic factors for children but adults are usually self-motivated. They learn because they want to. Offering rewards may not work with adult learners but recognising their values, respecting their opinions and being concerned will increase learner’s self esteem and sense of belonging. Mentor’s clear directions, enthusiasm for the subject, role modeling and rapport with mentees all support learning.⁴

Possess vast experiential learning
Adult learners come with a wealth of experiential learning. The good mentor should recognise this and build on it to promote new learning. These vast experiences can be drawn upon to provide peer to peer learning which is as powerful as learning from the teacher alone. Teaching-learning with adults is rewarding and stimulating for the mentor as a two-way traffic for sharing exists. However, previous learning can pose an obstacle to adult learning. The adage, ‘it is difficult to teach old dogs new tricks’ still holds true for adults who have difficulty “unlearning” what have been superseded by current evidence-based data.

Learning that can be immediately applied to their daily work
Adult learners prefer learning that can be immediately applied to their daily work. Family doctors may not be interested in learning the evolution theory but will prefer to learn how to start insulin therapy.

Relevant problem-based specific topics

Time is a precious commodity due to the competing demands from family and work. Hence adult learners are not interested in mere information gathering but would prefer specific problem based topics that are relevant to their needs. The General Practitioner with a large paediatric patient base will not be interested in learning broad topics like the history of medicine but will be keen to learn how to recognize Kawasaki disease. Adult learners learn best by focusing on problem-solving.  This method of delivery is the basis for problem-based and task-based learning, now adopted by most medical schools to promote life-long learning.³