Is adult learning theory enough?

For the past 20 years the professional guild of healthcare educators has been increasingly leveraging adult learning theory in the development of content and in the delivery of content to clinician learners. And every few years a meta-analysis is published exploring the impact of this education on knowledge change or attitudes or skills development.  And while there is little doubt that progress has been made, there remains this persistent reality that healthcare professional education is far from perfect, that despite what appear to be short-term advances in understanding and confidence, these changes rarely lead to the sustained ‘rapid learning healthcare system’ that is so desperately needed. This begs the question, why is knowledge transfer and knowledge translation so challenging in healthcare? And, what is missing from these educational programs that prevents them from driving broad scale and meaningful change?

These questions have bothered me for some time – without answers it seems that the profession of healthcare educators will continue to employ the same models, leveraging the same adult learning theory time after time after time again, without understanding what is missing. By all accounts, this is the definition of insanity…

Over the past 8-12 months we have spent a lot of time exploring these questions, but we have framed our exploration around a rather contradictory hypothesis: Instead of assuming the secret lies in the currently recognized adult learning theory, we began by assuming that these theories in and of themselves ARE NOT sufficient to drive learning. That is not to say that they are not important, simply to say that something else is needed.

This lead to our deconstruction of the learning process itself – what do clinician learners do as they receive the educational content being developed and delivered by healthcare educators?

And in brief, here is what we found:

Clinicians learners acknowledge that there are a distinct set of actions that they must take to ensure that medical education is successful. When these actions are efficiently and effectively taken learners describe their participation in medical education activities as being among ‘the most memorable learning experiences of their careers.’ But, when learners struggle to employ these learning  actions they describe their participation in medical education activities as being ‘hit or miss at best.’ This preliminary research suggests that without an adequate structure to support the ‘natural learning actions’ clinician learners are unable to learn effectively and instead are forced to take away one or two nuggets of information, ignoring 80-90% of the content that is available. And this, it seems, is the norm, not the exception.

Over the coming weeks we will be rolling out the next stages of our research program, we will be studying how clinicians leverage their learning actions in different settings, and we will be exploring whether different subsets of clinicians leverage different learning actions in different ways. These data will be collected from a number of continuing educational initiatives that we will be launching with our partner groups, and these data will be collected in partnership with several leading Academic Medical Centers, Medical Schools, and Medical Societies who have agreed to conduct more controlled studies in both the undergraduate and post-graduate settings and with different clinical disciplines.As an educator, this is truly frustrating and it is hard to look past the missed opportunities, but it is also very exciting – with this new understanding of what is needed we have begun to redefine the roles and obligations of the educator. It is no longer acceptable to develop, package, and deliver content to learners absent of a supportive structure that ensures the learning actions are effectively employed. Being an educator is more than understanding needs and creating content. Being an educator is more than providing lip service to the adult learning theory.

While there is little doubt that medical education is an essential element in the quality of healthcare both in the US and abroad, there is also very little doubt that our existing medical education models are far from having the impact that is needed. Our goal is to take a novel and evidence-based approach to this challenge. Our ask is that you think through how these new lessons might be applied in your setting and in you programs and that you remain open to the reality that the adult learning theories we have leveraged for decades, may not be enough to drive sustainable, critical learning and change.