1.5.1 Development of knowledge, skills, attitudes and values
This section focuses on knowledge, skill, attitude and value acquisition in adult learners.
Malcolm Knowles, an American educationalist, laid the foundations upon which adult learning may take place and coined the term ‘androgogy’ to describe this (Knowles, 1988). He stated that as a person develops they move from being dependent to self-directed, growing an increasing wealth of experience upon which they learn. An individual will also move from being subject-centred to problem-centred. Motivation to learn becomes increasingly internal, but individuals must be able to see the relevance of their learning to their practice (Knowles, 1988). Teaching and learning today is still based upon the key principles advocated by Knowles such as the need for learners to be involved in the planning and evaluation of teaching and the value of experience in driving learning.
Students learn in different ways. There is no individual theory that explains how healthcare professional students learn however the literature outlines a number of theories which may play a part including the behaviourist
(Thorndike, 1911; Skinner 1954) and cognitive theory (Piaget, 1952; Bruner, 1966; Ausubel 1968).
In a behaviourist paradigm learning is said to be “any more or less
permanent change in behavior which is the result of experience” (Jarvis et al, 2003). The emphasis is clearly on behavioural outcomes associated with learning. While previously favoured, it does not acknowledge the
in its approach. The main criticism being that ‘human beings are… more complex than just the sum of their behaviours’ (Jarvis et al, 2003).
Cognitive theories differ from behaviourist theory depending on the
perspective of the theorist. Piaget (1929) based his work on small groups of young learners and recognised a relationship between stage of cognitive development and learning. In doing so he stated that with a child’s age grows the ability to conceptualise, though he acknowledges this is a continuous process his detailed writings cease at age 15 (Jarvis et al, 2003). Kohlberg (1986) perceived this notion to be too simplistic and expanded on this work by suggesting modes of thought are mixed in moral development, hence not entirely age related.
Other theories were also considered. Humanistic theories which focus on self-actualisation and self-direction in learning have been described (Durning and Artino, 2011) while transformative theory explores how critical reflection can be used to challenge learners beliefs and constructions (Mezirow, 1978, 1990, 1995), however it is argued that this does not recognise the impact of context and social factors on professional education.
Constructivist theory forms the basis of curriculum development, learning and teaching strategies, assessment and programme evaluation in medical education (Taylor and Hamdy, 2013) as well as other related subjects including pharmacy. Through constructivism the teacher is viewed as a facilitator to learning rather than someone who provides knowledge (Kaufman, 2003). It also assumes the stance that for things to be learned enough time must be given for experiences to be held and examined (Kaufman, 2003).
Social constructivists (Vygotsky, 1978) focus on the way the community supports learning. Schon’s (1987) communities of practice theory describes this. Learning is said to be a byproduct of working in a community as
opposed to being deliberate, and is a result of social interaction (Lave and Wenger, 1991). Learners become a member of the community through professional socialisation (Taylor and Hamdy, 2013) and move towards the centre of the community as they learn through a process known as ‘legitiate peripheral participation’ (Lave and Wenger, 1991). Meaningful learning is said to occur when connections can be made between new and existing information (Regan-Smith et al 1994). This is in line with the theory of subsumption (Ausubel, 1968), which considers how individuals consolidate material through integrating new with previous knowledge. Educators can assist in this process by providing the ‘scaffolding’ upon which constructions can be made (Ausubel, 1968). Through learning with individuals discussions will occur which increase the amount of practical knowledge a learner has. It is said that some things remain a mystery until we speak with someone with a different range of knowledge or understanding. The more diverse a
learning group’s membership the more likely the individual is to learn (Luft and Ingham, 1955).
Mukhalalati and Taylor (2018) describe how Duncan-Hewitt and Austin (2005) were some of the first to propose a restructure of pharmacy education based on communities of practice theory, whereby ‘students, residents, practitioners and faculty members work together and learn from each other” (Mukhalalati and Taylor, 2018). Mukhalalati and Taylor go on to describe a communities of practice framework developed through literature review, which can be used to inform the design of healthcare education programmes (Mukhalalati and Taylor, 2018).
1.5.2 Situated learning
Constructivist theory supports the need for learners to be positioned in the environment in which their learning is to be applied (Lave and Wenger, 1991). Shulman states that knowledge is not professional knowledge until it is “enacted in the crucible of the field. Professions are ultimately about
entry into practice (Shulman, 1998). Shulman’s view is consistent with the recent recommendations made for the enhancement to the initial education and training of pharmacists (Smith and Darracott, 2011). Through
experiential learning educators draw upon experiences to facilitate learning. Its relevance in medical education is widely acknowledged and focuses on developing competencies in specific contexts (Yardley et al, 2012). Artemeva et al (2017) describe how two types of situated learning inform and support each other in medical education, these include legitimate peripheral
participation and guided participation. Through the former the focus is on the learner working on essential but “lower-stakes” tasks, contributing to the “overall activity” whereas the latter has emphasis on tasks “intentionally designed by instructors to facilitate learning and assistance provided by instructor to leaners so the latter build the knowledge and skills necessary to perform the task more independently next time” (Artemeva et al, 2017).