Paradigma de Deporte

Adult learning is defined as “the process of adults gaining knowledge and expertise” (Knowles, Holton, & Swanson, 2015, p. 157). All decisions regarding the curriculum, teaching and assessments are significantly influenced by learning perspectives (Mann, 2002), and curriculum experts in tertiary institutions will often examine how adults learn when creating or developing learning outcomes for a course.

There is no single theory that can be applied to adult learning. Instead, multiple learning models have been discussed in the literature to identify how adults acquire

knowledge and how educators can help adult learners achieve the best outcomes from their practice. According to Bennett, Blanchard and Hinchey (2012), “adult learning theory is a complex phenomenon” (p. 129) comprising an interconnected set of learning models to address how adult learners gain knowledge. Although several learning

models are discussed in the literature, those of andragogy, self-directed learning and workplace-based learning will be discussed in the corresponding sections.

Andragogy

Leading theorist Malcolm Knowles (1980) is renowned for distinguishing the adult learner from the child learner. His andragogy theory, which is defined as the “art and science of helping adults learn” (Knowles et al., 2015, p. 40), outlines six

foundational principles through which adults learn. This theory is differentiated from that of pedagogy, which is defined as “the art and science of teaching children” (Knowles et al., 2015, p. 19). Although pedagogical assumptions are teacher-directed and based on the learner being dependent on the teacher—that is, learning only what the teacher teaches—assumptions about adult learners include need to know (learners must understand why they need to learn something to invest full energy into learning); self- concept (learners become increasingly self-directed and take responsibility and control for their life and learning); life experience (learners use their life experiences to aid their learning); willingness to learn (upon assuming a new life or social role, learners are ready to learn from real-world problems); orientation to learn (learners are problem- centred and contextualise their learning using real-world or simulated problems to apply that learning effectively and immediately); and motivation to learn (learners are

motivated by internal factors such as increased job satisfaction, self-esteem and quality of life) (Knowles et al., 2015). The authors further lament that theories of learning are only useful if they are applied in some way to facilitate learning.

According to the principles of andragogy, for educators to instil effective learning, effective teaching practices should be developed and enforced. Therefore, as the facilitators of learning, instructors and teachers should inform and clarify for adult learners why the content taught is necessary, and how the skills obtained through such learning can benefit learners in the workplace. The pre-clinical anatomy curriculum seeks to do this by planning and implementing clinically relevant teaching sessions such as tutorials, surface anatomy and imaging. Additionally, if learning outcomes and learning tasks are consolidated through practice while incorporating real-world problems (such as in PBL, case-based teaching, clinical settings and even clinically relevant assessments) rather than through memorisation, it would enrich students’ learning experiences and increase their participation, willingness and motivation to learn. This might in turn affect the learning approach used by adults, and subsequently their knowledge retention.

Self-directed Learning

As described by Knowles (1975), self-directed learning is a process:

…in which individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes. (p. 18)

Self-directed learners engage in self-teaching, which is an informal process that takes place outside the classroom setting and involves “taking control of the mechanics and techniques of teaching themselves” (Knowles et al., 2015, p. 171). In addition, a level of personal autonomy develops as a result of self-directed learning (SDL). This involves learners taking control of their own learning, including establishing the purpose and goals of learning (Knowles et al., 2015). It is important to note that not all

learners possess good SDL skills; in such individuals, learning in an environment that is highly dependent on SDL can make them feel frustrated and intimidated. Similarly, not all self-directed learners can be autonomous, as is the case when teaching and the curriculum are highly structured and controlled. Therefore, self-teaching and autonomy are independent of each other, and possessing one form does not necessarily translate into possession of the other.

SDL has been widely incorporated into medical education—particularly with the introduction of blended learning models such as the flipped classroom and TBL. This is considered beneficial to helping learners recognise the importance of self-study— particularly as they move from the classroom setting to the real world, where formal teaching is absent or not as prevalent, and where lifelong learning is considered an essential skill. Adult learners must learn to develop such skills by incorporating SDL into their daily regime using their own learning preferences. SDL forms a large part of the PBL-style curriculum in the graduate-entry Monash program, and this study will explore whether students are successful in learning independently of formal instruction. The reason for incorporating SDL into the program is to prepare students for the clinical years. SDL is a large component of adult learning in the workplace, as formal modes of instruction are replaced by adults assuming responsibility for their own learning. This is both an intrinsic and extrinsic process because learners develop a professional identity and workplaces impose criteria that require initiative and autonomous effort.

Workplace-based Learning Theories

All individuals are in a phase of constant learning that is neither restricted nor enhanced by intentional or educational means, and their everyday thoughts, actions and interactions with their environment shape what they learn. Therefore, workplace-based learning theories help educators to understand how and where learning takes place.

Although many people associate learning with knowledge that has been gained mainly through formal education and training, and they regard working and learning as two separate and non-intersecting activities, many leading theorists in this area, including Stephen Billet and Michael Eraut, have observed the opposite—that is, on-the-job learning is an essential component of adults’ overall learning experience (Eraut, 2004).

Learning occurs through active participation in the workplace, where learning and participation are inseparable (Billet, 2001). This is similar to situated learning theory. Students occupy the periphery of a community in the pre-clinical years and then move towards the centre of the community in the clinical years as they acquire and develop more knowledge and experience and contribute as active and useful members of society (Lave & Wagner, 1991). As students become engaged in communities of practice, the workplace and the learner play an equal role in enhancing learning (Billett, 2001). Learning takes place when learners actively seek and engage with opportunities that are available in the workplace. Further, workplaces (e.g., clinical settings) that have a particular physical and social environment enhance adult learning by offering a

supportive atmosphere that not only engages learners, but also encourages participation. According to Billett (2016):

their occupationally authentic goal-directed activities and interactions grant access to and assist in securing the kinds of knowledge required for effective health care work, in ways that classroom-based experiences alone cannot. (p. 125)

A unique feature of the Monash graduate 1 + 3 curriculum is that students have three years of clinical ‘on-the-job’ training through which they can acquire, build and perfect their skills. Therefore, in the absence of any formal anatomy teaching during this period, it can be hypothesised that students can learn and revise anatomy if the clinical

environment is conducive to allowing them to gain exposure and experience through supportive means.

Learning at work is viewed as a process that involves individual and social aspects (Eraut, 2004). Learning in the workplace occurs through informal means, through the learner’s experience and through interactions with other individuals and colleagues in their environment in the absence of any formal structured or organised event. Informal learning can be implicit, deliberate or reactive. Learning that takes place without the learner being consciously aware of what has been learned is known as

implicit or tacit learning (Eraut, 2000; Reber, 1993). Such reflective learning can occur during the clinical years, when students who are immersed in their clinical environment assimilate knowledge through observation and practical experience. This is different to tacit knowledge, which arises from implicit processing of knowledge and is described as personal knowledge used to generate a hypothesis or other source of action, such as in making a medical diagnosis (Eraut, 2004). Deliberative learning occurs during a time specifically set aside for it and includes deliberate engagement in activities and definite learning goals. Students often recognise and acknowledge learning something when they have been engaged in deliberative learning that takes place within formal teaching sessions. In contrast, reactive learning is “near spontaneous and unplanned” (Eraut, 2000, p. 115) because the learner’s level of intentionality is variable (as it occurs during the middle of action), although they are aware of what has been learned (Eraut, 2000, 2004).

Considering the ways in which learning takes place in the workplace, Dreyfus and Dreyfus (1986) developed and described a five-stage progression model of learning through which adults acquire skills in the workplace. The model begins with the learner as a novice member of their workplace setting (Year B student) and can be contrasted to

the novice learner in an educational setting (Year A student), where they are part of a larger cohort in a similar state (Eraut, 2008). The Dreyfus model, which is similar to situated learning theory, documents the process of informal learning and tacit

knowledge that develops as an individual acquires experience in the workplace setting. They view the learner as progressing from a novice to an advanced beginner, wherein they begin to follow a set of explicit rules and guidelines to develop an understanding of their day-to-day environment. Individuals become competent when they progress to the third level (final-year medical student), and it becomes easier to complete explicit tasks that previously required much effort. Upon mastering the skills in this stage, the learner progresses towards becoming a proficient worker (intern/resident) who can view and tackle situations using a holistic approach. As Eraut (2008) states:

The difference between being competent and being proficient is neatly captured by the old training distinction between a trained worker and an experienced worker. The experienced worker will normally be more productive, need less supervision, be more aware of contextual variations and be competent in a wider range of situations. (p. 4)

The final stage in this five-step model is the expert (consultant/specialist), who no longer relies on rules or guidelines because they have a deep and tacit understanding of the situation at hand. This understanding usually comes about because of experience, which encapsulates basic science concepts and constructs more progressive and

sophisticated schemas around clinical activity. While basic science information becomes implicit as the learner progresses further away from being a novice (i.e., as pre-clinical students progress through the clinical years), it forms a framework around which clinical knowledge is built (Kulasegaram et al., 2013). Therefore, medical curricula must inculcate such knowledge to provide the best learning opportunities and

environments for students. Of course, one must also account for the fact that learning does not always progress in such a linear fashion as each individual develops at a different rate and possesses a range of prior experiences which impact on their learning. Therefore, a spiral approach to expertise must also be considered – one in which an individual experiences phases of progression, regression and pauses in their learning process.

When examining factors that affect learning in the workplace, two major issues are confidence and commitment to learn, and the performance and progress of the individual’s role. When students are proactive in seeking opportunities to learn in the clinical environment, and when they become engaged in the act of doing—that is, when they successfully and progressively meet new challenges and receive feedback and support from their clinicians and supervisors—they not only develop confidence, but also a motivation to learn (Eraut, 2004, 2007). However, if the learning environment does not foster good professional relationships and encouragement and trust between students and their colleagues, then learners (students) will be uncomfortable in the environment. As a result, they will be less likely to seek opportunities and take the initiative to enhance their learning; hence, they are less likely to be confident. In this context, ‘confidence’ refers to the concept of self-efficacy, or students’ ability to successfully execute or perform a task or role (Bandura, 1982).

Further, for students to progress in their learning, they must be aware of the learning outcomes. If learning goals are not made explicit or are too broad, students may find it difficult to understand what needs to be accomplished and how to go about achieving these goals (Billett, 2016). In addition, tasks set for students who have just entered the clinical years (i.e., novice learners) in the workplace must be gauged at an appropriate level so students can approach the tasks in a positive way. The work should

be varied enough that it challenges students but does not daunt them, otherwise students may develop ineffective coping mechanisms and be less confident because “learning at work is either facilitated or constrained by (1) the organization and allocation of work and (2) relationships and the social climate of the workplace” (Eraut, 2004, p. 270).

Although workplace environments such as clinical settings can vary in structure, they are rarely structured with learning in mind (Eraut, 2004). Therefore, environments that lack sufficient access to activities that develop learners’ skills and provide guidance for performing such activities in clinical settings could be considered detrimental to effective learning because students are deprived of opportunities to gain appropriate clinical knowledge. These issues will be explored in this study from a constructivist perspective that considers the views and experiences of participants in the clinical setting and how they affect students’ learning of anatomy. However, regardless of the stage of learning, the task of acquiring knowledge is ultimately based on learners’ actions and intentions. The physical and social environments of the workplace significantly contribute to learners effectively acquiring the skills they need for their occupation.