Learning theories

For centuries great philosophers and teachers have been intrigued how people think, acquire new knowledge and internalize it into the system of their prior beliefs. They have developed various learning theories that are successfully used in teaching via simulation even today.

Socrates is often considered to be one of the founders of Western philosophy. He lived in Greece from 469 B.C till 399 B.C. and believed that learning was the seeking of truth based on the questioning and interpreting the wisdom and knowledge of others. According to Socrates, no one was perfect and had all knowledge. He argued that other people were necessary to share their knowledge and experience with the learner to promote learning. His teaching method was a one in which a teacher, by asking leading questions, guided learners to discovery. This method lied a foundation to what is currently known in healthcare simulation as a facilitated discussion debriefing technique. Using this technique, an educator avoids giving out too many answers and rather concentrates on guiding learners to reaching the learning objectives by asking them challenging questions.

Plato was one of the followers of Socrates. He preserved for us beliefs and doctrines of his teacher in his writings. Plato and his teacher, Socrates, shared an idealistic view of the world and education. They believed in the importance of philosophic ideas and that people could live in a perfect world. In his work, The Republic, Plato used an allegory of cave which stated that everything perceived in material world was just a mere shadow of reality. What does the allegory of cave teach us and how does it affect our teaching with the use of simulation? At your spare time, please read more about it using a link to the further reading materials in the end of this learning module. One of the messages of the allegory of cave was that all new information is perceived through the prism of the prior knowledge and experience. That was a revolutionary idea of that time and it remains being one of the fundamental principles of education and curriculum design. Plato also believed that knowledge and wisdom of other people should be applied by a learner to his or her inner self. That concept was a matter of disagreement between Plato and his student, Aristotle, that is currently known as nature vs nurture debate over which scientists and philosophers keep debating even today.

Aristotle was a student of Plato and lived in Greece in the fourth century B.C. He was born in 384 B.C. in Stageria, Greece, served as a tutor to Alexander the Great, and established a school in Athens known as the Lyceum. In contrast to his teachers, Socrates and Plato, Aristotle was a follower of the realistic philosophic school that believed that the world is orderly and could be objectively and scientifically analyzed. He was especially interested in science and medicine. He disagreed with his teacher, Plato, regarding that one could find the truth and knowledge within himself or herself. He argued that learners need to use knowledge of others and look for the truth in the outside world rather than within themselves. The principle of self-fulfilling prophecy was developed in the 60s of the twentieth century and was inspired by the teachings of Aristotle. According to this principle, if an educator has high expectation for the learners and the learners are aware of this, they will perform according to the expectation. It is hard to overestimate the importance of respect and positive attitude between educators and learners.

In the 40s of the twentieth century behaviorism became a leading learning theory. Thorndike, Watson, Pavlov, Skinner, Tolman, Tyler, Bandura, and Gange were the scholars who contributed to development of the behavioristic learning theory. According to that theory:

1. learning can be observed through behavior

2. learning can be reinforced by response

3. learning is teacher centered.

That theory has become very popular when a book by Tyler “Basic Principles of Curriculum and Instruction” was published in 1949. It set a standard for writing learning objectives and outcomes, and that practice is still in use. The limitations of the behaviorist learning theory were that it did not explain the intrinsic motivation of the learner, not always learning is expressed via behavior, and that fixed learning objectives and educational outcomes might limit the educational richness of the curriculum. With time, behaviorism was replaced by the constructivism that remains the dominating learning theory today.

Piaget has set a foundation for the constructivism learning theory which was further advanced by Vygotsky. According to this theory:

1. learning is an active experiential process

2. learning is built upon the foundation of the prior learner’s knowledge

3. teaching and learning processes are learner focused.

Discovery method is sub-type of the constructivism and is well summarized by Postman and Weingarter:

1. The teacher rarely says what the students ought to know because it preoccupies the students, creates fixations, and deprives them in their search for solution of the problem.

2. If the teacher’s intervention is required, the main method used is questioning.

3. Generally, the teacher does not accept a single statement as an answer to a question. The teacher is looking for the reasons, not a reason. The method of finding an answer is as important as is the correct answer.

4. Generally, each lesson poses a challenging, but not impossible problem for the students.

Experiential learning is one of the theories that is a part of the constructivist framework. It was developed by Kolb in 1984 and has been widely used in simulation-based education. There are four stages of Kolb’s learning theory cycle:

1. Concrete experience built from interaction with reality

2. Observation and reflection based on the interaction with reality

3. Forming abstract concepts

4. Testing abstract concepts in new situations.

Whenever a learner goes through the entire Kolb’s experiential learning cycle, integration of the new knowledge into the existing knowledge base occurs. This process is called internalization of the new knowledge. Forming of the abstract concepts and testing them in new situations is vital for translation of knowledge and skills acquired in a simulated environment to clinical practice.

One of the cornerstones of simulation-based education is a principle of deliberate practice. It was first developed by Ericsson for physical education and later was adopted for healthcare education. Deliberate practice refers to “the individualized training activities specially designed by a coach or teacher to improve specific aspects of an individual performance through repetition and successive refinement.” Expert feedback is the key of this theory. Individualized and repeated practice is essential for achieving mastery of a given skill.

Equipped with the theory of deliberate practice, what would be your answer to the medical school’s administrator’s question, “Should we set simulators in a place where students could come and use them without supervision?”

Malcolm Knowles is known by his book “The Adult Learner: The definitive classic in adult education and human recourse development” that introduced the term adragogy. Andragogy definition is the methods and techniques of teaching adults as opposed to pedagogy which is teaching children. He stressed that for adults relevance of the subjectis one of the great importance that determines if learning is going to occur.

This short learning module only touches the tip of the iceberg of the wonderful field of the learning theories and their application for healthcare education.

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