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Learning : Definition

Learning means the ideas that we acquire from our day to day life and from our past (Prozesky, 2000).  It could be knowledge, facts, skills and attitudes.  It is a complex process involving physical, social and psychological stimuli ultimately leading to the acquisition of knowledge and skills.

Teaching : Definition

In contrast to learning, teaching means guiding or directing others to learn new skills, attitudes, knowledge and facts (Prozesky, 2000).

Teacher : Definition

An educator, or teacher, is a person who can facilitate learning.

Theories : Definition

Theories are the pieces of information that are intended to describe, explain and provide guidance on the how and why something occurs, for example, educational theories describe the how and why of learning (Aliakbari F, et al. 2015).

Learning Theories : Definition

Learning theories are the study of how different individuals process and retain information.

Teaching Theories : Definition

Teaching theories is how teachers and trainers employ different styles of teaching to meet the needs of their students.

Learning and teaching theory or the education theory means a framework of useful instructions built-up by a motivated teacher (Artino Jr. and Kokopasky, 2018).

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Purpose of learning/educational theories

The purpose of learning educational theory is to produce good educators. Educational theories give educators the tools to understand how and why people learn, and allow them to adapt their teaching to fit the given context (Artino Jr. and Kokopasky, 2018).

Learning is a broad and complex field hence there are a vast amount of educational theories, with no one single theory being able to represent learning in its entirety.

Importance of learning theories :

The learning theories help the educators to understand the best circumstance for teaching and learning to work most for the learners.

There are a wide variety of educational theories developed over many centuries (Aliakbari et al., 2015).  It is important for students to understand the different learning theories so they can identify which works for them.

Besides, using the learning and educational theories means that educators will use theories that are based on research and evidence and being systematically tested and improved incrementally (Hodges and Kuper, 2012). This is in contrast to using the traditional and ritual in teaching the students.  There are many educational theories that could be used like the social cognitive theory which means that the teacher helps the students to plan, monitor and reflect on their own learning process based on their values, beliefs and goals (Bandura, 1986).

Thus, educational theory means using a systematic approach in teaching the learners; this approach should be based on the best available teaching evidence to achieve the best outcome to the learners.

The purpose of learning educational theory is to produce good educators. Educational theories give educators the tools to understand how and why people learn, and allow them to adapt their teaching to fit the given context (Artino Jr. and Kokopasky, 2018).

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Types of learning theories :

The three main types of learning theories are behaviourism, cognitivism and constructivism.

Behaviourist theory / Behaviourism

Behaviourist theory states that learning is related to the change in the learner’s behaviour which is triggered by a stimulus.  It is the idea in which the teacher imparts knowledge onto students by repetitive actions (or stimuli), rewards and punishments. In other words, the learners react to either the negative or positive stimuli to change their behaviour. The fact that learners receive knowledge passively is one of the major drawbacks of this theory. This is because learners need incentivization to learn and if this is missing, the acquisition of new knowledge is hampered. (Macleod, 2003). The implication of this is that constant and consistent stimuli are required to encourage learners to receive new knowledge or otherwise it would be lost.

Behaviourism refers to learning as a form of conditioning.  There are two main types of condition classical conditioning and operant conditioning. Classical conditioning was famously described by Ivan Pavlov and his studies of dog behaviour (Stussi Y., et al, 2019). Behaviourism is classically a teacher-led learning process, whereby the teacher gives a stimulus, enticing a response from the learner. This has been criticised for dismissing social meaning, with some educationalists suggesting it is not useful in human learning as they believe it only useful is socially dysfunctional beings (Wenger E. 2018).

Use of Behaviourist theory in Medical Education

In medical education behaviourist theory is commonly used to teach skills-based competencies e.g. venepuncture (Torre, et al., 2006).

Cognitive Theory / Cognitivism

Cognitivism focuses on the mental and psychological processes rather than learning through behavioural changes. It suggests students learn information through processing information (Taylor and Hamdy, 2013). 

It focuses on the way the observer internalises the world, focusing on the individual’s mental activities including thinking, memory, perception, interpretation, reasoning and the ability to solve problems (Higueras-Herbada A, 2019 & Clark KR, 2018).  Cognitivists believe that learning is an active process where new knowledge is built on the knowledge one already maintains (Kaufman D, 2019).

This theory thus argues that learners are actively involved in the learning process. They tend to develop their knowledge by weighing the knowledge acquired against the existing knowledge which they had. There is also a reflection on new knowledge and how it could be applied. One could contend that the cognitive theory’s assumption that all learners need to be active in the process suggests that all of them can absorb, assess, reflect and apply knowledge in the same manner.  However, individual learning styles is a huge factor when it comes to how individuals process new knowledge (Duff, 2004).

Constructivist Theory / Constructivism

Constructivism identifies that learning is a process that builds upon knowledge and skills that have already been acquired (Aliakbari et al., 2015).

Constructivism theory posits that learners create their knowledge based on the input and experiences they gain from their environments (Elliott et al., 2000). It focuses on an individual’s mental structure that is used to make sense of a given situation; associating the situation with their baseline knowledge already obtained (Kaufman, 2019).  Whilst constructivism encourages the self-construction of knowledge, there is a danger that the product of such creation could only be useful to the individual as opposed to other learners.

Constructivist Theory Example in Medical Education

For example, in a hospital setting, doctors who might create their understanding of how to treat certain indications still need to have their approaches peer-reviewed for these to be generally accepted treatment techniques. 

Problem Based Learning

An example of constructivist learning style is problem-based learning, where an individual is given a problem e.g., a case scenario and then goes away and uses self-directed learning to answer the specific scenario (Barnard-Ashton, P. et al, 2017).

Other learning theories :

Humanistic theory :

The humanistic theory assumes that everyone is unique but that humans desire to grow in a positive way. Motivation is derived by an individual and a desire to grow and learn occurs through curiosity.

Transformative learning theory :

Transformative learning theory explores learning through a process by which humans make meaning of their lives and experiences.

Connectivist Theory / Connectivism :

Learning and knowledge is populated by the diversity of opinions, the connectivist theory is based on deriving connections between specialized nodes or information sources, accumulation of more/new knowledge and the facilitation of continual learning.

Situational learning theory :

This theory argues that knowledge should be learned in the same place as it is used.

Situational learning theory allows people to come together and collaborate to enhance learning and team resources (Artino Jr & Konopasky, A 2018).

Lave initially in 1990, suggested that situational learning theory was effective due to the authenticity of the context therefore implying that learning should occur corresponding to the behaviour applied if a similar scenario was reproduced (Lave & Wegner, 1990).

Situated learning in essence builds on the idea of apprenticeships, where you are learning from a team member whose role you are trying to emulate in an environment where you will be expected to reproduce the ideas and knowledge that you have learnt.

This theory can be difficult in actual practice if you are in a setting where you have little supervision or access to a senior colleague who can perform the teacher role.

Situational learning theory in Medical Education :

Training of doctors includes working in clinics with patients. Doctors learn communication and consultation skills mostly by being within the environment where these skills are needed and practical application i.e., the learners gain knowledge in the same place as it used.

Communities of practice :-

Communities of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly.

A community of practice can be viewed as a social learning system.

Wenger describes a community of practice as ‘the simplest social unit that has the characteristics of a social learning system’ (Wenger, 2018).

This theory states how a number of people who share common interests, or goals, can work together to share information, be innovative and come up with new ideas and act as a community with which to mutually enhance their knowledge in a certain field.

There are three key areas in the formation of any community of practice. These are mutual engagement, joint enterprise and shared repertoire (Pyrko et al., 2016).

Bandura’s social learning theory/Bandura’s social cognitive theory

The social cognitive theory was introduced by Albert Bandura in 1986 and was known as Bandura’s social cognitive theory (Bandura, 1986)

This theory emphasizes the learning from observations and environment.  It states that learning is done by interacting with the environment, person, and behaviours. In essence, on the situation’s social influence. It considers the person’s past experiences which primarily determine a person’s behavioural activity aiding in the learning process and building on it.

Bandura’s theory of social learning may be particularly useful for this group as it focuses on how students learn in an observational capacity in a social setting (Horsburg and Ippolito, 2018). Bandura’s theory was based on four key elements: attention, retention, reproduction and motivation (Irby, 1986).

While all the other theories are responsible for the initiation of behaviour, social cognitive theory claims to lead to initiation as well as maintenance of behaviour. Thus this concept leads to learning that drives behaviour which is sustainable (Glanz, 2001).

We are all social beings, knowledge is a matter of participation, and meaning is our ability to experience the world and our engagement with it.

Concepts underlying Social Cognitive Theory

The social cognitive theory includes the following important concepts: (Bandura, 1986)

Reciprocal determinism: this represents the dynamic interaction between the person, their environment and behaviour.

Behavioural capability: it indicates that that knowledge and skills are important elements in performing any behaviour.

Observational learning, which means the people can change their behaviour based on their observation and witnessing others behaviour.

Reinforcements, which means that person’s behaviour can be changed either positively or negatively based on the internal or external stimuli.

Expectations, which refers to the projected consequences of the behaviour and their positive and negative impact.

Self-efficacy, which means the individual’s belief and confidence that they will be able to achieve a certain behaviour.

Example of Bandura's Social Cognitive Theory in Medical Education

For example, a child will do what it will see the parents doing and not what the child is taught to do.  The medical student is just like a child in the medical school, naïve to all the new things around.  In such a circumstance, a lot of learning takes place with all the theories possible and described, but which cannot be ignored is the learning that takes place with the help of what is referred to as the social cognitive theory by Bandura  (Bandura, 1986).  The students are taught actively and passively, leading to cognitive processing of the information and behavioural change, but what the student strives to become ultimately is the replica of the ‘mentors’.  This concept of learning is more relatable at the postgraduate level than the undergraduate level of medical school.  The medical school is the environment that a medical student grows up in and it has an enormous impact on the overall process of learning and the functioning of all the other theories of learning.  It states that people learn not only from the teachings but by observing the actions of others and the results of those actions. This theory emphasises on imitation and modelling as a process of learning. It shows how observation is an important source of learning.

Vicarious activity/Vicarious Capability

Vicarious activity is a learning process through others’ experiences.

The social cognitive theory of Bandura describes vicarious capability as the ability to learn through observation, imitation or modelling others’ behaviours and attitudes.  (Laranjo, 2016).

Example of Learning through Vicarious Capability

Knowledge of this method of human learning has given us a valuable tool – the social media.  This is the present and shall be the future of the learning theories.

We are all aware of the impact of social media and social networking sites on human behaviour.  As the generation progresses, this impact is found to be increasing day by day (Boyd & Ellison, 2007).    This tool can be used for healthcare education and inculcating positive health behaviour in people. 

According to Coiera (Coiera, 2015), social media not only provides educational resources for self- care, but also gives access to peer support groups which are important in influencing decisions and actions (Lieberman, et al., 2003).

Empathy - Learning through Vicarious Capability

Until recently, this was considered a speculative part of neurobiology sciences. Mirror neurons were discovered in the 1990s in Parma as same parts of the brain that were triggered by performing actions were also triggered by observing others performing the same action (Gazzola & Keysers, 2009). It allows subject to exhibit the same state of mind. This discovery aided in the understanding of how empathy is perceived, one of many important components of the social- cognitive theory. However, vicarious learning is not solely found in emotions.  An experiment carried out by Gazzola et. Al (Gazzola & Keysers, 2008) showed activation of higher somatosensory centers in the same brain areas from observing others either by hearing or seeing them move objects in a goal directed manner.

Kolb's Experiential Learning Theory :

Kolb describes ‘experiential learning’ where we learn from concrete experiences on which we make personal observations and make our own abstract concepts from those experiences. We then use these abstract concepts to apply them to future, similar experiences.

Example of Kolb's Experiential Learning Cycle in Medical Education

Using Kolb’s experiential learning cycle in medical education, the senior doctors can teach the junior colleagues through active participation in procedural work to develop learning experiences.

In medical education, seeing repeatedly the clinical cases, over time, of the same condition would be similar to what Kolb describes as ‘concrete experiences’. These cases are an experience which we would then reflect upon and consider, perhaps making our own abstract rules about how certain cases present and how to distinguish between different presentations or manage certain aspects.

Gibbs reflective cycle :-

This theory offers a structure of learning from experiences through reflection.

Schon reflective cycle :

Schön described the learning of professionals as being one of reflective practice – being able to reflect on actions – for example clinical work in the ever-changing world of healthcare – as part of a lifelong learning process.

Knowledge can be broken down into three categories “what you know” “the things you recognise that you do not know” and “the things that you do not recognise that you do not know”.

Example of Schon's Reflective Learning Cycle in Medical Education

In medical education, a learning portfolio or diary where clinical experiences are revisited and evaluated is one technique for encouraging reflective practice.

Gagne’s 9 events of instruction :

Gagne’s model is based on “The information processing model of the mental events that occur when adults are presented with various stimuli and focuses on the learning outcomes and how to arrange specific instructional events to achieve those outcome”.

Principles of adult learning (Andragogy)

The principles of adult learning are :

  1. Adults need to be involved in the planning and evaluation of their instruction.
  2. Experience (including mistakes) provides the basis for learning activities.
  3. Adults are most interested in learning subjects that have immediate relevance to their job or personal life.
  4. Adult learning is problem-centred rather than content-oriented.

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Application of learning theories in medical education:

Learning in medicine is a continuous process.  Not any theory is all inclusive and learning at any point of time takes place by more than one theory usually.   To summarise the discussion, in a broad perspective, the most common theories that lead to learning of a medical student in a medical school are as follows: –

In the initial days, Kolb’s theory of experiential learning (Kolb, 1984) forms a major part of the learning where concrete experiences are taught to the students in the form of lectures on which the students build up with the help of their own abstract concepts and then they apply these abstract concepts in future when they encounter patients.  

As the student grows and shadows the Consultants in the wards, moving from the classroom to the hospital, the social cognitive theory (Bandura, 1986) plays a major role because now the student is in an environment which facilitates learning.   In understanding drills and procedures, simulation also plays an important role (Rauen, 2004).  

As one moves on from the post graduate level to the consultant level, most of the learning comes from Shon’s theory of reflective practise.  The consultants reflect onto their practise and modify their future actions accordingly when faced with similar situations.  A major part of the learning at this point of time also comes from the Communities of Practise (Wenger, 2018).  The conferences, the panel discussions in the conferences and the continued medical education programmes are the living example of the success of Communities of Practise model of learning (Pyrko et al., 2016),  because at the consultant level most of the problems that one faces can be dealt with discussion with the peers and not merely reading of the resource material.  These discussions by the communities of practice then ignite researches and the future formulation of guidelines.

Summary

Due to the wide variety of teachers/learners and educational theories different combinations will work better for different groups of teachers and learners.  It is important for students to understand the different learning theories so they can identify which works for them. 

The one size fits all approach is not ideal when it comes to learning.

References :

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Bandura A (1986).  Social foundations of thought and action: A social cognitive theory.  Englewood Cliffs, NJ: Prentice-Hell.

Barnard-Ashton P., Rothberg A., McInerney P. (2017). The integration of blended learning into an occupational therapy curriculum: a qualitative reflection. BMC Med Ed. 135.

Boyd DM, Ellison NB. (2007).  Social network sites: definition, history, and scholarship. J Comput Commun;13(1):210 – 30.

Clark, K.R. (2018). Learning theories: behaviourism. Am Soc Radiol Tech. 90(2), pp.172-175.

Coiera E (2015). Guide to health informatics. 3rd ed. CRC Press; p. 710

Duff, A. (2004). The role of cognitive learning styles in accounting education: developing learning competencies. Journal of Accounting Education, 22(1), pp.29-52.

Elliott, S.N., Kratochwill, T.R., Littlefield Cook, J. & Travers, J. (2000). Educational psychology: Effective teaching, effective learning (3rd ed.). Boston, MA: McGraw-Hill College.

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Glanz, K. (2001). Current Theoretical Bases for Nutrition Intervention and Their Uses. Nutrition in the Prevention and Treatment of Disease, 83–93.

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Hodges, B.D., Kuper, A. (2012).  Theory and practice in the design and conduct of graduate medical education.  Acad Med., 87, 25-33.

Horsburgh J and Ippolito K. (2018).  A skill to be worked at: using social learning theory to explore the process of learning from role models in clinical settings. Bmc Med Educ.; 18:156.

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