ABC of learning and teaching in medicine

Applying educational theory in practice

BMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7382.213 (Published 25 January 2003)
Cite this as: BMJ 2003;326:213

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  1. David M Kaufman

    How many times have we as teachers been confronted with situations in which we really were not sure what to do? We “flew by the seat of our pants,” usually doing with our learners what had been done with us. It would be useful to be able to turn to a set of guiding principles based on evidence, or at least on long term successful experience.


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    Fortunately, a body of theory exists that can inform practice. An unfortunate gap between academics and practitioners, however, has led to a perception of theory as belonging to an “ivory tower” and not relevant to practice. Yet the old adage that “there is nothing more practical than a good theory” still rings true today. This chapter describes several educational theories and guiding principles and then shows how these could be applied to three case studies realting to the “real world.”

    Adult learning theory

    Malcolm Knowles introduced the term “andragogy” to North America, defining it as “the art and science of helping adults learn.” Andragogy is based on five assumptions—about how adults learn and their attitude towards and motivation for learning.

    Andragogy—five assumptions about adult learning

    • Adults are independent and self directing

    • They have accumulated a great deal of experience, which is a rich resource for learning

    • They value learning that integrates with the demands of their everyday life

    • They are more interested in immediate, problem centred approaches than in subject centred ones

    • They are more motivated to learn by internal drives than by external ones


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    Learners need to feel safe and comfortable expressing themselves

    Knowles later derived seven principles of andragogy. Most theorists agree that andragogy is not really a theory of adult learning, but they regard Knowles' principles as guidelines on how to teach learners who tend to be at least somewhat independent and self directed. His principles can be summarised …

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