Intended for healthcare professionals

Clinical Review ABC of learning and teaching

Educational environment

BMJ 2003; 326 doi: (Published 12 April 2003) Cite this as: BMJ 2003;326:810
  1. Linda Hutchinson

    A student might find a particular question threatening and intimidating in one context yet stimulating and challenging in a different context. What makes one learning context unpleasant and another pleasant?

    Many factors influence learning

    Learning depends on several factors, but a crucial step is the engagement of the learner. This is affected by their motivation and perception of relevance. These, in turn, can be affected by learners' previous experiences and preferred learning styles and by the context and environment in which the learning is taking place. In adult learning theories, teaching is as much about setting the context or climate for learning as it is about imparting knowledge or sharing expertise.


    Motivation can be intrinsic (from the student) and extrinsic (from external factors). Assessments are usually a strong extrinsic motivator for learners. Individual learners' intrinsic motivation can be affected by previous experiences, by their desire to achieve, and the relevance of the learning to their future.

    A teacher's role in motivation should not be underestimated. Enthusiasm for the subject, interest in the students' experiences, and clear direction (among other things) all help to keep students' attention and improve assimilation of information and understanding.

    Maslow's hierarchy of needs for motivating learning. Adapted from Maslow A H. Motivation and Personality, New York: Harper and Row, 1954

    Even with good intrinsic motivation, however, external factors can demotivate and disillusion. Distractions, unhelpful attitudes of teachers, and physical discomfort will prompt learners to disengage. Maslow described a model to illustrate the building blocks of motivation. Each layer needs to be in place before the pinnacle of “self actualisation” is reached.

    Physiological needs

    Although the need to be fed, watered, and comfortable seems trite, many teachers will have experienced, for example, the difficulties of running sessions in cold or overheated rooms, in long sessions without refreshments, in …

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