Andragogy Workshop

Objectives
1. Contrast the theories of pedagogy and andragogy.
2. Recognize the six principles of andragogy.
3. Explain how to effectively prepare for an adult learning experience. 
4. Describe why an adult classroom is more heterogeneous than a grade school classroom.
5. Summarize why it is difficult to teach a topic to an adult that they are not motivated to learn.
6. Contrast the role of an instructor in an adult and youth classroom.
7. Describe why an adult may assume a passive role in a classroom while an active role in their life.
8. Debate which of the six assumptions you feel is most critical to success in the adult classroom.
Overview of Andragogy
In the book The Adult Learner by Knowles, Holton III, and Swanson (2015) a theory of andragogy is proposed and explained. Pedagogy, or the way children are taught and how they learn was described first. Pedagogy is based on the assumption that the teacher is the instiller of knowledge and that children are the receivers. The teacher is the single responsible party for education. The authors state that teachers of children must thoroughly understand how children learn and what techniques are necessary for them to  get the most of their education. Knowles et al. (2015) felt that expertise, though a different kind is necessary, when teaching adults as well. The teacher assumes the role of facilitator and provides a safe environment for adult learners to participate in more active, self-directed learning.

The six primary assumptions in the theory of andragogy or adult learning put forth by Knowles et al. (2015) are:
The need to know: Knowles et al. (2015) state that the teacher determines what children need to know, but adults are used to making their own decisions, prioritizing their goals and determining what is the best use of their time. They go on to say that in order to have adults "buy in" to education, adults need to know what will be taught, why it is important and how it will benefit them in their daily life. On the flip side, they need to understand the ways they will be disadvantaged if they do not learn the content or skill (Knowles et al., 2015). Like most adult activities, learning is most successful for adults if they are encouraged to share in choosing which learning strategies will be utilized.
The learner's self concept: Knowles et al. (2015) point out that adults have developed the ability and responsibility to make their own decisions which leads to their autonomy. This ability to make decisions and the consequences of the choices they make lead to their developing self-concept. To have another tell them what they need to learn and how they would learn it best is antithetic to this. According to Knowles et al. (2015) sometimes adults are used to the learning experiences being what they remember from grade school and frequently they will assume the passive role of "learner". Helping adults understand that they need to apply the same decision making abilities that they use in their life to their education helps them move from dependent to self-directed learners (Knowles et al., 2015). On the flip side, denying a self-directed adult the ability to make decisions on how they learn best will thwart learning as well.
Adults have experience: Children come to a classroom with a paucity of life experiences and they must be assisted in learning how to file or consolidate the new material they learn. Careful scaffolding must be supplied by the teacher to allow the student to progress. Knowles et al. (2015) contrast this with adults who have a lifetime of experience. By its nature, this leads to much greater heterogeneity in the adult classroom. Knowles et al. (2015) said that effective adult learning requires the ability to tap into these experiences as a resource and make the learning an experience in itself. A lifetime of experiences contribute to an adult's self concept. The authors feel that ignoring this experience devalues the adult learner. Adult learners may not need careful scaffolding of knowledge, they can consolidate or make mental models and file information with their lifetime of experiences (Knowles et al., 2015). 
Readiness to learn- Knowles et al. (2015) stress that learning experience is richest and most beneficial for an adult when it is timed when an adult is ready to learn it. Adults understand that knowledge can be power and can help them in their social and work life. For this reason, they are more inclined to fully participate in learning that clearly contributes to their personal or work goals (Knowles et al., 2015). Pratt (1988) provided a model explaining why adults may be comfortable and self- directed in their learning in one circumstance, but require direction and support in another. 
Orientation to learning: Knowles et al. (2015) feel that adults want to learn how to complete a task or to solve a problem instead of learning organized by subjects. In addition to the learning being well timed it needs to be practical and to have real-life application. Studies have shown that people learn math concepts best when they are taught in terms of everyday math problems and language is best learned if the learner is taught the words that they will need in their everyday life (Knowles et al., 2015). 
Motivation to learn: Knowles et al.(2015) say that adults can be motivated to learn something from a motivator outside of themselves, but the strongest motivators are internal. Concepts like improving self-esteem, quality of life and job satisfaction are strong motivators for adults (Knowles et al., 2015). 
Andragogy in Practice
Knowles et al. (2015) explain that to put andragogy into practice requires preparation, though a different kind than teaching children. The authors feel that to prepare adult learners they must be clearly told what they can be expected to learn, as well as realistic expectations of how they will learn the content and then apply it. Knowles et al. (2015) stress that a climate must be planned that is both collaborative, respectful and warm. Adults must be welcomed into the learning and must feel that they are safe. Since adults learn best if they are motivated to learn according to Knowles et al. (2015), instructors know that the content must be timely and applicable to real life. This requires the learner and instructor to collaborate on what needs to be taught, the needs to be addressed, and the objectives of the course. According to Knowles et al., (2015) learning activities must be active, experiential, and logically sequence. Finally, the course must be evaluated by both the instructor and the learners on how well it meets the learner's needs (Knowles et al., 2015). 
If learning for adults is structured in this way, it can lead to better retention as well as completion rates for adult classes (Knowles et al., 2015). If instructors structure a class as a collaborative experience and assume the role of co-learners seeking feedback and encouraging two way communication, they are more likely to be successful as an instructors (Knowles et al., 2015). 
Applying the Principles to Giving Feedback
Need to know: Medical students need to know how to give and receive feedback. On a recent survey completed by both faculty and students, the ability to give and received feedback was one of the top learning goals identified. Students need to understand how to give appropriate feedback to their instructors and they need to understand that receiving feedback is how they will grow in their clinical skills and learn effective decision making skills. The student's evaluations, which strongly contribute to their success or failure at obtaining the residency of their choice in the specialty they desire, depend on their ability to successfully evaluate and learn from feedback. Explaining to viewers how they contributed to the topic being chosen will help get buy-in for participation. It must be clearly expressed to the students that it was a mutual decision on what topics are learned and that it is relevant and important to their medical student career.
Learner's self concept: Medical students are adult learners. They are responsible for their own lives and their own learning. Their patients will depend on them effectively learning medical knowledge and clinical decision making skills. They are autonomous and feel comfortable that they know what they need to learn. Taking the time to ask them to think of a previous experience where their inability to effectively give or receive feedback was detrimental to their home or work life will help them see why it may be important for them to consider learning more about feedback, its purposes, communication styles and under what terms feedback should be given. 
Role of learner's experience: We have all received feedback throughout our life. We have a wealth of experience to draw on when considering when feedback was given effectively and when it failed miserably. Case studies will be utilize to allow students to draw on their past experiences, incorporate their new knowledge and evaluate how they will give feedback in the case study circumstance. An assessment at the end of the video will review the technique so that all learners are prepared to participate in the case studies. 
Readiness to learn: Students have been provided feedback in the way of grades throughout their educational career. This continues through medical school. The need to score high on their exams as well as have excellent clinical skills summaries provide the motivation to learn how to both give and receive feedback well. A student who is resistant to feedback and does not want to improve or change or one that provides inappropriate feedback to their preceptors will not only run the risk of scoring low on their clinical assessments, but also be a danger to patients. 
Orientation to learning: Explaining the strong correlation between improvement in their clinical skills and their clerkship comments or evaluations and then subsequently their Medical School Performance Evaluation should provide a strong external incentive to want to learn how to give and receive feedback effectively. The desire to improve communication skills, deliver bad news and encourage growth and change in their future patients will provide internal motivation to learn how to provide feedback in a way that strengthens relationships. 
Motivation to learn: Students will be motivated by the aforementioned improvement in clinical skills, clerkship grades, Medical School Performance Evaluation comments, but most importantly an improvement in their clinical decision making and therefore an improvement in their ability to effectively take care of patients. 
Assessments

    Assessment on andragogy
References
Knowles, M. S., Holton III, E. F., & Swanson, R. A. (2015). The adult learner (8th edition). New York, NY: Routledge.
Pratt, D.D., and associates (1988) Five perspectives on teaching in adult and higher education. Malabar, FL: Krieger.