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 Table of Contents  
SPECIAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 2  |  Page : 278-283

Emerging pedagogies for effective adult learning: From andragogy to heutagogy


Dean Medical Education and Department of Community Medicine, Believers Church Medical College, Thiruvalla, Kerala, Director, PSG-FAIMER Regional Institute, Past President, Academy of Health Professions Education, Past Secretary-General SEARAME (S-E Asia Regional Association of WFME), India

Date of Web Publication27-Dec-2018

Correspondence Address:
Dr. Thomas V Chacko
Department of Community Medicine, Believers Church Medical College, Thiruvalla - 689 103, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_141_18

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  Abstract 


Understanding the way the student learns effectively is important for teachers so that they can then more effectively design their learning experiences. As the student in the health profession education progress across the long period and phases of learning from being an advanced beginner in a wider range of competencies during Undergraduate (UG) to becoming proficiently competent in areas of their specialization during their Postgraduate (PG) period and then after professional specialization while engaging in learning for expertise on-the-job during early professional development, they transition from a low learner maturity phase to full learner autonomy where they determine what and how to learn. Whereas pedagogy with high degree of teacher control matches low learner maturity, as the learners become more autonomous, teachers face the dilemma about how much they need to let go of their power and control to transition from “sage-on-stage” to “guide-on-the-side”. This article examines some of these dilemmas and attempts to suggest use of effective pedagogies (teaching methods) that match the transition of the adult learner engaged in the art and science of healing and progressing through the professional course's stages of competence progression from being a novice to a competent professional and after their formal professional qualification to help them reach expertise and improve quality of care by engaging in continuing professional development (CPD). This knowledge about learner maturity and adult learning principles will also help diagnose and address learner's problems and obstacles to effective learning that is happening at the institutional level.

Keywords: Andragogy, Adult learning theories, continuing professional development, e-learning, heutagogy, pedagogy, self-directed learning, self-determined learning, web 2.0 Technology


How to cite this article:
Chacko TV. Emerging pedagogies for effective adult learning: From andragogy to heutagogy. Arch Med Health Sci 2018;6:278-83

How to cite this URL:
Chacko TV. Emerging pedagogies for effective adult learning: From andragogy to heutagogy. Arch Med Health Sci [serial online] 2018 [cited 2019 Jul 15];6:278-83. Available from: http://www.amhsjournal.org/text.asp?2018/6/2/278/248661




  Introduction Top


The learning during childhood is what all of us are familiar with. Here the child in a protected environment is taught by the teacher, where the teacher determines what the child learner needs to learn. The child, of course, has no prior knowledge of what is being taught, is like an empty vessel waiting to be filled in by the prior knowledge gained by an adult teacher and so whatever the teacher says is accepted by the child in a nonquestioning way. We use the term “pedagogy” to describe the methods mostly used by teachers during childhood.

We often encounter such students in the preclinical years during their learning of basic sciences in the 1st year of medical schools where they have to acquire new basic science knowledge, and this is compounded by the fact that they are fresh from high school where the teaching is also pedagogical unidirectional transfer of knowledge from teacher to the learner. These students are transitioning from adolescence to adulthood, and so teachers are in a dilemma as to whether they should continue with pedagogy or switch to methods directed toward adult learning or andragogy. In the era of competency-based medical education (CBME); however, even in preclinical phase since the application of basic science knowledge to its clinical application is being introduced, using principles of adult learning for application of this new knowledge needs to be initiated and so teachers must become familiar with and use adult learning principles and design learning experiences to externally motivate the learner and initiate internal motivation by revealing the relevance of why the basic science knowledge needs to be acquired. During paraclinical and clinical phase, greater scope for using adult learning theories and methods presents. It also becomes important for teachers to introduce the students at this stage to become familiar and start using adult self-directed learning and reflection on their learning. In fact, it is the habit of reflection on the learning that differentiates and marks the transition from pedagogy to andragogy. Later, after the students graduate and become professionals, their learning needs and methods also change and so it becomes a dilemma for the teachers of these adult learners who are pursuing their postgraduate (PG) courses and some who have completed formal higher specialization courses but are still in the learning and growing stage of professional proficiency toward expertise about when to use didactic methods and when to use adult learning theory and learning methods modelled on these principles. Educators have recognized the need for a different approach to meet the learning needs and style of the newly qualified professionals who are highly autonomous and for whom pedagogical and even andragogical educational methods are no longer an answer to preparing the professionally qualified learners for thriving in the workplace and so a more self-directed and self-determined approach is needed where the learner reflects on what is learned and how it is learned and where the educators teach the learners how to teach themselves, this is termed as Heutagogy building on humanistic theory of the 1950s.[1] Heutagogyis a form of self-determined learning by an autonomous learner with practices and principles rooted in andragogy where the learner chooses what is to be learned and even how they would like to learn it. In this learner-centered and learner determined learning, the “teacher” takes the role of facilitator, guide or mentor suggesting to the autonomous learner how the desired learning might take place and if a formal assessment of learning is required, assist in determining an appropriate method of assessment.

Therefore, as teaching faculty, for facilitating the learning of students we are entrusted with, the dilemma and questions that need to be answered are: What are the adult learning theories and method based on them that we could use to facilitate student learning at different phases of undergraduate (UG), during PG and while mentoring them during early professional development? How will knowing adult learning theories inform us teachers to facilitate their learning more effectively? This article examines some of these dilemmas and attempts to suggest effective pedagogies (teaching methods) for the adult learner learning the art and science of healing and progressing through the professional course's stages of competence progression from being a novice to a competent professional and after their formal professional qualification, at the workplace reaching the level of professional proficiency and expertise.


  An Overview of Adult Learning Theories and Their Implications for Medical Education Top


Knowles[2] was the one who brought the concept of adult learning into prominence when he stated that adults learn in different ways from children and introduced the word andragogy. However, his interest in this theory led him to find out that it was first used by a Dutch adult educator Alexander Kapp in 1833 who described it as fitting the educational theory of the Greek philosopher Plato as the normal process by which adults engage in continuing education. Building on his own work, Knowles[3] reiterated that for applying modern principles of adult learning, andragogy leverages the assumption that adults are independent and self-directing, have various degrees of prior experience, integrate learning to the demand of their everyday life, are more interested in immediate problem-centered approaches and are motivated more by internal than external drives.

Taylor and Hamdy[4] citing Knowles et al. (2005) list how adult learners differ from child learners in six respects: first, the need to know (Why do I need to know this?); second, the learners' self-concept (I am responsible for my own decisions); third, the role of the learners' experiences (I have experiences which I value, and you should respect); fourth, the readiness to learn (I need to learn because my circumstances are changing); fifth, the orientation to learning (learning will help me deal with the situation in which I find myself) and finally the motivation (I learn because I want to).

Abela[5] in his review on adult learning theories in the realm of medical education stated that adult learning theories describe ways in which adults assimilate knowledge, skills, and attitudes and that the adult learning theories can be grouped into five main classes of learning (instrumental, self-directed, experiential, perspective transformation, and situated cognition) and Andragogy being one of the popular theory of adult learning under self-directed learning. Taylor and Hamdy[4] also give a good overview of the adult learning theories categorizing them into instrumental learning theories, humanistic theories, transformative learning theories, social theories of learning, motivational models, and reflective models.

Taylor and Hamdy[4] concluded that since instrumental learning theories focus on individual experiences and include behaviorist and cognitive learning theories, behavioral theories are the basis of many competency-based curricula where the focus is on individual learning and explicitly states what the graduate of a course or a learning experience must be able to do with observable performance or professional behavior measured as the outcome to be achieved. Experiential learning theory has helped educators create learning experiences in the curricula to facilitate learning through discovery. Kolb's experiential learning cycle helps curriculum planners and educators make the learners plan for and later reflect on the learning experience so that they are better prepared for the next time they are faced with the same problem or professional task and thereby improve the quality or effectiveness with which the task is carried out. Maudsle and Strivens,[6] reiterate that in experiential learning using the Kolb's framework helps in professional knowledge acquisition, fosters critical thinking, problem-solving and lifelong professional learning by encouraging learners to test out and apply new knowledge.

Transformative learning theories

Mezirow's theory of transformative learning[7] encourages critical reflection on an established frame of reference (currently accepted as “fact' or “truth”) to challenge the assumptions and search for evidence. Learners are taken through experiential learning experience or simulated scenarios, and the teacher's role is to facilitate the learners to question and reflect on own and others assumptions. Critical thinking, perspective transformation in the affective domain, leadership, and change management competencies can be learned using this theory. Methods that work include the use of critical incident analysis, small group discussion to arrive at ways to solve and formulate new ideas and engaging in reflective practice helps in bringing about the change in perspectives. Greenhill et al.[8] using clinical immersion models of clerkship rotations in hospital and community over 4 years observed that the learners gained insights in the areas of self-awareness, patient-centeredness, systems thinking, self-care, clinical skepticism, and understanding diversity.

Social theories of learning

Bandura[9] posited that learning happens by observing how others behave, a form of learning in context. In our apprenticeship model of medical education, most professional behaviors and attitudes, as well as ethics, are imbibed by students observing their role model teachers. With the CBME curriculum being launched with attitude, communication and ethics modules as a pilot, success will depend on teachers demonstrating through their everyday action and interaction with patients– the hidden curriculum. Wenger[10] emphasized the importance and influence of “communities of practice” (CoP) in guiding and encouraging the learner. CoP has three elements- one, members are bound together and hold each other accountable to the joint enterprise; second, build the community through mutual engagement building trust, and sense of partnership; third, they produce a shared repertoire of resources for use to gain the required competencies. Forming groups with common purpose help the group members to learn from and with each other. Learning within health systems, in health teams, and in CoP helps to know each other's shared values and contribution to a shared common purpose. Professionals engaged in continuing professional development (CPD) and health professions education students engaged in interprofessional education to foster team-work and better health service delivery in teams are good candidates for this mode of social learning in context and within CoP.


  Motivational Models Top


These, along with the reflective models help better understand factors influencing adult learning among educational theories. Ryan and Deci.[11] postulated three innate psychological needs--competence, autonomy, and relatedness which when satisfied yield enhanced self-motivation and mental health and when thwarted lead to diminished motivation and well-being. These influencers need to be kept in mind by the educator and the academic leadership within institutions to create a supportive learning environment. This theory also helps diagnose problems in adult learning where the learner seems to be not motivated enough to learn and thereby acts as an obstacle to improved performance as expected by the institution. Kusurkar and Ten Cate.[12] (2013) applying this theory to medical students found that intrinsic motivation in education is associated with deep learning, higher academic performance, greater creativity, higher engagement, higher persistence, lower dropout, and more positive well-being when compared with extrinsic motivation. They recommend that curricular reformers need to pay more attention to the motivational component of learning and that teachers play an important role in determining student motivation, and that autonomy-supportive teaching can be learned and is not difficult to practice.

Reflective models

Schon's “reflection on practice” when combined with deliberate practice and feedback for improving the performance of the novice learner and “reflection in practice” for the proficient or experts are helpful for improving their level of competence and quality of outcomes, respectively.[13] They help students become autonomous learners and later after their formal professional training is over, they find it easy to engage in CPD.

Humanistic theories guide learning for self-improvement that is mostly applicable for professional development after formally qualifying as a professional. They are learner-centered, produce individuals who have the potential for self-actualization, are self-directed and internally motivated. We can also use this theory for helping acquisition of competencies in the early stage of professional development where the teacher will have to take remedial measures to counteract the absence of self-motivation in the learning through role modeling with real patient encounters in the ambulatory and inpatient settings.

Heutagogy

This approach to adult learning is most effective when directed to adult learners who are already professionally qualified and are self-motivated and self-determined to improve practice due to the challenges and complexities at the workplace. Heutagogy needs to be seen as a continuum of andragogical adult learning theory in line with the transition in graduate medical education directed toward becoming competent using core andragogy of self-directed learning to an autonomous, self-determined learner once the professional qualifies and focus now shifts from competency to capability (proficient and then on to the state of expertise). Blaschke[14] presents the features of heutagogy as a continuum of andragogy as follows:

  • Andragogy (self-directed learning) → Heutagogy (self-determined)
  • Single loop (experiential) learning → Double-loop (reflection on experience)
  • Competency development → Capability development
  • Linear design and learning approach → Nonlinear design and learning approach
  • Instructor-learner directed → Learner-directed
  • Getting students to learn content → getting students to understand how (process).


Heutagogical methods addressing the self-directed learning needs of the autonomous professional learner include distance learning and use of Web 2.0 technologies. Designing curricula and the learning modules used for CPD require a different set of teaching skills as course and learning module creator and provider of feedback that recognize the needs and styles of these learners is different.


  Andragogy and Heutagogy: A Good Fit for Professionals as Methods for Continuing Medical Education and Continuing Professional Development Top


Scott[15] studying and using evaluative research framework to explore theoretical models to explore the relationship among key elements of certain theoretic models as applied to continuing medical education (CME) program concluded that physicians as adult learners are:

  1. Self-directed and experientially oriented (Knowles)
  2. Impacted by their physical age and stage in life (Bennett)
  3. Influenced by year or decade of graduation (Savatsky)
  4. Impacted by four dimensions of practice (Nowlen)
  5. Require a force and image for change (Fox)
  6. Must be motivated to participate in CME (Knox).



  How the Adult Learning Theories Inform Practice and Medical Education Top


For the educationist, knowledge of adult learning theories helps them to serve as a lens to look at the learning problems and diagnose the reasons for and answer why effective learning is not taking place in a given scenario or context. Once the diagnosis is made, then remedial measures in the form of effective strategies and approaches present themselves. Let us, for example [Table 1], examine how medical educators can leverage the six ways in which the adult learners differ from child learners to improve the efficiency of learning of our adult student learners.
Table 1: Leveraging adult learning principles to increase efficiency of learning by adults

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  Emerging Pedagogies for Effective Adult Learning Top


Knowing how adults learn across different phases of professional education during formal UG, PG, and during early professional development helps us to identify and choose methods that match the learner's maturity transition see [Figure 1] from immature learner during early UG period to a self-directed one during later clinical years when single loop experiential learning takes place and during PG years self-directedness gets stronger but happens within the structured curriculum of the higher education system within institutions. Postqualification as a specialist, the autonomous professional who is capable of determining their own learning needs on the job, the heutagogical methodologies [Figure 2] become the methods of choice by the proficient professional in search of gaining further expertise in an increasingly competitive world of knowledgeable colleagues and patients and thereby putting pressure for quality improvement in service delivery to ensure better patients' outcomes and patients' satisfaction.
Figure 1: Spectrum of learning in medicine from Pedagogy to Andragogy and Heutagogy

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Figure 2: Learning environment and methods for learning and self-improvement

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The pedagogies of old– giving didactic lectures and teacher directed courses are still useful and effective for both the immature learner just coming out of high school and need a good knowledge base in a short time. However, these need to be gradually weaned off as learner maturity increases and experiential learning methods in simulated and real-life situations become more interesting and triggers and boosts internal motivation of the adult learner to learn. Over the years, many innovative methods for engaging the learner starting with interactive lectures have been tried and tested. Group discussions and critical reflection on existing frames of reference and worldview in thinking and feeling brings about transformative learning in feeling and thinking and builds critical thinking. Case or problem triggered learning helps the learner understand the relevance of learning basic sciences for future professional practice as a doctor. Problem-based learning makes them familiar with the process of self-directed learning and diagnosis of their own further learning needs. Use of technology always creates interest in the 21st century learners and the introduction of such technologies including the use of social media builds on what they are already familiar outside the classroom. Flipped classrooms where students deliver the content and classroom time is used for higher cognitive and deep learning make the student learning more effective. Inter-professional team training makes the learner better prepared for working in teams in the healthcare delivery systems. Early exposure to reflection on learning and seeking feedback make them imbibe this important skill of self-improvement in professional practice.

Although Heutagogical methods are more suited for the professional who by then becomes a mature autonomous learner who is internally motivated to improve professional skills and so determines and chooses what to learn and how to learn and how to get self-assessed to measure improvement in practice, exposure to these methodologies even in the early phase of professional education makes learning interesting, breaks the monotony of the usual didactic teacher controlled pedagogies and prepares them for the way they would be learning in the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hase S, Kenyon C. From Andragogy to Heutagogy. Ulti-BASE In-Site; December, 2000. Available from: http://www.pandora.nla.gov.au/nph-wb/20010220130000/;http://www.ultibase.rmit.edu.au/New/newdec00.html. [Last accessed on 2018 Dec 07].  Back to cited text no. 1
    
2.
Knowles MS. Andragogy: Adult learning theory in perspective. Condensed from chapter in book “The adult learner: A neglected species”. Houston Tx: Gulf Publishing Company. Community Coll Rev 1978;5:9-20. Available from: https://www.journals.sagepub.com/doi/pdf/10.1177/009155217800500302. [Last accessed on 2018 Dec 07].  Back to cited text no. 2
    
3.
Knowles MS. Andragogy in Action: Applying Modern Principles of Adult Learning. San Francisco: Jossey-Bass; 1984.  Back to cited text no. 3
    
4.
Taylor DC, Hamdy H. Adult learning theories: Implications for learning and teaching in medical education: AMEE guide no. 83. Med Teach 2013;35:e1561-72.  Back to cited text no. 4
    
5.
Abela J. Adult learning theories and medical education: A review. Malta Med J 2009;21:11-8. Available from: http://www.um.edu.mt/umms/mmj/showpdf.php?article=234. [Last accessed on 2018 Dec 07].  Back to cited text no. 5
    
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Maudsley G, Strivens J. Promoting professional knowledge, experiential learning and critical thinking for medical students. Med Educ 2000;34:535-44.  Back to cited text no. 6
    
7.
Mezirow JE. Perspective transformation. Adult Educ (USA) 1978;28:100-10.  Back to cited text no. 7
    
8.
Greenhill J, Noreen Richards J, Mahoney S, Campbell N, Walters L. Transformative learning in medical education: Context matters, a South Australian longitudinal study. J Transformative Educ 2017;16:154134461771571.  Back to cited text no. 8
    
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Bandura A. Social Learning Theory. New York: General Learning Press; 1971.  Back to cited text no. 9
    
10.
Wenger E. Communities of practice and social learning systems. Organization 2000;7:225-46.  Back to cited text no. 10
    
11.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000;55:68-78.  Back to cited text no. 11
    
12.
Kusurkar R, Ten Cate O. AM last page: Education is not filling a bucket, but lighting a fire: Self-determination theory and motivation in medical students. Acad Med 2013;88:904.  Back to cited text no. 12
    
13.
Schon D. The Reflective Practitioner: How Professionals Think in Action. London: Temple Smith; 1983.  Back to cited text no. 13
    
14.
Blaschke LM. Heutagogy and lifelong learning: A review of heutagogical practice and self-determined learning. Int Rev Res Open Distance Learn 2012;13:56-71. Available from: http://www.irrodl.org/index.php/irrodl/article/viewFile/1076/2113. [Last accessed on 2018 Dec 07].  Back to cited text no. 14
    
15.
Scott CJ. Applied adult learning theory: Broadening traditional CME programs with self-guided, computer-assisted learning. J Contin Educ Health Prof 1994;14:91-9.  Back to cited text no. 15
    


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