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 Table of Contents  
Year : 2019  |  Volume : 5  |  Issue : 1  |  Page : 75-79

Learning process and how adults learn

1 Department of Medicine, SMS Medical College and Hospital, Jaipur, Rajasthan, India
2 Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission27-Aug-2018
Date of Acceptance10-Dec-2018
Date of Web Publication23-Apr-2019

Correspondence Address:
Dr. Uma Advani
Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJAM.IJAM_41_18

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Learning is a process of changing behavior of learner. Teaching–learning process lasts the entire life span of each individual. Adult education is the intentional systematic process of teaching and learning by which person who occupies adult role acquires new value, attitude, knowledge, skill, and discipline. Art and science of helping adults in learning is called andragogy. Adult learners are autonomous, self-directed, reluctant to learn new things, and they focus mainly on immediate implementation of knowledge. The theories to explain adult learning are conditioning theory, theory of connectionism, and cognitive theory. Adult learning knowledge in medical education helps to keep update for recent advances in different fields. To improve teaching–learning, the principles of adult learning should be applied like active involvement of learner by allowing debate and challenge of ideas using audience response system technique. The adult learner should always be motivated and reinforced by positive feedback. Adults are usually goal oriented; so, we should always relate learning to participant's goal.
The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Professionalism, Systems-based practice.

Keywords: Adult learning theories, andragogy, principles of adult learning

How to cite this article:
Prakash R, Sharma N, Advani U. Learning process and how adults learn. Int J Acad Med 2019;5:75-9

How to cite this URL:
Prakash R, Sharma N, Advani U. Learning process and how adults learn. Int J Acad Med [serial online] 2019 [cited 2023 Jun 5];5:75-9. Available from: https://www.ijam-web.org/text.asp?2019/5/1/75/256800

  Introduction Top

Learning is a process of changing behavior of learner. Learning results in some modification, relatively permanent change in the way of thinking, feeling, and doing of the learner. Learning can be both an emotional and intellectual process.[1] Teaching–learning process lasts the entire life span of each individual. There are some basic differences between children and adult learning process. Adult learning allows an adult to acquire, renew, upgrade, or complete knowledge, skill, and attitude for functioning effectively in a constantly changing science.[2] “A teacher can never truly teach, unless he is still learning himself.” For a medical teacher, learning is a lifelong commitment. Dynamic status of medical knowledge today is to keep update for recent advances in different fields like to gain hands-on experience in various advancing techniques, for example, laparoscopic surgery, laser surgery, and in vitro fertilization techniques.[3]

In medical education, the plenty of attention given to “what is said” but often little consideration is given to “how it is said.” The purpose of teaching is not mere dispensing of information but to develop learning habits.[2] Medical educators must be aware of several assumptions about adult learners. They must understand that adults learn differently than children and that individual differences in learning style should be seen not as an obstacle but as an opportunity while designing programs for adult learners.[4]

There are different categories of adult learners such as (1) self-directed learners: they plan, conduct, and assess their own learning, (2) goal-oriented learners: on enrolling in a course, usually they know what goal they want to attain, (3) activity-oriented learners: they learn more readily with various activities, and (4) learning-oriented learners: they must see a reason for learning something; learning has to be applicable to their work or other responsibilities to be of value to them.[5],[6]

  Adult Learning Top

Adult education is the intentional systematic process of teaching and learning by which person who occupies adult role acquires new values, attitude, knowledge, skill, and discipline. “Pedagogy” and “andragogy,” both these words are derived from Greek words. “Peds” from “paid” meaning “child” and “agogus” meaning “leader of.” “Andra” means “man” not “boy.”[4] Andragogy means the explanation of adults, motivation and disposition to learning.[7] There are differences in teaching–learning process in children and adults. The characteristic data obtained as a result from various researchers[4],[5],[6],[7] have been summarized in [Table 1].
Table 1: Difference between pedagogy and andragogy

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  Characteristics of Adult Learners Top

Adult learners are autonomous, self-directed, and always expect respect and equal status. “The difficulty lies not so much in developing new ideas as in escaping from old ones.” They focus mainly on immediate implementation of knowledge and are reluctant to learn new things.[8] It is wrong to presume that all the information transmitted to the students are always learnt and since that does not happen, a lot more information is to be transmitted so that something will be learnt.[9] Adult has a deep need to be self-directed; the teacher therefore engages in inquiry with student to awaken interest rather than searing as an oracle of knowledge. For example, medical student should be encouraged to participate in debate, questioning, case solution, and seminar presentation and set the basis for research activities. Many educators and psychologists have contributed to the development of various theories to explain the processes of the human mind.[10],[11] Are they correct? May be partly. Then why use them? Because they provide a structure that helps us to understand how to teach and glues together the episodes of learning.

  Theories of Adult Learning Top

Conditioning theories

It explains learning process in terms of stimuli and response. Any event a person can perceive is called as a stimulus and the reaction of a person is called as response. Operant conditioning involves reinforcement of a spontaneously emitted response or behavior. For example, in a class, if a student emits correct response (operant) to an open query, reinforcement occurs if teacher rewards him/her by a smile or a nod or by appreciation words. Similarly, undesirable operant like making noise in the class can be negatively reinforced by the teacher. Thus, desirable behavior can be selectively strengthened and undesirable behavior can be selectively weakened.

Theory of connectionism (Thorndike)

It explains learning in terms of the formation and strengthening of bonds or neural connections between stimuli and responders, with the following four laws:

  1. Law of readiness: Stimuli response bond is ready to act and gives satisfaction. If do not act, it causes annoyance
  2. Law of exercise: Exercise strengthens learning (law of use) while lack of exercise weakens a learning (law of disuse)
  3. Law of effect: Learning is stamped in if the effect is satisfying while learning is stamped out if effect or outcome is annoying
  4. Law of belongingness: Inter-related acts are learnt more easily than a collection of unrelated acts. In medical education, integrated modular learning will be more useful by explaining topic all points of view.

Field/cognitive theory

Learning is not simply an addition to existing complex pattern or cognitive structure in mind, but it is reconstructing of existing pattern or cognitive field to make it better organized: more meaningful and clearer.

Learning modules

Various teaching–learning modules have been described; these help in building up of concepts and understanding of lesson. Inquiry training model uses steps of scientific problem solving for learning and understanding a topic. In medical education, physicians of tomorrow are taught by teachers of today with curricula of yesterday. It is better to manage change than to manage inertia. Computer-assisted learning and the integration of e-learning into medical education can catalyze the shift toward applying adult learning theory.[12],[13]

  Principles of Adult Learning Top

To improve teaching–learning, it should be made active by applying principles of adult learning.[14] It is like “A Beacon in the Night,” as it provides guidance to medical educators.


Learning is better with subject matters of immediate relevance. If it is for long-term goal, students should be properly motivated.

Keep it interesting

Complex matter should be made simple using suitable examples and anecdotes and by making it learner centered: contextual with use of more photos, images, or videos.

Active involvement

There should be active involvement of the learner; he/she should be active contributor to the educational process.[15] It can be done by small group discussion or by interactivity in large group. Encourage participants to be resources to you and to each other.


Establish a climate which is conducive to feedback, could stop twice in the lecture, and ask questions to discuss response. Training should be designed in such a way that it covers approximately one-third part to presentation and two-third part to application and feedback. The use of audience response system (ARS) technology can be an effective teaching tool that encourages active learning in a lecture format. ARS lecture format can increase knowledge gained from lectures.[16],[17]

Rebound effect of evaluation

Students usually learn for the sake of examinations. Therefore, regular tests or objective-structured questions or quiz can be used for better learning by asking questions on what we want them to learn.[18],[19]

Learning modalities

Learning is composed of multiple sensory and intellectual inputs such as sound, sight, and smell. Some individuals learn better orally, some visually, some kinesthetically, and some by combinations. Learning begins with a new experience which may be by seeing, touching, tasting, smelling, hearing, or feeling. More effective the learning experience (also depends on teacher), the better is the learning.

The stimulation of sensory receptors will influence learning. Based on this, different types of learners have been identified such as (1) visual learners: they prefer print material, learn best by reading or responding to visual cues such as chalkboard/overhead transparencies, (2) auditory learners: they prefer listening, lecturing works best for them, (3) tactile learners: they like to manipulate objects, laboratory or hands-on methods are most appropriate for them, and (4) kinesthetic learners: like to learn through experiential activities; they prefer simulations, exploratory activities, and problem-solving. A simulator and the simulated clinical experiences provide the opportunity to meet the needs of learners like multiple objectives with multiple learners. Retention improves as students see the results of their actions. Experiential learning gives time to facilitate critical thinking, diagnostic reasoning, and problem-solving.[20],[21] Studies show that varying study methods and materials will improve retention and recall of information and enhance learning experience. The “learning pyramid,” sometimes referred to as the “cone of learning,” developed by the National Training Laboratory, suggests that most students only remember about 10% of what they read from textbooks but retain nearly 90% of what they learn through teaching others. The learning pyramid model suggests that some methods of study are more effective than others and that varying study methods will lead to deeper learning and long-term retention. People generally remember 10% of what they read, 20% of what they hear, 30% of what they see, 50% of what they hear and see, 70% of what they say, and 90% of what they say as they do a thing. Hence, there is no doubt that technical devices have greater impact and dynamic informative system.[22],[23]

Hear it, see it, say it, do it, and teach others to improve retention. There is more effective retention if more than one training method is used[24],[25],[26] as shown in [Table 2].
Table 2: Effect on retention rate by different training methods

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  Components of Learning Top

Important components of learning are motivation, reinforcements, retention, and transference.[27],[28],[29]


Good eye contact, smiles, and active listening skills such as nodding always help to motivate students. In addition, certification by reputed or recognized authority and promotion or admission to higher studies will motivate adult learners. Like saying “You can lead the horse to water but you cannot make him drink,” a good motivator can produce thirst in learners. Use of role models by medical educators has a major impact on learners. Mediocre teacher tells, good teacher explains, superior teacher illustrates while exceptional teacher inspires.


The greater the number of inputs attached to a particular idea, the greater the retention of the information. Factors which affect retention are active involvement of learners and degree of initial learning. More easily if learners can relate it to their past experiences, they are sequential learners. As per saying “You cannot pour fresh tea in a cup full of stale tea,” the application of knowledge depends on factors such as association with known information, its similarity, and degree of original learning.


Positive reinforcement is done by encouraging correct mode of behavior and performance. It can be given in the form of effective feedback by peers and encouraging participation and teacher.[30] In case of negative reinforcement, we have to be careful; it should be restricted to formative assessment results only.


Ability to use information, its implementation, and application of knowledge is transference. Hence, first remember, then understand, and at the end, apply the learnt knowledge.

  Conclusion Top

Good teaching–learning practices should be followed whether teaching is conducted in the classroom, clinic, or hospital. It requires time: time to instruct, observe, and assess the students and also time for self-reflection and time for our own professional development. Purpose of teaching is not mere passing on information but develop lifelong learning habit making it an enjoyable process. Encourage participants to be resources to faculty and to each other. Allow debate, questioning, and challenge of ideas in adult learning. Relate learning to participant's goal with active involvement of adult learners.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

Not applicable - This is a review article.

  References Top

Singh T, Gupta P, Singh D, editors. Teaching and learning. In: Principles of Medical Education. 4th ed. Gwalior: SIAP National Publication House, Jaypee; 2013. p. 1-8.  Back to cited text no. 1
Singh T, Anshu, editors. Portfolios in learning & assessment. In: Principles of Assessment in Medical Education. 1st ed. New Delhi:Jaypee; 2012. p. 173-9.  Back to cited text no. 2
Kaufman DM. ABC of learning and teaching in medicine. Applying education theory in practice. BMJ 2003;326:213-6.  Back to cited text no. 3
Bransford JD, Brown AL, Cocking RR, editors. How People Learn: Brain, Mind, Experience and School. Washington D.C: National Academy Press; 2000. p. 3-23.  Back to cited text no. 4
Simpson BJ. The classification of educational objectives: Psychomotor domain. Illinosis. J Home Econ 1966;10:110-4.  Back to cited text no. 5
Krigolson OE, Hassall CD, Handy TC. How we learn to make decisions: Rapid ropagation of reinforcement learning prediction errors in humans. J Cogn Neurosci 2014; 26: 635–644.  Back to cited text no. 6
Dave RH. Psycomotor levels. In: Armstrong RJ, editors. Developing and Writing Educational Objectives. Tucson AZ: Educational Innovators Press; 1970. p. 33-4.  Back to cited text no. 7
Palis AG, Quiros PA. Adult learning principles and presentation pearls. Ophthalmic Education Update. Middle East Afr J Ophthalmol 2014;2:114-22.  Back to cited text no. 8
[PUBMED]  [Full text]  
Caldwell JE. Clickers in the large classroom: Current research and best-practice tips. CBE Life Sci Educ 2007;6:9-20.  Back to cited text no. 9
Kumar S. Teaching-learning principles implications and applications. In: Sethuraman KR, Kumar S, editors. Medical Education Principles & Practice. 2nd ed. Jipmer Pondicherry: Shantha Publishers; 2000. p. 27-38.  Back to cited text no. 10
Sethuraman KR. Computer assisted a learning. In: Srinivasa DR, Ananthakrishnan N, Sethuraman KR, Kumar S, editors. Medical Education Principles & Practice. Pondicherry: National Teacher Training Centre, JIPMER; 1995. p. 77-81.  Back to cited text no. 11
Nettath S. Computer assisted learning (CAL) as a teaching learning method in teaching experimental pharmacology. Int J Basic Clin Pharmacol 2014;3:63-65.  Back to cited text no. 12
Coniam D. The increasing acceptance of onscreen marking – The tablet computer effect. J Educ Technol Soc 2013;3:119-29.  Back to cited text no. 13
Newble DI, Entwistle NJ. Learning styles and approaches: Implications for medical education. Med Educ 1986;20:162-75.  Back to cited text no. 14
Collins LJ. Livening up the classroom: Using audience response systems to promote active learning. Med Ref Serv Q 2007;26:81-8.  Back to cited text no. 15
Tregonning AM, Doherty DA, Hornbuckle J, Dickinson JE. The audience response system and knowledge gain: A prospective study. Med Teach 2012;34:e269-74.  Back to cited text no. 16
Alexander CJ, Crescini WM, Juskewitch JE, Lachman N, Pawlina W. Assessing the integration of audience response system technology in teaching of anatomical sciences. Anat Sci Educ 2009;2:160-6.  Back to cited text no. 17
Duggan PM, Palmer E, Devitt P. Electronic voting to encourage interactive lectures: A randomised trial. BMC Med Educ 2007;7:25.  Back to cited text no. 18
Gülpinar MA, Yeǧen BC. Interactive lecturing for meaningful learning in large groups. Med Teach 2005;27:590-4.  Back to cited text no. 19
Idris AT, Shamsuddin IM, Arome AT, Aminu I. Use of audio-visual materials in teaching and learning of classification of living things among secondary school students in Sabon Gari LGA of Kaduna state. Plant 2018;6:33-72.  Back to cited text no. 20
Shabiralyani G, Hasan KS, Hamad N, Iqbal N. Impact of visual aids in enhancing the learning process case research: District Dera Ghazi Khan. J Educ Pract 2015;6:226-33.  Back to cited text no. 21
Hutchison L. ABC of learning and teaching. Educational environment. BMJ 2003;326:810-2.  Back to cited text no. 22
Brown G, Manogue M. AMEE medical education guide no. 22: Refreshing lecturing: A guide for lecturers. Med Teach 2001;23:231-44.  Back to cited text no. 23
Gormally C, Evans M, Brickman P. Feedback about teaching in higher ed: Neglected opportunities to promote change. CBE Life Sci Educ 2014;13:187-99.  Back to cited text no. 24
Haak DC, HilleRisLambers J, Pitre E, Freeman S. Increased structure and active learning reduce the achievement gap in introductory biology. Science 2011;332:1213-6.  Back to cited text no. 25
Brownell SE, Price JV, Steinman L. A writing-intensive course improves biology undergraduates' perception and confidence of their abilities to read scientific literature and communicate science. Adv Physiol Educ 2013;37:70-9.  Back to cited text no. 26
Knowles MS, Holton RA 3rd, Swanson RA. The Adult Learner. 7th ed. Burlington (MA): Elsevier; 2011. p. 64-9, 183-203.  Back to cited text no. 27
Anderson SJ, Hecker KG, Krigolson OE, Jamniczky HA. A reinforcement-based learning paradigm increases anatomical learning and retention – A neuroeducation study. Front Hum Neurosci 2018;12:38.  Back to cited text no. 28
Johnson D. Adult educators need to have enthusiasm. Adult Learn 2009;4:11-4.  Back to cited text no. 29
Beeks W. The 'millionaire' method for encouraging participation. Act Learn High Educ 2006;7:25-36.  Back to cited text no. 30


  [Table 1], [Table 2]

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