Adult Learning Theory

Learning as an adult is vastly different from learning as a child. During primary and secondary education, goals and objectives are set by the instructor, and learning is structured around defined teaching plans. However, education as an adult is frequently more loosely structured, self-directed, task oriented, and experience based. As a result, the transition to medical school can represent a significant challenge for many learners. The abundance of material can test the limits of the student's approach to learning. Even more challenging is the transition to residency, where syllabi, learning plans, and frequent tests disappear and the breadth and autonomy of scholarship can become overwhelming. Moreover, residents are expected to be students in their specialties as well as teachers for junior learners.

  • Understanding adult learning theory becomes essential both as a learner and as an educator. In 1984, Knowles proposed four principles listed below that are essential to adult learning theory:
  • Adults need to be actively involved in the planning and evaluation of their education
  • Experience (including mistakes) provides the basis for learning activities
  • Adult learners are most interested in learning subjects that have immediate relevance and impact in their discipline and career
  • Learning is problem-centered rather than content-oriented

Several theories of adult education have been developed and studied over the past century. Evidence supports the application of different learning methods for different circumstances, and a combination of approaches is frequently best. The table below, taken from the EMRA Resident as Educator guidebook, summarizes a few of the major contemporary learning theories.


Three important general concepts for adult learning theory described by Smith and Ricotta in the NEJM article “The Resident as a Teacher” and especially pertinent to residents follow:

  • Relate new knowledge to existing knowledge and real experience
  • Encourage active critical thinking and allow for engagement
  • Guarantee a learning environment without discrimination for new and diverse ideas

Furthermore, understanding the Taxonomy of Learning Domains proposed by Bloom in 1956 can allow for improved learner comprehension and retention. Asking questions that focus on the “why” and “how” instead of the “what” allows learners to reason through a problem and provides educators with the opportunity to guide the learner to the correct answer by analyzing and synthesizing a variety of information. The diagram below is an adaptation from the NEJM article “The Resident as a Teacher” for the Taxonomy of Learning Domains.


A practical approach to learning is also very important. In the article “ED Registrar’s Guide to Clinical Teaching” written by Nickson and published in the Life in the Fast Lane website, a four-step system for clinical teaching is suggested. These four steps are explained below:

Assess the learner: Evaluate existing knowledge base with clear, brief, and open-ended questions.

Determine the content: Determine gaps in understanding and use a patient-orientated approach.

Determine the instructional method: Choose an appropriate method for delivering the information.

Didactic: Gives voice to clinical reasoning processes.

Socratic: Leads the learner to the correct answer through serial questioning.

Demonstrative: Uses simulation where possible and demonstrates clinical skills and proper communication using a hands-on and performance-based approach.

Determine the effectiveness of learning: Assess learning efficacy by questioning, application, or using case-based hypotheticals.

Works Cited

Bloom, B. e. (1956). Taxonomy of Educational Objectives: The Classification of Educational Goals. Handbook I: Cognitive Domain.New York: David McKay Company.

Guth, T. A. (2012). EMRA Resident as Educator Handbook.Irving, Texas: Emergency Medicine Residents' Association.

Knowles, M. (1984). Andragogy in Action.San Francisco: Jossey-Bass.

Knowles, M. (1984). The Adult Learner: A Neglected Species(3rd ed.). Houston, Texas: Gulf Publishing.

Nickson, Chris, and Mutaz Eltayeb. “Emergency Medicine Registrar's Guide to Clinical Teaching.” 

LITFL • Life in the Fast Lane Medical Blog, 18 May 2016

Norman, Geoffrey R. “The Adult Learner: a Mythical Species : Academic Medicine.” Academic Medicine, 8 Aug. 1999.

Schumacher, Daniel J., et al. “Developing the Master Learner: Applying Learning Theory to the Learner, the Teacher, and the Learning Environment.” Academic Medicine, Lippincott Williams and Wilkins, 11 Sept. 2016.

Smith, Christopher, and Daniel Ricotta. “The Resident as Teacher.” The Resident as Teacher, NEJM, 2 Dec. 2016. 

Torre, Dario M., et al. “Overview of Current Learning Theories for Medical Educators.” The American Journal of Medicine, vol. 119, no. 10, 2006, pp. 903–907.