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Adult Learning Theory
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Read the following and answer in 100-200 words

Question 1

Adult Learning Theory and New Hire Training

In summary, Knowles theory says adults learn best when

* they are allowed to be self-directed and make choices about how they learn

* the training builds on their past experience

* it is relevant (they are not interested if it is not)

* the training is about real life problems they will encounter on the job, not theory

* they are told why they have to learn something before they are sent to training


Which of these was most important to the improvement in the new hire training? Which is most important to the way you learn? 


Abstract This article suggests the construct of medical simulation education in the air medical industry can integrate principles of crew resource management by training in the same environments that flight crews function. The multidisciplinary crew-centered approach to designing simulation education can improve overall crew performance and reinforce safety in daily operations. This concept is far from novel and has a proven track record in the aviation industry, but air medical medicine can benefit from this proven system as well. In an article titled “Teams, Leaders, and Organizations: New Directions for Crew-oriented Flight Training,”1 Hackman states that “it is the team, not the aircraft or the individual pilot, that is at the root of most accidents and incidents.” Simulation in aviation has a long history, dating back to early decades of the industry. With cockpit or crew resource management (CRM) becoming a staple of the air medical industry, we find ourselves on the precipice of using simulation to teach the foundational concepts of CRM. Consistent with Hackman’s statement, medical errors in the air medical industry may be caused by system errors and a breakdown in team functions. It is important to acknowledge that all air medical team members are adults and, therefore, adult learning theory becomes relevant and potentially influential; it is, in fact, referenced frequently in current “educational simulation” literature. Respected adult education theorists include Jean Piaget, John Dewey, D.A. Kolb, Malcolm Knowles, and many others; although each theorist has their respective tenets, there appears to be a shared commonality to the science behind adult learning and education. It is generally accepted that adults operate on the following common principles: 1. Adult education takes place through interplay of real life actions and conditions. 2. Adults bring with them a set of unique ideas based on their unique experiences. 3. Adults learn in several domains including psychomotor, cognitive, and affective domains. 4. Each of these domains can be isolated and usually are presented as such. 5. An “overlap” of these domains promotes a more universal learning experience. 6. The full effect of learning can be absorbed more fully through an active reflection of the learning event. Educators can integrate CRM principles when applicable and design simulations to promote the same. Foundationally, it is a multidisciplinary team of paramedics, nurses, respiratory therapists, and occasionally physicians that comprise the medical crew. By adding communication specialists and pilots to complete the full team composition, educators can begin to better understand their simulation construct. Integration of the full crew configuration and recreation of realistic environments will further strengthen CRM principles. The Institute of Medicine acknowledges in its report “To Err is Human” that “most care delivered today is done by teams of people, yet training often remains focused on individual responsibilities, leaving practitioners inadequately prepared to enter complex settings . . . the ‘silos’ created through training and organization of care impede safety improvements.”2 When using a team-based approach to design and deliver simulation, the educator should be aware of several intrinsic tendencies among team learning events. Kayes et al3 identified the following summation of team-based learning challenges that educators and designers of team-based simulations should be aware of: 1) overreliance on the most dominant person within the team; 2) a tendency to resort to conforming to the overall group ideas, even when the group is wrong; 3) shirking responsibilities because of thinking that “someone else will do it”; and 4) social daydreaming in which 1 or more members lose interest in the process, thus decreasing team effectiveness.4 Entire teams should be integrated in the delivery of care much like the real-life environment dictates. As such, it is the evaluation of the team rather than the individual that must occur. Henriksen and Moss5 state that, “Health care providers work together, but are trained in separate disciplines. Few receive training in teamwork.” The following recommendations of Hamman6 for creating these team-based constructs are suggested in his 5-step process: 1) identify team topics and subtopics, linking performance indicators to objectives; 2) select incidents to simulate, preferably from a data set of real events; 3) identify objectives and the observable behaviors that will indicate their completion as tracked by a validated assessment instrument; 4) test the simulation scenario with at least 2 different expert teams and confirm validation of the assessment instrument; and 5) modify and finalize the simulation based on expert team feedback and deliver the simulation scenario to its intended audience. Emphasis on the second bullet point is relevant to this discussion. Air medical agencies typically conduct a systematic and recurrent chart review; the recreation of performance gaps found in these reviews resultantly provide the infrastructure for the “data set of real events.” These chart audits can provide realistic detail that can be presented to crewmembers with learning opportunities and provide a link to the overall quality improvement process; they also create an evidencebased approach to the delivery of educational content. Now that the direction has been suggested for the overall construct of the simulation-based learning event from Hamman, let's discuss just how the learning takes place. Kayes et al3 cite the following 3 principles deduced from a review of research on experiential learning in teams in general: 1. “To learn from their experiences, teams must create a conversational space where members can reflect on and Implementing Simulation in Air Medical Training: Integration of Adult Learning Theory David Matics, MS talk about their experiences together.” The team must be flying under “visual flight rules” in that they must be able to see what they are doing by active reflection. 2. “As a team develops from a group of individuals into an effective learning system, members share the functional tasks necessary for team effectiveness.” The team cannot rely on 1 dominant person to lead the event, but rather a shared and equal assumption of responsibility must occur. 3. “Teams develop by following the experiential learning cycle.” This is the cycle developed by Kurt Lewin and discussed by Kolb of concrete experience, reflective observation, abstract conceptualization, and active experimentation. Kolb’s model closely follows the tenets of simulation by recommending that 1) knowledge, skills, and attitudes are assessed by presenting them in the context of a real-world environment; 2) there is a built-in time frame for debriefing (an open dialogue of the positive and negative aspects of the event); and 3) through this active reflection on the event, learning and improvement occurs. As noted in the Kolb model (Fig. 1), this reflects an evolving and continual process of examining ideas through practice. Furthermore, it would be ideal to create a realistic scenario, emphasizing a team-based application with an evidence-based data set of real events using chart audits and peer review. These processes are typically already in place. Understand that although we preach CRM daily and how everything is a teambased success or failure, frequently our education constructs do not support this thought. Team-based, multidisciplinary educational events are an integral part of the design and delivery of air medical education. Evidence-based education assists us in costeffectiveness by replacing the concept of “throwing darts.” Teambased delivery addresses the concept of how we live and operate in this high-stakes environment—create a realistic environment; initiate a team-based application of psychomotor, cognitive, and affective skill sets presented in the context of real life events; identify and measure outcomes based on objectives for the event; and provide the actual learning stage through a debriefing in which students can actively reflect in open dialogue. As was coined in the movie White Squall, 7 “Where we go one, we go all.” The air medical industry is a team-based unit, and education should be designed, delivered, and evaluated as such.


Read the following and answer in 100-200 words

Question 2

Implementing Simulation in Air Medical Training

This week we are focusing on training design. This article makes the point that individuals receive specific training as part of an Air Medical Crew. But the crew has to work together to deliver the care. Errors are typically made when there is a breakdown in team functions. 


So it makes sense to design practical training around delivering care as a team. Adult learning principles apply here. Because these are life or death situations, common team problems must be overcome.


 Think about functions in your organization where it is really a team that deliver the service, not just one individual. What ideas from the article might be applied to training your teams? 




To test if adult learning theory can inform a training program for newly-hired employees in industry, a training program was set up using Knowles' concepts of andragogy. Evaluation results from before and after the new training program indicate that the perceptions of those in the new training program changed in a positive direction. This indicates that the concept of andragogy does translate to the workplace

           There is too often a difference between theory and practice. This is especially true in corporate America where practice must have a positive impact on the bottom line, and there is little room to experiment with theory that may or may not work in certain contexts. One such context is corporate new-hire training for those newly hired (new hire), and one such theory is adult learning. At the foundation of adult learning theory, Malcolm Knowles' assumptions of the adult learner hold true for the self­ directed person solving everyday life problems. However, it was not known if Knowles' assumptions of the adult learner would translate into effective new-hire training at the corporate level. Based on the belief that andragogy would transfer to the context ofnew-hire training in the business world, the trainer at one company used Knowles' assumptions of the adult learner, along with various other adult learning theories, as a guide to develop a new-hire training process with the following results.



           The problem at this company was that the evaluations indicated the training was inadequate and did not properly prepare new-hires to perform effectively on the job. To alleviate this problem the new-hire trainer was asked to create a new comprehensive training process that matched the complexity of the job and that provided the skills required for a new hires to do their job effectively. To determine the effectiveness of the new training process, evaluations from before the new training were compared to those after the new training model was implemented




The context in which this project took place was the new-hire customer service department in a large electric utility. Overall, the company employees around 20,000 employees and about 600 are telephone customer service representatives spread out over 6 states in the United States. In the customer service centers where the telephone representatives work, the training department trains approximately 200 new-hire employees each year.



Knowles' (1980) andragogical model was originally based on four assumptions of adult learners and how they develop:

•  Concept of learner--Their self-concept moves from one of being a dependant person to one who is self-directed.

•   Role of learners' experience--As individuals grow, they accumulate

a reservoir of experience that becomes an increasingly rich resource for learning.

•   Readiness to learn--Learners see education as a process for developing

increased competence to achieve their full potential in life.

•  Orientation  to learning--As  real  life problems occur some learning

·          situations require immediate attention. (pp. 43-44)

Knowles ( 1998) later added two additional andragogical assumptions.

•  Motivation--Adults tend to be more motivated to learn things that help them solve problems in their lives or results in internal rewards.

•  Adults need to know why they need to learn something before undertaking learning it. Knowing why an adult needs to learn something is the key to giving them a sense of volition about their learning.  (p. 149)


Using Concepts of Andragogy


Concept of Learner: Some adults have a high need to be self-directed, but for the sake of consistency, the new-hire material has to ensure everything is covered. Time was allowed each day for the trainee to focus on whatever they felt they needed most. Based on individual need, the trainee had the autonomy to self-direct this additional learning experience.

Role of Learner's  Experience:  Since not  all  new-hires  have job

specific experience and in order to ensure everyone has experiences to draw on, time was set aside for the new-hires to observe the job, and even to perform thejob while sitting side-by-side with experienced employees. This "mentor" program was essential because it gave the trainees valuable experiences to use throughout the training program. The trainer often had trainees reflect upon these experiences.

Readiness to Learn: It is hard to know whether learners in the context

of new-hire training are learning to achieve their full potential in life or learning the bare minimum just to get by. However, it is likely many trainees see new-hire training as part of the process for developing competence to achieve their full potential. This assumption was the underlying philosophy that permeated  the entire training process initiative.

Orientation to Learning: In new-hire training, the trainee's "problem"

is that they know nothing about the new job. The goal of the trainer is to work with the trainees to help them immediately solve the problem of knowing nothing to becoming fully functional, productive employees.

Motivation: On the first day of training the desired behaviors and characteristics of a successful employee are communicated. Throughout the training program, these behaviors and characteristics are modeled through words and actions from everyone involved in the training. Additionally, the trainees continuously receive feedback in the form of positive reinforcement or correction. All of these things are designed to motivate the trainee. Whether or not this motivation is intrinsic or extrinsic is based on the individuals' perception, values, and work ethic. The individual will decide whether or not the motivation is intrinsic, extrinsic. or most likely, a combination of both (Schein, 1980).

Adults Need to Know Why: Learning objectives were communicated before each section of the new-hire training manual. The objectives not only explained what was to be learned but also why it is important to learn that subject. Thoroughly explaining the objectives and desired outcomes address "why they are learning something."

Table I: Pre- and Post-Evaluation  Result

Answer Pre Post

Strongly Agree 14% 27% +48%

Agree 57% 63% +10%

Neutral 18% 10% -44%

Disagree 9% 0% -100%

Strom!lv Disaszree 2% 0% -100%


As Table I indicates, there was substantial improvement on the evaluation question "My initial training provided the skills required to do my job effectively." None of the respondents either strongly disagree or disagree with the statement after the new training model was implemented compared to 11% under the old training model. Ninety percent of the respondents either strongly agree or agree with the statement for the new training compared to 71% for the old.




Based on the evaluation results, the new-hires' perception of training changed in a positive direction. In this case, theory and practice did go hand-in-hand. The logical conclusion, therefore, is that Knowles' concept of andragogy and his notion of the adult learner does translate to the workplace to increase the effectiveness of new-hire training.


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