In the complex world of healthcare simulation, the comprehension of adult learning theories is essential for effective education design. These theories form the foundation for meaningful educational experiences that resonate with healthcare professionals. This article is part one of a two-part series by Rémy Roe, Ph.D., Simulation Technology Specialist at the Stanford University School of Medicine’s Center for Immersive and Simulation-based Learning (CISL), will explore seven classic learning theories: Andragogy, Experiential Learning, Behaviorism, Cognitivism, Constructivism, Social Learning Theory, and Transformational Learning. Each theory offers unique insights into how adults learn and retain knowledge, with direct applications to healthcare simulation.
Andragogy: The Adult Learning Principle
Malcolm Knowles’ theory of andragogy (1977) stands as a cornerstone of adult education. This principle emphasizes that adult learners differ from child learners in several key aspects. Adults need to understand the reason for learning something new, prefer self-directed approaches, and draw upon their life experiences during this entire process.
In healthcare simulation, andragogy manifests through scenario design that relates directly to clinical practice. A simulation might challenge experienced nurses to manage a complex patient case, to allow them the opportunity to apply their previous knowledge while learning new skills. The scenario’s relevance to their practice provides immediate motivation for engagement and supports long-term retention of new information.
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Experiential Learning Theory
Experiential Learning, as proposed by David Kolb (2014), describes learning as a four-stage cycle: concrete experience, reflective observation, abstract conceptualization, and active experimentation. This theory aligns perfectly with simulation-based education, where learners actively participate in scenarios, reflect on their performance, develop new comprehension, and apply these insights to future situations.
Healthcare simulation centers can maximize this theory’s impact through structured debrief sessions. These debriefing sessions allow participants to process their experiences, reflect on their actions, and formulate new approaches for future clinical encounters. The implementation of video-recorded sessions enhances the reflective component and allows learners to observe their own performance objectively.
Behaviorism in Healthcare Education
Behaviorism focuses on observable behaviors and the role of environmental stimuli in the formation of responses. This theory, developed by scholars like B.F. Skinner (1977) emphasizes the importance of reinforcement and consequences in learning.
In healthcare simulation, behaviorist principles appear in task training and skill acquisition. When teaching cardiac resuscitation techniques, clear protocols, immediate feedback, and positive reinforcement help establish correct procedures. The theory supports the use of repetitive practice to develop muscle memory for clinical procedures, from basic skills like intubation to complex team-based responses.
Cognitivism: Understanding Mental Processes
Cognitivism examines how the brain processes, stores, and retrieves information (Ertner & Newby, 2013). This theory moves beyond observable behaviors to consider internal mental processes such as memory, problem-solving, and decision-making.
Healthcare simulation applications of cognitivism include the use of mental models and cognitive aids. Simulation scenarios might incorporate decision-making frameworks or cognitive tools to help learners develop robust mental models for crisis management. This theory supports the development of clinical reasoning skills through structured problem-solving activities and case-based scenarios.
Constructivism in Simulation Education
Constructivism posits that learners construct new knowledge based on their previous experiences and comprehension (Ertner & Newby, 2013). This theory emphasizes active learning, personal interpretation, and the social nature of knowledge construction.
Healthcare simulation centers can apply constructivist principles with the creation of scenarios that build upon clinical knowledge already possessed by learners. Group simulations allow participants to construct shared comprehension through collaboration and discussion. Progressive complexity in scenario design allows learners to build their knowledge systematically, from basic patient assessments to complex multi-patient situations.
Social Learning Theory
Albert Bandura’s Social Learning Theory (Rumjaun & Narod, 2020) emphasizes the importance of observation, modeling, and social context in the learning process. This theory suggests that individuals learn not only through direct experience but also through the observation of others as they perform tasks and interact with their environment.
Healthcare simulation centers leverage this theory through demonstration sessions and peer learning opportunities. Expert clinicians might model complex procedures and narrate their thought processes. The theory supports the value of video-based learning, peer observation throughout simulation scenarios, and the importance of role modeling in healthcare education.
Transformational Learning
Jack Mezirow’s (2018) Transformational Learning Theory focuses on how adults revise their current beliefs and assumptions through critical reflection and dialogue. This process often occurs when learners encounter situations that challenge their previous comprehension of healthcare practices.
Clinical simulation scenarios designed to prompt critical thinking and challenge preconceived notions facilitate transformational learning. Debrief sessions become crucial spaces for learners to examine their perspectives and develop new frameworks for the comprehension of clinical situations. This theory supports the use of scenarios that push learners beyond their comfort zones and endeavor to maintain psychological safety.
A Review of Part One
Each of the theories discussed in this article offers valuable insights into how adults learn and retain knowledge and provides essential guidance for simulation educators and program designers. The application of these theories in healthcare simulation requires thoughtful consideration and strategic implementation. The comprehension of these foundational theories allows simulation educators to create more effective educational experiences that resonate with adult learners and promote better retention of clinical skills and knowledge.
As simulation technology continues to advance, these fundamental theories remain relevant, as they guide the development of new educational approaches and ensure that healthcare simulation maintains its focus on effective adult learning principles. The integration of these theories into simulation design and delivery helps create meaningful educational experiences that translate into improved clinical practice and patient care outcomes. The thoughtful application of these classic theories transforms healthcare simulation from a simple skills-practice environment into a rich learning ecosystem that promotes deep understanding, personal growth, and professional development. This comprehensive approach to simulation education ultimately leads to better-prepared healthcare professionals and improved patient care.
The second article in this series will explore contemporary approaches and motivational models in healthcare simulation education. These modern theories build upon the classical foundations discussed and provide additional tools for the creation of effective simulation-based learning experiences.
Learn More About How to Develop Nursing Simulation Scenarios!
References
- Ertner, P. A., & Newby, T. J. (2013). Behaviorism, cognitivism, constructivism: Comparing critical features from an instructional design perspective. Performance improvement quarterly, 26(2), 43-71. https://doi.org/10.1002/piq.21143.
- Knowles, M. (1977). Adult learning processes: Pedagogy and andragogy. Religious Education, 72(2), 202–211. https://doi.org/10.1080/0034408770720210.
- Kolb, D. A. (2014). Experiential learning: Experience as the source of learning and development. FT press.
- Mezirow, J. (2018). Transformative learning theory. In Contemporary theories of learning (pp. 114-128). Routledge.
- Rumjaun, A., & Narod, F. (2020). Social Learning Theory—Albert Bandura. In: Akpan, B., Kennedy, T.J. (eds) Science Education in Theory and Practice. Springer Texts in Education. Springer, Cham. https://doi.org/10.1007/978-3-030-43620-9_7.
- Skinner, B. F. (1977). Herrnstein and the evolution of behaviorism. American Psychologist, 32(12), 1006–1012. https://doi.org/10.1037/0003-066X.32.12.1006.
