LIFELONG LEARNING 1483

Education Techniquesfor Lifelong LearningPrinciples of Adult Learning1

Jannette Collins, MD, MEd

The adult education literature supports the idea that teaching adultsshould be approached in a different way than teaching children andadolescents (preadults). Many aspects of effective teaching apply to allage groups. However, adults have had more life experiences and inmany ways are differently motivated than children. Adults are moreself-directed in their learning and have a greater need to know why theyshould learn something. Self-initiated learning is the most lasting andpervasive. Learning should be applicable to the learner’s work or toother responsibilities valued by the learner. Thus, it is important thatthe instructor know the learner’s needs and design learning activitiesthat are relevant to those needs. The learner should be actively in-volved in learning, with the instructor acting as a facilitator. The in-structor should recognize that adults have different learning styles andshould tailor instruction to the characteristic ways adults prefer tolearn. Understanding the principles of adult learning can help teachersbecome better facilitators of learning.©RSNA, 2004

Index terms: Education ● Radiology and radiologists

RadioGraphics 2004; 24:1483–1489 ● Published online 10.1148/rg.245045020 ● Content Code:

1From the Department of Radiology, University of Wisconsin Hospital and Clinics, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI53792-3252. Presented in the RSNA Faculty Development Workshop, September 2004. Received February 17, 2004; revision requested March 22and received March 26; accepted March 29. The author has no financial relationships to disclose. Address correspondence to the author (e-mail:j.collins@hosp.wisc.edu).

©RSNA, 2004

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IntroductionThe adult education literature supports the ideathat teaching adults should be approached in adifferent way than teaching children and adoles-cents (preadults). Many aspects of effective teach-ing apply to all age groups. However, adults havehad more life experiences and in many ways aredifferently motivated than children. Adults aremore self-directed in their learning and have agreater need to know why they should learnsomething. They have set habits and strongtastes. They may have prejudices, which are detri-mental to the learning environment. They want achoice in what they learn. These characteristics ofadult learners can be addressed in the learningenvironment to optimize learning. Understandingthe principles of adult learning can help teachersbecome better facilitators of learning. The impor-tance of these principles is recognized in educa-tional and business settings (1). This article dis-cusses the differences in how adults and preadultslearn, the science of adult learning principles, andhow these principles can be applied to radiologiceducation.

Adult versus Child LearnersThe assumption that teachers of adults shoulduse a style of teaching different from that usedwith children is based on “informed professionalopinion; philosophical assumptions associatedwith humanistic psychology and progressive edu-cation; and a growing body of research and theoryon adult learning, development, and socializa-tion” (2,3). Malcolm Knowles, who is consideredthe father of adult learning theory (4–6), coinedthe term andragogy to describe the study of adultlearning. He distinguished adult learning frompedagogy, the study of how children learn. Ini-tially, it was thought that pedagogy and andra-gogy were two distinct processes, but currenttheory sees the two processes on a continuum,with pedagogy on one end and andragogy on theother. What separates these two processes on thecontinuum is the quantity and quality of experi-ences the learners have when they enter the learn-ing experience and the amount of control that thelearners have over the learning process and envi-ronment (7).

By contrasting andragogic, or learner-centeredmethods, with pedagogic, or teacher-centeredmethods, Knowles argued that adults differ frompreadults in a number of important ways that af-fect learning. According to Knowles, the peda-gogic model is inappropriate for use with adults.

However, since he first proposed the model,Knowles has gradually modified his position re-garding the contrast between how preadults learn(pedagogy) and how adults learn (andragogy).According to Feuer and Geber (3,8), “what heonce envisioned as unique characteristics of adultlearners, he now sees as innate tendencies of allhuman beings, tendencies that emerge as peoplemature.”

Science of Adult LearningUntil recently there has been no effort to testwhether teachers actually use a different stylewhen teaching adults. In two different studies(2,9,10), researchers found that teachers believedadults to be significantly more intellectually curi-ous, motivated to learn, willing to take responsi-bility for their learning, willing to work hard atlearning, clear about what they want to learn, andconcerned with the practical applications and im-plications of learning than were children and ado-lescents. In one of these studies (10), the follow-ing groups of teachers were found to be the mostflexible and responsive in both adult and preadultclasses: less-experienced teachers, female teach-ers, teachers who taught personal enrichmentadult classes, secondary teachers, and teacherswho reported high teaching differences betweenhow they taught adults and preadults.

Although teachers perceive adults as being dif-ferent, these perceptions do not automaticallytranslate into differences in approaches to teach-ing (3). Perhaps the real issue is not whetherlearner-centered methods are universally appliedby teachers of adults, but rather for what pur-poses and under what conditions such methods(and others) are most appropriate and effectiveand in fact are used by teachers (2). The educa-tional approach should be based on the purposeof the teaching-learning situation. The andra-gogic or learner-centered approach is probablynot appropriate in all adult education settings (8).The approach should be based on the goals of thelearners, the educational content, and other fac-tors. The concept of adult learning is relativelynew, and more research is needed in this area todetermine the most effective applications of adultlearning principles.

Adult Learning PrinciplesThere are a number of “principles” that havebeen associated with adult learning (Table 1).Some of these are unique to adult learning andsome apply to preadult learning. (As stated, cur-rent theory sees the two processes on a con-tinuum with pedagogy on one end and andragogyon the other.)

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Adults bring a great deal of background experi-ences and prior learning to any new learning pro-cess. Acknowledging adults’ understanding andexperiences validates them as competent and ca-pable learners. It is important that the facilitatorof adult learning help adult students see the con-nections between earlier learning experiences andnew information. Thus, teachers of adults shouldbegin educational sessions by finding out whatthe adults already know about the topic. For ex-ample, knowing whether or not a group of medi-cal students has an understanding of interstitiallung diseases would be helpful to the radiologyteacher who plans to show the students radiologicexamples of the diseases. A student with no fun-damental knowledge of such diseases, who maybe unfamiliar with the disease names, would haveno current knowledge to tie the radiologic imagesto.

There are several effective strategies for assess-ing prior learning (7). One is the KWL strategy,in which the teacher asks learners (on a handout)what they already KNOW about the topic, whatthey WANT to learn about the topic, and (at the

end of the session) what they did LEARN aboutthe topic. Another strategy is a presession quizabout the topic. The quiz can be given severaldays or weeks before a session or at the beginningof the session. When an audience response systemis used to test learner knowledge, both the learn-ers and the instructor can find out what learnersalready know and whether the information theyknow is accurate. An additional strategy to assessprior learning allows participants to react, in writ-ing, to statements or questions about the topic atthe beginning of the session. A discussion of theresponses ensues, allowing the instructor to re-view them with the group and ask for clarificationabout what was written. Obtaining this kind ofinformation allows the instructor to facilitate aneducational activity that has built-in flexibility,allowing on-the-spot changes to address currentneeds. The information is useless if it is not usedto design an educational program that best meetsthe needs of the learners.

Table 1Principles of Adult Learning and Their Application to Radiologic Education

Principle Application

Adults have accumulated afoundation of life experi-ences and knowledge.

Connect life experiences and prior learning to new information.

Adults are autonomous andself-directed.

Involve participants in the learning process, serving as a facilitator and not justa supplier of facts.

Adults are goal-oriented. Create educational programs that are organized with clearly defined elements,clearly showing how the program will help participants reach their goals.

Adults are relevancy-orientedand practical.

Help learners see a reason for learning something by making it applicable totheir work or other responsibilities of value to them.

Adults (all learners) need tobe respected.

Acknowledge the experiences that adult participants bring to the learning envi-ronment, allowing for opinions to be voiced freely.

Adults are motivated to learnby both intrinsic and ex-trinsic motivation.

Show learners how the learning will benefit them and create a comfortable andappropriately challenging learning environment.

Adults learn best when theyare active participants inthe learning process.

Limit lecturing and provide opportunities for sharing of experiences, questions,and exercises that require participants to practice a skill or apply knowledge.

Not all adults learn the sameway.

Accommodate different learning styles by offering a variety of training methods(eg, group discussion, role-playing, lecturing, case studies, panel/guest ex-pert, games, structured note-taking, individual coaching, demonstration,and variation in media used) and by using visual, auditory, and kinesthetictechniques.

Adults learn more effectivelywhen given timely and ap-propriate feedback andreinforcement of learning.

Provide opportunity for feedback from self, peers, and instructor.

Adults learn better in an en-vironment that is informaland personal.

Promote group interaction.

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Knowles (4) promoted the concept of self-di-rected learning. He felt that adults should createpersonal learning objectives that would allowthem to set individual goals and to practice usingthe new learning in practical ways. Self-initiatedlearning is the most lasting and pervasive (11).Learning is most effective when adults can pro-ceed at their own pace, so independent studyshould be encouraged. Independent study can befacilitated by providing learners with referencesand handouts. Knowles created the concept of alearning contract, which allows participants toidentify and write down personal goals and howthey feel that these goals could be met. Instruc-tors can share the intended agenda for the learn-ing experience and ask for input from the learn-ers, asking them what they would like to knowabout the topic. Their suggestions should not bethe sole input into development of objectives andeducational content. Learners may be unaware ofthings that they need to know, and the instructorneeds to anticipate this based on experience withother learners at similar levels of development.Formal testing is one way to determine whatlearners do and do not know.

Adults are goal-oriented. They like to knowhow the educational activity will help them reachtheir goals. The facilitator should explicitly statethis objective at the beginning of the activity. Forexample, a learner may attend a lecture on high-resolution computed tomography (CT) of thechest, with a goal to understand the different pat-terns of disease seen on CT scans. At the begin-ning of the lecture, the instructor outlines sevenpatterns that will be discussed and contrastedwith each other, making it clear to the learnerhow the lecture will help him or her understandpatterns of disease on CT scans in a way that willbe applicable to his or her practice. To fulfill thisneed of adult learners, instructors should createlectures that are organized with clearly definedelements.

Adults desire course content to be relevant andpractical. Learning should be applicable to thelearner’s work or other responsibilities valued bythe learner. In other words, adults want to know“what’s in it for me” (WIFM). They want contentthat can be applied to real-life situations. Adultstend to be problem-centered rather than subject-centered learners and learn best through practicalapplications of what they have learned. To createa problem-centered learning environment, theinstructor needs to know what the learner’s needsare and to design learning activities that are rel-evant to those needs. Early in the learning experi-

ence, there should be an opportunity for thelearner to identify his or her specific needs. Tech-niques that can be used to facilitate making con-tent relevant are use of collaborative, authenticproblem-solving activities; anticipating problemsin the application of the new ideas to the learner’ssetting and offering suggestions; and using storiesto link theory to practice.

All learners need to be respected as individu-als. Creating respectful learning environments, inwhich all opinions are valued, helps to allay anyconcerns or discomfort. Adults should participatevoluntarily. In a true learning community, all par-ticipants, including the instructor, share ideas andlearn from each other. The instructor is seen as afacilitator or guide rather than the only one withknowledge. Adults respond positively to comfort-able physical environments, frequent breaks,snacks, and opportunities to collaborate with oth-ers in the session. Learners respond to personalinteraction, such as when the instructor calls thelearner by name and listens to the learner’s ques-tions and viewpoints. The instructor should al-ways be courteous and patient, assuring learnersthat mistakes are part of the learning process, andshould encourage learners to support one anotherin learning endeavors. Learning takes place in anenvironment that is considered “safe” by thelearner, one in which the learner feels he or shecan be successful. An example of an unsafe envi-ronment is one in which radiology residents arebelittled in front of their peers for not knowing acorrect answer. Learners appreciate activities thatuse time effectively and follow a planned sched-ule. Otherwise, they feel that their time is notconsidered valuable. An instructor can create arespectful learning environment by consideringwhat he or she would desire as a learner and treat-ing learners in the same way.

Another aspect of adult learning is motivation,which is both intrinsic and extrinsic. At least sixfactors serve as sources of motivation for adultlearning (12): (a) social relationships (makingnew friends, meeting a need for associations andfriendships), (b) external expectations (complyingwith instructions from someone else, fulfilling theexpectations or recommendations of someonewith formal authority), (c) social welfare (improv-ing one’s ability to serve mankind, preparing forservice to the community, and improving one’sability to participate in community work),(d) personal advancement (achieving higher sta-tus in a job, securing professional advancement,and staying abreast of competitors), (e) escape orstimulation (relieving boredom, providing a breakin the routine of home or work, and providing acontrast to other exacting details of life), and(f) cognitive interest (learning for the sake oflearning, seeking knowledge for its own sake, and

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satisfying an inquiring mind). Successful continu-ing medical education courses provide opportuni-ties for social relationship, personal advancement,and escape or stimulation.

Unlike children, adults have many responsibili-ties that they must balance against the demandsof learning. Because of these responsibilities,adults have barriers against participating in learn-ing (12). Some of these barriers include lack oftime, money, confidence, or interest; lack of in-formation about opportunities to learn; schedul-ing problems; “red tape”; and problems withchild care and transportation. Typical motiva-tions include a requirement for competence orlicensing, an expected (or realized) promotion,job enrichment, a need to maintain old skills orlearn new ones and adapt to job changes, or theneed to comply with company directives. Thebest way to motivate adult learners is to enhancetheir reasons for participation and decrease thebarriers. Instructors can motivate learners by es-tablishing a friendly, open atmosphere of helpful-ness and by setting the degree of difficulty of thelearning experience high enough to challenge par-ticipants but not so high that they become frus-trated by information overload.

Teaching is not something that should be doneto the learner. The learner should be actively in-volved in learning and should be encouraged tobe active. He or she should be given an opportu-nity to practice new behavior in a safe, supportingsituation. Active participation engages learners inthe learning process and enhances retention ofnew concepts. Active learning techniques includeactivities that are student-centered (eg, not a“talking head” lecture), encourage sharing of ex-periences and questioning, and weave discussionsections with exercises that require learners topractice a skill or apply knowledge. In his bookFreedom to Learn, Carl Rogers (13) distinguishedtwo types of learning: cognitive (meaningless) andexperiential (significant). Cognitive is seen as aca-demic knowledge, whereas experiential equates tolearning by doing. Rogers saw the qualities of ex-periential learning as personal involvement, selfinitiated, evaluated by the learner, and havingpervasive effects on the learner.

Transfer of learning is the result of training. Itis the ability to use the information taught in thecourse in a new setting. Positive transference, likepositive reinforcement, occurs when the learnersuse the behavior taught in the course. Negativetransference, like negative reinforcement, occurswhen the learners no longer do what they are toldnot to do. Negative transference results in a posi-tive (desired) outcome. Transference is mostlikely to occur when learners can associate thenew information with something that they already

know (association), when the information is simi-lar to material that participants already know(similarity), when the learner’s degree of originallearning was high, and when the informationlearned contains elements that are extremely ben-eficial on the job (critical attribute element) (12).Radiology review courses are an example of aneducational activity in which learners benefit fromnew knowledge that is based on and reinforcescurrent knowledge that the learner will apply inpractice (clinical practice or in a certification ex-amination).

Not all people learn in the same way. Researchshows that there are many different learning stylesor characteristic ways that adults prefer to learn.Individual learning styles are influenced by per-sonality, intelligence, education, experiences, cul-ture, and sensory and cognitive preferences. Toengage all learners, it is best to vary the methodsin which information is communicated. Thesemethods can include small- and large-group dis-cussion, role-playing, lecturing, case studies,games, questioning, and varying technology (eg,media, video, computer, interactive). Studies re-veal that over a period of 3 days, the retention oflearning is 10% of what we read, 20% of what wehear, 30% of what we see (demonstration), 50%of what we see and hear (discussion), 70% ofwhat we say (practice), and 90% of what we sayas we do (teach others, immediate use). It followsthat an effective learning protocol is to watch one(demonstration), do one (practice), and teach one(use new learning).

There are several different “learning intelli-gences” or ways in which individuals can learninformation. Instructors should attempt to in-clude as many of these different intelligences aspossible in the design of their educational activi-ties. These intelligences are linguistic (languageand words), logical and mathematical (numbersand problems), spatial (perception of objectsthrough senses), kinesthetic (use of body tolearn), interpersonal (social skills, working withothers), intrapersonal (learn on one’s own), musi-cal (learning through music), and naturalistic(learning through the natural world).

Boud and Griffin (14) suggest that we have sixlearning capabilities comparable to the six stringson a guitar. The six strings are rational (we arethe most familiar and have the most experiencewith this capability, as we assume that learning isa rational, intellectual activity), emotional, rela-tional (learning is enhanced through relationshipswith others), physical (learning can be enhancedor inhibited by our physical state), metaphoric

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(learning can be enhanced through symbol, meta-phor, intuition), and spiritual (a deep sense ofconnection with everyone and everything). Learn-ing experiences occur more often when more ofthe “guitar strings” are activated.

Providing timely feedback leads to successfullearning and mastery of content and skills. Sensi-tive feedback helps learners correct errors andreinforces good behaviors. As the name implies,positive reinforcement is “good” and reinforces“good” (or positive) behavior. Negative reinforce-ment is useful in trying to change modes of be-havior. The result of negative reinforcement isextinction—that is, the instructor uses negative

reinforcement until the “bad” behavior disap-pears or becomes extinct. Instructors need to usereinforcement on a frequent and regular basisearly in the process to help learners retain whatthey have learned. The Accreditation Council forGraduate Medical Education (ACGME) requiresthat radiology residency programs evaluate resi-dents on a quarterly basis and encourages evalua-tion after every rotation (15). However, residentscan benefit from feedback (formal and informal)on a more frequent basis. More frequent feedbackis especially beneficial for first-year radiology resi-dents, who may feel insecure about their role andlevel of competence. Reassurance from the radiol-ogy faculty that these feelings are natural and ex-pected can help to create a safe learning environ-ment, one in which the resident is not hesitant tobe an active participant.

Table 2Questions for Educators Seeking to Apply Adult Learning Principles

Principle Question

Learning is enhanced when it is immediatelyapplicable to real-life contexts.

What are some of the ways you can make training relevantto the learners’ practices?

Learning is enhanced when adults have controlor influence over the educational experience.

What are some of the ways you can give participants controlover their learning?

Learning depends on past and current experi-ences.

What are some of the ways you can use the learners’ experi-ences as a resource for learning?

Learning depends on active involvement of thelearner.

What are some of the ways you can keep learners stimulatedand involved?

Learning depends on a climate of respect andcomfort.

What are some of the ways you can create a safe, respectful,comfortable learning atmosphere?

Learning is enhanced when learners achieveself-direction.

What are some of the ways you can encourage learners to bemore self-directed and to continue learning on the job?

Learning is enhanced when connections arecreated.

How can you create connections among participants andthe workplace?

Learning is enhanced when learners are suc-cessful.

What are some of the ways you can help ensure that learnersare successful?

Learning is facilitated when learners receivefeedback.

What are some of the ways you can reinforce learners andfacilitate self, peer, or instructor feedback?

Source.—Reference 7.

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Self, peers, and instructor can all provide im-portant feedback. Success in achieving objectivesfacilitates further learning. Critical reflection is animportant element of adult learning programs. Ithas been suggested that people do not learn fromexperience, but rather they learn from reflectingon experience (7). Writing reflective journals canbe helpful in enabling adults to keep track ofchanges in their behavior or actions as a result ofnew learning and to keep track of how thosechanges affect their practice over time. Journalsallow adults to chart their own courses and to beaware of their personal growth and development.

SummaryIn general, all theories of adult education arebased on valuing the prior learning and experi-ence of adults (11). Adult learning requires build-ing on this prior learning, using methods thattreat learners with respect, and recognizing thatpeople have different learning styles and have avariety of responsibilities and time commitments.Effective educators also recognize that adults of-ten learn collectively from each other. The opti-mal role of the adult learner in the learning situa-tion is that of a self-directed, self-motivated man-ager of personal learning who collaborates as anactive participant in the learning process and whotakes responsibility for learning. Educators will bemore successful if they understand the basic prin-ciples of adult learning and apply these principlesin their teaching (Table 2).

References1. Flaxington BD, Cohen LA. Using adult-learning

principles to educate employees about investments.Profit Sharing 1996; September-October:12–14.

2. Beder HW, Darkenwald GG. Differences betweenteaching adults and pre-adults: some propositionsand findings. Adult Education 1982; 32:142–155.

3. Imel S. Teaching adults: is it different? ERIC Di-gest No. 82. Available at: http://www.ericfacility.net/ericdigests/ed305495.html. Accessed February 5, 2004.

4. Knowles MS. The modern practice of adult edu-cation: andragogy versus pedagogy. New York,NY: Association Press, 1970.

5. Knowles MS. The modern practice of adult edu-cation. Rev ed. Chicago, Ill: Association Press/Follett, 1980.

6. Knowles MS. Introduction: the art and science ofhelping adults learn. In: Andragogy in action: ap-plying modern principles of adult learning. SanFrancisco, Calif: Jossey-Bass, 1984.

7. Pennsylvania Pathways: Professional Developmentfor Child Caregivers. Training Resource Manual,Adult Learning Principles. Available at: http://www.papathways.org/TRM_AdLearnPrinc.htm. Ac-cessed February 5, 2004.

8. Feuer D, Geber B. Second thoughts about adultlearning theory. Training 25, no. 12 (December1988):31–39. ERIC Digest No. EJ 381 416.

9. Gorham J. A current look at modern practice: per-ceived and observable similarities and differenceson the same teachers in adult and pre-adult class-rooms. In: Proceedings of the 25th Annual AdultEducation Research Conference, Raleigh NC,April 5–7, 1984. (ERIC Document ReproductionService No. ED 269 554).

10. Gorham J. Differences between teaching adultsand pre-adults: a closer look. Adult EducationQuarterly 1985; 35(4):194–209.

11. O’Brien G. What are the principles of adult learn-ing? Available at: http://www.southernhealth.org.au/cpme/articles/adult_learning.htm. Accessed February5, 2004.

12. Lieb S. Principles of adult learning. Available at:http://honolulu.hawaii.edu/intranet/committees/Fac-DevCom/guidebk/teachtip/adults-2.htm. AccessedFebruary 5, 2004.

13. Rogers CR. Freedom to learn. Columbus, Ohio:Merrill, 1969.

14. Boud D, Griffin V, eds. Appreciating adults learn-ing: from the learner’s perspective. London, En-gland: Kogan Page, 1987.

15. Accreditation Council for Graduate MedicalEducation Program Requirements for GraduateMedical Education in Diagnostic Radiology.Available at: http://www.acgme.org. Accessed July16, 2004.

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