Educational Theory in Medical Education: An HRD View

The reception of andragogy and the time lag

AMEE Guide 83 by Taylor and Hamdy (2013) brings together Knowles’s andragogy and self-directed learning, Kolb’s experiential learning, and Schön’s reflective practice. Systematized in the 1970s–90s, these ideas continue to inform instructional design. The guide describes the distinction between andragogy and pedagogy as artificial and introduces social learning theories.

The analysis by Misch (2002) explained how medical students’ intrinsic and extrinsic motivations intertwine depending on the context. The review by Merriam (2001) examined debates from the 1990s about andragogy’s focus on the individual and its limited attention to sociohistorical context. Examining how a theory is received can involve tracing how its concepts spread and how the conditions for applying them are discussed.

Turning theory into techniques

The thought experiment introduced by de la Croix and Veen (2018) presents the ‘reflective zombie’: a learner who follows prescribed steps of thinking and reproduces the outward form of reflection. The thought experiment explores how operationalizing reflection can diminish its philosophical grounding and complexity.

The study by Schaepkens et al. (2024) analyzed conversations among GP registrars in the Netherlands. Participants acknowledged the value of reflection and described difficulties they had experienced in the curriculum. They constructed its value differently depending on how it was combined with other educational tasks. AMEE Guide 83 also distinguishes self-directed learning from ‘directed self-learning’ and discusses how much autonomy learners exercise in practice. Self-direction and reflection take shape in the choices learners make and the meanings they assign to tasks.

Individual learners and the workplace

The analysis by Bleakley (2006) argued that medical education draws on a narrow range of theories relative to the breadth of the educational literature. It also argued that accounts focused on individual learning have limited scope for explaining learning in fluid clinical teams. The work by Swanwick (2005) examined approaches that use cognitive information processing to explain informal learning in graduate medical education. It described learning as participation in social practice.

The account by Billett (2001) explains how learning arises from individual participation and the opportunities workplaces provide to engage in activities and receive support. The account of informal and incidental learning by Marsick and Watkins (2001) provides concepts for analyzing everyday problem-solving and the learning that occurs in the process.

Learning among working adults

The analysis by O’Sullivan and Irby (2011) identified a tendency for faculty development research to focus on individual participants. The authors proposed a model linking communities formed in programs with workplace communities where teaching takes place. The model includes networks, organizational culture, teaching work, and mentoring.

Studying how working adults learn allows researchers to trace connections among participation in education, work opportunities, networks, and careers.

Where the two bodies of literature meet

Issue	Discussion within medical education	Related discussion in adult education and HRD
Reception of andragogy	Misch (2002), Taylor and Hamdy (2013)	Merriam (2001)
Turning reflection and self-direction into techniques	de la Croix and Veen (2018), Schaepkens et al. (2024)	—
Individual units of analysis	Bleakley (2006), Swanwick (2005)	Billett (2001), Marsick and Watkins (2001)
Faculty as working adults	O’Sullivan and Irby (2011)	Workplace learning and career development research

In medical education, clinical settings are also learning settings. Requirements for patient safety, licensure, and accreditation define the scope of participation and responsibility. Applying concepts of workplace learning involves considering levels of supervision and work-related risks alongside learning opportunities.

References

• Billett, S. (2001). Learning through work: Workplace affordances and individual engagement. Journal of Workplace Learning, 13(5), 209–214. https://doi.org/10.1108/EUM0000000005548
• Bleakley, A. (2006). Broadening conceptions of learning in medical education: The message from teamworking. Medical Education, 40(2), 150–157. https://doi.org/10.1111/j.1365-2929.2005.02371.x
• de la Croix, A., & Veen, M. (2018). The reflective zombie: Problematizing the conceptual framework of reflection in medical education. Perspectives on Medical Education, 7(6), 394–400. https://doi.org/10.1007/s40037-018-0479-9
• Marsick, V. J., & Watkins, K. E. (2001). Informal and incidental learning. New Directions for Adult and Continuing Education, 2001(89), 25–34. https://doi.org/10.1002/ace.5
• Merriam, S. B. (2001). Andragogy and self-directed learning: Pillars of adult learning theory. New Directions for Adult and Continuing Education, 2001(89), 3–14. https://doi.org/10.1002/ace.3
• Misch, D. A. (2002). Andragogy and medical education: Are medical students internally motivated to learn? Advances in Health Sciences Education, 7(2), 153–160. https://doi.org/10.1023/A:1015790318032
• O’Sullivan, P. S., & Irby, D. M. (2011). Reframing research on faculty development. Academic Medicine, 86(4), 421–428. https://doi.org/10.1097/ACM.0b013e31820dc058
• Schaepkens, S. P. C., de la Croix, A., & Veen, M. (2024). ‘Oh yes, that is also reflection’—Using discursive psychology to describe how GP registrars construct reflection. Medical Education, 58(3), 318–326. https://doi.org/10.1111/medu.15183
• Swanwick, T. (2005). Informal learning in postgraduate medical education: From cognitivism to ‘culturism’. Medical Education, 39(8), 859–865. https://doi.org/10.1111/j.1365-2929.2005.02224.x
• Taylor, D. C. M., & Hamdy, H. (2013). Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Medical Teacher, 35(11), e1561–e1572. https://doi.org/10.3109/0142159X.2013.828153