Informing Through Evidence, Transforming Through Engagement.
Core Principles and Theory
The program to teach primary health care providers to improve their practices in accordance with the C-CHANGE clinical practice guideline involves several core principles and theories of adult education. These can be summarized as follows:
Andragogy: This theory, propounded by Malcolm Knowles, forms the foundation of adult learning(1). It posits that adults are self-directed and expect to take responsibility for their decisions. This program allows physicians to take active roles in their learning, guiding them to find their own solutions during case-based interactive workshops.
Experiential Learning: As per Kolb's theory of Experiential Learning, adults learn best through experiences(2). Small group workshops allow physicians to learn through real-life cases, thereby bridging the gap between theory and practice. The cycle of concrete experience, reflective observation, abstract conceptualization, and active experimentation is fostered.
Transformative Learning: Mezirow's theory holds that adults learn best when they are able to critically reflect on their experiences and assumptions, leading to transformative changes in their perspectives(3). This program encourages physicians to critically reflect on their current practices and make necessary changes to align with the C-CHANGE guidelines. Also to explain how learners can change their point of view about educational technologies.
Social Learning Theory: Bandura's theory emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others. In small group interactive workshops, in person, on-line with facilitation, health care providers can learn from their peers' experiences and feedback, fostering collaborative learning. Social media can also increase learner engagement (4).
Self-efficacy Theory: This program also adopts Bandura's theory of self-efficacy which posits that individuals are more likely to engage in activities in which they believe they can succeed (5). Linking quality improvement principles and data, allows health care providers to compare their practice parameters to the whole, providing incentive and affirmation of practice change.
Adult Learning Principles: These include readiness to learn, orientation to learning, and relevance. Adult learners want education that is problem-centered rather than content-oriented, and are more motivated to learn something that will have an immediate impact on their work. The program, is designed including needs, both perceived (needs assessments) and unperceived (new clinical practice guideline recommendations), with cases directly relevant to clinical practice.
In summary, this program incorporates numerous evidence-based adult learning principles to ensure a comprehensive and effective learning experience. By combining different theories, it ensures that health care providers are engaged, confident, and able to apply what they have learned in their own practices. It is rigorous, yet flexible, catering to the unique needs and preferences of adult learners.
1. Knowles MS, Holton III EF, Swanson RA. The adult learner: The definitive classic in adult education and human resource development. Routledge, 2014
2. Kolb DA, Boyatzis RE, Mainemelis C. Experiential Learning Theory: Previous Research and New Directions in Perspectives on Thinking, Learning, and Cognitive Styles (Educational Psychology Series). 2001;
3. Kitchenham A. The evolution of John Mezirow's transformative learning theory. Journal of transformative education 2008;6:104-123
4. Deaton S. Social learning theory in the age of social media: Implications for educational practitioners. Journal of Educational Technology 2015;12:1-6
5. Johnson JA. Self-efficacy theory as a framework for community pharmacy-based diabetes education programs. The Diabetes Educator 1996;22:237-241