Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St. Pomona, CA

Don't Perspire. Inspire.
Teaching the Adult Learner

For the past two years, my eight year-old son has been taking dance lessons. Initially, this was a hobby to spend some extra time and energy while providing that needed exercise. His dance quickly metamorphosed into something much more serious once he joined the dance studio's "company," the competitive side of things. In order to be a member of company, my son takes four to five days per week of classes including preparation for several weekend competitions, all culminating in a trip to Las Vegas for the national competition.

With all of this comes increased pressure from my son's dance teachers. They take this absolutely seriously. As a result, my son recently had a discussion with one of his teachers regarding his dislike of his teacher's methods. Without getting into any of the details, my son took umbrage with certain words used by the teacher that would be considered negative reinforcement. He felt the teacher would be more effective at motivating others if they used more positive motivational techniques. At almost eight years-old, I was very proud that my son was taking a stand on something and wasn't letting anyone be disrespectful. It turns out my son was more worried about the girls he dances with than himself – that's my boy!

Of course, I felt I needed to get involved, and spoke with the teacher. While having this meeting with my son and his teacher, I couldn't help but think about the ways in which we motivate our trainees, be they students, residents, or fellows. What type of motivation is best? Does the psychology research have any good answers? Let's take a quick look.

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What Does the Research Say?

First, it is important for us to realize that, despite my 8 year-old son's example, we are dealing with adult learners rather than children. Thus, I'll focus our discussion on adults. The science of adult learning (or andragogy) is relatively new, the seminal theory of which has been discussed by Malcolm Knowles in his book The Adult Learner. In this text, he defined the following characteristics specific to adult learners:

Autonomous and self-directed
Pre-existing foundation of life experiences and knowledge
Goal-oriented
Relevancy-oriented
Practical
Need for respect

These 6 characteristics are pretty self-explanatory. However, another 6 characteristics are discussed that may be a little less clear regarding motivating factors for adults to learn new things:

Social relationships – meeting a social need
External expectations – to fulfill expectations of an outside authority
Social welfare – to improve one's ability to serve humankind
Personal advancement – to achieve higher personal status in society
Escape/stimulation – to relieve boredom
Cognitive interest – learning for the sake of learning.

How do we use this information to motivate our trainees? Four critical elements need to be addressed for learning to occur:

Motivation – The student must see the need to learn the particular skill, and the instructor must establish a positive rapport. How does one do this? According to current theory, this may be accomplished in the following ways:

Set a positive tone and safe atmosphere.
Set an appropriate level of concern. For example, highly important information should be approached with more tension.
Set an appropriate level of difficulty. A task that is impossible to perform will lead to a demotivated individual.
Provide appropriate and specific feedback.
Establish some reward for learning, even if a simple pat on the back or demonstration of the importance of the new knowledge.

Reinforcement – This is defined as encouragement of correct modes of behavior and performance. This consists of positive reinforcement (reinforcing "good" behavior) and negative reinforcement (providing a "noxious" stimulus to change negative behavior – AKA: punishment). Experts recommend using both methods to change and maintain behavior, but positive reinforcement is more effective during the early stages of learning.

Retention – The student/resident must practice the skill repeatedly in order to retain the skill for any significant period of time. It is the instructor's job to communicate the importance of the skill in order for the student to feel the urge to practice.

Transference – This is the ability to use the previously taught skill in a new setting. It requires a higher level of concept understanding.

Consider how one might apply these concepts to your next resident educational experience. For example, allowing a first year podiatry resident to be the primary assistant on day one of their residency would violate the motivational concept of appropriate level of difficulty. Their likely failure would be a potential demotivator.

Similarly, providing very specific feedback immediately after a surgical procedure would be highly beneficial in motivating the resident. I'll wager this is a relatively uncommon educational technique in our residencies. How often do our attendings sit down with us and provide feedback about our skills immediately after a case? Imagine how beneficial this would be for both skill acquisition as well as motivation.

Give some of these tools a try the next time you have an educational encounter with a student or resident.

Postscript

For those who are curious, the motivation-in-dance drama at the Shapiro household is somewhat ongoing. As it turns out after the first meeting my son was unhappy with the answer he received about motivational techniques (he was basically told tough luck, buddy, this is how it is). This negative experience then motivated my son to create a survey in which he polled his fellow dancers if they thought the teacher's methods were encouraging or discouraging. His preliminary results were a 50/50 mix. It seems 50% of the dancers felt negative reinforcement was encouraging while 50% felt it was discouraging. Say what you will for the teacher's methods, but they sure motivated my son.