Adult Learning Principles
Introduction
Principles of Adult Learning
Conducting a Participant Strengths and Needs Assessment
Education is one tool in the fight against cancer. Fully
informed health care professionals and consumers can act
more effectively to care for their patients, themselves, and
their loved ones. It is vitally important that everyone
learn how to decrease their risks for getting cancer, the
importance of screening and early detection, and ways to
access various treatment options.
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Cancer education can take many forms: individual counseling and
education, group training sessions, media campaigns, and printed
materials such as brochures, pamphlets, and newsletters. This
trainer's guide is designed for both lay people and health
professionals who are conducting group-training sessions with
community and scientific audiences. It offers practical suggestions
for taking your knowledge, tailoring it to the specific needs of your
audience, and packaging the information in new ways. The guide
provides ways to enliven your training, encourage more active
participation, and enrich the learning experience for everyone
involved.
The trainer's guide also provides examples of icebreakers,
energizers, and closing activities as well as checklists and charts
to help you write objectives, develop a training plan, and conduct an
evaluation.
Guiding principles that serve as underpinnings for the development
of this trainer's guide are:
We all have incredible assets to bring to the training
experience. You, as trainers, already have a wealth of
information and skills. This trainer's guide is merely an opportunity
to review, refresh, and reinvigorate your training. This guide also
describes ways to elicit the experiences and skills of your
participants so that they are actively engaged in the learning
experience.
Application is an important part of any learning
experience. Just as the trainer's guide encourages you to
construct opportunities for your participants to apply their new
information and skills during your training, it also provides you
with a chance to do the same. Most sections have worksheets that give
you an opportunity to apply the information from that section.
Changes in knowledge, attitudes and behaviors, and
skills are primary objectives. The trainer's guide provides
suggestions for ways to use training methods that lead to increased
information and skill acquisition, and to improved attitudes.
All trainers should understand the principles of adult learning;
however, cancer education poses some unique challenges. The word
"cancer" still strikes fear in the hearts and minds of many people.
Participants in your training sessions may come with a number of
emotions, unresolved feelings, fears, and concerns that will
influence their receptivity to the training content. They also may
bring experiences, perspectives, and insights that will enrich the
training. Thus, cancer education is not just a matter of presenting
new information to a passive, receptive audience. The trainer must
carefully consider the emotional context in which this education
takes place.
Malcolm Knowles, often referred to as the "father of adult
education," found that adult learning occurs best when it follows
certain principles. If trainers follow these guidelines, they will
greatly enhance the learning experience for participants (Knowles,
1990). Arnold et al. (1991), among other adult educators, state that
people retain:
20 percent of what they hear
30 percent of what they see
50 percent of what they see and hear
70 percent of what they see, hear, and
say (e.g. discuss, explain to others)
90 percent of what they see, hear,
say, and do
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Therefore, for participants to retain what they learn in
cancer education workshops, they need a chance not only to
hear a lecture or discussion, see a demonstration or visual
aids, and discuss the material, but they must also have an
opportunity to do something with the new information and
skills. This can take the form of applying their new
insights to a case study or role play exercise, or it can
take the form of developing an action plan of ways to use
their training insights in real life.
It is also important to remember the adult learning
cycle. Participatory training is the hallmark of adult
learning. It moves participants through the four phases of
the adult learning cycle.
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Using the Adult Learning Cycle
It is important to move participants through this cycle at least
once per module or 4-hour session. If your training will be more than
4 hours in length, it will be necessary to complete proportionately
more full cycles.
Applying the Adult Learning Cycle to Cancer Education: An
Example
Let's look at how a training program on cancer survivorship might
move participants through this cycle.
Once the trainer has set the stage for the training, reviewed the
agenda, and conducted an icebreaker, he or she can move through the
adult learning cycle.
Phase 1: Experiencing
The trainer might first lead an activity designed to get
participants talking about how receiving a cancer diagnosis impacts
their life.
If all of the participants were cancer survivors, the trainer
would know that everyone has had the experience of first learning
their diagnosis, so a small group discussion might be an appropriate
beginning place. However, if some participants were not survivors but
were social workers from an oncology unit, the design of this
activity should be modified. Since they have not necessarily
personally experienced the feelings associated with a cancer
diagnosis, a small group discussion would not be appropriate as a
beginning place. A more appropriate beginning might be a panel
presentation by a group of survivors.
Phase 2: Processing
The trainer would then lead a discussion about what people heard
during their small group discussions or what feelings the panel
aroused in them.
Phase 3: Generalizing
The next part of the discussion might lead to a comparison between
getting a cancer diagnosis and other life-altering news.
Phase 4: Applying
The trainer would then encourage all participants to think of ways
they might use these new insights. For oncology social workers, the
discussion might yield insights that would help them be more
compassionate and understanding with their newly-diagnosed patients.
For cancer survivors, the discussion may have generated ideas to take
back to their support groups or about how to get more support for
themselves.
Repeating the Cycle
The trainer would then move to the next activity and the adult
learning cycle would be repeated using the same structure of
experiencing, processing, generalizing, and applying.
Ensuring that the Training Addresses the Fact that People
Learn in Different Ways
Trainers must be aware that in any audience the participants will
learn in different ways:
Since trainers are unlikely to know the individual learning styles
of the participants in their audience, it is best to assume that
there are people with all learning styles in each group and design a
variety of strategies to meet the learning needs of all participants.
These training methodologies will be discussed in detail in section
II.2.
It is also important to consider the learning strategies to which
different audiences are accustomed. For example, health care
professionals are used to learning from lectures, demonstrations, and
case studies. They may be less used to learning via experiential
exercises and some of the creative strategies listed in section II.2.
On the other hand, community members and groups of survivors or
patients and family groups may prefer more interactive methods over
lectures and PowerPoint presentations.
Trainers need to be judicious about matching training
methodologies to the specific audience. This does not mean that
health care professionals will never respond to experiential
exercises, nor that community groups will never benefit from
lectures. However, it does mean that training methods that the
audience is not accustomed to should be used in moderation and with
sensitivity.
For example, the trainer might warm up an audience of health care
professionals by using experiential methods such as small group
discussions about a case study before using role plays. Likewise,
community groups might prefer lecturettes (i.e., brief lectures of no
more than 15-20 minutes) followed by a question and answer period
rather than a lengthy lecture.
Trainers will be most effective if they carefully consider the
"culture" of their audience when choosing appropriate methodologies.
In this way, participants can be carefully encouraged to explore new
ways of learning.
Assisting Participants in Being Comfortable with the Learning
Process
One of the trainer's primary tasks is to help participants feel
comfortable with the learning process. There are many factors that
hinder learning, such as fear of finding out that one's lifestyle
predisposes one to a higher risk of cancer, fear of exposing one's
ignorance to others, or fear of stirring up painful memories of loved
ones lost to cancer. By creating a positive and non-threatening
learning environment, the trainer can reassure the participants that
these feelings are normal and will be carefully considered throughout
the course of the training session.
Before designing a program that is "one size fits all," it is
important to conduct an assessment of participants' prior knowledge
and experience as well as their hopes and expectations for the
training. This can be accomplished through a variety of mechanisms
that are employed before or at the very beginning of the training. It
is important to keep in mind that training participants will bring a
number of strengths and experiences as well as the need for new
information, insights, and skills. Often assessments focus on "needs"
but a comprehensive assessment should include both the strengths and
needs of participants.
Before the Training
If you know the backgrounds of the people (i.e., general community
members, health care professionals, or cancer patients and survivors)
who will be participating in the training, you can conduct an
assessment before planning the content and format. The best case
scenario is to do this assessment with some or all of the people who
will actually be participating in the training.
If you do not have a roster of who will be participating or your
time is limited, another option is to conduct an assessment with key
informants (i.e., people who may be demographically matched to those
who will be participating, such as oncology nurses, survivors from a
local support group, etc.). With this information, you will be able
to design a training that builds on the strengths of the participants
in order to add new information, develop new skills, and enhance
understanding. Assessment methods that work well with particular
participant groups include the following:
Audience
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Assessment
Methods
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Health care professionals
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E-mail, fax-back, or telephone surveys
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Community members or survivors
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Focus groups, in-person interviews, or telephone
surveys
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It is important to include enough people in your
assessment to cover a variety of perspectives and
experiences. For example, if you were conducting a community
training on the importance of colorectal screening, it would
be important to include a variety of health care providers
(e.g., physicians, nurses, social workers, and health
educators), general community members, colon cancer
survivors and their family members, etc. This would give you
a fuller picture of the knowledge and experience the
community participants will bring to the training.
Possible questions include:
What do participants already know about the
topic?
What experiences or insights related to the topic
do participants already possess?
What do participants believe are the challenges or
barriers related to the issue? (For example, why do they
think people do not avail themselves of colorectal screening
services?)
What do participants hope to gain from the
training? (This includes new knowledge, skills, resources,
etc.)
What do participants desire regarding the
logistics of the training (e.g., location of training,
length of program, optimal number of days of training, best
day of week, time of day, etc.)?
The more specific the questions, the more useful the
feedback will be. You can then use the information to
develop the content and format of the training as well as to
guide decisions related to training logistics. Assessments
can pique community members' interest in the training topic
as well as gather data for planning.
If you do not have access to community members or enough
time to conduct an assessment, it is also helpful to review
evaluations from prior training programs.
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At the Beginning of the Training
If you are not able to conduct an assessment before the training,
there are a variety of techniques that can be used to determine
participants' knowledge and expertise as well as their hopes for the
training that day.
Hopes and Expectations
One quick way to conduct an assessment is to ask participants to
write down their hopes and expectations about the training as they
arrive. One way to accomplish this assessment follows:
Post sheets of flipchart paper on the walls of the training
room with titles such as "one to two things I hope to learn at this
training" and "one to two concerns I have about this training."
Ask each participant (as they enter the training room) to
write their comments on the flipchart paper.
Review all of the comments.
Let participants know which expectations will likely be met
through the training and which may be beyond the scope of the
training.
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For example, if one of the participants wrote that he was
concerned that the trainer would use too much technical
language or difficult scientific concepts, the trainer can
reassure him by saying, "Some people seem concerned that
this training will have too many concepts that are difficult
to understand. We are really going to try hard to make the
concepts as user-friendly as possible. However, if we start
using scientific jargon or talk about things you don't
understand, please let us know at that time or talk with one
of the trainers during a break. We really want this training
to be meaningful for everyone, so please help us by asking
questions and giving us feedback."
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For another example, if someone wrote that she wanted to
find specific clinical trials for a particular stage of
colon cancer, the trainer might state, "Actually, we
won't be covering that specific information but I can refer
you to the NCI Web site for clinical trials and give you the
toll-free telephone number to call for more
information." In this manner the trainer can be a
helpful resource for topics outside the scope of the
training. However, if a number of participants have hopes
and expectations that are not covered in your training plan,
it would be helpful to take time to address these
expectations before moving on with the training as
you have planned.
This approach is respectful of peoples' perceived needs
and eliminates one impediment to learning. If you feel that
it is necessary, you can even revise your agenda by spending
time addressing the needs of your participants and
discarding a less important portion of the training. In
this case, flexibility is key.
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Group Snapshots
Another quick way to assess participants' knowledge or
experience is to take a group "snapshot." To do this, give
participants a series of questions, and ask for a show of
hands if the question pertains to them. For example, you
might ask:
How many of you know someone who has been screened
for colorectal cancer?
How many of you know someone who has been
diagnosed with colorectal cancer?
How many of you know the screening recommendations
for colorectal cancer?
This information can help the trainer structure or
restructure activities to more closely draw on the
participants' experiences and meet their needs.
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Throughout the Training
The following strategy is not considered an assessment strategy.
However, it is a way to continue the assessment process throughout
the training. A good trainer is able to read the body language of the
participants to ascertain the appropriateness of the content, the
pace of the training, and the energy level in the group. This
technique is further discussed in section III.1.
In summary, the needs and strengths assessment provides invaluable
information that will assist the trainer in developing appropriate
training goals and objectives.
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