I read with great interest the commentary “The Adult Learner: A Mythical Species,” by Geoffrey R. Norman, which appeared in the August 1999 issue.1 While I am sympathetic to some of Dr. Norman's views, I feel that he has tried to lay the blame for too many things on adult learning methods. Norman tries by the method of reduction to absurdity to suggest that problem-based learning and self-directed learning, if applied to medical education, will lead to untrained and unskilled doctors. He is confusing methods with outcomes.
Problem-based learning is a method. We all learn in different ways—some learn better using problems, some don't.2 Self-directed learning is not, as Norman implies, based solely on the wants of the student; it is also based on the requirements of the curriculum and the needs of patients. Self-direction might allow a student to move into areas of study away from the core curriculum, but nonetheless it is well recognized that the examination system will usually ensure that learning also takes place around the core curriculum!
At both the medical school and the graduate levels, learners are guided in their “self-direction” by some educational supervisor or mentor. This serves to overcome the well-recognized problem we all have in identifying our own learning needs or addressing those areas we don't find exciting. Here is an advantage for using work-based problems as the focus for learning: a mentor can discuss deficiencies in problem solving revealed by a case and help the learner begin to direct his or her own learning. Any system that moves students away from remembering a huge knowledge base and then simply regurgitating it when required at examination time and moves them toward thinking about problems and how they can help solve them must be an improvement.
So, yes, let us have innovation in education, let us have differing methods of teaching and learning, but let us not do it by suggesting that adult learning theory is in some way inappropriate in medicine.
1. Norman G. The adult learner: a mythical species. Acad Med. 1999;74:886–9.
2. Newble D, Entwhistle N. Learning styles and approaches: implications for medical education. Med Educ. 1986;20:162–75.