Teaching Strategies in Adult Education to Improve CME

Teaching Strategies in Adult Education to Improve CME

During nearly ten years in education, I have seen approaches, methods, and techniques come into and out of fashion, very often with each next big thing heralded as the savior, or panacea, that will revolutionize learning and teaching. In a similar vein, I have seen technology and tools come and go with an almost similar alacrity, ready again to be the savior of all our educational needs.

No One-Size-Fits-All in Adult Education

For any field, there is never a one-size-fits-all solution—and perhaps more especially so for continuing medical education (CME). As Instructional Designers, the main thing we can do is to look at best practice design principles, be informed by what methods and approaches are available, and ensure that through thorough and robust needs assessment and planning, a sound educational intervention is created.

This post will explore some of the assumptions and perspectives that have shaped Adult Education in general and specifically the teaching of medical professionals and that can inform CME design. Until recently, formal adult education, of any kind, has been overlooked as a legitimate area for research. The Dark Ages in Europe saw the development of schools for teaching children based on a set of assumptions, or guiding principles, that became known as pedagogy, or, to put it another way, “the art and science of teaching children” (Knowles, 1998).

The repercussions of this are still felt around the world today.

This system of a very prescriptive, well-defined, teacher-oriented style of education was certainly one that I grew up on and was familiar with up until I started University. At the time, I didn’t know what to call it, but, in this higher education setting, I began experiencing the Socratic method, in which the leader poses a dilemma and engages the group to pool their experiences and backgrounds in search of a solution. I was given freedom to learn in the way I wanted and focus on materials that were relevant and interesting to my needs. I felt engaged, valued, motivated, and an agent of change for my own learning. I had experienced andragogy for the first time.

Andragogy versus pedagogy

What evidence is there that adults require such a different approach to learning? Well, apart from the anecdotal evidence above, the pedagogical model is rooted in dependency—the students expect that the teacher will make all decisions about the material to be learned and the manner in which it will be taught.

I remember a science class at primary school, which basically had the design principle of pedagogy:

“It is Tuesday, so we are going to learn about the solar system.”

The lesson continued with our earnest teacher saying that:

“I am going to draw on the board the order of the planets and you are going to copy them down into your notebook . . .”

This approach, at an absolute push, can be argued as being appropriate for children while their capacity to direct their own learning remains relatively immature. (I just accepted it—the solar system on Tuesday made perfect sense, and who was I to raise my hand as a six year old and say that I wanted to learn about cats today instead?) There is strong evidence, however, that “as individuals mature, their need and capacity to be self-directing, to identify their own readiness to learn, and to organize their learning around life problems increases steadily from infancy to preadolescence, and then increases rapidly during adolescence” (Knowles, 1998).

Assumptions in andragogy: relevance to CME

Moving away from my trip down memory lane and returning to the word of CME, several implications can be drawn.

Eduard C. Lindeman | Adult Education

Eduard Lindeman

To reach a physician audience more expediently, those stakeholders in education must understand a set of assumptions regarding adult learners. A good place to start is with Eduard C. Lindeman. In his Meaning of Adult Education (1926), Lindeman identified five key assumptions about adult learners. Looking at these, their applicability and relevance to CME training is readily apparent:

1. Adults are motivated to learn, as they experience needs and interests that a proposed area of learning will satisfy; learning activities, therefore, should be centered on these points.

How this can relate to CME: a group of physicians reporting confusion about the most up-to-date data on the management of glycemic control should seek out CME experience in that area.

2. Adults’ orientation to learning is life-centered; the appropriate bases for organizing learning, therefore, are life situations, not subjects.

How this relates to CME: a training session on motivational interviewing should begin and end with reflection on the importance of this skill for the trainee’s life as a clinician.

3. Experience is the richest source for adults’ learning; therefore, reflection on experience is the core methodology of adult education.

How this relates to CME: a development session on diabetes education should start and end with reflection on the importance of this skill for the trainee in the real world.

4. Adults have a deep need to be self-directing; the teacher, therefore, engages in inquiry with the student rather than serving as an oracle of knowledge.

How this relates to CME: Clinicians could be encouraged to follow up on the activity with journal articles and other activities of interest to them and their settings.

5. Individual differences among individuals. Adult educators should optimize learning by taking account of differences in style, place, and time of learning.

How this relates to CME: a CME activity can attract a very wide range of attendees, these range from the newly trained to the nearly retired. As much as possible, activities should be planned as much as possible that appeal to all of the learners’ differing needs and, ideally, different learning preferences.

Summary of Lindeman’s key assumptions about adult learners:

  • Adults are motivated to learn as they experience needs and interests that learning will satisfy.
  • Adults’ orientation to learning is life-centered.
  • Experience is the richest source for adults’ learning.
  • Adults have a deep need to be self-directing.

These assumptions have been built upon and expanded over the years and have directed educational interventions in a variety of fields, e.g., Knowles (cited above), Merrill, others.

CME professionals may do physicians a disservice by using pedagogical methods such as didactic lectures all the time, when their learners are ready for andragogy. Interestingly, despite continuous teaching and learning, there have been few discussions about applying adult learning theory to the education of medical professionals in general and even fewer related to CME (Cf. Moore, 2009).

Medical education can learn from adult education theory and writing, and this reinforces the importance of considering the special needs of adult learners. It is important for medical educators to consider these principles when designing and implementing educational programs for CME. There is, however, more to this! We can break this down further to look at medical professionals as a distinct cohort of adult learners, and this will be the focus of the next post.


Knowles, M. S., Holton, E. G., & Swanson, R. A. (1998). The adult learner: The definitive classic in adult education and human resources development. Houston, TX: Gulf Publishing Company.

Knowles, M. S. (1980). The modern practice of adult education: From pedagogy to andragogy. Englewood Cliffs: Prentice Hall/Cambridge.

Lindeman, E. C., (1926) Meaning of Adult Education New York: New Republic, republished in 1989 by Oklahoma Research Center for Continuing Professional and Higher Education.

Kolb, D. A. (1984) Experiential Learning, Englewood Cliffs, NJ.: Prentice Hall.

Maslow, A. (1968) Towards a Psychology of Being 2e, New York: Van Nostrand. See, also, A . Maslow (1970) Motivation and Personality 2e, New York: Harper and Row.

Merriam, S. and Caffarella (1991, 1998) Learning in Adulthood. A comprehensive guide, San Francisco: Jossey-Bass.

Rogers, C. and Freiberg, H. J. (1993) Freedom to Learn (3rd edn.), New York: Merrill.

Moore D.E .Jr, Green J.S., Gallis H.A., Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities.J Contin Educ Health Prof. 2009 Winter;29(1):1-15.