This section acquaints the preceptor or supervisor with principles of adult learning and provides guidance in developing, conducting, and evaluating training experiences.

Adult learning is facilitated through an innate ability to acquire additional knowledge or skills and through environmental influences. While the preceptor or supervisor has no control over innate abilities, he or she can influence learning through the design of learning events, structured activities, and a supportive environment to help the learner gain knowledge and skills and to shape professional values. Learning is effective when it is purposeful and when the experiences involve both cognitive and effective skills of the learner.

“Laws” of learning: Professor Edward L. Thorndike, one of the pioneers in educational psychology, postulated several “laws” of learning. These laws represent Thorndike’s work and its application to the adult learning process in healthcare management.

• Law of Readiness: Adults learn best when they are ready to learn. If adult learners accept the purpose of the learning activity, the learning objective is clear, and the knowledge or skill being learned is relevant, then they approach learning with eagerness. People will not learn if they see no reason for learning. While motivation is an individual responsibility, the preceptor or supervisor can encourage a readiness to learn.
• Law of Exercise: Things most often repeated are best retained. This law is the basis of all practice and drill in learning activities. The preceptor or supervisor can implement the law of exercise by providing opportunities for practice or by repeating learning activities that strengthen skills. This activity is especially effective when accompanied by constructive feedback.
• Law of Effect: Learning is strengthened when accompanied by positive feedback that generates a satisfying feeling; learning is weakened when associated with an unpleasant feeling. An experience that produces feelings of frustration, defeat, hostility, or confusion will hamper learning. An adult should be corrected when a mistake has been made, but the correction should be positive, instructive, and reinforcing.
• Law of Intensity: The adult learner will gain more from the learning activity if it is structured as an intense learning experience. The greater the intensity of the experience and personal involvement, the more likely it is that the learner will achieve the learning objective. An exciting learning experience will be more valuable than a routine or boring experience. Opportunity for direct involvement will produce a greater learning experience than will mere observation. The preceptor or supervisor should structure learning activities that incorporate the law of intensity.

Developing learning objectives: A practical work experience should begin with a professional development plan. Although this plan is the responsibility of the fellow or trainee, it should be accomplished with the participation of the preceptor or supervisor. The professional development plan is a comprehensive statement of what the fellow or trainee intends to accomplish during the training period and should include the following information:

• A biographical sketch of the fellow or trainee
• A concise statement of the individual’s career interests and goals
• A brief description of the individual’s personal and professional strengths
• A brief description of the individual’s attributes and qualities that need to be developed during the training period
• A list of educational objectives for the training experience

In developing learning objectives, there are two major considerations. First, the preceptor or supervisor and fellow or trainee must decide which knowledge, skills, and values are most important and determine the level of proficiency required. Then they must state the learning objectives to clearly convey the observable learning outcomes.

Levels of learning: Recognized domains of learning include cognitive (understanding), effective (appreciating, valuing), and psychomotor (physical coordination). The preceptor or supervisor is concerned with cognitive and effective skill development.

Cognitive levels of learning begin with simple knowledge and proceed through the evaluation of complex materials or events. To illustrate:

• Knowledge: Remembering previously learned material
• Comprehension: Ability to grasp the meaning of material
• Application: Ability to use learned material in new and concrete situations
• Analysis: Ability to understand both content and structure and perform critical analysis
• Synthesis: Ability to create new material or ideas for prior learning
• Evaluation: Combination of other levels of ability so that expert judgment and valuing can be achieved

Effective learning begins by giving attention to something and then proceeding to develop a value system. To illustrate:

• Receiving: Giving attention
• Responding: Responding with interest
• Valuing: Appreciating value of material or concept
• Organization: Organizing and bringing together different values to form a conceptualization
• Characterization: Internalizing the values so that they are a characteristic of the individual

Learning objectives: Once the subject matter or skill is selected and the level of learning determined, the preceptor or supervisor and trainee must jointly prepare statements of learning objectives. A properly written learning objective

• Identifies the terminal behavior desired (i.e., the observable knowledge base of skills)
• Describes the conditions under which the terminal behavior will occur
• States the criteria for judging acceptable performance

The following examples will illustrate these points:

• Poor: Fellow or trainee will gain experience in budgeting
• Better: Given published budget guidelines, appropriate forms, and statistical data, the trainee will learn to prepare a departmental operations budget that accurately reflects the department’s financial need according to criteria in the guidelines

Developing learning strategies: To achieve the desired result, the individual must perform certain learning activities. A learning strategy is an organized collection or series of tasks that should enable the trainee to achieve the learning objective. In determining and structuring learning events, the preceptor or supervisor should consider the following guidelines:

• Whole-part-whole approach: Broad concepts should be presented first, followed with detailed attention to components. Then all components should again be considered as a whole. For example, first explain several budgeting techniques, such as standard, flexible, continuous, and zero-based. Then address the details of each technique. Finally, illustrate the total concept through a comparison of the strengths and weaknesses of the budgeting technique.
• Known-to-unknown: Adult learners learn best when they progress in a systematic manner from current knowledge to new knowledge, while relating each new concept or skill to past experience.
• Problem- or issue-oriented: Learning will be more effective if the focus is on problems or issues that exercise analytical abilities rather than simple observation.
• Trainee-centered: Trainee-centered learning activities ensure that the trainee actively participates, rather than observing the preceptor or supervisor. Such learning events are designed for maximum intensity and direct involvement of the trainee.

Learning activity techniques: Several techniques for conducting learning activities exist. Each has its advantages and disadvantages. A few of the more useful techniques are described below:

• Log diary: The trainee maintains a log of activities and observations used for self-analysis and joint review and critique with the preceptor or supervisor.
• In-basket exercise: The trainee is routinely assigned items from the preceptor’s in-basket that require decisions and/or actions. The trainee makes the decision, completes the action, or refers it to the preceptor. The preceptor and trainee then jointly critique the trainee’s actions.
• Oral examinations: The preceptor or supervisor periodically conducts an oral examination to determine how effectively the trainee addresses hypothetical or real problems, current issues in healthcare management, or specific subjects, such as finance or marketing.
• Management study: The trainee is assigned responsibility for designing and conducting an applied research investigation of a particular problem to learn systematic analysis of problems or opportunities.
• Crisis management: The trainee is put under intense pressure by being assigned an existing or hypothetical crisis. Behavior is observed and critiqued by the preceptor or supervisor.
• Management audit: The trainee is assigned the task of designing and conducting a management audit of a function or department. This teaches the trainee how to evaluate efficiency and effectiveness by comparing performance standards with actual performance.

Evaluation: Evaluation of both the trainee and the training program is a major responsibility of the preceptor. Evaluation should be integrated and consistent, not simply accomplished only at the conclusion of training. Effective evaluations have several important characteristics.

• Evaluation serves a primary purpose in providing information for making decisions about training.
• Evaluations should be designed to support program improvement.
• Evaluations should be timely.
• Evaluations should take into account the overall objectives of the training.

Evaluation must be incorporated into the design of the training and be an integral part of the total experience for both the preceptor or supervisor and trainee, although it is the primary responsibility of the preceptor or supervisor. Evaluations must be conducted in a mutually supportive climate as a collaborative effort between preceptor or supervisor and trainee.

Effective evaluation is descriptive, not value-laden. It is categorized as follows:

• Self-evaluation of process and achievement by the trainee
• Evaluation of the progress and specific achievements of the trainee by the preceptor or supervisor
• Evaluation of the training program graduate by the first-placement supervisor
• Evaluation of the overall training by the trainee
• Evaluation of the training in general by all parties

Summary: Basic knowledge of adult learning concepts is essential to a preceptor or supervisor, as is an understanding of characteristics and “laws” of adult learning, an understanding of how to develop learning objectives, and strategies. Evaluation should prove useful to preceptor or supervisor in carrying out this important task. Effective learning does not simply occur; it must be planned and nurtured by the preceptor or supervisor who understands the adult learner.