How Professional Healthcare Students Approach Learning

This section will offer a simplified explanation of how most professional healthcare students and practitioners in the USA typically approach learning. Understanding this is useful in preparing simulation based curriculum, because the majority of simulation participants will fall into this adult learner category.

Adult Learners typically approach learning in one of the following three ways (3).

Surface (superficial) Learner: Typically just wants to do the minimum necessary to get by. Characteristics: fears failure, memorizes facts without context of understanding concepts, cannot relate facts.

Deep Learner: Understands vocational relevance of subject, wants to understand concepts as they relate to facts.

Strategic Learner: Predominantly interested in achieving high grades and will use whatever approach that allows them to achieve while doing the least amount of work.
A learner's approach has a direct impact on the outcome of the learning activity.

It is important for a course facilitator to be sensitive to "Cultural Differences" in students, their communication skills, and reaction to authority. For example, what may seem like a passive learning student may actually reflect a different cultural norm where the student normally does not question authority or is not confident in their communication skills with a foreign language.

It is also important for facilitators to remember that all learning is emotional. The most under-appreciated aspect to teaching is addressing the Affective Domain. While simulation tends to be an active learning environment, it falls to the facilitator to make the experience one that was perceived as valuable. In the field of healthcare simulation it is important to differentiate and understand that an activity that is perceived as valuable is not necessarily always fun. Participants will not generally object to stressful simulation activities if they perceive them as valuable. Therefore, it is important for a facilitator to continuously guide the participants to learn from their mistakes and to understand the relevancy of an activity's objectives to their practice. This is particularly true if the simulation learning activity is likely to be stressful.

Facilitating and Providing Feedback

This section offers basic information on teaching and learning styles to assist in the facilitating and providing feedback in simulation learning activities. The information is generic to all forms of simulation and should be viewed as a foundation upon which additional specific modes of facilitation and feedback unique to a given activity can be added.

Teaching Styles

The following are some common teaching styles (5):

Type Philosophy Method Characteristic Technique Control Goals and Objectives
Authoritarian Teacher knows best Lecture, demonstration leading questions Declarative, authoritarian, assertive Teacher-centered Efficiency, knowledge, comprehension, role-modeling
Socratic Existential, knowledge is in the student's mind Question and answer, nonverbal direction Suggestive, directive, questioning, challenging Teacher-centered Using knowledge, application, synthesis, analysis, evaluation, appreciation
Experimental, thinking processes are primary Discussion, "What are you thinking about? How did you get that?"< Analytic process-oriented Teacher-centered Problem-solving, evaluation, pattern recognition, self-perception, organizational skills

Effective simulation facilitators teach; they don't "preach." They probe for understanding of concepts and relate important facts. Most importantly they keep the simulation experience learner-centered, not teacher-centered.

Preparing the Participant for the Simulation Learning Environment

In preparing the participants for the simulation learning environment, there a several key concepts for the facilitator to keep in mind.

Experience has shown that when facilitators keep these concepts in mind, participants understand and value the training opportunity despite making mistakes.

Tips and Traps in Providing Feedback: Background

Feedback is the primary opportunity for learning in the simulation environment. Rogers tells us, "Although adult learners want feedback on their performance, most students perceive inadequate feedback is provided during their training. Reasons that teachers cite for providing poor feedback include a concern that there will be unintended consequences, such as damaged teacher-student relationship or poor faculty evaluation. Without formative feedback, however, poor clinical performance is not corrected, appropriate behavior is not reinforced, and students develop their own system of self validation." (6)

Feedback should be specific, appropriately timed, and expected. Specific feedback should be directed towards achieving success and therefore should be accompanied by a description of how to succeed. When done well, the participant will see the facilitator as someone who is genuinely interested in helping them succeed. Facilitators should address behaviors without making assumptions about attitudes. Therefore, they should not use judgmental language.

The most powerful forms of learning require the internalization of assessment criteria so that the learner is engaged in a process of self-observation and self critique. Therefore engaging the participant to practice self-observation in context of the educational goals and objectives of the course is optimal.

Tips and Traps in Providing Feedback: "Ego Management"

Understanding and recognizing the ego pattern of the participant to whom he/she is providing feedback may help the facilitator to guide them to the appropriate path. Difficult participants can create a barrier that interferes with learning. This is particularly true in the simulation environment. The follow list some common ego types.


  1. Bloom BS: Taxonomy of Educational Objectives. In: The Classification of Educational Goals. Handbook 1/Cognitive Domain. A Committee of College and University Examiners (Ed). New York, Longman, 1956, pp120-200.
  2. Gronlund NE: In Miller R (ed): How to Write and Use Instructional Objectives. New York, Macmillan, 1991.
  3. Newble DI, Entwistle NJ: Medical Education 20:162, 1986
  4. Newble DI, Entwistle NJ: Medical Education 20:162, 1986
  5. SEA Workshop on Facilitating Learning, May 1 – 5, 1999
  6. Developing a Curriculum for Medical Students in Critical Care Medicine", Rogers MD, P., New Horizons 1998; 6:248-254.