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Metacognition, ‘nudges’, and adult education

It appears nearly universally accepted that adult education is quite different than child and adolescent education. Adult learners are more aware, they operate from a broader base of experience, and they demand that their energies be invested in relevant content that connects back to individual needs. In a way these principles of adult learning could be boiled down to the belief that adult learning is a largely metacognitive activity.cognition in action

“Metacognition: literally means cognition about cognition, or more informally, thinking about thinking. [it has been] defined as knowledge about cognition and control of cognition. For example, I am engaging in metacognition if I notice that I am having more trouble learning A than B; [or] if it strikes me that I should double check C before accepting it as fact.”

Thus the idea of metacognition, or the foundation of adult learning theory, suggests that there are structural boundaries in which new learning can exist…and that education operating outside of these boundaries is largely ineffective and inefficient. This may be the most critical lesson an adult educator can ever learn!

That being said, there are other connections between metacognition and adult education that are equally critical and increasingly practical. For example, we at ArcheMedX have spent nearly two years pioneering the Learning Actions Model. This is an educational framework that deconstructs the process of learning and provides both adult learners and educators with an e-learning architecture that centralizes and simplifies the natural learning actions.

The origins of the Learning Actions Model lie in the complexity of adult learning and the reality that learning behaviors are rarely evolved – while most HCPs, early in their careers, devise individual systems of studying for a test, few HCPs devise a system for lifelong learning. It might help to reflect on this statement: the actions one takes to consume and memorize content for a short-term goal (a test) are not necessarily the same actions required to support higher level learning that leads to changes in attitudes, skills, or behaviors. What we have come to understand through our field research, and have subsequently validated in educational programs powered by ArcheMedX, is that adult learners benefit from uniquely structured learning experiences that simplify real lifelong learning….

For example, when a lecturer or facilitator introduces a new clinical practice guideline or new clinical best practice an adult learner will begin to relate these advances to their own practice and patient population – this is a classical Knowlesian moment. But does this mean that a learner will inherently process this information to form a new insight or that they will structure this new information such that it becomes a long-term memory or drives a new skill or behavior? No – the recognition or seed of a new insight does not in-and-of-itself lead to learning. Instead, learning is only achieved if the learner can organize this learning moment through a structured process of notes, reminders, search, and learning triggers. And this is where metacognition, nudges, and adult learning collide. Control of cognition is a shared responsibility, shared between the learner and the guide (the educator).

To be certain, we are not alone in this vision of newly structured model of life-long learning, in fact the premise has recently gained significant traction within the community of higher education.

“The softening and opening up of [education] are part of this soft paternalistic family of subtle behavior modification strategies. The learner enmeshed in digitally mediated networks is forever being nudged from afar rather than instructed; subtly tutored instead of lectured; her behaviour itself mediated through coded webs of affiliations, affinities, and associations rather than restricted through regulatory powers or directed through didactic techniques. We are seeing the emergence of a much less coercive education environment, based on emerging ideas about how we behave as we do when we are situated in dynamic, networked, open environments, and the programmed techniques of persuasion which script our interactions in such environments.”

In other words, the learning environment must play an equal part in the learning experience. And therefore structured content, connected to ones natural learning actions, and guided by the educator as they “nudge” the learner to reflect and take action, create the most effective and most efficient opportunity for learning and change. This structured approach to learning is best represented in the Learning Actions Model depicted below.


The truly transformative benefit to this new model of structured and guided learning is the ability to personalize and continuously refine the learning experience over time. When an educator embraces the obligation to scaffold the adult learning experience, they begin to uncover vast new information and insights into the effectiveness of the education they are providing and how learning is actually taking place. By ensuring that adult learners are leveraging effective learning actions, the actions themselves present to the educator new ways of understanding cognition, which in turn enables the educator to personalize and refine the learning experience.

Although I am naturally inclined to advocate on behalf of the Learning Actions Model, having seen its transformational impact on education powered by ArcheMedX, these ideas have been discussed elsewhere with great eloquence and perspective.

“When students use software as part of the learning process, whether in online or blended courses or doing their own research, they generate massive amounts of data. Scholars are running large-scale experiments using this data to improve teaching; to help students stay motivated and succeed in college; and even to learn more about the brain and the process of learning itself.”

Our challenge within the community of healthcare professional continuing education is to remain open to these new frameworks for learning and analytics, while ensuring that the learners themselves find the comfort and familiarity with the learning environment and content – without comfort, there is likely to be little learning. But this doesn’t negate our community’s responsibility to evolve lifelong learning in the healthcare professions. We must ensure that time invested in learning is efficiently spent and that learning itself is effective.  It is our belief that the learning actions model is a key to this evolution and provides the community with the requisite tools and insights to improve online learning, to improve retention, and to drive the critical behavior change that will improve patient-centric care.

Written by

Brian is a research scientist and educational technologist. He helped transform Pfizer’s Medical Education Group and previously served in educational leadership roles at HealthAnswers, Inc.; Acumentis, LLC.; Cephalon; and Wyeth. He taught graduate medical education programs at Arcadia University for 10 years. Dr. McGowan recently authored the book "#socialQI: Simple Solutions for Improving Your Healthcare" and has been invited to speak internationally on the subject of information flow, technology, and learning in healthcare.

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