Three Lenses on Learning: Frames for Residency Education

Program directors and faculty face continuous demands to develop and improve curricula and instruction. Learning theories can provide a lens to guide curricular innovations and offer new teaching strategies, yet few faculty feel the need or are equipped to apply these theories to inform practice. A simple typology, based on 3 key lenses on learning,^1,2  can help faculty demystify learning theories and appreciate their utility in guiding practice.

Consider a program director who is baffled by residents' inability to master central line placement after watching a high-quality video. Each lens on learning provides a different perspective on why residents are struggling.

Behaviorist: “Video-based instruction failed because it omits trial and error with direct feedback.” For a behaviorist, learning occurs through actions and consequences using rewards and punishments (feedback) to reinforce or discourage specific behaviors (operant conditioning). Graduate medical education (GME) often uses behaviorist learning approaches with procedural skills training followed by checklists or ratings to assess behaviors.

Cognitive: “This was too complicated—it overloaded learners.” Using this lens, the instructor could assess what residents understood about central lines, and build on this to integrate cognitive and psychomotor skills to support knowledge transfer to real situations. Learning involves connecting new information with prior knowledge and experience.³  Resident morning report and rounds exemplify cognitive strategies to enhance clinical reasoning. In these settings, attending physicians assess residents' clinical judgment by asking them to articulate their thought processes, and then probe areas of uncertainty, with the intent of moving residents to the next level of understanding.

Sociocultural: “We need residents to observe this in real life to see how others plan, set up, and execute line placements.” In the sociocultural lens, learning occurs through active participation in particular social and cultural contexts.⁴  When faculty members consider how the situation (eg, context, content, community, participation, and identity) contributes to learning, or when a physician describes how novice learners acquire knowledge and skills through observation and progressive responsibility (legitimate peripheral participation), they are applying a sociocultural lens. Multi-source, work-based assessment aligns with sociocultural principles.

Each of these learning lenses draws on different theories and disciplines (eg, psychology, anthropology). Key features of each lens for learners and educators are outlined in the Table and applied to a code blue curriculum example.

• 1. 

  Decide what you assume about learning and what lens best represents your teaching. Review your residency curriculum, and consider what you might do differently in your teaching or curriculum if you used a different lens.

• 2. 

  Reflect with GME learners about how they learn. Give residents time to discuss how they are taught and how they learn. This can also help residents identify their individual learning needs and approaches. Their insights can point to areas where a different lens on learning suggests new instructional strategies.

• 3. 

  Incorporate reading on learning theory into your next journal club. Group discussion of literature on learning (eg, excerpts from How Learning Works: Seven Research-Based Principles for Smart Teaching⁵) can provide both a theoretical framework and practical application.

• 1. 

  Develop a learning theory workshop for new clinician educators. Hands-on activities that evaluate existing and potential curricula or teaching strategies through learning lenses can enhance comfort in applying theory.

• 2. 

  Involve GME learners in educational scholarship. Learning theories provide helpful guidance for residents engaging in curricular innovations; the lenses establish a solid foundation for future scholarship.