Education Essay

Adult Developmental Learning and Change – an essay.
This essay is a narrative of my thoughts after reflecting on my learning and teaching experiences over the past 4 or 5 decades. It was written as an assignment for the Postgraduate Certificate of Primary Care Education in September 2001.

An essay is a composition and as such allows thoughts, theories and ideas to be described, reflected upon and developed. An essay is, therefore, different from a scientific paper, a review of evidence or a historical account of events.
I have been a learner, teacher and facilitator of education in varying degrees all my adult life. The people I have encountered throughout this time have had a great effect on my direction and development.
Gollanz (1923) pointed out, in his preface to Shakespeare’s ‘As You Like it’, that the division of life into 14,10 or 7 periods is found in Hebrew, Greek and Roman literature and that in the 15th century the seven ages became a common theme in literature and art (the mosaics on the pavement of the cathedral at Siena). Appendix 1 shows 3 versions of “ages of man”.
Levinson’s Developmental Periods described by Daloz (1986 p 55) is the structure I will use to organize my thoughts. Appendix 2 is a transcript of the figure from that page.
What is an adult and when did adult learning start for me? In law, an adult is one who has reached full legal age, the age of majority – 18 years in this country. It also means mature or grown up. Brookfield, 1986, outlined his 6 principals of adult learning and I feel these are stated in appendix 3.
I went to Queen Elizabeth Grammar School, Wakefield from the age of 6 to nearly 18. Assessment took place in the basic form of term reports. I can be described, on some of those early days, by one of Shakespeare’s seven ages of man from his comedy, As You Like it:
“ Then the whining schoolboy, with his satchel and shining morning face, creeping like snail unwillingly to school”.

Termly assessments were written throughout school and these were read by one’s parents. The assessments were both a threat and a motivator. They were both summative and formative.
School was in no way voluntary and the aims and objectives of the curriculum were teacher and exam driven. It is an axiom of American education that parents are partners in their children¹s education. The pupil can end up with parents acting as coaches or tutors. This role of parents may embrace some adult learning principals as the environment of the home may be freer than school.
As one progressed through the sixth form, there was a feeling of mutual respect between teacher and student. Praxis, collaboration and empowerment
were introduced. If one behaved as a child one was treated as a child and punished as a child despite attempts of the teachers to treat us as adults. Perh
The objectives of sixth form learning that were strongly shared by teachers, parents and me included passing A levels such that I got a place in a medical school.
Levinson described the stage of me about to enter Medical School as moving from pre- to early adulthood and he stated that this begins at about age 17 and is called the early adult transition.
On the 30th September 1963, not yet 18 years old, I attended my first lecture at University College, London. The lecture was by the Professor of Anatomy, J. Z. Young and I can remember the content of that lecture, as well as it’s objectives, well and clearly to this day. He was eminent, charismatic, a communicator and a “lecturer extraordinaire”. He delivered the Ferrier and Croonian lectures at the Royal Society in 1950 and 1965 respectively. He was a Fellow of the Royal Society. He used lectures, tutorials and written material as his main ways of communicating but also the radio. Indeed, he was the Reith Lecturer for the BBC in 1951 and he said in one of those broadcasts:
“Whether we like it or not, we can be sure that societies that use to the full the new techniques of communication, by better language and by better machines, will eventually replace those that do not”. (Young 1951 p 7).



The advantage of a lecture is that it lets an expert share his or her knowledge, attitudes and skills with a large number of people in a short time (Chambers and Wall 2000 p 79). The disadvantages are that there can be passive listening, the pace is the same for all, and attention is lost after a few minutes. A good lecturer, like J. Z. Young, on that first day for us at medical school, knew the level of expertise of the audience, had rehearsed and timed it, used appropriate visual aids in the form of colour slides and sparked the imagination of the audience, keeping their attention with his style and subject matter. He used better language and machines to communicate. He had the full text of his Reith Lectures published in a book so we could reflect on these in our own time. All these ways of improving a lecture are known today (Chambers and Wall 2000 pp 81-83), but often ignored.
The educational methods used at Pre-clinical medical school were mainly lectures and group tutorials on specific topics. There were also Physiology and Biochemistry practical classes with roaming supervisors. The dissection table encouraged teamwork and friendship as well as dealing with the morbid - all relevant for General Practice.
After pre-clinical I took 18 months out to undertake a B.Sc. in Anatomy and this is where I learned what adult learning was all about and how I appreciated it. The head of department was Professor J Z Young and he employed the Oxford Tutorial System as a teaching method.
“The foundation of undergraduate teaching at Oxford is the tutorial system. It is not a system of spoon-feeding. Undergraduates are expected to pursue a course of independent study under the guidance of their tutors, who set problems to solve or essays to write, and suggest books to read and university lectures to attend. Teaching is also sometimes carried out in classes of larger numbers. The tutor provides constructive comment on the undergraduate's written work and a discussion is opened up. The success of the tutorial system depends on the undergraduates; they must organise their time effectively, work steadily, and contribute fully to the dialogue.” (Merton College, Oxford University, Web Site, 2000).
We were encouraged to question, doubt, discuss ideas with our tutors as equals and socialise with them. I realised that interactions with both my teachers and fellow students were as important to me as knowledge and skills acquisition. I spent 6 weeks in the Stazione Zoologica in Naples researching the conduction velocities of the giant axons of squid as part of this course. While there we visited all the famous Roman sites as well as enjoying many meals in the company of visiting researchers. This trip gave me a life long-interest in Italy as well as science and I experienced the interaction of environment, art, history and social intercourse on learning – the visible and invisible words (see page 12 below).
In 1966, aged 21, I started my 3 years clinical studies at The London Hospital followed by a year of house jobs there after qualification. This was not a happy experience. I was not yet in Levinson’s adult world but still in early adult transition (Levinson 1978 p 57). Yet, on reflection, during the B.Sc. course, I had just experienced adult education at it’s very best and felt I needed serious adult learning experiences in order to progress with my medical education. However, I entered the world of the apprentice, with masters and pupils, paternalism and teaching by humiliation being commonplace. This way of teaching creates doctors with attitudes and behaviour disliked by their patients. Brookfield’s mutual respect was notable by its absence.
Smith complained that the apprenticeship system was still employed significantly in clinical training, especially in surgery (1996). Wass realised there was something wrong but stated, weakly,
“the time-honoured apprenticeship system of medical training should be improved by a more structured approach and better supervision.” (1996)
Paternalism was deeply ingrained in General Practitioners in the late 40’s and early 50’s (MacGregor 1997). Despite increasing openness throughout the 1990s, there now exists widespread dissatisfaction with the attitude of some doctors because of their paternalistic approach and poor communication skills (Irvine 1997). The President of the General Medical Council, commenting after the Ledward case said, “ some doctors still think they’re playing God (Irvine 2000). It is a view that the attitudinal problems of our profession were as a direct result of the educational methods used in clinical schools and postgraduate medical education in teaching hospitals. Despite many changes in medical school and postgraduate hospital based courses radical improvements are still required.
Clinical teaching delayed my entering the adult world of exploration of the possibilities of adult life (Levinson 1978 p 82) until the age of 25. I became a Lecturer in Physiology at The London Hospital Medical College and researched hypothermia to Ph.D. level. Appendix 5 is the preface of my thesis (Sloan 1976). I learned so much from all the people I worked with and one can see from this appendix that the learning involved a supervisor as well as critical reading and publishing work which was assessed by journal editors. The job also involved my lecturing, facilitating tutorials and running and supervising practical classes. For the latter aspect of the job I had no training and no opportunity to learn about educational theory and methods. This was the norm for both pre-clinical and clinical teaching. It was assumed all doctors could teach. I was persuaded that the lecture was the best method of teaching and concentrated my efforts on these rather than learning how to run groups or undertake educational needs assessments or evaluation.
For the research aspect, I chose my supervisor after 2 months in the department. I chose the area of work I wanted to research. The relationship I had with my supervisor was of guide and mentor rather than apprentice and master. Bill Keatinge had the attributes of a mentor described by Chambers and Wall - “an experienced, highly regarded, empathic person” who “guides an individual in the development and re-examination of their own ideas, learning and personal and professional development” (2000 p 146). The education I experienced embraced closely all 6 of Brookfield’s principals of adult education, just as I am experiencing now with this postgraduate certificate.
I entered General Practice as a Principal in 1974 without vocational or any other training. I could hardly remember how to treat a sore throat and had not dealt with patients for 3 years. The practice and I were happy with this situation! On reflection, my learning needs would have better been addressed by a period of training. I wrote up my Ph.D. over the next two years and this involved the reading and writing that I loved. I gave a few lectures in postgraduate centres. I went to a few courses and lectures at the local postgraduate centre. I was in the “Age thirty transition” (Levinson, 1978, p 58). General Practice was to be my career. Levinson points out that for some, this can be an “age 30 crisis” and indeed that period of 4 or 5 years in Cheltenham, London then Castleford, involved my moving house 5 times, getting divorced, leaving General Practice and resigning after one week as a lecturer in Physiology.
I went through what I call my educational dark age from 1977 to about 1983 – aged 32 to 38 – The Second life Structure: Settling Down (Levinson 19783 p 59). I remarried, bought a house in which we still live but was working as a single-handed practitioner with an increasing list. It was my dark age because of the nature of being single-handed. I attended a few courses and lunchtime lectures and read a bit and that was it. By the end of this period I decided to become a trainer and was taking on a full time partner.
In 1985, aged 40, I entered the mid-life transition, the beginning of middle adulthood, which is a period of advancement within a stable life structure (Levinson, 1979, p192&201). This was the start of my deep involvement with the Yorkshire Education Network. I became a trainer, then Continuing Medical Education (CME) Tutor for GP Principals and then a Course Organiser for the Vocational Training Scheme (VTS) for the Pontefract District.
To become a Trainer the Practice had to be set up as a learning environment of excellence according to National and Regional criteria. There is a course for prospective trainers called the “O Course” which allowed one to reflect on one’s potential training skills and feel what training is all about. This was facilitated by an educationalist with senior tutors from the Yorkshire Education Network. My assessment started there and reassessment for training is every one to three years. This involves an inspection of the surgery by a team of fellow and senior educationalists who also examine tutorial skills by assessing a video of these. Reassessment of CME Tutors and VTS Course Organisers involves an annual appraisal. Trainers have to attend workshops monthly and residential courses at least every 2 years. Tutors and course organisers attend residential seminars about three times a year. Here I have learned about running a group, course planning, time management, learning styles, learning needs assessment, facilitation, motivation and other elements important in postgraduate medical education.
Mentoring and being a member of a local Professional support Group that looks at under-performing and ill GPs and GP Registrars has been my “Age 50 Transition”. I nearly feel I am an expert in postgraduate medical education. Nearly!
This course, the people on it and running it, have got me back to the academic way of thinking, researching for evidence, writing referenced accounts, essays and praxis.
I am at the start of the ‘culmination of middle adulthood’.
“For men who are able to rejuvenate their selves and enrich their lives, the decade of the fifties can be a time of great fulfilment.” (Levinson 1978 p 62).
I realise that I have picked up the academic approach that I left behind after I had completed writing my Ph.D.
“The wheel is come full circle” (Shakespeare 1608 King Lear).
There have been such circles throughout my adult life and not only at the end of my educational development.
· I was a medical student and then a lecturer teaching medical students.
· I have been on the “O Course” and now I am a tutor for this course.
· I researched the literature for my Ph.D. and now again I am researching the literature.
· My first lecture was from a Reith lecturer and I have just met another Reith Lecturer in my role as a Trustee of our Pontefract-based Prince of Wales Hospice.
Many of the people I have had the good fortune to be associated with in my adult life have been versed in art, music, languages, ethics, philosophy, history and politics. These people have had a significant, albeit unquantifiable, effect on my knowledge, skills and attitudes. There is more to education than meets the eye.
“Surely, therefore, we need to look towards the creation of greater balance in the way we educate people so that the practical and intuitive wisdom of the past can be blended with the appropriate technology and knowledge of the present to produce the type of practitioner who is acutely aware of both the visible and invisible worlds that inform the entire cosmos.” (The Prince of Wales 2000.)

I look forward with relish to late adult transition and late adulthood in the company of my wife Kath who has taught me more than anyone else. I hope to have a similar enthusiasm in that age of my life as J Z Young did. He died aged 90 and was in the middle of writing a book on the cephalopods (Tucker 1997).
(2400 words)

REFERENCES.

BROOKFIELD S (1986) Understanding and facilitating adult education Milton Keynes: Open University Press.

CHAMBERS R and WALL D (2000) Teaching Made Easy – a manual for health professionals Radcliffe Medical Press Ltd Oxfordshire.

DALOZ L A (1986) Effective Teaching and Mentoring San Francisco: Jossey-Bass.

GOLLANZ I (1923) As You Like It Preface Shakespeare J M Dent and Sons Ltd London p xii.


Appendix 1.

Ages of man.

1. Shakespeare. As you like it. Act 2, sc. vii, lines 139 – 166.

Jaq. All the world’s a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages. At first the infant,
Mewling and puking in the nurses arms.
Then the wining school-boy, with his satchel
And shining morning face, creeping like snail
Unwillingly to school. And then the lover,
Sighing like furnace, with a woeful ballad
Made to his mistress’ eyebrow. Then a soldier,
Full of strange oaths, and bearded like the pard,
Jealous in honour, sudden and quick in quarrel,
Seeking the bubble reputation
Even in the cannon’s mouth. And then the justice,
In fair round belly with good capon lined,
With eyes severe and beard of formal cut,
Full of wise saws and modern instances;
And so he plays his part. The sixth age shifts
Into lean and slipper’d pantaloon,
With spectacles on nose and pouch on side,
His youthful hose, well saved, a world too wide
For his shrunk shank; and his big manly voice,
Turning again toward childish treble, pipes
And whistles in his sound. Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sanse taste, sans every thing.


Appendix 2.



Figure 1. Levinson’s Developmental Periods.

Late Adulthood
65
LATE ADULT TRANSITION
60
Culmination of Middle Adulthood
55
Age 50 Transition. Middle adulthood
50 Entering Middle Age
45
MID-LIFE TRANSITION
40
Settling Down
33
Age 30 Transition
28 Early Adulthood
Entering the adult world
EARLY ADULT TRANSITION
(Childhood and Adolescence)

Appendix 3.


Brookfield’s Principals of Adult Education.

6 principals applying to teaching-learning encounters or to curriculum development. The six principals of effective practice in facilitating learning
1. Participation is voluntary
2. Respect among participants of each other’s self worth. Attention to increasing adult self worth underlies all facilitation attempts.
3. Facilitation is collaborative - setting objectives, curriculum development, and evaluation. Continual renegotiation of priorities.
4. Praxis is placed at the heart of effective facilitation
5. Facilitation aims to foster in adults the spirit of critical reflection. Adults will come to question many aspects of their professional, personal and political lives.
6. The aim of facilitation is the nurturing of self directed empowered adults.



IRVINE D (1997) The performance of doctors. i : professionalism and self regulation in a changing world Education and Debate British Medical Journal 314 p 1540.

IRVINE D (2000) Editorial The Sunday Times Newspaper 4th June.

LEVINSON D J (1978) The seasons of a man’s life Alfred A Knopf New York.

MACGREGOR S (1998) From paternalism to partnership British Medical Journal 317 p 221.

MERTON COLLEGE Web Site (2000) Oxford University
http://www.merton.ox.ac.uk/prospectus/tutorial-system.html.

PRINCE CHARLES The Prince of Wales (2000) We must go with grain of nature The BBC Reith Lecture The Times Newspaper 18th May Section 2 p 7.

SHAKESPEARE, W. (1599) As you like it ii, vii, lines 145 – 147.
SHAKESPEARE, W. (1608). King Lear. v, iii, line 174.

SLOAN R E (1976) The effect of age and sex on body cooling rates Ph.D. Thesis, University of London pp 9 – 10.

SMITH T (1996) Apprentice Surgeons Soundings British Medical Journal 312 p 1223.

TUCKER A (1997) John Zachary Young – Broad grasp of the Brain Obituaries The Guardian Newspaper July 14 1997.

WASS J (1996) The core curriculum for senior house officers Career Focus British Medical Journal 313 p 7054

YOUNG J Z (1951) Doubt and Certainty in Science. A biologist’s reflections on the brain Oxford University Press.