Chapter 11 Understanding learning

Learning is not just about acquiring facts or knowledge. Social skills, beliefs and values are also learned. We learn how to respond emotionally, how to recognize symptoms and, as children, we learn appropriate (and inappropriate) ways of behaving (Fig. 1). If we understand how behaviour is learned we may be able to change it. We may wish to change to a healthier lifestyle, to learn how to monitor our own glucose levels or to overcome a phobia. Understanding learning has been of central concern to psychologists, and the source of much debate (Eysenck, 1996).

Fig. 1 If an infant approaches the Christmas tree decorations it will be restrained: this will decrease the frequency of approach. In practice punishment is a very poor way of changing behaviour and often it arouses emotional responses. What does the baby do when it is not allowed to touch the tree (or approach medical equipment)?

Learning can be defined as a relatively permanent change in behaviour. Behaviourist theories of learning assume that there are laws of learning that are fundamental to all animals, and that humans are no different in this respect. Behaviourism suggests that learning results from stimulus–response associations. A stimulus can be any change, such as the sight of food or a moving ball. A response is a reflex action such as salivation, or a muscular response such as catching the ball. Of course much learning is cognitive – such as the acquisition of knowledge and concepts that is taking place as you read this book. Research into adult learning has informed medical teaching and the way in which you are taught is likely to differ from the experience of senior medical staff. It is recognized that adults learn in different ways from children so you may find a very different approach to learning from your school experience.

Theoretical background

Operant conditioning

A kind of learning, known as operant conditioning, was described by an American psychologist, B.F. Skinner. In operant conditioning, the likelihood of a response occurring again is increased if the behaviour is followed by reinforcement. Thus, the behaviour is controlled by its consequences. The principles of operant conditioning have been established through experimentation on animals such as rats and pigeons, as well as humans (Table 1).

Table 1 Principles of operant conditioning

If a goal results from an accurate kick, then the motor responses leading up to the kick will be reinforced. In this case the reinforcement would be in the form of satisfaction and approval by the team and fans. Success in walking following an amputation would be rewarded internally by feelings of mastery and enhanced self-efficacy, and externally by the approval of others. Praise (especially from medical staff) can be a very powerful reinforcer.

Classical conditioning

Operant conditioning is contrasted with classical conditioning described by a physiologist, I. Pavlov. In classical conditioning an initially neutral stimulus becomes associated with an involuntary response by its association with a previously conditioned stimulus. Pavlov worked with dogs, who naturally salivate at the sight of food. After pairing a bell with the food, the dogs learned to salivate at the sound of the bell alone. These principles were later tested with human emotional responses.

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