Kolb's learning cycle

Think back to learning how to put in a cannula. There was the equipment to get used to, the attempt itself, and then the problem of working out why it had or hadn’t gone well. The next attempt might be better. Or it might be different without being any better, which is rather frustrating when you can’t explain the difference.

Cannulation was the example in our original article on Kolb, and it still works well. We can recognise the experience, the thinking afterwards and the decision to try something differently. The interesting question for an educator is where we can help.

Clockwise arrows link concrete experience, reflective observation, abstract conceptualisation and active experimentation. — Kolb’s four familiar stages. They give us things to talk about after an experience, although actual learning is unlikely to follow the arrows quite this neatly.

Four stages, familiar territory

Kolb’s experiential learning cycle describes concrete experience, reflective observation, abstract conceptualisation and active experimentation. The terminology can make this sound more mysterious than it is. We do or encounter something, think about what happened, develop an explanation and use it to inform another attempt. Kolb and Kolb’s account describes learning through this transformation of experience.

On the usual diagram, experience sits at the top. You can enter elsewhere: perhaps you begin with an idea you want to try out. Nor should the arrows persuade us that everyone must move through an identical timetable. This is a model for thinking about learning, and clinical learning can be rather less orderly than a diagram.

Even so, it helps us spot things we may be missing. Someone can accumulate a great many experiences without examining them. We can have an excellent discussion after a case and then never find out whether it changes anything. The gaps between the stages may be where our teaching needs attention.

Back to the cannula

Imagine a learner practising on a task trainer. Their first attempt is unsuccessful. Before they have another go, ask what they think happened. You may have seen something they didn’t notice, or they may describe something you couldn’t see. Put the two accounts together.

This is already a different conversation from telling them they did it wrong. It also gives you something more specific to discuss than whether the attempt was a success. What happened to the equipment? At what point did they change what they were doing? What had they expected?

Now move towards an explanation. If the learner lacks some relevant knowledge, explain it or demonstrate the technique. We don’t have to sit patiently while they rediscover everything we could have taught them. We do need to hear enough of their thinking to understand why the explanation might help.

The questions in the original article remain good ones. Why do you think that happened? Would you expect the same thing to happen again? How might different anatomy affect your approach? They encourage the learner to consider how this experience relates to another, rather than treating each attempt as a separate event.

Agree what to try next and what to pay attention to. Afterwards, come back to the prediction. If it worked, does the explanation still make sense? If it didn’t, what else needs considering? Changing several things at once may produce a better result, but it can leave both of you unsure which change helped.

A task trainer gives us room to do this. With a patient, the appropriate procedure, supervision and limits on attempts take priority over finishing a learning cycle.

More than writing a reflection

“Reflect on that” is a wonderfully brief instruction for the teacher. The learner has rather more work to do. It helps if we’ve given them something specific to examine and are prepared to discuss it afterwards.

That might be an ordinary event. A clear referral or a conversation that went well can repay attention, even if it will never make an exciting conference case. After a difficult event, someone may need support and time before they want an educational discussion. Our conversation with Richard Lyon about debriefing explores the care needed in those conversations.

Then there is the return to practice. When will the learner try the approach again, and who could help them review it? A completed reflective form doesn’t answer either question. Without that return, we can become very good at documenting what we intend to do.

A word about learning styles

Kolb also developed work on learning styles. That doesn’t mean we should label someone and restrict their teaching to a preferred way of learning. Pashler and colleagues’ review found insufficient evidence to justify routinely using learning-style assessments in education. Having a preference is different from showing that matching teaching to it improves learning. They didn’t claim every possible version of the idea had been tested.

Ask what helps a learner access the teaching, and take that seriously. But choose the teaching approach with the task in mind too. A learner who likes reading will still need to practise a procedure.

There are also criticisms of the cycle itself. Morris’s review questioned how concrete experience is defined and argued for more attention to context and critical reflection. The proposed revision still needs empirical testing. We can use Kolb without expecting it to explain everything about learning.

The next time you supervise an attempt, it may be worth pausing before the next one. Find out what the learner thinks happened and what they intend to do with that experience. You may discover that the part they need help with comes after putting the equipment down.