Kolb, integration and the messiness of workplace learning

‘I don’t know what’s wrong with our students. We’ve taught them all they need to know but they just can’t seem to remember any of it when they’re at work’. This paraphrase may be a familiar call of some teachers bemoaning how students have difficulty in applying their learning. Linking classroom theory to workplace practice is the focus of a systematic review in this issue of Perspectives on Medical Education [1], but let’s start with a brief, and idiosyncratic, history of learning. People have been learning from work and from experience since the earliest days of our evolution. Some time ago we must have decided it was a good idea to separate theory from practice so that we would teach the theory and that presumably would make the practice more robust. The dark days of the 19th century, factory style schooling attests to this philosophy: students in darkened classrooms being taught but not necessarily learning. Flexner had the best of intentions to link medical practice to theory but even here this was translated into doing the theory first and the practice later [2]. Then we must have realized that we needed to put the theory closer to practice and integrate. Within medical education, integration became the next buzzword but there was potential for confusion. We realized that learning anatomy separately from physiology made it difficult for students to make the links between structure and function – so we invented horizontal integration where we combined previously separated disciplines in our teaching. Next came early clinical contact so that practice can be brought earlier into our curriculum – so called vertical