Transformative Learning in Clinical Education: Using Theory to Inform Practice

  • Anna JonesEmail author
Living reference work entry


Transformative learning is a way of understanding learning when the central focus is profound change in both thinking and behavior. Although Mezirow is key to transformative learning, the work has been developed and used in a range of contexts. In clinical education the notion of transformative learning is increasingly being used as a framework to understand the ways in which clinicians learn in ways that promote fundamentally new ways of thinking. As a tool for curriculum design and teaching development, transformative learning provides a means by which educators can plan for learning. The key elements of transformative learning are disequilibrium or a “disorienting dilemma” that is a trigger to prompt critical reflection. The final stage is a change in both thinking and action. These stages can then be expanded into a much more fine-grained process. This chapter provides the theoretical background to transformative learning before examining its use in clinical education. This is illustrated through a vignette. While transformative learning requires effort and persistence on the part of both learner and educator, the possibilities for creating learning environments that enable a flexibility of thought, interdisciplinary collaborations, and an openness to new ways of working are essential in a rapidly changing healthcare system.


Transformative learning Transformation Change Reflection Critical thinking 


  1. Abela J. Adult learning theories and medical education: a review. Malta Med J. 2009;21:11–8.Google Scholar
  2. Briese PM. Application of Mezirow’s transformative learning theory to simulation in nursing education. Leadership connection conference, September 15–18, 2018. Indianapolis; 2018.Google Scholar
  3. Brookfield S. The skillful teacher: on technique, trust and responsiveness in the classroom. San Francisco: Jossey-Bass; 1990.Google Scholar
  4. Brookfield S. Putting the critical back into critical pedagogy. J Transform Educ. 2003;1(2):141–9.CrossRefGoogle Scholar
  5. Buchman S. Transformative teachers. Can Fam Physician. 2012;58:1.Google Scholar
  6. Christie M, Carey M, Robertson A, Grainger P. Putting transformative learning theory into practice. Aust J Adult Learn. 2015;55(1):9–30.Google Scholar
  7. Clark H, Taplin D. Theory of change basics: a primer on theory of change. New York: Actknowledge; 2012.Google Scholar
  8. Cook J. The Bawa-Garba case: a timeline. GP Online [Internet]. 8th June 2019.Google Scholar
  9. Cranton P, Hoggan C. Promoting transformative learning through reading fiction. J Transform Educ. 2012;13(1):6–25.Google Scholar
  10. Dirkx J. Self-formation and transformative learning: a response to ‘calling transformative learning into question: some mutinous thoughts’ by Michael Newman. Adult Educ Q. 2012;62(4):399–405.CrossRefGoogle Scholar
  11. Donnelly R. Application of Mezirow’s transformative pedagogy to blended problem-based learning. Dublin: Dublin Institute of Technology ARROW@DIT; 2016. p. 1–21.Google Scholar
  12. Dyer C, Cohen D. How should doctors use e-portfolios in the wake of the Bawa-Garba case? BMJ. 2018;360:572.CrossRefGoogle Scholar
  13. Foshee C, Mehdi A, Bierer B, Traboulsi EI, Isaacson JH, Spencer A, et al. A professionalism curricular model to promote transformative learning among residents. J Grad Med Educ. 2017;9:351–6.CrossRefGoogle Scholar
  14. Friere P. Pedagogy of the oppressed. New York: Continuum; 1970.Google Scholar
  15. Gravett S. Action research and transformative learning in teaching development. Educ Action Res. 2004;12(2):259–72.CrossRefGoogle Scholar
  16. Greenhill J, Poncelet AN. Transformative learning through longitudinal integrated clerkships. Med Educ. 2013;47:336–9.CrossRefGoogle Scholar
  17. Greenhill J, Richards JN, Mahoney S, Campbell N, Walters L. Transformative learning in medical education: context matters, a South Australian Longitudinal Study. J Transform Educ. 2018;16(1):58–75.CrossRefGoogle Scholar
  18. Hoggan C. Transformative learning as a metatheory: definition, criteria and typology. Adult Educ Q. 2016;66(1):57–75.CrossRefGoogle Scholar
  19. Illeris K. Peter Jarvis and the understanding of adult learning. Int J Lifelong Educ. 2017;36(1–2):35–44.CrossRefGoogle Scholar
  20. Jarvis P. Teaching, learning and education in late modernity. London: Routledge; 2012.CrossRefGoogle Scholar
  21. Kear T. Transformative learning during nursing education: a model of interconnectivity. Nurse Educ Today. 2013;33:1083–7.CrossRefGoogle Scholar
  22. Kegan R. What ‘form’ transforms?: a constructive-developmental perspective on transformational learning. In: Mezirow J, editor. Learning as transformation: critical perspectives of a theory-in-progress. San Francisco: Jossey-Bass; 2000. p. 35–70.Google Scholar
  23. Kember D, Leung DYP, Jones A, Loke AY, McKay J, Sinclair K, et al. Development of a questionnaire to measure the level of reflective thinking. Assess Eval High Educ. 2000;25(4):381–95.CrossRefGoogle Scholar
  24. King K. Both sides now: examining Transformative learning and professional development of educators. Innov High Educ. 2004;29(2):155–74.CrossRefGoogle Scholar
  25. King K. The handbook of the evolving research of transformative learning based on the learning activities survey. Charlotte: Information Age Publishing IAP; 2009.Google Scholar
  26. Kirkpatrick DL. Evaluating training programmes: the four levels. San Francisco: Berrett-Koehler; 1994.Google Scholar
  27. Larrivee B. Transforming teaching practice: becoming the critically reflective teacher. Reflective Pract. 2000;1(3):293–307.CrossRefGoogle Scholar
  28. Markless S, Jones A, Reedy G. Using theory-based evaluation: an approach to dealing with complexity. AERA conference, 5–9 April. Toronto; 2019.Google Scholar
  29. McAllister M. STAR: a transformative learning framework for nurse educators. J Transform Educ. 2011;9(1):42–58.CrossRefGoogle Scholar
  30. Mezirow J. Transformative dimensions of adult learning. San Francisco: Jossey-Bass; 1991.Google Scholar
  31. Mezirow J. Transformative learning: theory to practice. New Dir Adult Contin Educ. 1997;74:5–12.CrossRefGoogle Scholar
  32. Mezirow J. Learning as transformation: critical perspectives on a theory in practice. San Francisco: Jossey-Bass; 2000.Google Scholar
  33. Newman M. Calling transformative learning into question: some mutinous thoughts. Adult Educ Q. 2012;62(1):36–55.CrossRefGoogle Scholar
  34. Offredy M. Decision-making in primary care: outcomes from a study using patient scenarios. J Adv Nurs. 2002;40(5):532–41.CrossRefGoogle Scholar
  35. Pennington D, Simpson G, McConnell M, Fair J, Baker R. Transdisciplinary research, transformative learning and transformative science. Bioscience. 2013;63(7):564–73.CrossRefGoogle Scholar
  36. Renigere R. Transformative learning in the discipline of nursing. Am J Educ Research. 2014;2(12):1207–10.CrossRefGoogle Scholar
  37. Romano A. The challenge of the assessment of process and outcomes of transformative learning. Educ Reflective Pract. 2017;1:184–219.CrossRefGoogle Scholar
  38. Stuckey HL, Taylor E, Cranton P. Developing a survey of transformative learning outcomes and processes based on theoretical principles. J Transform Educ. 2013;11(4):211–28.CrossRefGoogle Scholar
  39. Sweller J. Cognitive load during problem solving: effects on learning. Cogn Sci. 1988;12(2):257–85.CrossRefGoogle Scholar
  40. Taylor D. Adult learning theories: implications for learning and teaching in medical education. AMEE Guide No 83. Med Teach. 2013;83:e1561–e72.CrossRefGoogle Scholar
  41. Taylor E, Cranton P. A theory in progress? Issues in Transformative learning theory. Eur J Res Educ Learn Adults. 2013;4(1):33–47.CrossRefGoogle Scholar
  42. Walters L, Prideaux D, Worley P, Greenhill J. Demonstrating the value of longitudinal integrated placements to general practice preceptors. Med Educ. 2011;45:455–63.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.School of Medical EducationKing’s College LondonLondonUK

Personalised recommendations