**3. Health and the biomedical model**

As preceded in outlining the historical development of medicine and medical education, it is observed that medical education has transitioned from being unstructured and designed by individual endeavors, known as healers in offering holistic health services [22], to become more structured, institutionally-based and regulated by members of professional medical practice. In other words, the transition emphasized the biomedical model, as the sole path to improving health in the community.

The biomedical model is the most prevalent in medical practice and educational institutions in the western countries and other parts of the world [14, 23]. Cockerham [24] revealed that ignoring the social role in studies of health and illness is a sign for the pervasiveness of the biomedical model in conceptualizing sickness. According to Cockerham, this model is based on the concepts of pathogens as causes of disease that are prevented or controlled by medical interventions such as medical procedures and medications. In an argument to dispel the current prevalent role of the biomedical model, Roy Porter [25] argued that "Basic research, clinical science and technology working with one another have characterized the cutting edge of modern medicine" (in Cockerham, 2021, p.10). In a counterargument of the benefit of the biomedical model, Cockerham argued that the biomedical model was useful when infectious diseases were most prevalent as it provided the right drugs to treat these infections. However, in the recent days, with the changing patterns of disease outbreaks as in the most recent Corona Virus pandemic, and the emergence of chronic diseases, such as heart diseases and cancer as a result of the increasing life span of the population, there are new factors to consider. Globalization, modernization of life styles, economy, and the quality of working environment which also have influenced the kind of diseases and health problems that people suffer from, imply the need to revisit medical treatment management strategies, schools' curricula and instructional methods.

Understanding the past control of infectious diseases (i.e., small pox and poliomyelitis), the recent emergence of viral infections, concerns about chronic diseases, and the increased life span of the people, together with modern life and environmental and work conditions change call for an alteration in medical approaches to treat health problems. A more holistic approach of care that deals with the whole person became more eminent. In this regard, the biomedical model which dealt with microorganisms, pathology and biochemistry falls short of providing care based on humanistic modes of care, and suggestions of a replacement model with new strategies for treatment should emerge to meet this change in the healthcare needs.

#### **4. Current medical education and adult learning theories**

Medical education has undergone significant transformations reflecting the changes that have occurred in global healthcare as well as educational systems [26]. One of the most significant changes is the shift from passive learning to active learning using a variety of teaching and learning strategies. These strategies include case-based learning, experiential learning, peer problem solving, and project-based learning [26]. However, many challenges were associated with this shift that are related to the organization, resources, staff, and students [27]. The traditional medical model focused on passive learning and emphasized biological aspects of diseases and disorders with total disregard to psychological, social, behavioral, and spiritual aspects and responses [28, 29], while active learning focused on the implementation of adult learning theories.

Adult learning theories based in "andragogy", provide a guiding framework for all types of higher educational programs, including programs for healthcare professionals. Andragogy focuses on viewing the "adult learner" as a partner in the

#### *Toward a Holistic Approach in Medical Education DOI: http://dx.doi.org/10.5772/intechopen.100062*

teaching-learning process who possesses the ability to determine his/her learning needs based on various experiential backgrounds, skills, and motivations. Educational programs for healthcare professionals usually stem from different philosophical and theoretical frameworks that provide curricular guidance in the formulation of educational programs and their contents. There are several adult learning theories based on a constructivist philosophy which entails building new knowledge on previously existing knowledge and is congruent with the views presented in andragogy which was established by Alexander Kapp in 1833 and revived and modified by Malcolm Knowles in the 1980s. Modern andragogy is based on five assumptions which are self-concept, experience, readiness to learn, orientation to learning, and motivation to learn [30]. Adult learning theories include instrumental, humanistic, transformative, social, motivational, reflective, and constructivist theories.

Instrumental theories include behavioral theories, cognitivism, and experiential learning [31]. Behavioral theories stipulate that learning happens as a result of the influence of environmental stimuli on the individual which manifests in behavioral changes. Cognitivism focuses on the cognitive processes such as perception, memory, and reflection that are precursors to knowledge acquisition and retainment. In experiential learning, knowledge is constructed through interactions and active experiences with the individual's environment. Humanistic theories focus on viewing the learner through a humanistic lens that emphasizes studentcentered, self-directed learning and views educators as facilitators. Transformative theories focus on empowering the learner to evaluate and reflect on previously held assumptions and meanings to transform to a new level of knowledge. Social theories focus on acquiring knowledge and learning through social interactions. The main premise in motivational theories stipulates that motivation and reflection are precursors to learning. Reflective theories are based on two types of reflection: reflection-on-action and reflection-in-action which help the learner to test knowledge and learn from experience and practice. Constructivist theories focus on the sociohistorical and situated dimension of learning. The learner acquires new knowledge through social interactions with their peers and instructors and builds upon previously acquired skills.

The use of varied adult learning theories, which have both strengths and shortcomings, in medical education programs around the world has led to varied instructional methods employed by faculty and ultimately varied levels of achievement of learning outcomes.
