Education Theory Made Practical – Volume 2, Part 7: Action Learning

(Here are links to the previous chapters in this series <Zone of Proximal Development; Transformative Learning Theory; Spaced Repetition Theory; Self-Determination TheoryOrganizational Learning and, Dreyfus Model of Skill Acquisition> We need your help. Before we publish all of these chapters as an ebook, we want the health professions community to weigh in on the confusing, missing, and disputed sections of each chapter.  Please include your comments at the bottom of the post. We will acknowledge your contribution in the forthcoming ebook.)


Authors: Neeral Shah MD, Tina Dulani MD

Editor: Michael Gottlieb, MD

What is your Educational Theory?
Name of Theory:

Digital Natives

Main Authors or Originators:

Marc Prensky

Other important authors or works:

Frank Kelly, Ted McCain and Ian Jukes; “ Teaching the Digital Generation” 2009

Don Tapscott “Grown Up Digital: How the Net Generation is Changing Your World”  2009

Charles Kivunja, “Theoretical Perspectives of How Digital Natives Learn” 2014

Part 1:  The Hook
Paige is a third-year medical student at a university-based medical school. During her pre-clerkship years, she received exceptional grades on assignments and exams. She was able to keep up with the course work and kept organized notes in all of her classes. Having always used technology to organize her files, she had developed a system of folders on her laptop to organize all her study materials. Using apps, Paige was able to annotate slides from lectures and develop collaborative documents for group studying.  

Paige has enjoyed starting her clerkship rotations and applying foundational material at the bedside. During rounds, she is always able to help by answering questions in real-time using the medical apps, reference material on her smartphone, or Internet search engines.  

One day, Paige was asked about the pathophysiology of a patient’s medical diagnosis. She remembers this disease being mentioned during her pre-clerkship classes but could not recall the exact genetic basis of the disorder. At the end of the day, the attending physician asks Paige to arrive the next day ready to teach the other students on the rotation about the mechanism of this disease state.  

Paige decides to use an Internet search engine to find the mechanism of the disease process.  She finds conflicting information through this method and decides to use Pubmed to find articles about the disease.  She downloads various articles and case reports, but the authors write very little in the background section describing the mechanism of the disease. After spending hours on this self-directed learning exercise, Paige realizes she is not much closer to the answer than when she began this process.  

She returns the next day and presents case reports, the conflicting data from articles, and a summary from the clinical online resources. The attending commends Paige on the volume of information she has reviewed during this process, but also mentions the foundational textbook that has two full pages covering the mechanism of this disease. Paige was able to find the same information, but deciphering the accuracy of each source through her normal search channels was a bit more difficult.

Part 2:  The Meat
Overview of this theory

The theory of ‘digital natives’ is based in the idea that learners born in the era of computers, tablets, and smart phones (usually considered after 1980) have been surrounded by digital screens their entire life. This has allowed this generation to develop the unique skill set of multi-tasking, process items with speed, and instant gratification with inquiries and questions. Since day one, these learners have neural plasticity which allows them to adapt and think at the speed of devices.1 This is in contrast to ‘digital immigrants’ who encompass all those who were not born into the digital world and have adopted aspects of digital technology later in life. While digital immigrants can adapt to new technology, they tend to retain teaching styles that are familiar and inherent to their own learning process – lectures and step-by-step logical instruction. Thus, the digital immigrant teaching style is at odds with the digital native learner. It is this dilemma that digital immigrant teachers must address in order to effectively teach digital native learners. Critics argue that this fast-paced, parallel (as opposed to linear) learning model will not scratch the surface of important topics. On the other hand, proponents argue that adapting and changing our teaching models will not only allow us to reach our learners but also enhance our teaching experience.

Background about this theory

Marc Prensky first coined the terms ‘digital natives’ and ‘digital immigrants’ in 2001 as a way to describe the disconnect between learners embracement of digital technology outside of the classroom and lack of application in the classroom.2,3 He attributed this disconnect to the decline of education in American schools. Prensky argued that digital natives think and process information differently because of their immersion in the digital world via the Internet, video games, cell phones, email, and instant messaging. He calls their minds, ‘hypertext minds’ – minds that are programmed to leap around and process information in parallel. The cognitive skills enhanced include the ability to multi-task (attentional deployment), develop multi-dimensional visual-spatial skills, and inductive discovery. Failing to recognize these skills and target these strengths in the classroom created a learning environment where learners struggled to engage and remain interested. The solution, Prensky argues, is to recognize these skills and change the way that we teach to facilitate effective learning. This means that digital immigrants need to reorganize their content and become more imaginative and inventive in their teaching methods. This does not simply involve using electronic hardware and software, but also utilizes the broader ethical, political, and sociological components related to the content. Simpl, taking ‘traditional’ (ie, reading, writing, logical thinking) content and digitizing it misses the concept of digital learning. A deeper analysis into selecting content essential for knowledge construction is required. Furthermore, he recommends using technology that digital natives are familiar with to deliver this content. One example is adapting content to game-based education. This is one solution to addressing shorter attention spans and utilizing parallel information processing. Taking cues from our learners and being imaginative in our approach to teaching can improve our effectiveness as educators.

Modern takes or advances in this theory

Prensky introduced the idea of digital natives and digital immigrants, which still applies to this day. Advances in this educational theory does not involve redefining these groups, but rather learning how to co-exist and optimize the transfer of knowledge. It is important that teachers and educators who are digital immigrants adapt to this newer style of learning and modify educational exercises to harness the enthusiasm of technology among digital natives.

Charles Kivunja in his article “Theoretical Perspectives of How Digital Natives Learn” reviews general education theory and contemporary theories on how digital natives learn.4 Kivunja reviews multiple historical learning theories including those of behaviorism, cognitivism, and constructivism. He then discusses the application of these theories to contemporary theories. Since Prensky’s landmark articles in 2001, leaders in the field have delved into understanding how digital natives learn.

Frank Kelly, Ted McCain, and Ian Jukes discuss how digital technologies have influenced the thinking and behaviors of digital natives in their 2009 article, “ Teaching the Digital Generation.” Similar to Prensky, they argue that the immersion of digital natives in the digital world of the Internet, emails, and increased computer usage impacts the way that digital natives think and seek out information. The digital world is highly accessible and integrates illustrations, media, and video. The allure of the sensory-rich platforms and the accessibility allows digital natives to be constructionist in their approach to learning (ie, they are active learners who assume responsibility for their own learning).

Don Tapscott, in his book “Grown Up Digital: How the Net Generation is Changing Your World” describes the unique qualities of digital native learners that impact their approach to learning. He postulates that digital natives are natural collaborators, who prize openness, freedom of choice, and innovation. Though having fun while learning is preferred and attention spans are short, they care greatly about their education. These are but a few of the qualities that are explored by Tapscott. He proposes using hands-on strategies in our teaching techniques and offering open discussions as a way of communication.

Kivunja synthesizes the historical learning theories and these contemporary analyses and outlines a set of strategies that are essential to help digital immigrants teach this group of learners. First, review materials to ensure the knowledge, ethics, policies, and theories are congruent with the thinking of digital natives and remove outdated material. Second, incorporate technology into teaching to engage the audience, encourage use of their own devices for learning, and avoid digital distraction from other programs. We must complement education with technology and avoid forcing it into material, as it can easily take the focus off of the primary learning objective. Third, as digital immigrants succeed with new, creative endeavors it is imperative to share these ideas with other educators to create a new generation of learning. Overall, the digital natives’ habits and practice should not seem to be a threat to traditional learning, but rather a challenge that we can overcome to develop digital fluency between these two groups.

Other examples of where this theory might apply in both the classroom & clinical setting

Charles Friedman provides some insight into the digital age of medicine. Information is mostly available in its digital form and the volume available appears to grow exponentially. Finding a framework to sift through this data and identify pertinent pieces of information will be essential for this generation of learners. In the article “Educating medical students in the era of ubiquitous information”, Friedman tackles this concept and provides strategies to help this transition.5 First, it is important that students know what they know and recognize what they don’t. This will encourage learners to research those things that are unfamiliar to them, while remaining efficient and not focusing on concepts that they already understand. Second, it is important to know how to ask a good question. This is essential in finding the right resource. Without a focused question, research can take many tangents and result in answers with little relevance to the original question. Finally, one must know how to evaluate and weigh evidence. The Internet seems to have a never-ending supply of resources, so finding the most impactful information is essential to sift through the fields of data. Competent clinicians must be able to filter the huge amounts of information and pick out the most relevant and useful aspects. Clinical decisions will ultimately be made by people even with the vast amounts of material available at our fingertips.

For example, a resident that is working a shift in the emergency department is told to look up the dose of a commonly prescribed antibiotic by her attending physician. The resident can use a variety of ways to look up this information. These include an Internet search engine, a drug database, or drug applications that can be downloaded to her smartphone. If she were to simply type in the antibiotic name into a search engine, she would see an immense amount of superfluous information. In addition to knowing the indication for the antibiotic, she must also know the patient characteristics (eg, weight, other home medications) that may change the dosage and the duration of the antibiotic. Ultimately the resident, as a clinician, needs to synthesize all of the clinical and non-clinical information before deciding upon the correct dosage.

Annotated Bibliography of Key Papers on this theory

Prensky M. Digital Natives, Digital Immigrants Part 1. On the Horizon. 2001; 9(5): 1-6

Prensky M. Digital Natives, Digital Immigrants Part 2: Do They Really Think Differently?. On the Horizon. 2001; 9(6): 1-6

Prensky’s two-part article discusses the basic differences between digital natives and digital immigrants. This is an enjoyable and easy introduction to the different characteristics of these groups.

Kivunja C. Theoretical perspectives of how digital natives learn. International Journal of Higher Education 3.1 (2014): 94.

This paper examines historical learning theory and contemporary thoughts on how digital natives learn. This is an excellent paper that reminds us of the basics of learning theories and moves us forward to the modern dilemma of teaching digital natives effectively.

Limitations of this theory

Much has been written about digital natives and their approach to learning since Prensky coined these terms in 2001. Apostolos Koutropoulos examined the assumptions and generalizations made by Prensky and argued that simply being born into the age of digital technology does not infer access or inherent competency with technology.6 He argues that describing a population of people born into the age of technology as digital natives creates an artificial dichotomy that ignores the cultural context, which are the socio-economic factors and privilege that are at play in developing the skills thought to be inherent to digital natives. Furthermore, the generalizations made about digital natives put them in a de-privileged position because there is a stereotype that they are expected to meet. Calls for changes in education that aim to incorporate the tools that digital natives use daily do not address obstacles that learners might face. Assumptions of Internet access, computers, and technology at the fingertips of learners is harmful to those who do not have such privilege. Koutropoulos cites survey data by Garcia and Qin that suggest older students are more likely to change their approach to learning as compared to digital natives. The underlying issue is disengagement from course work and a lack of incentive. The focus, Koutropoulos states, should be on developing a pedagogy and teaching skills to critically analyze information. These skills are inherent to success in both the pre-digital and digital generations. He cautions against stereotyping generations and making assumptions about their knowledge base and skills set. Understanding that learners do not know what their knowledge deficit is and targeting our approach to include technology but with a focus on critical thinking and analysis is paramount to being an effective educator.

Part 3:  The Denouement
Paige met with her attending physician the next day to discuss her workflow and strategies to answer clinical questions. The attending warned her against using Internet search engines with unfiltered responses to answer the questions that arise. Paige reassured her attending that she tries to preferentially select those sources that are more established, but the amount of information is overwhelming at times.

The attending realized that, in suggesting a textbook, he assumed Paige would have access to this text and would have had to purchase this book. By adapting the discussion to electronic resources that are available on devices, Paige would have been more receptive and able to change her practice.  

The attending pointed out that many textbooks are available electronically through the library website and could be a potential source of information. While these resources are not updated for rapidly changing information, they could still be a good source for foundational material. Further, much of the content in textbooks will not appear in basic Internet searches. In addition to this, Paige and her attending also discussed how to refine her searches in PubMed to filter for content such as review articles that may be helpful in providing both basic and updated information on topics.

Paige pointed out that having knowledge of resources that are available electronically is helpful for her to do real-time learning and be more efficient in answering clinical questions. Paige felt much more comfortable after the rotation in answering questions by using textbooks for foundational material, but still using the Internet and PubMed for novel therapies and management based upon newer studies and case reports.


  1. Thompson, Penny. “The digital natives as learners: Technology use patterns and approaches to learning.” Computers & Education 65 (2013): 12-33.
  2. Marc Prensky, (2001) “Digital Natives, Digital Immigrants Part 1”, On the Horizon, Vol. 9 Issue: 5, pp.1-6,
  3. Marc Prensky, (2001) “Digital Natives, Digital Immigrants Part 2: Do They Really Think Differently?”, On the Horizon, Vol. 9 Issue: 6, pp.1-6,
  4. Kivunja, Charles. “Theoretical perspectives of how digital natives learn.” International Journal of Higher Education 3.1 (2014): 94.
  5. Friedman CP, Donaldson KM, Vantsevich AV. Educating medical students in the era of ubiquitous information. Med Teach. 2016 May;38(5):504-9.
  6. Koutropoulos A, (December 2011) “Digital Natives: Ten Years After”, MERLOT Journal of Online Learning and Teaching, Vol. 7, No. 4.
  7. Haluza D, Naszay M, Stockinger A, Jungwirth D. Digital Natives Versus Digital Immigrants: Influence of Online Health Information Seeking on the Doctor-Patient Relationship. Health Commun. 2017 Nov;32(11):1342-1349. doi: 10.1080/10410236.2016.1220044. Epub 2016 Oct 6. PubMed PMID: 27710132.
  8. de Wet C, Yelland M. The challenges and opportunities in medical education for digital ‘natives’ and ‘immigrants’ in Scotland and abroad. Scott Med J. 2015 Nov;60(4):152-4. doi: 10.1177/0036933015597177. Epub 2015 Sep 1. PubMed PMID: 26329587.