By Jonathan Sherbino (@sherbino)

(A bit of context… this post also serves as the “show notes” for a presentation I gave at the Social Media and Critical Care conference, Chicago, 2015)

It’s a silly task to distill the field of medical education and the discipline of cognitive psychology into a Top Ten list of essential theories. It’s akin to asking an intensivist to list the ten diagnoses that encompass their practice. Yet, that’s exactly what we’re going to tackle today. So with a nod to the absurdity of it all, here’s the Top Nine…

HOW WE LEARN

Knowledge is constructed, not transferred

As Clinician Educators, too many of our instructional methods assume that we merely need to deliver data via lectures, handouts, videos etc. for simple downloading into the mental hard drive of our learners. This flawed analogy from computer science (ironic that computer science is rapidly trying to adopt human reasoning) falls flat. Learning is NOT a function of “drag and drop.” Rather learning involves:

Stimulus

Coding

Retrieval

The modal theory of memory (Atkinson & Shriff) suggests that memory is constructed via a series of caches or stores. Large amounts of environmental stimuli are unconsciously processed by a sensory store (with each sense having a separate substore). Attention to a stimulus by the “short term memory” allows for encoding into the long term memory, where knowledge is predominantly constructed in a semantic fashion.

Baddeley & Hitch advanced the theory of short term memory (aptly renamed working memory) to more effectively explain observed phenomena.

Certainly there are competing theories of how memory works. The modal theory of memory is frequently criticized for its linear/ simplistic design. Nonetheless, the key point is that each learner UNIQUELY constructs knowledge (a function of semantic representation).

Knowledge is socially constructed

The influential work of Berger & Luckman suggests that in all facets of life (and certainly relevant to the team-based environment of health professions education) our social environments (professional and peer groups) influence our attention, perception, encoding and semantic representation of knowledge. Here’s a landmine that I won’t touch… is there universal truth? Ask Descartes?

Flash cards (i.e. recall) are the most effective way to study

Check out the KeyLIME (Key Literature In Medical Education) podcast + abstract, Episode 10 for more details on this.

HOW WE TEACH

Sequencing of information is key

Contrary to opinion, lectures are not a bad thing. Lectures can provide an organizing framework for complex topics and help to structure future learning. Lectures can also induce an emotional connection between an audience and an idea, as a means to effect change. For these aspects of a lecture to be realized, sequencing of information must be attended to.

First, the serial position effect suggests that items addressed at the beginning and end of a series are best recalled.

Second, the von Restorff effect suggests that unusual items are best recalled.

So, if you sequence the delivery of information into small chunks with cognitive “wake ups” (i.e. unusual bits) you will be a more effective lecturer. TED figured it out (or ripped off the idea from evangelical preachers) when they limited talks to 15 minutes and integrated engaging vignettes into the narrative.

Emotional Activation is Key. Not too much, not necessarily only positive

Posner, Russell & Peterson in a review article (published in the ominous journal Development and Psychopathology…??) suggest that arousal / activation is necessary to optimize learning. Learning can occur in both the positive and negative valence (i.e. type of emotion). In other words, make sure your learners are engaged (excited OR stressed) but don’t tip the scale so far that they are emotionally overstaturated and unable to learn. There is a neurophysiology basis for this, but beyond the scope of the post. (Insert hand waving about dopamine, cortisol etc.)

Design your teaching as a spiral; ground it in authentic experiences

Kolb’s experiential learning model suggests that authentic experiences are more impactful than abstract ones. Also, one experience builds to the next resulting in greater insight and depth of understanding. The emphasis on work-based learning in competency-based medical education is strongly influenced by this model.

MYTHS

Learning styles should be accomodated

In fact, CEs should probably ignore learning styles. Certainly, an effective curriculum (or presentation for that matter) employs multiple techniques to engage an audience (see #4 and 5 above). However, tailoring an instructional method to a learner’s declared learning style will be a poor investment.

The punch lines, include:

Differences in cognition are continuous, not nominal/categorical as suggested by learning styles

The learning styles taxonomy is greater than 70. Differentiating among this excessive classification is not feasible.

Data supporting learning styles is predominantly self-report, retrospective data.

There is no strong correlation between matching instructional methods to learning style and outcomes

For more on this, checkout the KeyLIME podcast Episode 51.

Multi-tasking improves efficiency (and is a unique feature of the Homo zappiens/ digital natives)

Conscious attention to two simultaneous, complex tasks is not possible. The capacity of working memory (suggested by Miller to hold 7 +/-2 distinct items) is quickly saturated. Rather, when faced with multiple tasks, one task can be consciously attended to, while the other is automated. For two complex tasks to be completed simultaneously, rapid task switching is required. This process quickly introduces error into the equation. So, texting a friend during a small group session (two complex tasks) means that one or both tasks suffers (and it’s always small group participation that gets the raw end of the deal).

Adult Learning Theory is an actual theory

Adult learning theory, strongly influenced by Malcolm Knowles, suggests that adults have unique abilities / capacities that must be accounted for in curricula. The problem is that the face validity of the claims are not supported by empiric evidence. Rather, adults and children are hard to distinguish in terms of cognitive or learning processes. Clinician Educators, myself included, would do well to follow the general education (e.g. primary and secondary school) literature to inform our delivery of medical school and postgraduate medical education.

For a great discussion on adult learning theory, check this out.

So, what theory did I miss that you want to see? Add it below and we’ll feature it in a future post. Or if you prefer, the editorial board would welcome a submission / guest post describing a theory that the CE community should know about.

For a great (but slightly dated) review of a multitude of learning theories relevant to health professions education, Regehr and Norman provide a great narrative review.

For more details on what we’re reading at the ICE blog click here.

Image by NY used under CC License 3.0