Psychologist Elizabeth Loftus studies memories. More precisely, she studies false memories, when people either remember things that didn’t happen or remember them differently from the way they really were. It’s more common than you might think, and Loftus shares some startling stories and statistics — and raises some important ethical questions.
One of the best analogies on learning that I ever learned came in a rather unlikely place.
I had just walked from my car to meet a golf instructor (John), he was going to help me work through some issues with my game. 15 minutes into the lessons John could tell that I was getting frustrated with my new backswing and he asked me to join him on a quick walk. I put down my clubs and we began walking back towards my car. About half-way there John stopped me – the scene was not much different than the picture to the right – we were standing in the woods on a path that had been worn by years and years of golfers walking back-and-forth from the parking lot to the driving range.
John said, “Imagine for a second what this path looked like the first day a golfer found this short cut to the range… now compare that to today…” [Perhaps you can picture it?]
John continued, “This time, imagine what it would have looked like had no one ever repeated the trek…or if it was only traveled once a year?”
That 5-minutes spent on the walking path through the woods has stuck with me for years. And for years I have used the imagery of the worn path to help others understand why learning is rarely, if ever, immediate – instead, it is the end-product of spacing, time, and retrieval.
The first time a learner is confronted with new information, it is like the first walker through the woods…some grass and twigs get trampled, but in a matter of days the grass is likely to regrow and there will be no visible path. If the walker returns the next day, the next week, the next month….over time, the path is worn in and becomes permanent.
Neurobiologically, the first time new information is consumed it is like the first walk through the woods – and neural networks are weakly formed. If the new information is not revisited, the networks weaken and a learner’s ability to retrieve the information (to follow the path) is lost. However, if the learner is re-exposed to the information, if they revisit their notes, if they are presented with reminders or educational boosters; one-off learning experiences become worn neural networks, and strong, efficient retrieval is made possible (AKA, true learning; retention).
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At the heart of the Learning Actions Model is the recognition that learning is often inefficient and unsuccessful if the learner does not take the right actions (learning actions) at the right time. And one of the most critical learning actions is setting reminders that ensure a learner will be re-exposed to new content/information over time; with each subsequent experience or new exposure, the neural networks strengthen and worn path is formed.
In practice we find that learners often need even more support. While we can drive learners to take actions, we can do even more to catalyze learning – we can (and should) structure and optimize the spacing and timing of continuous learning. This recognition, married to the emerging science of microlearning, lead to the design, creation, and recent release of ArcheMedX Rich Content Posts (or RCPs) – short, concise, and intentional interventions published and disseminated to learners over time to reinforce, enhance, and extend learning and retention.
Beginning this month our partners leveraging the ArcheHome and ArcheTeam curricular experiences can now augment their interventions with an unlimited number of RCPs thereby creating planned or ad hoc continuous learning experiences for their learners and/or teams.
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If you are interested in learning more about the science of spacing and retrieval, let me know!
If you are interested in learning more about how your organization can leverage ArcheHome, ArcheTeam, and RCPs, contact [email protected]!
If you are interested in fixing your golf game, maybe we can meet up on that worn path and spend some time with John 😉
OBJECTIVES:
Acute states of agitation (ASAs) are frequent in daily medical practice. However, training on real ASAs raises technical and ethical issues, whereas lecture-based teaching hardly addresses some educational objectives, e.g., improving relational skills and team-based coordination. Simulation-based medical education (SBME) is a promising medium to train students on managing ASAs. We have recently implemented a role-playing training module on ASAs. In this scenario, four to five students play the role of the staff, while a trained professional actor plays the agitated patient. A subsequent standardized debriefing is conducted by a senior psychiatrist. A first wave of 219 students participated in a one-session training of this ASA module in June 2015. They completed pre-session and post-session questionnaires aiming to collect “proof-of-concept” data.METHODS:
The pre-session questionnaire investigated: previous experience of ASA among students during their clinical training; previous participation in a role-playing SBME; and perceived knowledge of the good practice rules for managing ASAs. The post-session questionnaire investigated among the students if: they thought having been able to appropriately manage the simulated ASA; they found the SBME medium more fitted for training than real situations; they found that the SBME session faithfully reproduced a real ASA; and the session was found useful for transmitting the skills on correct management of ASA. The average level of stress induced by the training was assessed using a numerical rating scale (0-10).RESULTS:
Two hundred and six of the 219 students completed the pre-session questionnaire (63% females; response rate 96.7%). A hundred and thirty four students played the scenario and completed the post-session questionnaire (65.7% females; response rate 100%). 38.3% of the responders reported having previously experienced a situation of ASA in their practice, and 31.1% deemed to know the good practices rules for managing an ASA. In post-session, 29.9% of the participants considered that they appropriately managed the ASA, 79.9% deemed that the role-playing session faithfully reproduced a real ASA, and 97% deemed that this SBME was more fitted and useful than a real clinical situation to improve their medical skills. Bivariate analyses revealed that the post-session responses and level of stress were not influenced by previous experience on ASA, previous participation in a SBME role-playing session, or thinking to know the rules for managing ASAs.CONCLUSION:
SBME role-playing training appears a promising, realistic, and well-accepted method for teaching the management of ASA.
Human papilloma virus (HPV) vaccination rates lag behind other vaccines, primarily because of weak provider recommendations, and are associated with nearly 30,000 new cancer diagnoses a year. Educating medical students about HPV using active, team-centered learning may increase assimilation of information and may increase vaccination rates. A team-based learning (TBL) module focused on HPV for first-year medical students about HPV will better increase knowledge and likeliness to vaccinate than traditional education methods. Baseline HPV knowledge in medical students across Texas was assessed by surveying all 4-year undergraduate medical schools. Students at one medical school then participated in a week-long TBL focused on basic and clinical concepts relating to HPV, and then were re-surveyed upon completion of the course module. At baseline assessment, first-year student at the intervention site performed at the same level as first-year medical students across the state of Texas on knowledge and satisfaction with their HPV-related medical school education. After the TBL implementation, students performed significantly better than similar-year students and equal to graduating seniors, on knowledge of HPV- and HPV-related cancers, and report significantly higher satisfaction with education measures. Students at the intervention site were significantly more likely to recommend the HPV vaccination in future practice. Short-term knowledge and willingness to recommend vaccination are improved with a targeted HPV TBL early in medical education, which may provide a basis of knowledge that could translate into improved vaccination rates.
INTRODUCTION:
Engaging residents across a multiyear training spectrum is challenging given the heterogeneity of experience and limited time available for educational activities. A “flipped classroom” model, in which residents prepare ahead of time for mentored topic discussions, has potential advantages.METHODS:
We implemented a curriculum consisting of topics distributed across the specialty. Weekly, each resident was randomly assigned to research a specific aspect of an assigned topic appropriate to his or her level of experience: junior residents about what characterizes each clinical entity, midlevel residents about when to intervene, and chief residents about how to administer treatment. Residents completed an anonymous survey 6 months after implementation. Board examination performance was assessed before and after implementation.RESULTS:
A total of 12 residents participated in the program. Weekly, 1.75±0.40 hours were spent in preparation, with senior residents reporting less time than junior residents. All residents indicated that the accumulation of experience across 7 years of residency was a major advantage of this program, and all preferred it to lectures. Performance on the board examination significantly increased after implementation (from 316±36 to 468±45, p<0.05).CONCLUSIONS:
The flipped classroom is a viable approach to resident education and is associated with increased engagement and improved performance using validated knowledge-assessment tools.
via Implementation of a “Flipped Classroom” for Neurosurgery Resident Education. – PubMed – NCBI.
BACKGROUND:
Otologic diseases are common and associated with significant health care costs. While accurate diagnosis relies on physical exam, existing studies have highlighted a lack of comfort among trainees with regards to otoscopy. As such, dedicated otoscopy teaching time was incorporated into the undergraduate medical curriculum in the form of a small group teaching session. In this study, we aimed to examine the effect of a small-group, structured teaching session on medical students’ confidence with and learning of otoscopic examination.METHODS:
Using a prospective study design, an otolaryngologist delivered an one-hour, small group workshop to medical learners. The workshop included introduction and demonstration of otoscopy and pneumatic otoscopy followed by practice with peer feedback. A survey exploring students’ confidence with otoscopy and recall of anatomical landmarks was distributed before(T1), immediately after(T2), and 1 month following the session(T3).RESULTS:
One hundred and twenty five learners participated from February 2016 to February 2017. Forty nine participants with complete data over T1-T3 demonstrated significant improvement over time in confidence (Wilk’s lambda = .09, F(2,48) = 253.31 p < .001, η 2 = .91) and learning (Wilk’s lambda = 0.34, F(2,47) = 24.87 p < .001, η 2 = .66).CONCLUSIONS:
A small-group, structured teaching session had positive effects on students’ confidence with otoscopy and identification of otologic landmarks. Dedicated otoscopy teaching sessions may be a beneficial addition to the undergraduate medical curriculum.
The flipped classroom (FC) pedagogy is becoming increasingly popular in medical education due to its appeal to the millennial learner and potential benefits in knowledge acquisition. Despite its popularity and effectiveness, the FC educational method is not without challenges. In this article, we identify and summarize several key papers relevant to medical educators interested in exploring the FC teaching methodology. The authors identified an extensive list of papers relevant to FC pedagogy via online discussions within the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. This list was augmented by an open call on Twitter (utilizing the #meded, #FOAMed, and #flippedclassroom hashtags) yielding a list of 33 papers. We then conducted a three-round modified Delphi process within the authorship group, which included both junior and senior clinician educators, to identify the most impactful papers for educators interested in FC pedagogy. The three-round modified Delphi process ranked all of the selected papers and selected the five most highly-rated papers for inclusion. The authorship group reviewed and summarized these papers with specific consideration given to their value to junior faculty educators and faculty developers interested in the flipped classroom approach. The list of papers featured in this article serves as a key reading list for junior clinician educators and faculty developers interested in the flipped classroom technique. The associated commentaries contextualize the importance of these papers for medical educators aiming to optimize their understanding and implementation of the flipped classroom methodology in their teaching and through faculty development.
To improve student preparedness for anatomy laboratory dissection, the dental gross anatomy laboratory was transformed using flipped classroom pedagogy. Instead of spending class time explaining the procedures and anatomical structures for each laboratory, students were provided online materials to prepare for laboratory on their own. Eliminating in-class preparation provided the opportunity to end each period with integrative group activities that connected laboratory and lecture material and explored clinical correlations. Materials provided for prelaboratory preparation included: custom-made, three-dimensional (3D) anatomy videos, abbreviated dissection instructions, key atlas figures, and dissection videos. Data from three years of the course (n = 241 students) allowed for analysis of students’ preferences for these materials and detailed tracking of usage of 3D anatomy videos. Students reported spending an average of 27:22 (±17:56) minutes preparing for laboratory, similar to the 30 minutes previously allocated for in-class dissection preparation. The 3D anatomy videos and key atlas figures were rated the most helpful resources. Scores on laboratory examinations were compared for the three years before the curriculum change (2011-2013; n = 242) and three years after (2014-2016; n = 241). There was no change in average grades on the first and second laboratory examinations. However, on the final semi-cumulative laboratory examination, scores were significantly higher in the post-flip classes (P = 0.04). These results demonstrate an effective model for applying flipped classroom pedagogy to the gross anatomy laboratory and illustrate a meaningful role for 3D anatomy visualizations in a dissection-based course
One of the drivers of the original Learning Actions research was a concern that in learning, as in so many facets of life, our subconscious mind undermines rational thinking, decision making, and behavior; yet the ‘adult learner’ has been (universally) seen as fully competent, autonomous, and self-directed. The premise itself seems to be irrational…perhaps the definition of irony?
In the end, my research validated that as learners attempt to consume content presented to them in learning environments that their attention, motivation, and capacity to rationally evaluate new information ebbs and flows. Explicit and implicit biases, along with countless other distractions and inefficiencies in their learning actions undermine learning – this is (and always has been) the reality of ‘adult learning’ despite what your text books might tell you.
For instructional designers, understanding and embracing the learning actions research is empowering; it provides needed perspective and makes a critical connection to closely related fields of cognitive psychology and behavioral economics. We now know that we must architect learning experiences to nudge learners to focus, to slow their thinking, and to leverage far more efficient learning actions.
In a recent Facebook conversation facilitated by Julie Dirksen, the idea was raised that eye-tracking might be used to study engagement in eLearning. For background, those in the discussion are unlikely to be familiar with the Learning Actions Model or to be practitioners of the model…yet they were exploring a topic that very much aligns with our on-going research. And the conversation moved me to dig into the evidence base a bit more and ensure I was up to speed. My guess is that there are far more robust ways to get at attention and engagement – we have had success doing that at ArcheMedX – but there are surely some lessons to learn from the existing eye-tracking research.
While I spend a few days pulling at the threads, I thought it might help to share a variety of resources that I initially found…and perhaps there may be some others out there with a similar curiosity. Many of these are simply starting points and I’ll be working around pay-walls and fluff to find the real answers, but in the meantime, I hope this helps!
Resources
This article presents the author’s experience using gaming and social media to enhance undergraduate nursing students’ pharmacology knowledge. Although gaming may help with rote learning, active participation in gaming was not associated with higher exam or final course grades. Active participation in social media, on the other hand, was associated with higher exam and final course grades.
via Active Learning Strategies to Enhance Nursing Students’ Knowledge of Pharmacology. – PubMed – NCBI.
ArcheMedX helps life sciences and healthcare organizations to better equip, evaluate, and predict team and clinician performance
