1. A Cognitive Perpective on How People Learn: Implications for Teaching
Geoff Norman, Ph.D.
McMaster University

2. The Cognitive Perspective
expertise
“The essence of intelligence is less a matter of reasoning and more a matter of knowing a lot about the world”
H.A.Simon, 1989

3. Teaching MUTES
Memory and
Understanding
Transfer
Exercises
Skills

4. Some assertions about learning
Learning and remembering results from assimilation of new knowledge into existing knowledge, and meaning is critical to learning
Transfer (applying old knowledge to new situations) doesn’t happen easily
Structured, planned, practice with multiple examples is key to transfer
General skills don’t exist – it’s all imbedded in knowledge

5. Learning and Understanding
Learning is strongly influenced by the meaning .
If we can understand what we are learning in terms of pre-existing knowledge, better learning and retention results
Meaning is a consequence of the interaction between learner and ‘to be learned’

6. Tomorrow, and tomorrow, and tomorrow,
Creeps in this petty pace from day to day,
To the last syllable of recorded time.
And all our yesterdays have lighted fools
The way to dusty death. Out, out brief candle!
Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage,
And then is heard no more. It is a tale
Told by an idiot: Full of sound and fury
Signifying nothing
W. Shakespeare, Macbeth, V, v

7. DAMES DONATE DUBLINS CITS SPEEDPILLS VELOCITOUS AEROLITHS BELIEF
SOPHIST WALLOPS HAUGHTY HELEN
SQUARE ON PROBOSCIS. SPARTANS GNASH MOLARS. ITHACANS VOW
PEN IS CHAMP
J. Joyce. Ulysses. P.148

8. Sound is walking, stage struts and a tale is heard
Sound is walking, stage struts and a tale is heard. No more a poor candle, frets life. A brief idiot, fury and shadow, is in a dusty fool.

9. drswa gtrus hdrkl opono rluta
sflta dnaro lensa bfdoa radit
sogfv sonap vfhoe qpofs cpoas

10. Meaning is imposed by the learner and involves an interaction between existing knowledge and new information

11. The procedure is quite simple
The procedure is quite simple. First you arrange things into different groups. Of course, one pile may be sufficient. If you have to go somewhere else due to lack of facilities, this is the next step. It is better to do too few things at once than too many. At first it seems complicated, but soon it just becomes a fact of life. After it’s over, you arrange the materials in groups again, then put them in the right place.

12. Washing Clothes
The procedure is quite simple. First you arrange things into different groups. Of course, one pile may be sufficient. If you have to go somewhere else due to lack of facilities, this is the next step. It is better to do too few things at once than too many. At first it seems complicated, but soon it just becomes a fact of life. After it’s over, you arrange the materials in groups again, then put them in the right place.

13. Evidence of the Role of Meaning
Chess
Nephrology

14. How do you get to be a chess master?
Is it:
- learning the rules?
- learning to think of more moves and deeper strategy? (process)
- learning to think better moves? (knowledge)

15. Recall of Chess Positions
4 levels of chess player
mid-game positions
5-7 sec exposure

17. Recall after 5 sec. Exposure (real positions)

18. Recall after 5 sec. exposure
The way they do it is by matching…

19. It’s not just Visual Patterns
Lab data, nephrology problems
5 research associates
6 students
5 experts

20. Recall of Nephrology Data
So with coherent meaningful data, expertise shows

21. Basic science and meaning
Why do students need basic science?
Some docs use it a lot?
Nephrologists, anesthesiologists, intensivists
Many docs use it a little?
With difficult problems
It may provide meaning and coherence for students…….

22. Basic Science and Meaning (Woods, Brooks, Norman, 2003)
4 neurology / muscular diseases
36 medical students
Basic Science or Symptom/Disease probability

23. Measurement Diagnostic Test Administered at 0, 7 days
15 cases, 4-6 features
Administered at 0, 7 days

24. Score on Dx Test

25. Score on Dx Test

26. Score on Dx Test

27. Woods et al., Exp 2 4 conditions; 6 features / condition
3/6 features have a causal (A>B>C) story
3/6 features no causal story
38 undergraduate students
Test with 15 cases
4-6 features mixed diagnoses
Test at 0, 7 days

28. Score on Dx Test

29. Basic science is used to construct and reconstruct coherent relations between symptom and disease

30. Summary
Remembering for meaningful material is enhanced because there are more links or pathways to the memory trace

31. Implications for Teachers
How can we, as teachers, help students impose meaning on what they’re learning?

32. Implications for Curriculum
What are we doing now?
“Traditional”
PBL
Does PBL enhance learning”
MACRO -- no or maybe
MICRO:
Active Learning
Imbedding problem
Everyday analogy

33. Effect of active, problem-oriented processing
(Needham & Begg, 1991)
Intro psychology students, 5 classic problems
“Try to solve these difficult problems”
( 27% successful)
vs.
“Remember the problem and solution so you can solve some additional problems”
(21% successful)

34. Effect of Active Problem-solving
Needham & Begg, 1991

35. Effect of Active Problem-Solving

36. Imbedding Principle in Problem
(Ross & Kilbane, 1997)
Practice and Test problems with:
SEQUENTIAL
Principle explanation, then problem example
IMBEDDED
Principle imbedded in problem, explanation as part of problem
“Reversal” = using original principle incorrectly

37. Reversal Errors

38. Analogy in Learning Science
(Donnelly & McDaniel, 1993)
48 students, 12 concepts
Literal description of concept vs. description + analogy in familiar domain
(e.g. pulsar star and lighthouse)
24 MCQs; 4/concept, 12 basic +12 inference

40. An application in Medical Education
Laplace Law:
Anybody remember LaPlace Law?
Anybody understand it?

41. Pressure and Tension on a Membrane
T = P * r
Law of Laplace

42. The “weight and string” problem
T = W / 2 sin(a) W

43. T = W / 2 sin(alpha) T T a W W

44. t T T t

45. Dual Explanations Three “Laws” Intervention Test 9 diagnostic cases
(Krebs, Dore, Norman, 2006)
Three “Laws”
Laplace , Right Heart Strain, Starling
Intervention
Mechanical + Biological Active Comparison
vs.
Biological explanation only
Test diagnostic cases
Sample -- undergrad psych students

46. Percent Correct

47. Implications for Teaching/ Curriculum
Arrange learning to integrate with prior knowledge
Active learning
Problem – based learning
Imbed principle in problem
Everyday analogy
Sequencing of concepts

48. Transfer
using old knowledge to solve new problems

49. As teachers, we act as if all the knowledge we impart to students will be available to them to solve problems in the future

50. As teachers, we act as if all the knowledge we impart to students will be available to them to solve problems in the future
Unfortunately….. it won’t

51. Views of Transfer General Transfer (1900-1915….)
Subjects like Latin, algebra teach general “habits of mind”
(disproved by Thorndike, 1913)
Specific transfer (Behaviorism,1910--> Now)
Learned concepts can only be transferred if new behavior = old behavior
(disproved by Judd, 1908, Wertheimer, 1959, Pressley 1990)
Intermediate / hybrid transfer
Learned concepts can be applied (with difficulty) to new, dissimilar problem situations

52. A general wishes to capture a fortress located in the centre of a country. There are many roads radiating from the fortress. All have been mined so that, while small groups of men can pass over the roads safely, a large force will detonate the mines. A full-scale direct attack is therefore impossible. The general’s solution is to divide the army into small groups, send each down a different road, and have the groups converge simultaneously on the fortress.

53. You are a doctor faced with a patient who has a malignant tumour in his stomach. It is impossible to operate on the tumour. X-rays can be used to destroy the tumour. If sufficient rays reach the tumour all at once, the cancer cells will be killed, but surrounding tissue will be damaged as well. How can you arrange the procedure to destroy the tumour cells without severely damaging the surrounding tissue.
Gick & Holyoak, 1980

54. Transfer and Context Specificity
The initial solution (multiple simultaneous paths) was learned in, and stored with the problem context (fortress and army).
To solve the new problem, must recognize that the old problem was analogous to the new, despite different contexts
To recognize analogy, we must recognize similarity in deep structure
this rarely happens…..

55. Example case + Principle:
e.g. Pr(D|S) = Pr(S|D)/Pr(D)
Test Cases:
(+/+) same situation, consistent solution
(+/-) same situation, inconsistent sol’n
(+/0)same situation, unrelated sol’n
(0/0) diff situation, diff solution

56. Why not just teach them the principle?
Teach the principle, then give them an example of the principle

57. Use of examples w. principle
(Ross, 1987)
Are examples used to:
Cue the principle
Provide analogy for solution

58. Example case + Principle:
e.g. Pr(D|S) = Pr(S|D)/Pr(D)
Test Cases:
(+/+) same situation, consistent solution
(+/-) same situation, inconsistent sol’n
(+/0)same situation, unrelated sol’n
(0/0) diff situation, diff solution

60. “…during early learning, the principle is only understood in terms of the earlier example… the principle and example are bound together. Even if learners are given the principle or formula, they would use the details of the earlier problem in figuring out how to apply that principle to the current problem”
Brian Ross

61. Effective Use of Practice Examples
Multiple examples vs. “Principle + Example”
Active Compare and Contrast vs. Separate (Gentner, 2003, Holyoak,1989)

62. Multiple Examples vs. Principle + Example
MBA Students , negotiation problem
Factor 1
Two cases, implicit principle vs.Principle + Case
Factor 2
Read case and principle (on successive pages) vs. Compare Case and Principle
Loewenstein& Gentner, 2003

63. Effect of Examples and Comparisons
Gentner, 2003

64. Effect of examples (Catrambone & Holyoak, 1989)
Undergraduate psychology students,
Two related examples vs. one example and control
“Summarize the two stories”
vs.
“Describe the ways the two situations are similar”

65. Effect of Examples, Comparisons
Catrambone & Holyoak, 1989

66. Problems in moving to the “Real World”
Near/far transfer is not so black/white
Surface and deep structure not orthogonal
Principles are “to be learned”
“aha” insights are the exception
Process of learning / application is more complex
“problem”(+/-) --> principle -->example (-/+)
--> practice, ---> test

67. Implications for Teaching
Transfer can be facilitated by use of examples during initial learning
multiple examples > principle + example
compare and contrast
Active search for deep structure

68. Transfer, examples and practice
Critical to learning, transfer is the opportunity to see the concept arise in multiple contexts
This can only arise with multiple practical exercises
What can we do to enhance the value of practice?

69. Strategies to Optimize Practice
Mixed vs. Blocked Practice (Hatala, 2002)
Distributed vs. Blocked Practice
(Schmidt &Bjork,1992)

70. What do you need to do stats?
An Observation:
With the availability of sophisticated statistical software, the central issue facing the statistics student is “ What test do I use?”
To learn this, students have to see data sets, think of possible strategies, and get feedback

71. What do you get in stats courses?
Instructional time occupied by equation proving, formula remembering
Practice at end of chapter of the form:
“Do a t test on these data”

72. So when do you do a t test?
At the end of the t test chapter

73. The solution
Mixed practice

74. Mixed vs. Blocked Practice
In the face of ambiguous features (which are subject to reinterpretation), and multiple categories, students must learn the features which discriminate one category from another, not those which support a particular category

75. Mixed vs. Blocked Practice Hatala, 2000
ECG Diagnosis -- 3 categories
6 examples / category
Blocked
Review, then 6 examples/category
Mixed
Review, 2/category, 12 (4 x 3) practice
TEST 6 new ECGs

76. Accuracy -- %

77. Optimizing the Sequence (Avrahami, 1997)
Sequence selected spontaneously
Ideal positive cases
Ideal negative cases
Borderline cases

78. Percent Correct with Different Strategies

79. Timing and Sequence of Learning
Would you rather learn to skate (type, play violin, speak Spanish):
1 hour/day, biweekly, for 60 weeks = 30
1 hour / day for 3 days/wk for 10 wks = 30
3 hours/day, 1 day/week, 10 weeks = 30
6 hours/day, 5 days, 1 week = 30

80. Massed vs. Distributed Practice
All learning takes place at one time
Distributed
Learning takes place over multiple occasions

81. Massed vs. Distributed (Raman, McLaughlin, 2010) 20 GI residents
Nutrition course
- 4 hr, one 1/2 day vs. 1 hr. 4 1/2 day
Multiple choice test, 0, + 1 wk., + 3 mo.

83. Distributed Practice Schmidt and Bjork, 1992

84. Implications for Teaching
Practice is critical for learning and transfer
to impose meaning on concepts
to overcome “context specificity”
to enhance transfer
Some practice works better than others
Mixed >> blocked
Distributed >> Blocked

85. Exercises, Experience and Expertise
The critical role of deliberate practice in acquisition of expertise
Is practice just a matter of learning to apply the rules?
remember the chess master!!!!

87. How long does it take to learn chess?
To learn the rules hr.?
To become an expert ---10,000 hr. / 10 yr.
Experts know about 50,000 strategies
(Ericsson, 2004)

88. Age and Skilled Chess Performance
Ericsson and Charness, 1998

89. How long does it take to learn to play:
Violin
Piano
Field Hockey

90. * *

92. How long does it take to learn to play doctor?

93. Age and Diagnostic Accuracy
Hobus & Schmidt, 1993

94. Schuwirth et al., 2004 Total score on the CCT test EXPOSURE 140000
120000
100000
80000
60000
40000
20000
Total score on the CCT test 70 68 66 64 62 60 58
Schuwirth et al., 2004

95. How many years after you finished specialty training before you felt yoou were competent?

96. Who do you choose?
Dr. JS. finished residency last year and was in top 5 on cardiology RCPS exam?
Dr. KT finished residency 10 years ago and was in top 1/3 on cardiology RCPS exam?

97. What does the clinician gain from years of experience?
Years of experiences

98. Is Expertise Just a Matter of Applying the Right Rules?
Experienced clinicians are poorer than recent graduates on formal tests (of the rules)
But no one picks a recent graduate for their doc
Experience provides a storehouse of prior examples

99. What are all these things?
A DIAGNOSTIC TASK
What are all these things?
each member is unique. lots of perceptual variation, but all treated as identicle category members. CLEAR LINK TO FUNDAMENTALS OF PSYCHOLOGY

100. chairs,
(of course)

101. What makes something a chair? What does the chapter on chairs in:
Harrison’s Textbook of Internal Design
look like?
(What are the signs and symptoms of chairs)

102. What makes something a chair? What are the rules of chairs
(as distinct from sofas, stools, tables)

103. The rule describes this….

104. Does it cover these…?

107. We can recognize chairs quickly, accurately, and effortlessly
But we can’t easily verbalize the rule
When we try, it’s incomplete
HOW COME?

108. Two Processes Recognition Verification
Based on similarity to a specific prior exemplar in memory
Verification
Based on application of conceptual rules

113. Similarity and recognition of everyday objects
When we recognize everyday objects, the process is effortless, seemingly unconscious.
We are not aware that we are eliciting or weighting individual features
The process appears to occur all at once (Gestalt)

114. Rapid, effortless, accurate recognition
Familiar Categories
Rapid, effortless, accurate recognition
- despite massive within – category variation
- despite no overt understanding of rules
Unfamiliar Categories
Slow, effortful, inaccurate recognition
Despite NO within – category variation
Despite an explicit and simple additive rule

115. Exemplar Theory - Medin, Brooks
Categories consist of a collection of prior instances
identification of category membership based on availability of similar instances
Similarity is “non-analytic” (not conscious), hence can result from objectively irrelevant features
Ratings of typicality, identification of features, etc. done “on the fly” at retrieval

116. Effect of Similarity (Allen, Brooks, Norman, 1992)
24 medical students, 6 conditions
Learn Rules
Practice rules
Train Set A Train Set B
(6 x 4) x (6 x 4) x 5
Test (9 / 30)

119. Accuracy by Bias Condition

120. Hatala et al, ECG Interpretation
Medical students/ Fam Med residents
PRACTICE (4/4 + 7 filler)
middle aged banker with chest pain OR
elderly woman with chest pain
Anterior M I
TEST ( 4 critical + 3 filler)
Middle aged banker
Left Bundle Branch Block

121. RESULTS Percent of Diagnoses by Condition

122. Moruzi, Regehr et al. Coordination of Analytic and Pattern Recognition Processes
Dermatology sides
Typical / Atypical – based on rules & features
Similar / Dissimilar – based on prior examples

123. Residents (n=16)
Diff (Typ) = .11
Diff (Sim) = .54

124. Students (n=39)
Diff (Typ) = .21
Diff (Sim) = .42

125. CONCLUSIONS - The Role of Examples
Categories and concepts are based on our specific experience with the world as well as application of rules

126. Implications What are we doing now? How should we do it differently?
“Traditional”
PBL
How should we do it differently?

127. Implications for Teaching
Practice with examples is critical in ambiguous domains
Practice results in a collection of exemplars as a problem-solving resource

128. What happened to Skills?
Any measure of “problem-solving”, “reasoning”, “critical thinking”, “clinical judgment”, etc. correlates across problems at about
Process measures of the above show no gradient with expertise

129. But what about technical (motor) skills?
Do surgeons (e.g.) have innate talent?
Are surgical skills generalizable (high transfer)?
Are there predictors of technical skills (e.g. motor ability, spatial ability?

130. Do surgeons (e.g.) have innate talent? No
Are there predictors of technical skills (e.g. motor ability, spatial ability? No
Age, gender, grades, manual dexerity don’t correlate with surgical skill.
Visual-spatial may, but swamped by practice

131. Are surgical skills generalizable (high transfer)? NO!
Transfer across similar procedures low
(Wanzel, 2002)
Strong gradient of mortality with no.of operation (within procedure)
Colorectal Cancer Recurrence rate 1.4 x for <21 resections/year
Abdominal aneurism Operative failure rate decreases up to 55/year
Pancreatic cancer resection
Mortality rate:
< 5 cases, 19%
5-50 cases 7%
>50 cases 1%

132. Recurring Themes Learning
Human learning and remembering is critically sensitive to the meaning the learner imposes on the “to be learned”

133. Recurring Themes
Transfer of concepts to new, dissimilar problem situations does not occur effortlessly or frequently
Enhanced by active learning, search for principles, multiple practice examples
Impeded by learning for memory, passive learning, single example

134. Recurring Themes
Formal conceptual knowledge is insufficient for expertise
Experience provides an array of prior examples to draw from and reduce memory load

135. Recurring Themes Kinds of Knowledge
Expertise is more a matter of having the right knowledge (both formal and experiential) and being able to mobilize it, than of any general skills

136. Thinking depends on specific, context-bound skills and units of knowledge that have little application to other domains….. The case for generalizable, context-independent skills that can be trained in one context and transferred to other domains has proven to be more a case of wishful thinking than hard, empirical evidence.
Perkins & Salomon, 1989

137. Conclusion
“The problem-solving difficulties of novices can be attributed largely to the inadequacies of their knowledge base and not to limitations in their problem-solving capabilities”
R. Glaser, 1984
We have discussed a number of strategies to improve the knowledge base

138. Thanks
The End

139. To use analogy, the user must:
Encode the problem in a way that
Retrieves the encoded analogy
Select the correct analogue rather than others brought to mind during retrieval then
Adapt the solution principle to the needs of the target problem

140. Context, Learning and Remembering
Recall of knowledge is strongly related to the match or mismatch between context of learning and context of recall

141. Godden and Baddeley

142. Eich et al. Marijuana

143. Implications for Teaching
Everything is learned in a context. You can’t teach a principle out of context.
sooo…..

144. Implications for Teaching
Everything is learned in a context. You can’t teach a principle out of context.
sooo…..
Expose students to the same principle in multiple contexts (multiple retrieval pathways)
(practice, practice,practice)