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

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Presentation on theme: "A Cognitive Perpective on How People Learn: Implications for Teaching Geoff Norman, Ph.D. McMaster University."— Presentation transcript:

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

2 The Cognitive Perspective 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 expertise

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) doesnt happen easily Structured, planned, practice with multiple examples is key to transfer General skills dont exist – its 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! Lifes 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


8 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. 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 its 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 its 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

19 Its not just Visual Patterns Lab data, nephrology problems 5 research associates 6 students 5 experts

20 Recall of Nephrology Data

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 15 cases, 4-6 features Administered at 0, 7 days

24 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 theyre 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 P T r T = P * r Law of Laplace

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

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

44 T T t t

45 Dual Explanations (Krebs, Dore, Norman, 2006) Three Laws Laplace, Right Heart Strain, Starling Intervention Mechanical + Biological Active Comparison vs. Biological explanation only Test 9 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 Unfortunately….. it wont

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 generals 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 soln (+/0)same situation, unrelated soln (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 soln (+/0)same situation, unrelated soln (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 1. Near/far transfer is not so black/white - Surface and deep structure not orthogonal 2. Principles are to be learned - aha insights are the exception 3. 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 TEST6 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 Massed 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 ---- 10 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 EXPOSURE 140000 120000 100000 80000 60000 40000 20000 0 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 A DIAGNOSTIC TASK What are all these things? A DIAGNOSTIC TASK What are all these things?

100 chairs, (of course)

101 What makes something a chair? What does the chapter on chairs in: Harrisons 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 cant easily verbalize the rule When we try, its incomplete HOW COME?

108 Two Processes Recognition 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 Familiar Categories Rapid, effortless, accurate recognition - despite massive within – category variation - despite no overt understanding of rules Unfamiliar Categories Slow, effortful, inaccurate recognition Despite NOwithin – 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 ATrain Set B(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? 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 0.1-- 0.3. 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 dont 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 The End Thanks

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 cant teach a principle out of context. sooo…..

144 Implications for Teaching Everything is learned in a context. You cant teach a principle out of context. sooo….. Expose students to the same principle in multiple contexts (multiple retrieval pathways) (practice, practice,practice)

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