1. HOW DO PEOPLE LEARN?
Contemporary Principles & Concepts Applied to Medical Education
Set:
Introduce self
Science background
Career change
Education as a lab event
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2. The meaning of knowing has shifted from being able to remember and repeat information to being able to find and use it
How people learn and the role of action, activity, movement-- That is what we will be addressing today.
Overall broader goal
: to enhance the ability to facilitate learning with understanding in a complex world of increasing information, decreasing time and resources for clinical work and scientific discovery. To do this through the implementation of sustainable learning strategies that are active for and activate both teachers and students.
Herbert Simon, 1966

3. LEARNING: Past - Present - Future
Early 20th century
3 Rs
End of 20th century
Read critically
Clear self expression
Solve complex problems
Early 21st century
Knowledge management
Sustainable learning
Changes in research and knowledge about learning
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4. OBJECTIVES Describe the basic paradigm of how people learn
Match teaching-learning methods & techniques to your context & learning objectives
Describe & apply 3-4 methods - techniques to activate learning
Most teachers are not up to date and don’t know how to incorporate knowledge of how people learn into their teaching – this is where activation of the learning and active participation of the teacher become important
This is intended to be practical and theoretical
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5. CYC: HOW DO PEOPLE LEARN?
CYC talk to person next to you about your understanding of how people learn: Between you, make a short list of the key elements that you think explain how people learn.
List on board while asking audience to identify them:
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6. “Nobody tells productions when to act; they wait until conditions are ripe and then activate themselves. By contrast, chefs in the other kitchens merely follow orders. Turing units are nominated by their predecessors, von Neurmann operations are all prescheduled, and LISP functions are invoked by other functions. Production system teamwork is more laissez-faire: each production acts on its own, when and where its private conditions are satisfied. There is no central control, and individual productions never directly interact. All communication and influence is via patterns in the common workspace – like anonymous “to whom it may concern” notices on a public bulletin boards” (Haugeland, 1985 in Schmidt, 1993)
PRIOR KNOWLEDGE ABOUT A SUBJECT IS THE MOST IMPORTANT DETERMINANT OF THE NATURE AND AMOUNT OF NEW INFOMATION THAT CAN BE PERCEIVED AND LINKED IN A MEANINGFUL WAY.
Most readers have trouble remembering this text. Could memorize it if had enough time for repetition. However, the result will likely not be real learning because the topic will not be understood, just memorized.
Not all readers will have difficult understanding this text. Those with computer sciences and artificial intelligence background will immediately understand the text as an attempt to characteristics various programming styles and will be able to memorize the text almost effortlessly.
The explanation is that they have engaged their prior knowledge of the subject in the act of comprehensions of the text. Therefore the amount of prior knowledge available determines to what extent something new can be learned. Those who lack relevant prior knowledge find it more difficult to understand and remember new information, because they have fewer ‘tools’ to construct a meaningful representation of what they text conveys.
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7. Memorize this Text
A newspaper is better than a magazine. A seashore is a better place than the street. At first, it is better to run than to walk. You may have to try several times. It takes some skills but it’s easy to learn. Even young children can enjoy it. Once successful, complications are minimal. Birds seldom get too close. Rain, however, soaks very fast. Too many people doing the same thing can also cause problems. One needs lots of room. If there are no complications, it can be very peaceful. A rock will serve as an anchor. If things break loose from it, however, you will not get a second change.
Subjects who studied this text with the accompanying title, Making and flying a kite, remembered almost twice as much information as those who studied that same text without a title. (Bransford and Johnson, 1972)
The availability of relevant prior knowledge is a necessary, net not sufficient condition for understanding and remembering new information. Prior knowledge also needs to be activated by cues in the context of which the information is being studied.
While both groups had experience and knowledge about flying kites, the knowledge was not activated in one group that did not have the title of the paragraph.
The title activates the knowledge by creating a context in which to remember with which new information can be related with existing knowledge. This is self organization and it is facilitated by context (deterministic learning), initial conditions and context.
This example may seem unusual, remember that in many educational settings, students are not able to related new information to what they already know about a certain subject (clinical students can’t relate current situation to subjects learned in the early part of medical school).
C= context
C= conditions (initial)
H = history, pre existing knowledge that is activated by context and a N2K based on the conditions.
Bransford & Johnson, 1972 in Schmidt, 1993.
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8. Knowledge is Decentralized & Linked to Stimulus & Context
Dog Bike
Bird School
Chair Flower
Man House
Genoa ESME
Task is to remember each pair of words so that when you hear dog you say bike, bird you say school etc.
We’ll come back here later
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9. Context & Remembering Experiment
Water - Land
Land - Water
Water - Water
Land - Land
Experiment with skin divers asked to hear words in different environments and then tested for recall .
Duncan Godden and Alan Baddeley (1975)
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10. Context & Remembering Duncan Godden and Alan Baddeley (1975)
Putting yourself back in the context where you experienced something can prime
your memory retrieval. Duncan Godden and Alan Baddeley (1975) discovered this
when they had scuba divers listen to a list of words in two different settings, either 10
feet underwater or sitting on the beach. As FIGURE 9.16 illustrates, the divers recalled
more words when they were retested in the same place.
Consider this scenario: While making notes in this book, you realize you need to
sharpen your pencil. You get up and walk downstairs. When you get there, however,
you cannot remember why you came. After trying to recall your purpose, you give up
and return to your desk. As soon as you sit down to work again, it hits you: “I wanted
to sharpen this pencil!” What happens to create this frustrating experience? In one
context (desk, reading psychology), it occurs to you that you want the pencil sharpened.
When you get up and go downstairs, you move into a different context where
you have few cues to lead you to the thought that brought you there. When you give
up and go back to your desk, you are back in the context in which you encoded the
thought (“This pencil is dull”).
Duncan Godden and Alan Baddeley (1975)
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11. LEARNING WITH UNDERSTANDING
Groups
1. Read &  text + Lecture
2. Did not read text, actively compared data + lecture
3. 2x time working with data + no lecture
Another example:
First thing is problem slide of three groups learning.
B. Consult your colleague – 1 minute
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12. PRE-EXISTING KNOWLEDGE
FOCUS ON PROCESS OF KNOWING
History shapes receptivity to information
New knowledge merges with pre-existing knowledge in multiple networks
Teachers need to know and activate students’ history (knowing)
Maljor theme of active learning.
Fish is fish story
Making Meaning
1.      Pre-existing knowledge- fish is fish
People construct new knowledge and understanding based on what they already know and believe.
        i.      They come to the classroom, lab or clinic with preconceived ideas.
If these ideas are not understood by the teacher, they may not learn fully or well. (learning that 1/8 is less than ¼ even though 8 is greater than 4)
Misconceptions of physical properties that cannot be easily observed—acid base regulation. Students at a famous east coast college persist in their beliefs that the changes in the seasons were due to the earth’s distance from the sun rather than its tilt on its axis.
In behavior, this includes stereotypes.
       ii.      For scientific understanding to replace the naïve understanding students must reveal the latter and have the opportunity to see where it falls short. This requires a safe learning environment, which must be constructed actively.
ASK THEM: GIVEN THE ROLE OF PRE-EXISTING KNOWLEDGE, WHAT DO THEY THINK THE ROLE OF THE TEACHER IS? If students’ initial ideas and beliefs are ignored, the understanding they develop can be very different from what the teacher intends.
How much time do we spend with remediation, with students who need extra work or are struggling to learn
New knowledge is constructed from existing ideas, experiences and concepts. I
Sense Making
Without knowing this history you are in the dark and risking ineffective teaching.
The role of the teacher – need to pay attention to the inconsistencies and incomplete understandings, false beliefs and naïve versions of core concepts that learners have and bring to the learning experience.
                                          
i.      And then teachers need to elicit this from learners and build on it or challenge the initial understanding.
This requires active inquiry by the teacher- not just delivering pearls and waiting for the assessments to see who got it.
Formative assessment and Feedback are two key tools here
    i.      Formative Assessment – for teacher and student both
    ii.      Feedback – labs, clinics, discussion groups
Building bridges – if students’ initial ideas and beliefs are ignored, the understanding that they develop can be very different from that intended by the teacher.
E.g. Kids who believe that the earth is flat, when told it is round, envision a pancake rather than a sphere. When told it’s a sphere they envision a pancake on top of a sphere or inside of it.
Constructivism – making sense can occur in a lecture hall while listening to a presentation, however as we saw earlier, if learners first grapple with the material and then have an organized lecture, the learning and transfer is enhanced.
This is a strong argument for Active learning. Having a case, a set of cases or problems to grapple with can create a need to know. just like in the clinic or lab when learners encounter an unknown and are motivated to learn, to seek out new information and make sense out of it in relation to the problems with which they are grappling.
There is good evidence that shows that learning is enhanced when teachers pay attention to the knowledge and beliefs that learners bring to a learning task, and use this knowledge as a starting point for their instruction.
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13. LESSONS FROM COGNITIVE PSYCHOLOGY
Problem solving is context bound
Data collection is influenced by questions being entertained
Context influences understanding & remembering
Timely feedback improves transfer of information
What’s this got to do with active learning?
B.     Active Learning 1. People need to feel that they have some influence (control) over their own
learning Being in a subordinate position as an adult LEARNER can be very frustrating
1.      They must learn to recognize when they understand and when they need more information. this is critical in the laboratory and the clinic.
3.      Active learning promotes transfer to new settings
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14. LEARNING WITH UNDERSTANDING
Expert problem solving requires rich body of knowledge
Beyond memory
Usable
Connected
Organized around concepts
Give the anatomy artery and veins eg
Students expected to remember that arteries are thicker than veins, more elastic and carry blood from the heart, veins carry it back to the heart.
Solve a problem or design an artificial blood vessel
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15. LEARNING WITH UNDERSTANDING
Takes time
Reorganize understanding with new information
Test for understanding
Disconnected facts not sufficient
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16. Memory and Expertise
Experts’ command of concepts shapes understanding of new information
Patterns, Relationships, Discrepancies
Extract meaning better than novices
Select and remember relevant information better
What have we learned from Studies of expertise?
Chess masters do better than near masters than amateurs than novices
No difference in random positions
Possible Position
Bizarre Position
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17. ORGANIZATION OF KNOWLEDGE
Core concepts and ideas
Experts – use principles
Novices – use surface features
Effortless recall of information
Beginning medical student telling everything about a patient
2nd year house officer giving key features, pertinent positives and negatives
Teach students early on to do this, lots of practice and feedback—active
Experts are more likely to try to understand a problem than to plug in a formula or procedure
Curricula should be organized around core ideas since experts think that way.
Use what if strategies to expand students’ repertoire
Fluency---learning to drive a car– at first very hard to do everything at once, then becomes more automatic and effortless.
    Experts, regardless of area, draw upon a richly structured information base—they are not merely good thinkers or smart people.
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18. A SIMPLE MODEL OF COMPETENCE
Professional authenticity
Performance or hands on assessment
Does
Shows how
Written, Oral or
Computer based assessment
Knows how
Knows
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.
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19. META ~ COGNITION (REFLECTION)
Changed in position or form
Altered -- Transposed
Going Beyond, higher
Substitutions in the 1,3 position in a benzene ring
COGNITION
The process of knowing in the broadest sense, including perception, memory, & judgment
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20. REFLECTION (METACOGNITION) (Adaptive Expertise)
Monitor own understanding
Identify new information for understanding
Consistent with what is known?
Analogies to advance understanding
Metaphors
2.      Metacognition refers to peoples ability to to predict their performances on various tasks; to monitor their current levels of mastery and understanding.
a.      Teaching tasks are those of “sense making”, self-assessment and reflection on what worked what needs improving (research lab setting and clinical setting)
b.      These practices (active learning) enhance transfer of what is learned to new settings and events.
c.       Give the learner space to explore and reflect and help them to be comfortable doing it. If we always tell them what to do, they can’t learn as well.
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21. IMPLICATIONS FOR TEACHERS
Actively inquire into students’ thinking
Create situations to reveal thinking
Build on their understanding
What teachers need to do actively to promote this quality
 Mennin Consulting, 2006

22. CHARACTERISTICS OF LEARNING AND TRANSFER
All new learning involves connecting to previous learning
Abstractions help – simile; metaphor
Learning is an active process
Transfer = ability to extend what has been learned in one context to new contexts
If initial learning involves transfer from previous learning, then it’s important for teachers to activate prior knowledge before beginning new material and building upon what is known.
Students may misinterpret new information because of previous knowledge they use to construct new understandings
They may have difficulty with some concept that conflicts with a cultural or religious belief.
Measures of transfer play an important role in the assessing the quality of people’s learning experiences. (board certification exams – what if –problems
Different kinds of learning abilities and experiences can look the same if test focus solely on recall.
Initial learning needs sufficient depth so that transfer can occur
Transfer is related to learning with understanding rather than mere memory.(again darts underwater)
Time to make meaning
Time to develop pattern recognition skills– and related knowledge
Covering too many topics too quickly slows learning down. Survey courses or lectures can reduce learning.
Focus on prototypes
Transfer is Active- requiring learners to actively choose and valuate strategies, consider resources and receive feedback.
This is different than asking learners to solve a problem immediately after they have engaged in an initial learning task. Transfer tasks repeatedly over several days works better than one time immediately.
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23. CHARACTERISTICS OF LEARNING AND TRANSFER
Time to learn
Deliberate practice
Importance of feedback in learning
Contrasting cases- “what if…”
Context
Active approaches to ‘transfer’ ‘level jumping’
Transfer = ability to extend what has been learned in one context to new contexts
Time to learn means time to process information
Measures of transfer play an important role in the assessing the quality of people’s learning experiences. (board certification exams – what if –problems
Context: Underwater expt.navy seals
Brazilian street kids can do math when making sales in the street but not in the classroom
Therefore teaching a subject in multiple contexts- activates transfer
Different kinds of learning abilities and experiences can look the same if test focus solely on recall.
Initial learning needs sufficient depth so that transfer can occur
Transfer is related to learning with understanding rather than mere memory.(again darts underwater)
Time to make meaning
Time to develop pattern recognition skills– and related knowledge
Covering too many topics too quickly slows learning down. Survey courses or lectures can reduce learning.
Focus on prototypes
Transfer is a dynamic process
 Mennin Consulting, 2006

24. IMPLICATIONS FOR TEACHING
Promote reciprocal teaching
Explicate-Elaborate-Monitor
Content expertise  pedagogical expertise
 Mennin Consulting, 2006

25. LEARNING FOR UNDERSTANDING
Adequate time
Deliberate practice with metacognition (reflection)
Feedback about understanding
Compare & contrast
What if…
Elaboration, Variable Iteration
Less can be more
Iterative guided practice with quality feedback
Compare and contrast leads to conditionalizing information and enhanced storage and retrieval.
Contextualize, metacognition both enhance transfer
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26. THREE TECHNIQUES Draw out and work with pre-existing understanding
In-depth teaching, multiple examples
Reflection on and in action (metacognition) in specific subject areas
Techniques see bibliography for a web page on active learning techniques
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27. TEACHING TECHNIQUES (Making Understanding Visible)
Consult your colleague
Reciprocal teaching
Polling the class
Frequent formative assessments
Tap into understanding
In-depth vs. superficial teaching
Prototypes
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28. TEACHING TECHNIQUES (Making Understanding Visible)
Develop expertise in how students learn your subject
Develop pedagogical expertise
In-depth assessment
Emphasize metacognition (reflection)
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29. TEACHING TECHNIQUES FEEDBACK
Timely
Constructive
Mutually agreed
Results in a plan
Supportive
“I” & “You” messages
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30. Knowledge is Decentralized & Linked to Stimulus & Context
Dog
Bird
Chair
Man
Genoa
Bike
School
Flower
House
ESME
Two groups were asked to remember the pairs of words
Just as is
Was asked to imagine relationships between the two words. For example, imagine a dog chasing you on a bike; a bird flying into an open school window
Group two performed much better on recall tests because the information is embedded in multiple networks and associations
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31. WHAT WILL YOU DO? NEXT STEPS
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32. PLUS DELTA
handout
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33. + Key Concepts  Role of pre-existing knowledge Context & learning
Reflection Metacognition
Match methods your context
Teaching techniques
Fill out form.
Get responses

34. OBJECTIVES Describe the basic paradigm of how people learn
Match teaching-learning methods & techniques to your context & learning objectives
Describe & apply 3-4 methods - techniques to activate learning
 Mennin Consulting, 2006

35. Additional Resources http://hsc.unm.edu/som/TED
How People Learn: Brain, Mind, Experience and School (2000)
BEME bibliography
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36. Additional Resources
Dent & Harden (eds) (2006). A Practical Guide for Medical Teachers. Edinburgh, Elsevier.
L. Dee Fink (2000). Creating Significant Learning Experiences: an integrated approach to designing college courses. San Francisco, Jossey-Bass.
Bransford & Johnson (1972) Journal of verbal Learning and Verbal Behavior 11:
 Mennin Consulting, 2006