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

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

Teaching MUTES Memory and Understanding Transfer Exercises Skills

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

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’

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

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

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.

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

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

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.

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.

Evidence of the Role of Meaning Chess Nephrology

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)

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

Recall after 5 sec. Exposure (real positions)

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

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

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

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…….

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

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

Score on Dx Test

Score on Dx Test

Score on Dx Test

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

Score on Dx Test

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

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

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

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

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)

Effect of Active Problem-solving Needham & Begg, 1991

Effect of Active Problem-Solving

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

Reversal Errors

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

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

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

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

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

t T T t

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 9 diagnostic cases Sample -- undergrad psych students

Percent Correct

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

Transfer using old knowledge to solve new problems

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

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

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

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.

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

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…..

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

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

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

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

“…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

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

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

Effect of Examples and Comparisons Gentner, 2003

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”

Effect of Examples, Comparisons Catrambone & Holyoak, 1989

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

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

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?

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

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

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”

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

The solution Mixed practice

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

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

Accuracy -- %

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

Percent Correct with Different Strategies

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

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

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.

Distributed Practice Schmidt and Bjork, 1992

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

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!!!!

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)

Age and Skilled Chess Performance Ericsson and Charness, 1998

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

* *

How long does it take to learn to play doctor?

Age and Diagnostic Accuracy Hobus & Schmidt, 1993

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

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

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?

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

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

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

chairs, (of course)

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)

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

The rule describes this….

Does it cover these…?

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

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

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)

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

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

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 5 (6 x 4) x 5 Test (9 / 30)

Accuracy by Bias Condition

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

RESULTS Percent of Diagnoses by Condition

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

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

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

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

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

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

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

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?

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

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%

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

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

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

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

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

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

Thanks The End

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

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

Godden and Baddeley

Eich et al. Marijuana

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

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)