>> HI, EVERYONE.
THANK YOU FOR COMING.
SO TODAY'S CLINICAL CENTER GRAND
ROUNDS, TEXT THE CME CODE.
FOR THOSE APPLYING FOR CME,
YOU'LL RECEIVE FEEDBACK SURVEY
VIA EMAIL LINK.
THE SURVEY WILL BE USED TO
PROVIDE US IMPORTANT FEEDBACK
ABOUT THIS PRESENTATION, AND
ALLOWS YOU TO SUBMIT ANY
SUGGESTIONS FOR FUTURE GRAND
ROUNDS TALKS.
SO FOLLOWING THE PRESENTATION,
THE QUESTIONINGS FOR THE SPEAKER
WILL BE TAKEN BY ME OR AT THE
PODIUM OR THE OTHER SPEAKERS,
AND THERE'S ALSO VIDEOCAST
QUESTIONS THAT WILL BE TAKEN BY
DR. CHUNG, SO WE'LL HAVE SOME
TIME TO ASK QUESTIONS.
SO OUR SPEAKER TODAY IS DR. JEN
SPICER, M.D., M.P.H., AND A
MASTER'S IN HEALTH PROFESSIONS
EDUCATION.
SHE IS NOW AN ASSOCIATE
PROFESSOR OF MEDICINE IN THE
DIVISION OF INFECTIOUS DISEASES
AT EMORY SCHOOL OF MEDICINE.
SHE EARNED HER COMBINED
MEDICAL DEGREE AND MASTERS OF
PUBLIC HEALTH IN EPIDEMIOLOGY
FROM EMORY UNIVERSITY IN 2012
AND THEN COMPLETED HER RESIDENCY
FOLLOWED BY A CHIEF RESIDENCY IN
INTERNAL MEDICINE.
SHE THEN DID HER INFECTIOUS
DISEASES FELLOWSHIP AFTER WHICH
SHE JOINED THE FACULTY OF EMORY
IN 2019.
SO JEN IS ONE OF THOSE RARE
INDIVIDUALS WHO ACTUALLY HAD A
DESIRE TO TEACH BEFORE SHE
PURSUED MEDICINE, AND AS SUCH,
SHE HAS STEADFASTLY PURSUED HER
GOALS IN OBTAINING KEY
EDUCATIONAL ROLES AS FACULTY,
SUCH AS SERVING AS A P.D. FOR
THE INTERNAL MEDICINE PROGRAM
THERE, AND ALSO DIRECTING THE
DISTINCTION IN MEDICAL EDUCATION
FOR INTERNAL MEDICINE RESIDENCY
PROGRAM.
SHE LEADS COURSES FOR FIRST YEAR
MEDICAL STUDENTS ON
MICROBIOLOGY, IMMUNOLOGY,
PATHOLOGY AND PHARMACOLOGY.
SO HER RESEARCH INTERESTS, NOT
SURPRISINGLY, INCLUDE CURRICULUM
DEVELOPMENT, EVALUATION, THE
SCIENCE OF LEARNING, ACTIVE
LEARNING TECHNIQUES, FACULTY
DEVELOPMENT STRATEGIES, AS WELL
AS IDENTITY FORMATION FOR
CLINICIAN EDUCATORS.
SHE HAS A SPECIAL INTEREST IN
CURRICULUM DEVELOPMENT AND HAS
ADVOCATED FOR DEVELOPMENT OF
FORMAL NATIONAL CORE CURRICULUM
WITHIN SPECIALTY SOCIETIES TO
MEET THE NEEDS OF OUR GROWING
HEALTHCARE SYSTEM.
SO SHE HAS RECEIVED NUMEROUS
TEACHING AWARDS THROUGHOUT HER
RESIDENCY, AND FELLOWSHIP
TRAINING AND IN HER SHORT
FACULTY STINT, AND MOST
RECENTLY, SHE RECEIVED THE
GOLDEN APPLE TEACHING AWARD IN
2023 AS THE BEST SUBSPECIALTY
TEACHER AT GRADY MEMORIAL
HOSPITAL.
SHE WAS ALSO NAMED ON THE 40
UNDER 40 LIST OF NOTABLE ALUMNI
OF EMORY UNIVERSITY.
SO DR. SPICER IS BOARD CERTIFIED
ABIM AS WELL AS THE AMERICAN
BOARD OF SPECIALTIES FOR
INFECTIOUS DISEASES, SHE'S A
MEMBER OF THE IDSA AND ALLIANCE
FOR ACADEMIC INTERNAL MEDICINE.
SO BEYOND HER ACADEMIC
ACCOLADES, SHE HAS GAINED
RECOGNITION ON SOCIAL MEDIA AND
PODCAST PLATFORMS AS MAJOR
CONTRIBUTOR TO MEDICAL EDUCATION
THEORY, AND IF YOU HAVE NOT SEEN
IT, HER YOUTUBE VIDEO ON THE
MYTH OF MERITOCRACY IS REALLY
WORTH VIEWING.
HER REACH HAS ACTUALLY GONE FAR
BEYOND THE TYPICAL ACADEMIC CV,
AND SHE'S HIGHLY SOUGHT FOR HER
SPEAKING ENGAGEMENTS AS A LEADER
AND EDUCATOR, AND AS I MENTIONED
AS I FOUND OUT OVER DINNER LAST
NIGHT, SHE IS JUST RECENTLY
PROMOTED TO ASSOCIATE PROFESSOR
OF MEDICINE, SO CONGRATULATIONS.
SO GET YOUR PENS AND PAPERS OUT.
I THINK YOU'LL WANT TO TAKE
AMPLE NOTES ON TODAY'S
PRESENTATION, MAKE IT STICK:
APPLYING THE SCIENCE OF LEARNING
TO OUR TEACHING.
PLEASE JOIN ME IN WELCOMING
DR. SPICER.
[APPLAUSE]
>> THANK YOU FOR THAT KIND
INTRODUCTION.
SO TODAY WHAT I REALLY WANT TO
FOCUS ON TALKING ABOUT IS SOME
OF THE EVIDENCE BASE BEHIND
EFFECTIVE WAYS FOR US TO TEACH.
AND FOR MANY OF YOU, YOU MAY BE
FAMILIAR WITH A LOT OF THESE
CONCEPTS.
YOU MAY NOT KNOW THE NAMES FOR
SOME OF THEM BUT HAVE UTILIZED A
LOT OF THESE IN YOUR TEACHING,
AND FOR SOME OF YOU, THIS MAY BE
NEW.
I FIND THAT IT'S OFTEN DIFFICULT
TO THINK ABOUT WHAT LEVEL TO
DISCUSS SOME OF THESE CONCEPTS
IN IN A GRAND ROUNDS THAT
CONTAINS PEOPLE FROM REALLY
DIVERSE EXPERIENCES, AND SO I'M
HOPING THAT EVERYBODY CAN GET A
LITTLE SOMETHING OUT OF THIS, NO
MATTER WHAT YOUR LEVEL OF
EXPERIENCE IN MEDICAL EDUCATION
IS.
SO I HAVE NO DISCLOSURES.
AND BY THE END OF THIS TALK, I
HOPE THAT YOU WILL BE ABLE TO
DESCRIBE SOME OF THESE
EVIDENCE-BASED LEARNING
PRINCIPLES THAT I'M TALKING
ABOUT, AND I'D REALLY LIKE TO
FOCUS ON PROVIDING CONCRETE
EXAMPLES OF HOW TO UTILIZE THEM
SO THAT YOU CAN INCORPORATE THEM
INTO CLASSROOM AND CLINICAL
TEACHING.
ALL RIGHT.
SO I ALWAYS WANT TO PROVIDE A
MAP OF WHERE WE'RE GOING, AND SO
THE WAY I'VE STRUCTURED THIS
TALK IS REALLY ON A SURVEY OF
PRINCIPLES FROM THE SCIENCE OF
LEARNING.
THIS REALLY TRIES TO BRING
TOGETHER RESEARCH IN THIS FIELD
OVER THE LAST 40 YEARS, MUCH OF
WHICH IS IN COGNITIVE
PSYCHOLOGY, AND HAS TRANSITIONED
TO MEDICAL EDUCATION PROBABLY
OVER THE LAST 10 TO 15 YEARS.
AND I'VE DECIDED TO BREAK THIS
DOWN INTO THINKING ABOUT THE
PROCESS OF LEARNING.
AND SO EFFECTIVE PRINCIPLES TO
HELP US UNDERSTAND HOW TO LEARN,
SO WE'LL TALK ABOUT SOME OF
THESE SPECIFIC LEARNING
PRINCIPLES IN THAT SECTION.
THAT'S GOING TO BE A BULK OF THE
TALK, IN FACT, BECAUSE IF WE
CAN'T GET PEOPLE TO UNDERSTAND
TO BEGIN WITH, WE HAVE NO HOPE
OF GOING ON TO THE NEXT STEPS.
BUT THEN HOW CAN WE HELP PEOPLE
RETAIN THE THINGS THAT WE TEACH
THEM OVER TIME?
HOW CAN WE THEN ENSURE THAT THEY
CAN APPLY TO CLINICAL PRACTICE
SINCE MOST OF US ARE TEACHING IN
A SETTING WHERE WE WANT PEOPLE
TO APPLY EITHER IN THE CLINICAL
SETTING OR IN THE RESEARCH SET
SETTING, AND FINALLY, HOW CAN WE
CONTINUE LIFELONG LEARNING WITH
MASTERY TO BECOME TRUE EXPERTS
IN THE THINGS THAT WE'RE DOING.
SO LET'S START WITH TALKING
ABOUT UNDERSTANDING, AND IN THIS
SECTION, I'M GOING TO FOCUS ON A
COUPLE DIFFERENT THEORIES, AND
PROVIDE EXAMPLES OF THEIR
PRACTICAL USE.
WE'RE GOING TO TALK ABOUT
COGNITIVE LOAD THEORY, HOW THAT
APPLIES TO MAYER'S MULTIMEDIA
PRINCIPLES AND TALKING ABOUT
ADVANCED ORGANIZERS IN OUR
TEACHING.
SO FIRST I WANT TO START WITH
JUST DISCUSSING WHAT WE KNOW
FROM RESEARCH ABOUT THE PROCESS
OF HOW WE TAKE IN INFORMATION.
SO WHENEVER WE ARE LEARNING
SOMETHING NEW, WE HAVE TWO
CHANNEL THAT WE CAN TAKE IN
INFORMATION FROM.
THROUGH THE VISUAL CHANNEL AND
THE AUDITORY CHANNEL.
AND THESE CAN ACTUALLY BE
COMPLEMENTARY, AND IDEALLY, WE
WANT TO LEVERAGE TO HAVE
SLIGHTLY DIFFERENT INFORMATION
IN EACH CHANNEL, WHICH I'LL TALK
ABOUT A LITTLE BIT MORE IN A
SECOND.
BUT WHEN THIS INFORMATION COMES
IN, IT GOES TO OUR WORKING
MEMORY.
AND OUR WORKING MEMORY CAN ONLY
HOLD ON TO THINGS FOR ABOUT
30 SECONDS.
SO THINK OF THIS AS WHEN YOU'RE
TRYING TO REMEMBER A TELEPHONE
NUMBER AND YOU'RE REPEATING IT
OVER AND OVER TO YOURSELF, AS
YOU'RE TRYING TO REMEMBER AND
RETAIN THAT INFORMATION.
AND SO WE CAN ONLY ATTEND TO
ABOUT FIVE TO SEVEN PIECES OF
INFORMATION IN THAT WORKING
MEMORY.
AND SO WE HAVE ALL OF THESE
INPUTS THAT WE HAVE IN THE WORLD
AROUND US, BUT WE CAN ONLY FOCUS
ON A FEW THINGS AT A TIME.
SO WHATEVER WE DECIDE TO FOCUS
ON, WE CAN THEN STORE IN OUR
LONG-TERM MEMORY.
SO THIS IS REALLY THE BOTTLENECK
FOR US OF BEING ABLE TO TAKE IN
AND UNDERSTAND INFORMATION, BUT
IN OUR LONG-TERM MEMORY, WE
BELIEVE THAT WE HAVE INFINITE
STORAGE.
AND THEN WE'RE ABLE TO RETRIEVE
THAT INFORMATION OVER TIME, AND
THE NUMBER OF TIMES THAT WE
RETRIEVE THIS INFORMATION, AS
WE'LL TALK ABOUT IN THE NEXT
SECTION ON HOW WE RETAIN, REALLY
HELPS TO STRENGTHEN THAT ABILITY
TO BRING INFORMATION OUT OF OUR
MIND AND USE AND APPLY IT.
SO FIRST LET'S TALK ABOUT THIS
PART OF WORKING MEMORY, AND HOW
CAN WE REALLY MAKE SURE THAT
WHEN WE'RE TEACHING SOMEBODY, WE
DO IT IN AN EFFECTIVE WAY TO
REALLY HELP THEM THEN MOVE
INFORMATION INTO OUR LONG TERM
MEMORY AND STORAGE.
SO THIS IS WHERE COGNITIVE LOAD
THEORY COMES IN, AND I FIND THIS
TO BE THE THEORY THAT COMES UP
AGAIN AND AGAIN WHEN WE'RE
THINKING ABOUT HOW TO TEACH IN
THE CLASSROOM IN THE CLINICAL
SETTING.
SO I'M GOING TO SPEND A LITTLE
BIT OF TIME ON THIS BECAUSE TO
BE HONEST, THE FIRST TIME I WAS
EXPOSED TO THIS, I FOUND IT
REALLY DIFFICULT TO UNDERSTAND
SOME OF THESE CONCEPTS AND TO
THINK WI ABOUT HOW TO APPLY THE.
SO THERE'S THREE COMPONENTS OF
OUR WORKING MEMORY AND THREE
IMOANTS COMPONENTS THAT WE CAN O
REALLY OPTIMIZE INFORMATION
PROCESSING.
SO THERE'S CONCEPT OF INTRINSIC
LOAD, AND THINK OF THIS AS THE
COMPLEXITY OF THE INFORMATION
WE'RE LEARNING.
TO BE HONEST, IT CAN BE A LITTLE
DIFFICULT TO CHANGE THIS.
THERE ARE JUST SOME TOPICS THAT
ARE REALLY COMPLEX, AND SO WE
HAVE TO THINK REALLY CAREFULLY
ABOUT HOW TO MANAGE THAT
INTRINSIC LOAD OF THE
INFORMATION.
EXTRANEOUS LOAD IS LIKE ALL THE
EXTRA STUFF THAT'S DISTRACTING
US FROM LEARNING SOMETHING.
AND THAT CAN BE EXTRA STUFF THAT
WE ARE PROVIDING AS A TEACHER,
IT CAN BE THINGS IN THE
ENVIRONMENT THAT ARE TOTALLY
UNRELATED THAT ARE DISTRACTING
PEOPLE.
AND THEN GERMANE LOAD IS THIS
CONCEPT OF THE EFFORT WE TAKE TO
ORGANIZE INFORMATION.
SO THIS IS THAT WAY THAT YOU'RE
THINKING IN YOUR BRAIN ABOUT
LIKE HOW AM I GOING TO REMEMBER
THIS, HOW DOES THIS CONNECT TO
PRIOR MATERIAL THAT I'VE
LEARNED.
SO LET'S TALK ABOUT STRATEGIES
THAT WE CAN THEN USE TO MANAGE
THESE DIFFERENT PROCESSES.
SO HERE IS THE SAME INFORMATION.
WE'RE GOING TO HAVE A TABLE AND
TALK ABOUT SOME OF THE
STRATEGIES THAT WE CAN USE, AND
SO FIRST TALKING ABOUT INTRINSIC
LOAD, OUR GOAL IS TO REALLY
THINK ABOUT HOW WE CAN DECREASE
COMPLEXITY HERE.
AND THIS IS GOING TO DEPEND ON
THE LEVEL OF YOUR LEARNER,
RIGHT?
SO ALL OF US HAVE TAUGHT AT
DIFFERENT LEVELS.
IF YOU'RE TEACHING A FIRST YEAR
MEDICAL STUDENT WHO HAS ALL
BRAND NEW INFORMATION, HAS NEVER
HEARD ABOUT A TOPIC, WHAT THEY
CAN TAKE IN IS VERY DIFFERENT
FROM AN EXPERT IN THE FIELD AT A
CONFERENCE THAT WE'RE TEACHING
AT WHERE PEOPLE KNOW MOST OF THE
INFORMATION.
AND SO HOW COMPLEX REALLY
DIFFERS DEPENDING ON YOUR
AUDIENCE, AND THINGS NEED TO BE
ADJUSTED ACCORDINGLY TO HELP
PEOPLE UNDERSTAND.
SO STRATEGIES WE CAN USE, ONE IS
PREVIEWING, REALLY HELPING
PEOPLE SEE SOME OF THE TERMS
AHEAD OF TIME BEFORE WE TALK
ABOUT THEM SO THEY CAN TRY TO
DIGEST AND UNDERSTAND.
THEN THINKING ABOUT HOW TO
DECREASE AND SIMPLIFY.
AGAIN, ACCORDING TO WHO THE
AUDIENCE IS AND WHAT THEIR
BASELINE LEVEL OF UNDERSTANDING
IS.
AND THEN YOU CAN CONTINUE TO
BUILD COMPLEXITY OVER TIME.
AND THEN USING ANALOGIES THAT
WOULD BE FAMILIAR TO PEOPLE.
NOW, THIS CAN BE TRICKY BECAUSE
SOME OF US MAY BE FAMILIAR WITH
DIFFERENT TYPES OF ANALOGIES,
BUT FOR EXAMPLE, IN PHYSICS,
THIS IS USED FREQUENTLY, RIGHT?
OR WHEN WE'RE TALKING ABOUT THE
LUNGS AND HOW THE ALVEOLI
EXPAND, MOST OF US HAVE HEARD
ABOUT PEOPLE TALKING ABOUT
BLOWING UP A BALLOON AND USING
THAT AS AN ANALOGY TO HELP US
UNDERSTAND.
SO IT HELPS TO UNDERSTAND THOSE
PROCESSES.
SO WAYS THAT WE CAN DO THIS AND
THAT I DO THIS IN THE CLINICAL
SETTING, SO ONE IS WHEN I DO
CHALK TALKS, EVERY DAY BEFORE
ROUNDS, I DO ABOUT A 10 TO 15
MINUTE CHALK TALK ON SOME TOPICS
TO OUR RESIDENTS AND FELLOW.
SO OFTEN I'LL PREVIEW THE
CONTENT FOR THEM.
I MIGHT SHARE A PODCAST.
THEY LOVE LISTENING TO PODCASTS.
I LIVE IN ATLANTA, WE HAVE A
LONG COMMUTE, AND SO I SHARE
THAT PEOPLE BECOME FAMILIAR WITH
SOME OF THE CONTENT, FAMILIAR
WITH SOME OF THE THINGS, AND
THEN THE NEXT DAY, WHEN I DO A
CHALK TALK, I THINK ABOUT HOW
CAN I SIMPLIFY THIS INFORMATION
AND PROVIDE STRUCTURE IN
BUCKETS.
SO FOR EXAMPLE, THIS IS A TALK I
GAVE EARLIER THIS MONTH WITH MY
BRAND NEW INTERNS AND MY BRAND
NEW FELLOW ON CULTURE NEGATIVE
ENDOCARDITIS.
SO I PROVIDED KIND OF THREE
DIFFERENT BUCKETS OF ORGANISMS
THAT THEY COULD THINK ABOUT.
THAT WAS A STRUCTURE THAT HELPED
THEM AS WE'LL TALK ABOUT WITH
GERMANE LOAD, BUT I DIDN'T TELL
THEM EVERYTHING I KNEW ABOUT IT,
BECAUSE THEY COULDN'T TAKE ALL
THAT IN.
I FOCUSED INSTEAD ON WHAT ARE
THE KEY ORGANISMS I WANTED THEM
TO KNOW, AND THEN YOU CAN BUILD
ON THAT OVER TIME.
SOY DIDN'T TALK ABOUT
DIAGNOSTICS, I DIDN'T TALK ABOUT
TREATMENT.
ALL OF THAT WOULD HAVE BEEN TOO
MUCH FOR THEM.
ALL RIGHT, WHAT ABOUT EXTRANEOUS
LOAD?
THIS AGAIN IS KIND OF THAT
DISTRACTION FROM MATERIAL SO
AGAIN WE'RE TRYING TO DECREASE
EXTRANEOUS LOAD WHEN WE'RE
TEACHING, SO ONE WAY TO DO THIS
IS MAKING SURE THAT WE'RE
PROVIDING STREAMLINED RESOURCES
TO PEOPLE.
I THINK A LOT OF TIMES WE GET
EXCITED ABOUT A TOPIC.
I HAVE LIKE 10 ARTICLES ON FEVER
OF UNKNOWN ORIGIN THAT I CAN
SEND TO PEOPLE, BUT THEN THEY
BECOME OVERWHELMED WITH THE
SELECTION OF THE MATERIAL AND
CAN'T REALLY FOCUS ON THAT
LEARNING PIECE.
WE CAN LIMIT TEXT IN PICTURES
TO, AGAIN, PEEL DOWN TO ONLY THE
NECESSARY CONTENT, AND I'M GOING
TO PROVIDE SOME SPECIFIC
EXAMPLES OF HOW TO DO THIS.
WE'LL TALK ABOUT THIS A LOT
MORE.
AND THEN ELIMINATING
DISTRACTIONS AROUND.
ASKING PEOPLE IN THE CLASSROOM
TO CLOSE THEIR LAPTOPS, TO PUT
THEIR PHONES AWAY.
WE STILL HAVE PAGERS AT OUR
INSTITUTION.
I DON'T KNOW ABOUT YOU, BUT YOU
KNOW, TAKING THE PAGER AWAY FROM
THE FELLOW WHEN WE'RE DOING A
TEACHING SESSION SO THEY HAVE
TIME TO REALLY PAY ATTENTION AND
LEARN AND DON'T HAVE THESE
CONTINUAL DISTRACTIONS.
SO AGAIN IN THE CLINICAL
SETTING, PROVIDING A SINGLE
RESOURCE.
I ALREADY TALKED ABOUT WHEN I
WANT TO TEACH ABOUT FEVER OF
UNKNOWN ORIGIN OR PROVIDE
RESOURCES, I TRY TO PROVIDE JUST
ONE ARTICLE TO PEOPLE OR ONE
RESOURCE THAT COMBINES IT.
I TRY TO TAKE AWAY THEIR PAGER
WHEN I'M DOING THE TEACHING.
SO THINKING ABOUT HOW WE CAN DO
THAT IN THE CLINICAL SETTING.
NOW, WHEN WE'RE TALKING ABOUT
LIMITING TEXT IN PICTURES, THIS
IS REALLY IMPORTANT FOR US TO
THINK ABOUT WHENEVER WE'RE
GIVING ANY KIND OF MULTIMEDIA
PRESENTATION.
AND I THINK THIS HAS BECOME MORE
AND MORE DIFFICULT OVER TIME,
WHEN WE WOULD GIVE CHALK TALKS.
IT'S A LITTLE BIT EASIER BECAUSE
YOU HAVE TO DRAW ALL THAT
INFORMATION, THAT AUTOMATICALLY
MAKES YOU ELIMINATE THINGS, BUT
IT'S REALLY EASY TO COPY AND
PASTE THINGS ON SLIDES, TO ADD A
LOT OF TEXT THAT HELPS US
REMEMBER THINGS WHEN WE'RE
TEACHING, AND IT TAKES A LOT
MORE EFFORT TO ACTUALLY DECREASE
WHAT'S ON THE SLIDES.
SO THIS IS WHERE MAYER'S
MULTIMEDIA PRINCIPLES COME INTO
PLAY.
THIS IS SOMETHING THAT YOU CAN
LOOK UP ON YOUTUBE.
THERE'S SOME GREAT VIDEOS THAT
GO OVER EXPLICIT EXAMPLES OF
THIS, AND I'M GOING TO TOUCH ON
JUST A COUPLE, AND WHAT THIS
REALLY TAKES ADVANTAGE OF IS
THIS IDEAL OF THE DUAL CHANNEL
PROCESSING THAT I MENTIONED, HOW
WE CAN TAKE IN THINGS FROM BOTH
THE VISUAL AND THE AUDITORY
CHANNELS.
AND SO WE CAN TAKE IN EQUAL
INFORMATION FROM BOTH OF THESE
IN AN ADDITIVE WAY, BUT YOU
DON'T WANT TO HAVE THE SAME
INFORMATION GOING INTO BOTH OF
THEM.
SO FOR EXAMPLE, YOU DON'T WANT
TO HAVE A SENTENCE ON THE SLIDE
THAT'S THE SAME THING THAT YOU
READ, BECAUSE WE'RE ONLY GOING
TO DO ONE OR THE OTHER, WE'RE
EITHER GOING TO READ IT OR WE'RE
GOING TO LISTEN.
SO YOU WANT TO THINK ABOUT HOW
CAN YOU MAXIMIZE BY PROVIDING
COMPLEMENTARY INFORMATION.
AND SO SOME OF THE IMPORTANT
MAYER'S MULTIMEDIA PRINCIPLES,
ONE IS WHAT I TALKED ABOUT WITH
INTRINSIC LOAD, RIGHT, THE IDEA
OF PRETRAINING WITH KEY CONCEPTS
AND TERMS, THE ROAD MAP I
PROVIDED AT THE BEGINNING OF
THIS TALK THAT SHOWED SOME OF
THE TERMS THAT WE'D BE TALKING
ABOUT.
THINKING ABOUT HOW TO USE MORE
THAN JUST WORDS BUT IN A WAY
THAT'S COMPLEMENTARY, SO
THINKING ABOUT HOW DO YOU
UTILIZE PICTURES.
WE DO THIS ALL THE TIME IN
RESEARCH WHEN WE'RE TRYING TO
PRESENT OUR FINDINGS, THINKING
ABOUT HOW TO USE GRAPHS AND
FIGURES IN A WAY THAT PROVIDES A
LOT MORE INFORMATION AT ONE
TIME.
THINKING OF COHERENCE OR HOW DO
WE ELIMINATE THE EXTRA.
SO REALLY LOOKING AT A SLIDE AND
TAKING AWAY EVERYTHING THAT
ISN'T NECESSARY TO BE THERE.
THINKING ABOUT SPATIAL AND
TEMPORAL CONTIGUITY.
SO FOR EXAMPLE, IF YOU'RE
LABELING A SLIDE, HAVING THE
WORD RIGHT NEXT TO IT.
IF YOU HAVE A GRAPH, INSTEAD OF
HAVING A LEGEND AT THE OTHER END
OF A GRAPH, HAVING LINES LABELED
RIGHT ON TOP OF THEM.
THESE ARE THINGS THAT MAKE IT
MUCH EASIER FOR US TO FOCUS AND
ATTEND TO THAT.
SIGNALING IS USING CUES TO
HIGHLIGHT.
YOU CAN USE THINGS LIKE
PROGRESSIVE ANIMATION, YOU CAN
USE COLOR LIKE I'VE USED BLUE ON
THESE SLIDES TO HIGHLIGHT SOME
OF THE KEYWORDS.
AND THEN PERSONALIZATION.
WE KNOW THAT A CONVERSATIONAL
TONE IS MUCH EASIER FOR PEOPLE
TO TAKE IN AND UNDERSTAND THAN A
FORMAL SCRIPT, AND SO TRYING TO
AVOID SCRIPTING OUR TALKS TOO
MUCH, AND REALLY PRACTICING
WITHOUT HAVING WORDS KIND OF ON
PRESENTER VIEW, PEOPLE ARE ABLE
TO TAKE IT IN MUCH BETTER.
THIS IS PROBABLY WHY STORIES
WORK REALLY WELL WHEN TEACHING
BECAUSE WE'RE FORCED TO TAKE ON
A CONVERSATIONAL TONE.
SO DOES THIS WORK?
THE SHORT ANSWER IS YES.
THERE HAVE BEEN MULTIPLE STUDIES
LOOKING AT THIS, BUT I REALLY
LIKE THIS ONE FROM MEDICAL
EDUCATION THAT WAS ACTUALLY A
PRIOR GRADUATE OF MY MASTERS OF
HEALTH PROFESSIONS EDUCATION
PROGRAM.
AND SO WHAT THEY DID WAS THEY
ACTUALLY TOOK MEDICAL SCHOOL
LECTURES, THEY HAD A COUPLE
COURSES, AND THEY WORKED ON
APPLYING MAYER'S MULTIMEDIA
PRINCIPLES TO THE SLIDES.
SO HERE'S AN EXAMPLE OF ONE OF
THE SLIDES BEFORE.
AND SO THIS IS TALKING ABOUT
SWAN-GANZ CATHETERS, BEING ABLE
TO TELL WHAT PART OF THE
WAVEFORM IT'S IN.
SO THEY FOLLOW A LOT OF THE
PRINCIPLES WE'VE LEARNED ABOUT
MULTIMEDIA PRESENTATIONS.
THERE'S PICTURES HERE, THERE'S
IMAGES, THERE'S NOT MANY WORDS,
THEY PROVIDE A KEY TITLE ON TOP,
AND SO ON FIRST GLANCE, THIS MAY
SEEM TO BE AN EFFECTIVE SLIDE.
BUT THEY MADE IT EVEN BETTER
AFTER AND THEY SHOWED BY DOING
THIS IN LECTURES, NOT CHANGING
ANY OF THE CONTENT, THAT
KNOWLEDGE IMPROVED IN THE GROUP
WHO HAD THE NEWER SLIDES.
SO LET'S TALK ABOUT SOME OF THE
EX-PREXPLICIT THINGS THEY DID H.
SO ONE IS, THEY ELIMINATED
UNNECESSARY THINGS.
THE COHERENCE PRINCIPLE.
SO PEOPLE THOUGHT THEY WERE
PROVIDING A HELPFUL ANALOGY,
RIGHT?
LIKE, IT'S LIKE SURFING THROUGH
THE BLOODSTREAM.
BUT THAT DOESN'T REALLY HELP
UNDERSTAND ANYTHING.
RIGHT?
THAT DOESN'T, LIKE, DESCRIBE A
PROCESS THAT HELPS UNDERSTAND
WHERE THINGS ARE AT DIFFERENT
PLACES, AND SO ALTHOUGH IT AN
ANALOGY, IT'S NOT REALLY A
HELPFUL ONE TO UNDERSTAND.
THEY USED SIGNALING TO HIGHLIGHT
ONLY THE ESSENTIAL MATERIAL, SO
WHAT THEY WANTED PEOPLE TO KNOW
WAS JUST WHAT WAVEFORMS ARE IN
WHAT PART OF THE HEART, SO
THAT'S WHAT THEY HAVE ON THERE
AND THEY HAVE ARROWS POINTING TO
THE EXACT PART.
THEY USE WORDS AND PICTURES
RATHER THAN JUST WORDS.
IT'S MUCH EASIER TO LIKE SEE
THESE TRACINGS AND TO SEE THE
PART OF THE HEART THAT IT'S IN
RATHER THAN JUST SAYING RIGHT
VENTRICLE, LEFT VENTRICLE AND
THINGS LIKE THAT.
AND SPATIAL CONTIGUITY
PRINCIPLE, RIGHT?
THEY HAVE THE WAVEFORM RIGHT
NEXT TO EACH CHAMBER OF THE
HEART THAT IT APPLIES TO.
AND SO I'M SURE MANY OF US, WHEN
WE HAVE BEEN TAKING TESTS OR
REMEMBERING THINGS, CAN THINK
BACK TO SPECIFIC IMAGES OR
FIGURES OR SLIDES THAT REALLY
HELP US RETAIN AND BRING BACK
THAT MATERIAL AND THIS IS AN
EXAMPLE OF HOW THAT CAN BE
EFFECTIVE.
LASTLY, GERMANE LOAD.
THIS IS THE EFFORT IT TAKES US
TO ORGANIZE THE MATERIAL, AND SO
THINGS THAT WE CAN DO HERE FOR
OUR LEARNERS, WE REALLY WANT TO
FOCUS ON INCREASING GERMANE
LOAD, INCREASING THAT
ORGANIZATION.
WE CAN DO THAT BY REFERENCING
PRIOR KNOWLEDGE.
SO REALLY HOPING TO BUILD ON
WHAT THEY ALREADY KNOW.
TO DO THAT, WE HAVE TO KNOW
WHERE THEY'RE STARTING AT.
THEN PROVIDING ORGANIZATIONAL
TOOLS, AND I'LL SHOW SOME
EXAMPLES, TO REALLY ORGANIZE THE
INFORMATION IN SOME TYPE OF
STRUCTURE OR HIERARCHY.
SO WE ALL DO THIS IN THE
CLINICAL SETTING ALREADY WITH
LEARNERS, RIGHT?
THIS IS THE SOCRATIC TEACHING AS
WE THINK ABOUT IT.
SO WHEN I'M TEACHING ABOUT
CULTURE-NEGATIVE ENDOCARDITIS,
BEFORE I JUST LAUNCH INTO A
CHALK TALK, I MAY SAY HOW DO YOU
APPROACH THE DIAGNOSIS OF
CULTURE NEGATIVE ENDOCARDITIS?
I FIND OUT WHERE THEY'RE AT,
WHAT THEIR KNOWLEDGE IS AND THEN
I KIND OF BUILD ON THAT.
THEN THINKING ABOUT HOW TO
ORGANIZE THINGS, SO THIS IS
ANOTHER CHALK TALK THAT I GAVE
EARLY IN JULY AND THIS WAS ON
ENVAL LINE BLOODSTREAM
INFECTIONS.
AGAIN NOT A LOT OF INFORMATION
THERE BUT I ORGANIZED THE WAY I
WANT THEM TO APPROACH IN A
PROCESS TO HELP THEM ORGANIZE IT
IN THEIR HEAD RATHER THAN KIND
OF TELLING THEM ALL THESE THINGS
ABOUT LENGTH OF TREATMENT, HOW
TO DO IT WITH DIFFERENT
ORGANISMS AND THINGS LIKE THAT.
AND THIS IS USING ADVANCED
ORGANIZERS, OKAY?
SO THERE'S LOTS OF ADVANCED
ORGANIZERS THAT WE ALL ALREADY
USE, BUT WE CAN THINK ABOUT THEM
IN A LITTLE BIT MORE PURPOSEFUL
OF A WAY.
SO IN MEDICINE, I FIND WE TEND
TO USE KIND OF THREE MAIN
CATEGORIES OF ADVANCED
ORGANIZERS.
WE LIKE TO THINK ABOUT PROCESSES
OR TIMELINES, AND SO EXPLICITLY
SHOWING THAT IN CASE
CONFERENCES, HAVING A TIMELINE
ON THE SLIDE INSTEAD OF JUST
LIKE WORDS FOR THE HPI CAN BE A
REALLY HELPFUL THING THAT I'M
SURE MANY OF US ALREADY DO.
BUT THAT'S EXPLICITLY USING AN
ADVANCED ORGANIZER TO HELP
PEOPLE, DECREASING THE AMOUNT OF
WORDS ON THE SLIDE.
HIERARCHY, USING PYRAMIDS, USING
ORGANIZATIONAL CHART HELPS
PEOPLE UNDERSTAND HOW THINGS ARE
RELATED IN THAT WAY.
AND THEN FINALLY, WE DO A LOT OF
COMPARING AND CONTRASTING WITH
DIFFERENTIAL DIAGNOSES OR
DIFFERENT TREATMENTS, AND SO WE
CAN DO THIS EXPLICITLY THROUGH
VENN DIAGRAMS OR THROUGH TABLES,
AND I'LL SHOW AN EXAMPLE OF HOW
I DO THIS IN THE CLINICAL
SETTING A LITTLE BIT LATER.
THIS IS A GREAT ARTICLE THAT
SPECIFICALLY TALKS ABOUT MINI
CHALK TALKS AT THE BEDSIDE AND
THEY PROVIDE A LOT OF EXAMPLES
OF ADVANCED ORGANIZERS THAT THEY
USED.
SO USING VISUAL PARADIGMS AND
GRAPHS AND PATHWAYS AND ANATOMIC
DRAWINGS, AGAIN, THINGS THAT
WE'RE ALL DOING, BUT THIS IS A
WAY FOR US TO THINK MORE
PURPOSELY ABOUT HOW TO USE IT.
SO AS I MENTIONED, COGNITIVE
LOAD THEORY IS ONE THAT'S REALLY
IMPORTANT TO HELP US UNDERSTAND
HOW TO TEACH EFFECTIVELY AND
HELP PEOPLE GET THE MATERIAL AND
UNDERSTAND IT BEFORE THEY CAN
MOVE TO THE NEXT STEP, SO I
WANTED TO SPEND A LITTLE BIT
MORE TIME ON THAT THAN SOME OF
THE REST.
BUT FOR ANY OF YOU WHO ARE
TEACHING FELLOWS, THIS ARTICLE
IS WORTH READING.
THIS WAS A GREAT RESEARCH
ARTICLE ON COGNITIVE LOAD OF
INPATIENT CONSULTS, AND WHAT WE
CAN DO AS FACULTY TO HELP PEOPLE
BETTER MANAGE THEIR INTRINSIC
LOAD, EXTRANEOUS LOAD AND
GERMANE LOAD.
AND THERE'S LOTS OF GREAT
EXAMPLES OF THINGS ON HERE AND
STRATEGIES, SO FOR EXAMPLE,
BEFORE LAUNCHING INTO TEACHING,
CHECKING IN WITH THE FELLOW
BEING LIKE, WHAT'S YOUR WORKLOAD
LIKE RIGHT NOW?
HOW MUCH STUFF DO YOU HAVE TO
DO?
THAT HELPS MANAGE THEIR
EXTRANEOUS LOAD.
AGAIN, THINGS THAT MANY OF US
ARE ALREADY DOING OVER TIME, BUT
I FOUND THIS TO BE A HELPFUL WAY
FOR ME TO BOTH SEE WHAT I'M
DOING AND WHY IT'S EFFECTIVE,
BUT ALSO TO GET SOME NEW IDEAS
OF STRATEGIES THAT I WASN'T
USING BEFORE.
IT HAS WONDERFUL QUOTES FROM
FELLOWS THAT ALSO HELP ME REGAIN
THAT PERSPECTIVE THAT I HAD
FORGOTTEN AFTER BEING OUT OF
TRAINING.
SO TO SUMMARIZE THE STRATEGIES
FOR HELPING PEOPLE UNDERSTAND,
THINKING PURPOSELY ABOUT OUR
PREP MATERIALS, ESPECIALLY IF WE
HAVE THINGS THAT ARE GOING TO BE
NEW TO PEOPLE.
THERE ARE LOTS OF WAYS THAT WE
CAN DO THIS, DEPENDING ON YOUR
LEVEL OF LEARNER, DEPENDING ON
HOW MUCH TIME THEY HAVE WILL
CHANGE WHAT YOU UTILIZE.
THINKING ABOUT HOW WE CAN BREAK
DOWN CONCEPTS MORE SIMPLY AND
BUILD SLOWLY OVER TIME HELPS
CONNECT THINGS.
IT ALSO HELPS SPACE LEARNING
WHICH WE'LL TALK ABOUT IN THE
NEXT SECTION AS A METHOD TO
RETAIN LEARNER, SO USING SPIRAL
CURRICULA.
BUT I THINK WHAT'S HELPED ME THE
MOST TO SIMPLIFY MY CONTENT IS
TO REALLY HAVE A NON-EXPERT
REVIEW MY CONTENT.
I TEACH M1s, I'M AN INFECTIOUS
DISEASE SPECIALIST.
I SPECIALIZE IN HIV.
MY KNOWLEDGE OF THAT FAR
SURPASSES WHAT THE MEDICAL
STUDENTS ARE LEARNING, AND THAT
CAN BE REALLY HARD TO REMEMBER
TERMS THAT THEY'VE NEVER HEARD
THAT ARE SO FAMILIAR TO ME.
AND SO BY HAVING A MEDICAL
STUDENT REVIEW IT S OR EVEN
SOMEBODY NOT IN MY SPECIALTY, IT
REALLY HELPS ME TO THINK ABOUT
WHERE I MAY BE MAKING
ASSUMPTIONS AND WHERE I MAY BE
TEACHING AT TOO HIGH OF A LEVEL.
WE TALKED ABOUT ELIMINATING
MATERIAL THAT IS AN ESSENTIAL,
PARTICULARLY THINKING ABOUT HOW
TO CLEAN UP OUR SLIDES.
BUT ALSO THINKING ABOUT OUR
TEACHING POINTS ON ROUNDS AND
KEEPING THOSE REALLY FOCUSED AND
BRIEF.
I TRY TO KEEP ONE TEACHING POINT
PER EACH DISCUSSION WE HAVE TO
REALLY HELP PEOPLE TAKE THAT
HOME.
AND THEN ORGANIZING THINGS IN A
WAY THAT HELPS PEOPLE RETAIN
CONCEPTS BECAUSE WE GET TAKEN
MORE INFORMATION THAT WAY.
SO USING ADVANCED ORGANIZERS,
AND I'M GOING TO GIVE SOME
EXAMPLES IN THE NEXT SECTION ON
SOME GUIDED HANDOUTS THAT WE CAN
USE TO HELP PEOPLE ORGANIZE IF
YOU'RE TEACHING A COURSE OR
SOMETHING LIKE THAT.
SO LET'S TALK A LITTLE BIT ABOUT
RETENTION.
I FEEL LIKE THIS HAS BECOME
REALLY POPULAR OVER THE LAST 10
YEARS, REALLY IN ALL ASPECTS OF
THE LAY PRESS.
AND SO SOME OF THESE MAY BE
REALLY FAMILIAR.
I FIND THE MEDICAL STUDENTS
ACTUALLY KNOW ALL OF THESE
CONCEPTS BECAUSE THEY'VE HEARD
ABOUT THEM, READ ABOUT THEM,
THEY'RE REALLY LEVERAGED AND
UTILIZED IN UNDERGRAD CLASSES.
OKAY.
SO AGAIN, WE HAVE A LOT OF
EVIDENCE ABOUT HOW WE LEARN.
THIS IS A REVIEW PAPER THAT'S 50
PAGES LONG THAT REVIEWS A LOT OF
BASIC SCIENCE ABOUT THIS OVER
THE PAST 40 TO 50 YEARS THAT I
FOUND REALLY INSTRUCTIVE WHEN I
FIRST GOT INTO THIS, AND
REALIZED LIKE, OH, WE ACTUALLY
KNOW A LOT MORE THAN WE THOUGHT
WE KNEW.
WE KNOW A LOT ABOUT THE SCIENCE
OF HOW WE LEARN AND TAKE IN AND
RETAIN INFORMATION.
SO HERE ARE FOUR PRINCIPLES THAT
HAVE BEEN SHOWN TO HAVE REALLY,
REALLY HIGH EFFICACY
FOREKNOWLEDGE RETENTION.
RETRIEVAL PRACTICE OR PRACTICE
TESTING, WHICH IS REALLY THE ACT
OF PULLING INFORMATION FROM
MEMORY.
WE USE FLASH CARDS FOR THIS,
TEST QUESTIONS, ASKING PEOPLE
QUESTIONS ON ROUNDS.
THESE ARE ALL FORMS OF RETRIEVAL
PRACTICE, BUT THE KEY IS, PEOPLE
HAVE TO BE RETRIEVING IT FROM
MEMORY.
AND THIS IS WHY FOR ANY OF US
WHO'VE HAD TO STUDY FOR BOARD
EXAMS, DOING QUESTIONS ALONE IS
OFTEN THE MOST EFFECTIVE WAY TO
STUDY IF YOU HAVE THE KNOWLEDGE,
RIGHT, BECAUSE YOU'RE JUST
TRYING TO MAKE THOSE CONNECTIONS
QUICKER AND EASIER TO RETRIEVE
THE INFORMATION.
SPACED PRACTICE, REVISITING
MATERIAL OVER TIME.
SO INTERESTINGLY, WHEN PEOPLE
STUDY, IF YOU CRAM LIKE MANY OF
US PROBABLY DID IN THE PAST AND
STUDY FIVE HOURS IN ONE DAY,
VERSUS FIVE HOURS SPREAD OVER
THE WEEK, YOU'RE GOING TO RETAIN
MUCH MORE IF YOU STUDY SPREAD
OVER THE WEEK.
STUDY AFTER STUDY HAS SHOWN
THIS.
YOU WILL PERFORM WELL ON THE
INITIAL EXAM EITHER WAY, BUT YOU
WILL NOT RETAIN IT WELL OVER
TIME IF YOU DO THE CRAMMING.
THIS IS ALSO WHY THINGS LIKE
ELECTRONIC FLASH CARD PROGRAMS,
IF ANY OF YOU INTERACT WITH
UNDERGRADS OR MEDICAL STUDENTS,
ONKI IS AN ELECTRONIC FLASH CARD
PROGRAM THAT EVERYBODY USES.
IT ALREADY USES THESE ALGORITHMS
FOR SPACE PRACTICE, BUT A LOT OF
OUR QUESTION BANKS NOW DO THIS.
SO OUR PROGRAM USES NEW ENGLAND
JOURNAL OF MEDICINE KNOWLEDGE
PLUS, AND THAT HAS A SPACED
ALGORITHM TO REALLY SPACE OUT
PEOPLE'S LEARNING AND REVISIT
TOPICS OVER TIME TO MAXIMIZE
THIS RETENTION.
INNER LEADIN
INTERLEAVING IS THE CONCEPT OF
MIXING UP TOPICS WHEN WE'RE
STUDYING.
SO THIS IS WHY WHEN WE'RE
STUDYING FOR A TEST OR FOR
BOARDS, INSTEAD OF FOCUSING ON A
SINGLE TOPIC AND JUST DOING
QUESTIONS IN THAT TOPIC, WE
ACTUALLY RETAIN A LOT MORE IF WE
DO MIXED QUESTION SETS.
NOW, IT'S HARDER, WE PERFORM
WORSE INITIALLY ON THAT MIX SET
THAN WE WOULD IF WE'RE JUST
DOING ONE TOPIC, BUT YOU PERFORM
MUCH BETTER IN THE LONG TERM.
THIS IS ALSO WHERE WE'LL TALK
ABOUT COMPARE AND CONTRAST
TABLES AS A WAY TO KIND OF MIX
UP THE INFORMATION AND SEE
EXPLICITLY HOW THEY'RE SIMILAR
AND DIFFERENT.
AND THEN FINALLY, ELABORATION,
THIS IS REALLY JUST HAVING
PEOPLE EXPLAIN CONCEPTS AND
CONNECTING YOUR PRIOR KNOWLEDGE.
SO THINGS LIKE HOW AND WHY
QUESTION.
AGAIN, WE ASK THIS ON ROUNDS ALL
THE TIME, WE ASK PEOPLE, WHY
DOES THAT MEDICATION WORK, WHY
ARE YOU SELECTING THAT MEDICINE?
THIS IS HELPING PEOPLE RETAIN
THAT KNOWLEDGE TO REALLY HAVE AN
UNDERSTANDING BEHIND IT, AND
THIS IS WHERE CONCEPT MAPS CAN
BE REALLY HELPFUL TOO.
SO IN THE CLINIC, WHEN WE ARE
SEEING PATIENTS, WE ARE
AUTOMATICALLY DOING A LOT OF
THIS, WHICH IS WHY TRAINING IN
THE CLINICAL SETTING IS SO
EFFECTIVE, RIGHT?
WHEN WE ARE MAKING CLINICAL
DECISIONS, WE ARE RETRIEVING
INFORMATION FROM MEMORY.
NOW, WE'RE SOMETIMES LIKE GOING
AND USING ANOTHER RESOURCE TOO,
BUT WE'RE RETRIEVING A LOT OF IT
FROM MEMORY.
WHEN WE'RE SEEING PATIENTS, WE
ARE REVISITING THE SAME DISEASES
OVER TIME.
WE ARE INTERLEAVING WITH
DIFFERENT TYPES OF DISEASES.
WHEN WE'RE DISCUSSING THINGS ON
ROUNDS, WE'RE ASKING PEOPLE
QUESTIONS, WE'RE FORCING THEM TO
RETRIEVE INFORMATION, ELABORATE
ON IT, AND WHEN WE DO CHALK
TALKS, WE'RE ALSO ASKING
QUESTIONS AND HAVING PEOPLE DO
THE SAME THING, AND THEN WE ASK
THEM TO APPLY THAT INFORMATION
TO PATIENTS IN THE FUTURE, LIKE
HEY, REMEMBER WHEN I TALKED
ABOUT THIS TOPIC?
AND THAT'S SPACING OUT THEIR
LEARNING.
SO THIS IS STUFF WE'RE ALREADY
DOING.
BUT ONE THING THAT I WOULD
RECOMMEND ALL OF US LEVERAGING A
LITTLE BIT MORE EXPLICITLY IS
INTERLEAVING BY USING COMPARE
AND CONTRAST TABLES.
AND THIS IS WHERE YOU HAVE A
DIFFERENTIAL DIAGNOSIS, YOU
THINK ABOUT THE MOST LIKELY
THINGS, AND YOU EXPLICITLY ASK
PEOPLE TO MAKE A COMPARE AND
CONTRAST TABLE AMONG THOSE KEY
DISTINGUISHING FEATURES THAT ARE
GOING TO HELP PEOPLE BE ABLE TO
RECOGNIZE AND DIFFERENTIATE
DISEASES.
SO THIS IS SOMETHING WHEN I HAVE
SOMEONE WITH A LESION WHO'S BEN
CHRONICALLY ILL, I CAN ASK THEM
TO DO THESE FOR OUR TOP THREE
DIFFERENTIALS.
WHEN WE HAVE A TICK-BORNE
ILLNESS, AGAIN, I CAN ASK PEOPLE
TO COMPARE AND CONTRAST AND DO
THIS IN THE NEXT DAY, COME BACK
AND TELL ME.
THIS IS MUCH MORE EFFECTIVE OF
US JUST TELLING PEOPLE TO GO
HOME AND READ ABOUT THE
DISEASES, BECAUSE THEY'RE REALLY
EXPLICITLY FORCED TO LOOK AT
THOSE KEY FEATURES, AND IT TAKES
LESS TIME BECAUSE THEY'RE NOT
READING A WHOLE CHAPTER ON LYME
DISEASE, A WHOLE CHAPTER ON
EHRLICH YA.
THEY'RE REALLY GOING AND FINDING
THE KEY INFORMATION THAT'S GOING
TO BE IMPORTANT.
SO THIS IS A WAY FOR US AS
EXPERTS TO MAKE SURE THAT WE ARE
PROVIDING A LITTLE BIT MORE
PURPOSEFUL TEACHING AND
INSTRUCTION.
SO WHAT ABOUT THE CLASSROOM?
SO FOR MANY OF YOU WHO MAY GIVE
DIDACTIC LECTURES OR BE IN
CHARGE OF SOME TYPE OF
CURRICULUM, THIS IS SOMETHING I
HAVE INTEGRATED INTO MY MEDICAL
SCHOOL COURSE AND HAS BEEN
REALLY EFFECTIVE FOR LEARNERS TO
REMEMBER THINGS.
LIKE THEY COME UP TO ME A COUPLE
YEARS LATER, WHEN THEY'RE IN THE
CLINICAL SETTING, WITH THINGS
LIKE DETAILS THEY REMEMBER FROM
MY CLASS BECAUSE OF US UTILIZING
THESE PRINCIPLES.
SO ONE THING IS USING IN-CLASS
QUESTIONS, THAT'S RETRIEVAL
PRACTICE AND DEPENDING ON HOW
YOU ASK THE QUESTION, MAY
INCORPORATE SOME OF THESE OTHER
PRINCIPLES.
BUT THIS IS WHERE POLLING, I
PERSONALLY USE POLL EVERYWHERE
BECAUSE OUR INSTITUTION HAS A
SUBSCRIPTION, BUT DURING CLASS,
I TAKE PAUSES AND I ASK PEOPLE
QUESTIONS TO HELP CONSOLIDATE
THEIR KNOWLEDGE.
OR IN OUR CASE CONFERENCES, WE
USE THIS TO HELP PEOPLE FORM A
DIFFERENTIAL DIAGNOSES TO COME
TO A DECISION.
AGAIN, HELPS THEM WITH THAT
RETENTION.
WHAT I'VE STARTED USE SOMETHING
PARTIAL LECTURE OUTLINES.
NOW MANY OF US, WHEN WE WERE
LEARNING IN COLLEGE, MAY HAVE
HAD PEOPLE GIVE US LIKE LECTURE
OUTLINES, FULL LECTURE OUTLINES.
THERE'S ACTUALLY A GOOD BIT OF
DATA SHOWING THAT HAVING PARTIAL
OUTLINES THAT PEOPLE HAVE TO
FILL IN IS MUCH MORE EFFECTIVE
FOR LONG TERM RETENTION.
AND THAT'S BECAUSE IT FORCES
THEM TO ELABORATE AND PUT THINGS
IN THEIR OWN WORDS.
THIS IS PROBABLY WHY SOME OF THE
DATA SHOWS THAT WRITING IS
BETTER THAN BEING ON A COMPUTER.
I DON'T THINK THAT'S ACTUALLY
TRUE BUT I THINK ON A COMPUTER,
PEOPLE TEND TO COPY AND PASTE
THINGS INSTEAD OF PUTTING IT IN
THEIR OWN WORDS, WHICH IS THE
ELABORATION PIECE OF IT.
SO IN MY COURSE FOR EVERY
LECTURE, WE HAVE A PARTIAL
OUTLINE.
THIS HAS BEEN WONDERFUL FOR TWO
REASONS.
ONE, IT FORCED MY FACULTY TO
RECOGNIZE HOW THEY'RE ORGANIZING
MATERIAL AND WHAT WAS AND WASN'T
IMPORTANT.
SO FACULTY CAME TO ME AFTER AND
SAID THIS WAS ACTUALLY REALLY
HELPFUL FOR ME TO IMPROVE MY
LECTURE WHEN I THOUGHT ABOUT
WHAT I WANTED TO PEOPLE TO TAKE
HOME, BUT IT WAS ALSO A REALLY
HELPFUL THING FOR LEARNERS TO BE
ABLE TO SIT -- I HAVE TABLES ON
HERE, OTHER TYPES OF ADVANCED
ORGANIZERS THEY FILL IN BUT THEY
HAVE TO PUT THINGS IN THEIR OWN
WORDS.
FLASH CARDS, WE TALKED ABOUT,
ACTUALLY REALLY INCORPORATE ALL
OF THESE CONCEPTS, WHICH IS WHY
FLASH CARDS CAN BE SO EFFECTIVE,
BUT MOST OF US THINK OF THEM AS
A MEMORIZATION TOOL.
WE USE THEM FOR VOCAB OR THINGS
LIKE THAT.
I ACTUALLY IN MY COURSE USE
FLASH CARDS THAT ASK QUESTIONS.
SO THIS IS AN ELECTRONIC FLASH
CARD APP, IT'S FREELY AVAILABLE
TO PEOPLE.
AND I CAN CREATE CARDS AND SHARE
THEM WITH PEOPLE.
SO RIGHT HERE, THIS IS THE
QUESTION ON THE FRONT, AND THEN
I HAVE SLIDES FROM OUR COURSE ON
THE BACK.
SO I ACTUALLY ASK MORE DETAILED
QUESTIONS THAT REQUIRE THEM TO
ELABORATE AND EXPLAIN WHY WHEN I
DO QUESTIONS, AND THIS HAS
REALLY BEEN EFFECTIVE FOR
HELPING THEM LEARN, THEY MIX IT
ALL UP, THEY'RE INTERLEAVING,
THEIR SPACING, RETRIEVAL
PRACTICE, ALL OF THAT.
QUIZZES, SOMETHING ALL OF US
HAVE TENDED TO USE, USING BOARD
QUESTIONS OR OTHER THINGS TO
HELP PEOPLE WITH THIS.
AND THEN HAVING STUDY PARTNER,
AGAIN, REQUIRES THAT
EXPLANATION, THE SAME THING
WE'RE DOING ON ROUNDS WHEN WE'RE
PRACTICING.
NOW ONE THING THAT I WANT TO
TALK ABOUT IS THIS CONCEPT OF
CREATING DESIRABLE DIFFICULTY TO
ENHANCE LEARNING.
I FOUND THIS HAS BEEN THE
BIGGEST BARRIER, ESPECIALLY WHEN
I'M TEACHING IN THE MEDICAL
SCHOOL.
A LOT OF TIMES PEOPLE WANT ME TO
DO THINGS THAT LIKE MAKE IT
EASIER FOR THEM.
THEY WANT ME TO GIVE THEM A
FILLED-IN HANDOUT, LIKE WHERE
ARE THE ANSWERS.
THEY THINK THAT'S BECAUSE IT'S
GOING TO HELP THEM LEARN, BUT WE
HAVE A LOT OF DATA SHOWING THAT
WE ACTUALLY NEED TO MAKE THINGS
A LITTLE DIFFICULT TO REALLY
ENHANCE LEARNING.
SO THERE'S KIND OF THINGS PEOPLE
CAN DO WITHOUT ASSISTANCE THAT'S
LIKE REALLY EASY, AND YOU CAN GO
AND SIT DOWN AND ANSWER ALL THE
PROBLEMS, IT REQUIRES NO EFFORT.
THAT DOESN'T RESULT IN LEARNING.
WE CAN MAKE THINGS SO HARD THAT
PEOPLE CAN'T DO IT EVEN USING
RESOURCES, AND THEY JUST GET
FRUSTRATED AND THAT DOESN'T HELP
LEARNING.
BUT WE KNOW THAT THERE'S THIS
MIDDLE ZONE WHERE IT'S A LITTLE
DIFFICULT, AND PEOPLE CAN DO
THINGS WITH ASSISTANCE, AND THIS
IS WHAT'S TONED THE ZONE OF
PROXIMAL DEVELOPMENT.
SO THIS CONCEPT HAS REALLY
HELPED ME IN THE CLINICAL
SETTING THINK ABOUT HOW TO DO
EFFECTIVE TEACHING.
SO I THINK ABOUT EACH OF MY
LEARNERS, THE ONES WHO MAY NOT
BE DOING QUITE AS WELL AND THE
ONES WHO ARE SUPERSTARS IN THE
CLINICAL SETTING ALREADY, AND I
THINK ABOUT HOW CAN I MAKE IT
JUST A LITTLE BIT MORE DIFFICULT
FOR THEM, WHERE CAN I REALLY
STRETCH THEIR KNOWLEDGE.
AND SO FOR EXAMPLE, IT MAY BE
SOMETHING LIKE BREAKING BY NEWS
FOR AN M1.
I HAVE AN M1 IN MY CLINIC RIGHT
NOW AND SHE IS TRYING TO LEARN
HOW TO JUST LIKE TALK TO
PATIENTS, RIGHT?
SO I COULD HELP PREP HER FOR
BREAKING BAD NEWS.
I COULD TALK HER THROUGH IT, I
COULD ROLE PLAY WITH HER, AND
THEN SAY WE'RE GOING TO GO INTO
THIS ROOM, I KNOW THIS IS GOING
TO BE UNCOMFORTABLE, IT'S GOING
TO MAKE YOU UNCOMFORTABLE, BUT
WHY DON'T WE TRY THIS AND I'M
HERE AS A SUPPORT MECHANISM, AND
YOU CAN TURN TO ME IF, LIKE, YOU
GET TO THE POINT THAT YOU CAN'T
MOVE FORWARD.
BUT THAT IS GOING TO BE A MORE
EFFECTIVE LEARNING EXPERIENCE
THAN MAKING IT EASY FOR
SOMEBODY.
SAME WITH PEOPLE ANSWERING
MULTIPLE CHOICE QUESTIONS.
THIS IS WHY USING HARDER
QUESTIONS TO STUDY ACTUALLY
HELPS YOU LEARN BETTER.
SO IN MY COURSE, I PROVIDE A LOT
OF SELF-STUDY QUESTIONS BUT I
MAKE THEM A LITTLE HARDER THAN
THE EXAM, AND THAT RESULTS IN
MUCH, MUCH BETTER LEARNING AND
RETENTION THAN MAKING THEM
EQUIVALENT OR EASIER THAN THE
EXAM.
WHAT ABOUT APPLICATION OF
KNOWLEDGE?
THESE ARE THE CONCEPTS OF
GENERATION AND TRANSFERABILITY.
SO THIS IS EASY IN OUR FIELD
BECAUSE EVERYTHING THAT WE'RE
DOING IS ALREADY TRYING TO APPLY
TO A REAL WORLD CLINICAL
SETTING.
BUT JUST TO DEFINE THESE TERMS,
GENERATION IS REALLY THIS
ABILITY FOR PEOPLE TO SOLVE
PROBLEMS ON THEIR OWN.
COME UP WITH THEIR OWN
ASSESSMENT AND PLAN, THEIR OWN
DIFFERENTIAL DIAGNOSIS AND
THINGS LIKE THAT.
TRANSFERRED IS THE ABILITY TO
THEN TAKE THAT LEARNING TO NEW
AND VARIED CONTEXTS.
SO HOW CAN WE DO THIS
DELIBERATELY IN THE CLINICAL
SETTING?
SO IF WE HAVE A PATIENT THAT
WE'RE SEEING WITH ONE OF OUR
LEARNERS, LET'S SAY A PERSON
COMING IN WITH FEVER OF UNKNOWN
ORIGIN, WE CAN FORCE THEM TO
COME UP WITH A PLAN, RIGHT?
A LOT OF OUR LEARNERS ARE
ALREADY DOING THIS, BUT
SOMETIMES PEOPLE JUST STOP AND
WANT YOU TO FILL IN THE GAPS,
AND INSTEAD OF DOING THAT,
REALLY ASKING THEM, LIKE, TELL
ME WHAT YOUR APPROACH IS FOR
THIS.
WHAT'S YOUR DIFFERENTIAL
DIAGNOSIS?
WHAT DIAGNOSTIC TESTS DO YOU
WANT DONE?
WHY DO YOU WANT T TO DO THAT?
AND THEN DO YOU WANT TO START
TREATMENT?
WHY OR WHY NOT?
SO WE DON'T WANT TO ASK EVERY
QUESTION FOR EACH PATIENT
BECAUSE THAT BECOMES REALLY
TIRING, BUT THINKING ABOUT WHAT
POINT THEY NEED HELP WITH AND
MAKING SURE TO MAKE THEM COMMIT
BEFORE WE PROVIDE THE TEACHING.
BUT I THINK THE THING THAT'S
MOST HELPFUL IS THINKING ABOUT
TRANSFER.
BECAUSE WE CAN DO THIS WITH OUR
LEARNERS WHO ALREADY SEEM TO
KNOW MOST OF THE INFORMATION.
YOU CAN ALWAYS MIX IT UP TO MAKE
IT MORE DIFFICULT AND TO REALLY
STRETCH THEIR LEARNING.
SO LET'S SAY THEY HAVE A GREAT
PLPLAN FOR THIS PATIENT WITH FER
OF UNKNOWN ORIGIN.
WELL, THEN YOU CAN ASK THEM A
QUESTION LIKE, HOW WOULD YOUR
DIFFERENTIAL DIAGNOSIS CHANGE?
IF I CHANGE THE AGE OF THE
PATIENT?
IF I CHANGE THEIR EPIDEMIOLOGY?
IF I CHANGED LIKE SOME OF THEIR
MEDICAL CONDITIONS?
HOW WOULD IT CHANGE IF I CHANGED
SOME OF THE CLINICAL FEATURES,
LIKE WHAT IF THEY'D HAD A FEVER
FOR A YEAR AND WERE COMING IN
VERSUS JUST A MONTH?
WHAT IF THEY HAD PANCYTOPENIA,
WHAT IF THEY HAD A MURMUR ON
PHYSICAL EXAM?
AGAIN, WHAT ARE THINGS WE COULD
DO TO MAKE IT JUST A LITTLE BIT
MORE CHALLENGING FOR THEM?
OR WITH TREATMENT.
LET'S SAY THAT WE HAVE A
PATIENT, THEY END UP HAVING
CULTURE NEGATIVE ENDOCARDITIS.
THEY COME UP WITH A GREAT
TREATMENT PLAN BUT A LOT OF
TIMES THEY MAY JUST BE SAYING
THINGS THEY FOUND IN THE
GUIDELINES OR READ SOMEWHERE.
SO REALLY LIKE FORCING THEM TO
THEN, LIKE, HOW WOULD YOU CHANGE
THAT REGIMENT IF THE PATIENT HAD
A PROSTHETIC VALVE?
WHAT IF THEY WERE ON DIALYSIS?
WHAT IF THEY HAD AN ALLERGY TO
THIS MEDICATION OR
CONTRAINDICATION?
WHAT ABOUT SYSTEMS FACTORS?
LIKE WHAT IF THEY COULD NOT
AFFORD LINASALED, WHAT IF THEY
COULD NOT DO AT-HOME ANTIBIOTICS
FOR WHATEVER REASON?
HOW WOULD THAT CHANGE HOW YOU
MANAGE IT?
I FOUND THIS PART OF TRANSFER IS
WHAT HAS REALLY ELEVATED MY
CLINICAL TEACHING, PE ESPECIALLY
WITH REALLY ADVANCED LEARNERS
WHO I FELT LIKE I HAD LIMITED
THINGS TO TEACH, I FELT BY
MIXING IT UP, I COULD REALLY
HELP STRETCH THEIR LEARNING.
NOW IN THE CLASSROOM, I THINK
THAT THIS IS WHERE CASE-BASED
LEARNING, IT SHOWS US WHY THAT'S
IMPORTANT.
LEARNING ISOLATED FACTS DOESN'T
HELP UNLESS WE CAN APPLY TO
STUFF, AND THIS IS WHY THE
LITERATURE SHOWS THAT THINGS
LIKE PROBLEM-BASED LEARNING,
TEAM-BASED LEARNING, ALL OF
THESE ARE MUCH MORE EFFECTIVE
WAYS TO LEARN THAN JUST GIVING A
LECTURE ON A TOPIC.
SO THINKING ABOUT EVEN IF WE'RE
GIVING A LECTURE, HOW CAN WE
INCORPORATE CASES INTO IT AND
QUESTIONS INTO TO AGAIN FORCE
PEOPLE TO GENERATE INFORMATION
AND TRANSFER INFORMATION TO NEW
CONTEXTS.
FINALLY WHAT ABOUT MASTERY?
THIS IS SOMETHING ALL OF US ARE
WORKING ON NO MATTER WHAT OUR
STAGE OF CAREER.
THIS IS THE CONCEPT OF
DELIBERATE PRACTICE.
THIS IS SOMETHING THAT SOME OF
YOU MAY HAVE READ THE BOOK
"PEAK."
THIS CAME OUT, I DON'T KNOW, 10
YEARS AGO, 15 YEARS AGO, BUT AN
DERS ERICKSON SPENT HIS ENTIRE
CAREER STUDYING EXPERTS AND HOW
PEOPLE BECOME EXPERT.
HE STUDIED CHESS PLAYERS AND HE
STUDIED MUSICIANS AND THIS BOOK
IS REALLY FASCINATING BECAUSE IT
TALKS ABOUT HOW DO PEOPLE
DEVELOP EXPERTISE?
WHY DO SOME PEOPLE BECOME
EXPERTS IN THEIR FIELD AND OTHER
PEOPLE NOT BECOME EXPERTS?
AND ONE OF THE THINGS THAT'S A
CENTRAL PREMISE OF WHAT HE FOUND
IS THAT EXPERIENCE DOES NOT
NECESSARILY EQUAL SPER TEET.
SO HE DIDN'T SAY YOU DON'T NEED
EXPERIENCE, BUT JUST HAVING
EXPERIENCE DOESN'T LEAD TO YOU
BECOMING AN EXPERT.
AND SO HERE IS AN ARTICLE THAT
HE WROTE IN ACADEMIC MEDICINE,
AND HE HAS THIS GRAPH WHICH I
HAVE A LITTLE BIT OF PROBLEM
WITH WHICH WE'LL COME TO IN A
SECOND, BUT HE TALKS ABOUT
PERFORMANCE OVER TIME, AND HERE
HE SHOWS THAT OVER TIME, WHAT
HAPPENS IS, PEOPLE FINISH
TRAINING AND THEN HAVE KIND OF
DEGRADATION OF THEIR SKILLS.
HE TALKS ABOUT PEOPLE WHO ARE
BECOMING FELLOWS OR SPECIALISTS,
REALLY YOUR FELLOWSHIP IS ABOUT
ENGAGING IN DELIBERATE PRACTICE.
YOU HAVE A MORE FOCUSED PATIENT
POPULATION THAT YOU'RE SEEING OR
DISEASES THAT YOU'RE SEEING, AND
YOU'RE ABLE TO LIKE GET REPS
OVER AND OVER AGAIN WITH
FEEDBACK FROM OTHER PEOPLE ABOUT
HOW YOU'RE FUNCTIONING, AND THAT
REALLY HELPS ACCELERATE YOUR
LEARNING, AND THEN YOU CAN
MAINTAIN THAT BUT, AGAIN, THAT
CAN DECAY OVER TIME.
AND SO ONCE WE GET OUT OF
TRAINING, HOW DO WE REALLY
PURPOSELY MAINTAIN THIS CONCEPT
OF DELIBERATE PRACTICE?
THAT'S WHAT ALL OF HIS RESEARCH
WAS ON.
AND IT REALLY COMES DOWN TO
SOMETHING VERY SIMPLE.
YOU HAVE TO ESTABLISH GOALS FOR
YOUR LEARNING.
THEN YOU PRACTICE, AND THEN YOU
GET FEAD B FEEDBACK SOME WAY.
SO THAT FEEDBACK CAN BE
OBJECTIVE FEEDBACK ON YOUR
PERFORMANCE, IT CAN BE LIKE
LOOKING AT YOUR PATIENT PANEL
AND WATCHING PATIENT OUTCOMES,
IT CAN BE PEER FEEDBACK, IT CAN
BE FEEDBACK FROM LEARNERS, BUT
YOU NEED TO GET FEEDBACK SOME
WAY, SEE IF YOU'VE ACHIEVED YOUR
GOALS, AND THEN CONTINUE TO
REFINE THINGS OVER TIME.
THIS IS THE RESEARCH ESPECIALLY
BEHIND PROCEDURES AND HOW WE GET
BETTER AT PROCEDURES.
IT'S LIKE YOU FOCUS AT ONE STEP
OF THE PROCEDURE AT A TIME AND
YOU THINK ABOUT HOW TO PERFECT
THAT AND YOU GET FEEDBACK ON
THAT SINGLE PROCEDURE.
THIS IS THE CONCEPT OF COACHING,
WHEN HE HAS SOMEBODY COME IN AND
WATCH HIS SURGERIES.
THAT'S THE CONCEPT OF DELIBERATE
PRACTICE OF SOMEBODY REALLY
FOCUSING ON HELPING YOU WITH A
GOAL.
SO THIS CAN B BE MORE THAN
PROCEDURES, THOUGH, I THINK
ABOUT THIS WITH COMMUNICATION.
LET'S SAY WE'RE TRYING TO REALLY
IMPROVE TOBACCO CESSATION, IT
REALLY IMPACTS THEIR HEALTH,
ESPECIALLY WITH HIV, WHICH IS AN
ACCELERATOR OF A LOT OF THE
DISEASES.
SO I MAY DECIDE ONE MONTH THAT
I'M GOING TO FOCUS ON TOBACCO
CESSATION COUNSELING.
SO I READ ABOUT IT, I SET GOALS
FOR MYSELF, I PRACTICE THAT SAME
SKILL OVER AND OVER AND FIGURE
OUT HOW I'M GOING TO GET
FEEDBACK.
IS IT GOING TO BE SEEING IF
PATIENTS QUIT, AND THEN ASKING
WHAT WAS EFFECTIVE?
IS IT GOING TO BE ASKING
PATIENTS FOR FEEDBACK?
IS IT GOING TO BE HAVING MAYBE
OUR PULMONOLOGIST IN THE CLINIC
COME AND WATCH ME, WHO DOES THIS
EVERY DAY IN HIS JOB.
FOR CLINICAL REASONING, MAYBE I
WANT TO REFINE SOME OF MY
ILLNESS SCRIPPS AND MY
APPROACHES TO DIFFERENT THING.
SO I HAVE A DIFFERENTIAL FOR
FEVER OF UNKNOWN ORIGIN, I SEE
THIS ALL THE TIME, IT'S PART OF
MY CLINICAL PRACTICE, BUT ARE
THERE WAYS THAT I CAN CONTINUE
TO ADD TO THIS IN A PURPOSEFUL
WAY?
ARE THERE WAYS I CAN REFINE MY
APPROACH AND FOCUS ON THIS FOR A
COUPLE MONTHS AS I SEE PATIENTS
ON THIS PARTICULAR SKILLSET.
OR PHYSICAL EXAM, RASHES, NOT AS
GOOD AS A DERMATOLOGIST, RIGHT?
THIS IS REALLY HARD.
THINKING ABOUT HOW TO DESCRIBE
RASHES, RECOGNIZE RASHES.
SO AGAIN, I COULD FOCUS ON THIS
FOR A MONTH.
BUT REALLY THINKING ABOUT HOW
INSTEAD OF JUST LEARNING EVERY
DAY, WE REALLY FOCUS ON SPECIFIC
GOALS AND TRY TO GET THOSE
BETTER.
SO HERE'S KIND OF A ROAD MAP OF
WHAT WE DISCUSSED.
I KNOW THIS IS A SURVEY OF A LOT
OF PRINCIPLES.
I FOUND IT IN THIS TYPE OF
SETTING, IT'S BEST TO PROVIDE A
LITTLE KIND OF INFORMATION ABOUT
EACH WITH SOME CONCRETE
EXAMPLES.
I THINK IT CAN BE HARD TO GO TOO
IN DEPTH FOR THESE.
BUT IF YOU TAKE NOTHING ELSE
AWAY FROM THIS TALK, WHAT I HOPE
YOU TAKE AWAY IS TO HELP PEOPLE
WITH LEARNING OR YOUR OWN
LEARNING, TO UNDERSTAND WE
REALLY WANT TO SIMPLIFY AND
ORGANIZE CONTENT THAT WE'RE
TEACHING.
WE THEN WANT TO ENGAGE IN
EFFORTFUL REPEATED PRACTICE ON
REALISTIC AND VARIED SCENARIOS.
AND WITH TARGETED FEEDBACK ON
THAT INFORMATION.
AND FOLLOWING THIS IS REALLY
WHAT HAS BEEN SHOWN TO HELP IN
THE SCIENCE OF LEARNING WITH OUR
OWN LEARNING AND OUR TEACHING.
SO IF YOU'RE INTERESTED IN
READING ABOUT SOME OF THIS
RESEARCH AND KIND OF SUMMARY
FORMAT, SPECIFICALLY FOR MEDICAL
EDUCATION, THESE ARE FOUR
WONDERFUL RESOURCES.
THIS PODCAST ON THE CURB SIDERS
TEACH OF THE SCIENCE OF LEARNING
IS EXCELLENT, AND THEN THERE ARE
THREE ARTICLES HERE, HOLLY
GOODING IS ACTUALLY A COLLEAGUE
WITH ME NOW AT EMORY AND TEACHES
IN THE HARVARD MAY SEE COURSE MS
CONTENT, IS REALLY AN EXPERT IN
IT AND REALLY A PHENOMENAL
ARTICLE THAT PROVIDES SOME
REFERENCES.
BUT THE WAY I GOT INTERESTED IN
THIS WAS ACTUALLY THESE BOOKS
WHICH SOME OF YOU MAY HAVE READ,
MAKE IT STICK IN PARTICULAR.
REALLY GOES INTO NOT ONLY WHAT
TO DO BUT THE RESEARCH BEHIND IT
AND SOME EXPLICIT EXAMPLES.
SO I FIND THAT FOR EDUCATORS,
THESE BOOKS ARE REALLY FUN TO
READ AND APPROACHABLE AND I USE
THEM WHEN I AM TEACHING OTHER
PEOPLE AND FACULTY DEVELOPMENT
OR MY MED ED TRACK IN THE
RESIDENCY PROGRAM.
SO I'M HAPPY TO TAKE ANY
QUESTIONS RELATED TO THIS OR
RELATED TO OTHER THINGS.
THANK YOU.
[APPLAUSE]
>> THANK YOU VERY MUCH.
I'M GOING TO HAVE EVERYBODY
REPEAT EVERYTHING SHE SAID JUST
FOR SPACE LEARNING, BUT HAPPY TO
TAKE SOME QUESTIONS.
EXPWR FIRS
>> JIM GILMAN, CEO OF THE
CLINICAL CENTER.
THANKS A LOT FOR YOUR TALK.
I ENJOYED IT VERY MUCH.
BUT I DO HAVE SOME QIS BECAUSE
THE ENTIRE TALK IS FROM THE
PERSPECTIVE OF THE TEACHER.
>> YEP.
>> THERE'S NOTHING IN HERE ABOUT
THE WAY DIFFERENT GROUPS OF
PEOPLE LEARN, NOTHING ABOUT
VISUAL VERSUS VERBAL LEARNERS,
AND I DON'T KNOW WHETHER IT'S
JUST THAT YOU'VE COVERED
EVERYTHING IN THE WAY -- IN ALL
THE DIFFERENT THINGS THAT YOU'VE
DONE, OR WHETHER IT'S NOT
USEFUL, IT'S NOT A USEFUL
CONSTRUCT AND TRYING TO
UNDERSTAND HOW INDIVIDUALS
LEARN.
SO THAT'S -- SO THAT'S A
QUESTION, I GUESS.
>> YEAH, THAT'S A GREAT
QUESTION, AND IT'S ACTUALLY ONE
OF THE MOST COMMON
MISCONCEPTIONS IN LEARNING, AND
SOMETHING THAT I DIDN'T REALLY
KNOW MUCH ABOUT UNTIL MY MASTERS
PROGRAM.
WE ACTUALLY SPENT AN ENTIRE,
LIKE, SESSION ON THIS TOPIC, AND
DEBATED WITH EACH OTHER ON IT
AND READ BOTH SIDES IN THE
LITERATURE.
AND ACTUALLY WHAT THE LITERATURE
SHOWS IS WE TALK A LOT ABOUT
LEARNING STYLES, THERE'S NO
EVIDENCE FOR LEARNING STYLES.
WE SHOULD NOT BE DOING IT AND
THERE'S ACTUALLY EVIDENCE
AGAINST IT, AND SO WE ALL HAVE A
TENDENCY LIKE, OH, I'M NOT AN
AUDITORY LEARNER, WHICH I ALWAYS
THOUGHT ABOUT MYSELF.
I NEED TO LIKE SEE THINGS AND,
YOU KNOW, ALL OF THAT.
WHAT WE'VE LEARNED IS PEOPLE DO
HAVE LEARNING PREFERENCES.
SOME PEOPLE MAY PREFER SOMETHING
BECAUSE OF WHAT THEY'VE BEEN
EXPOSED TO, BUT ADJUSTING TO AN
INDIVIDUAL'S LEARNING PREFERENCE
OR STYLE ACTUALLY DOES NOT
IMPROVE LEARNING.
WHAT'S MORE IMPORTANT IS
THINKING ABOUT THE TYPE OF
TEACHING WE DO DEPENDING ON WHAT
WE'RE TRYING TO TEACH.
AND WHERE PEOPLE'S EXPERTISE IS.
SO FOR EXAMPLE, IF WE ARE
TEACHING A PROCEDURAL SKILL, WE
KNOW THAT YOU NEED HANDS-ON
PRACTICE TO LEARN IT.
RIGHT?
BECAUSE YOU'RE DOING A
PROCEDURE.
AND SO YOU KNOW, PEOPLE TALK
ABOUT BEING HANDS-ON LEARNERS.
WELL, EVERYONE NEEDS DO THAT IF
THEY'RE LEARNING A PROCEDURE.
WE KNOW THAT VISUALS AND WORDS
TOGETHER HELP THE MOST AND IS
THE MOST POWERFUL FORM OF
LEARNING.
BUT INTERESTINGLY, DESPITE THAT
BEING SOMETHING THAT'S ACTUALLY
TAUGHT IN A LOT OF FACULTY
DEVELOPMENT COURSES EVEN,
THERE'S NOT A TON OF EVIDENCE --
THERE'S ACTUALLY NO EVIDENCE
THAT'S SHOWING THAT ADJUSTING TO
PEOPLE'S LEARNING PREFERENCES
MAKES A DIFFERENCE, BUT WE KNOW
THAT BASED ON THE TYPE OF THING
YOU'RE TEACHING IS REALLY WHERE
IT MATTERS.
AND I'M HAPPY IF ANYBODY IS
INTERESTED, FEEL FREE TO EMAIL
ME AND I CAN SHARE YOU THE
RESOURCES WE HAD IN OUR CLASS.
I FOUND IT FASCINATING TO READ
SUMMARIES OF THE RESEARCH BEHIND
IT.
IT'S A HUGE DEBATE IN THE FIELD
STILL, AND THERE'S STILL ONGOING
RESEARCH, BUT SO FAR IT HASN'T
PANNED OUT.
>> HI.
THANK YOU FOR A GREAT TALK.
I HAD A QUESTION MAYBE MORE
SPECIFIC TO OUR SETTING.
AT THE CLINICAL CENTER WE LIKE
TO SAY WE HAVE HIGH COMPLEXITY
AND LOWER VOLUME, AND SO SOME OF
THIS MAY PLAY OUT A LITTLE BIT
DIFFERENTLY IN HOW YOU MIGHT
APPROACH TEACHING.
DO YOU THINK YOU COULD TRY TO
ADDRESS OUR SITUATION HERE?
>> YEAH, ABSOLUTELY.
IT WAS ACTUALLY WONDERFUL TO
JOIN ROUNDS, EVEN THOUGH I WAS
ONLY ABLE TO JOIN FOR SUCH A
SHORT TIME, BECAUSE I THINK THAT
IT'S REALLY AN OPTIMAL
EXPERIENCE TO LEARN HERE, RIGHT?
BECAUSE YOU REALLY GET TO DIVE
DEEP INTO CASES AND REALLY
UNDERSTAND.
THE CHALLENGE, I THINK --
BECAUSE LIKE ON ROUNDS, YOU GET
TO SPEND SO MUCH TIME ON ONE
PATIENT AND YOU GET TO DO
MULTIPLE TEACHING POINTS OF SOME
OF THE NUANCE, WHICH I THINK IS
GREAT.
THE CHALLENGE IS GOING TO BE HOW
DO YOU GIVE PEOPLE ENOUGH REPS
ON DIFFERENT DISEASES TO REALLY
FEEL COMFORTABLE WITH THAT
VARIED CONTEXT, RIGHT?
BECAUSE YOU MAY SEE THE SAME
DISEASE A COUPLE TIMES, BUT
ESPECIALLY SOME OF MAYBE THE
MORE COMMON STUFF, YOU DON'T SEE
AS MUCH.
SO REALLY HELPING, I THINK, WITH
THAT COMPARE AND CONTRAST TABLE
OF OTHER DISEASES THAT MAY HAVE
SIMILAR PRESENTATIONS THAT MAY
NOT BE SEEN QUITE AS FREQUENTLY
IS ONE WAY TO DO THAT, TO
PROVIDE PEOPLE WITH THAT KIND OF
FILLING IN THEIR KNOWLEDGE GAPS.
I THINK THAT THE OTHER THING
THAT'S REALLY IMPORTANT IS USING
THAT TRANSFER OF PROVIDING --
TRANSFERRING TO NEWER VARIED
CONTEXT.
SO EVEN THOUGH YOU MAY NOT SEE A
TON OF CASES OF SOMETHING, YOU
CAN STILL ASK PEOPLE THE
QUESTIONS OF HOW WOULD YOU
CHANGE IT IN THIS SCENARIO OR
THIS SITUATION.
AND I THINK THAT THAT'S
SOMETHING THAT CAN HELP PEOPLE
GET EXTRA REPS SEEING PATIENTS
WITHOUT ACTUALLY HAVING TO SEE
MORE PATIENTS.
SO I THINK YOU CAN STILL
ACTUALLY HAVE THE SAME LEARNING
AND MAYBE EVEN BETTER BECAUSE
YOU'RE ABLE TO REALLY EXPLICITLY
DECIDE HOW DO I WANT TO VARY
CASES INSTEAD OF IN MY
INSTITUTION, WE HAVE VERY HIGH
VOLUME ON OUR ID CLINICAL
SERVICE.
IT'S GREAT, OUR FELLOWS SEE A
HUGE VARIETY, BUT WE MAY NOT
ALWAYS GET TO QUITE AS
EXPLICITLY COMPARE AND CONTRAST
THE DIFFERENT PRESENTATIONS.
SO I THINK THAT THAT PRINCIPLE
IS PROBABLY THE MOST IMPORTANT
TO UTILIZE IN A SETTING WHERE
YOU MAY HAVE LOWER VOLUME BUT
HIGHER COMPLEXITY, IS THINKING
ABOUT HOW DO YOU CHANGE WITH
DIFFERENT NUANCES.
>> ANY QUESTIONS ONLINE?
OKAY.
I HAVE A QUESTION FOR YOU.
SO YOU DID A LOT OF TRAINING IN
YOUR HEALTH PROFESSIONS
EDUCATION.
HOW MUCH DO YOU THINK -- WHAT
DID YOU LEARN IN THAT SETTING
THAT IS TRANSFERABLE TOWARDS
EDUCATION AS COMPARED TO PEOPLE
THAT JUST NATURALLY END UP IN A
CLINICAL TEACHING ROLE, AND WHAT
ARE WAYS WITHOUT ACTUALLY
GETTING A DEGREE THAT PEOPLE CAN
ADVANCE THEIR REPERTOIRE?
>> I THINK THE MOST HELPFUL
THING -- I WAS TALKING EARLIER
WITH SOME OF THE PEOPLE WHO COME
FOR DISCUSSION, LIKE GETTING A
DEGREE WITH ME WAS ABOUT BOTH
BEING ABLE TO DO EDUCATIONAL
SCHOLARSHIP AND NETWORKING AND
ADDING CREDENTIALS TO MY CV THAT
HELPED ME WITH THAT EXPERTISE
PART WITH LESS EXPERIENCE EARLY
ON.
I THINK THAT IN PARTICULAR, WHAT
I FOUND HELPFUL WAS SOME OF THE
EXPOSURE TO THINGS THAT I WOULD
NOT HAVE GONE TO LEARN ON MY
OWN, AND REALLY UNDERSTANDING
THE EVIDENCE BEHIND SOME OF
THIS, RIGHT?
BECAUSE YOU KNOW, I SIT DOWN, I
READ JOURNAL ARTICLES, BUT
REALLY HAVING AN EXPERT IN THE
FIELD KIND OF COMB THROUGH THE
LITERATURE AND REALLY TELL YOU,
LIKE, HERE ARE THE THINGS TO
READ ABOUT LEARNING PREFERENCES
OR LEARNING STYLES OR ABOUT HOW
WE SHOULD STRUCTURE OUR TEACHING
SESSIONS REALLY HELPED ME NOT
ONLY UNDERSTAND THE EVIDENCE OUT
THERE, BUT UNDERSTAND THE GAPS
IN THE EVIDENCE, UNDERSTAND WHAT
WE DO AND DON'T KNOW BECAUSE I
FIND THAT THERE'S LOTS OF MYTHS
AROUND EDUCATION, JUST LIKE
THERE ARE AROUND OTHER THINGS,
AND SO HAVING PEOPLE WHO REALLY,
REALLY KNEW A CERTAIN FIELD LIKE
RENEED YAIGREMEDIATION THAT COUK
ABOUT WHAT ACTUALLY THE EVIDENCE
SAYS ABOUT REMEDIATION WAS THE
MOST HELPFUL.
>> WONDER IF YOU'D LIKE TO
COMMENT ABOUT AUDIENCE
PARTICIPATION, BECAUSE THAT'S
ONE OF THE THINGS THAT'S MISSING
IN REMOTE LEARNING.
WE DON'T ASK THE AUDIENCE TO
RESPOND.
>> YEAH.
NO, I THINK THAT'S A GREAT
QUESTION.
SO THIS IS A BIG DISCUSSION OF
ACTIVE VERSUS PASSIVE LEARNING.
SO WE KNOW THAT PEOPLE HAVE TO
MANIPULATE INFORMATION IN SOME
WAY IN ORDER TO LEARN IT.
AND SO SOME PEOPLE ARE SITTING
IN A LECTURE AND DOING THAT,
RIGHT?
THEY'RE TAKING NOTES, THEY'RE
THINKING ABOUT THINGS,
CONNECTING IT TO KNOWLEDGE, BUT
WE CAN'T ENSURE THAT EVERYBODY
IS.
AND THAT'S EVEN HARDER WITH
VIRTUAL TEACHING, ESPECIALLY
BECAUSE PEOPLE ARE ON A DEVICE
AND MAY ALSO BE DOING OTHER
THINGS.
I MEAN, I DO, RIGHT?
LIKE, WE ALL TEND TO MULTITASK.
AND SO WAYS TO DO IT IN VIRTUAL
TEACHING IS USING A LOT OF THE
SAM THING.
THE -- SAME THING.
SO USING POLLING, PEOPLE HAVE TO
PARTICIPATE IN THAT.
HAVING GUIDED HANDOUTS WHERE
PEOPLE ARE TAKING NOTES, AND
I'VE FOUND SOME OF THE MOST
HELPFUL THINGS FOR VIRTUAL
TEACHING IS FOCUSING A LITTLE
BIT LESS ON THE CONTENT
DELIVERY, BECAUSE IF I'M JUST
TEACHING SOMEBODY INFORMATION IN
A VIRTUAL SETTING, WHY DON'T I
JUST RECORD IT AS A VIDEO AND
HAVE THEM WATCH IT, RIGHT?
BECAUSE REALLY, IT KIND OF THE
SAME THING.
THEY'RE WATCHING A VIDEO
ALREADY.
IT'S DIFFERENT THAN AN IN-PERSON
LECTURE THAT WOULD BE REALLY
DIFFERENT FROM A VIDEO, AND I
TRY TO USE THAT TIME AS LIKE A
BRIEF DIDACTIC, BUT MORE
APPLYING TO CASES AND THINGS
LIKE THAT.
SO IF I'M DOING CLINICAL
TEACHING, I APPLY TO CASES
EITHER THROUGH AUDIENCE
PARTICIPATION WITH QUESTIONS,
SOMETIMES I'VE HAD PEOPLE TYPE
THINGS IN THE CHAT.
I USE A LOT OF OTHER VIRTUAL
LIKE BULLETIN BOARD TOOLS LIKE
PADLET, WHERE I CAN PUT PEOPLE
IN BREAKOUT ROOMS AND THEY CAN
ACTUALLY, LIKE, PUT THINGS ON.
HOW TO EFFECTIVELY DO BREAKOUT
ROOMS AND SOME OF THOSE IN A WAY
THAT DOESN'T MAKE EVERYBODY
GROAN IS LIKE A WHOLE SEPARATE
TALK BECAUSE I THINK WE'VE ALL
BEEN IN LIKE REALLY AWFUL
BREAKOUT ROOMS AND SESSIONS LIKE
THAT THAT TRY TO BE TOO
INTERACTIVE AT NOT THE RIGHT
TIME, BUT I'D SAY THAT FOR A
SESSION WHERE IT'S PART OF A
COURSE, THINKING ABOUT HOW TO
USE SOME OF THESE THINGS THAT DO
FORCE PEOPLE TO ENGAGE IS
HELPFUL, BUT IF YOU'RE TEACHING
AT A CONFERENCE AND DELIVERING
INFORMATION TO EXPERTS, HONESTLY
A LECTURE IS EFFECTIVE BECAUSE
PEOPLE ARE ADDING ON SLIGHT
NUANCED KNOWLEDGE IN THAT
SETTING SO I DON'T THINK WE HAVE
TO DEVIATE FROM THAT NECESSARILY
AND PEOPLE WILL PAY ATTENTION TO
WHAT'S EFFECTIVE FOR THEM TO
LEARN.
>> MAKES SENSE.
THANKS.
>> ALL RIGHT.
WELL, I'M HAPPY TO STICK AROUND
IF ANYBODY HAS ANY ADDITIONAL
QUESTIONS AND THANKS FOR COMING.
[APPLAUSE]