The Knowledge that Represents Phenomena in the Subject Domain

Learning medicine requires the memorization of a tremendous amount of facts, theories, skills, etc. Remembering is a key requirement for the most common type of clinical reasoning, Forward Thinking.


So let's examine how memory works. We remember because of the way information is stored and because of the way it is accessed. We need to help students store information, so it can be accessed in the long term.





Passive vs Active Learning
Ask yourself, "What is the goal of teaching?" Studies have shown that students who passively sit and listen to lectures remember about 10% at the end of the lecture, whereas students who are actively engaged mentally and physically will remember about 40%. So if they passively listen to you lecturing about 100 items, they will remember 10. If you engage them with 50 things, they will remember 20. Yes, you taught less but they remembered more.

Recognition vs Knowing
Recognition is not understanding; it is the first step on the journey. In the Cycle of Learning, recognizing that you have heard this before is part of the transition between Unconscious and Conscious Incompetence. This is one of the issues with multiple choice questions; students use their recognition of words to make decisions that they really don't understand.

The Content Jungle
Listen to a podcast about this important concept.

Working Memory
In order to store information in long term memory, the student has to actively manipulate it in working memory in some way. In order to manipulate it, they have to be paying attention. The human attention span lasts about 15 minutes and that decreases if students are fatigued, hungry or distracted with personal issues. Think of your voice as a hypnotic agent, the students look like they are paying attention but they won't remember the experience. As a teacher, you need to do something every 15 minutes to refocus attention:

1. Pausing allows students to reflect and move what they have been hearing from working into short term memory
2. Asking for questions refocuses attention even if no one responds
3. Changing topics
4. Changing focus by introducing a case, telling a story, making them laugh
5. Involving the students in a short activity such as a quiz, demonstration or game.

Working memory has a limited capacity, so divide your content into chunks of about 7 or fewer items. Allow students to process the 7 items by actively engaging them through questions, group activities, memory devices (see linked storage below). Then you can present 7 more items.

Random Storage: Many students make the mistake of memorizing what they need to know as discreet facts. They stuff as much information into their memory as they can. They use techniques such as cue cards to remember long enough to write an exam; then cram in more discreet information. I call this bulimic learning because, although they are stuffing themselves, they lack real knowledge. Most of this information will be lost over the long term because the student doesn't remember where they stored it.

Linked Storage (Long Term Storage): Information that is linked to something else is easier to memorize and easier to retrieve later because the links connect memories together. If you remember one link, it will be easier to retrieve other links. The most common links are: Relevance to the daily activity of physicians. See Illness Scripts for an example of making this link. Patterns such as numbers, mnemonics, songs, more songs, algorithms and humour that assist in serial recall Closed questions that link previously learned material to new material Images that hold a symbolic or emotional meaning for the learner Questions used as advanced organizers for focusing attention during pre-reading that assist in cued recall.

This illustration is based on my 50 year old memory of learning the Great Lakes in Grade 3: Huron, Ontario, Michigan, Erie, Superior. I would not have remembered them this long without this device.

Spacing Effect
Storage needs to be reinforced over time, so it's important to reinforce links between previously learned and new material as well as reviewing the material. PowerPoint Games and student response clickers can be used for this type of activity. Application exercises (working through real or virtual cases, especially in peer groups) are the best ways of reviewing and reinforcing previously learned material. Other ideas for using remembered information to complete more complex thinking tasks are available here. Anki is a website based on this concept that helps students set-up flashcards where content is reviewed at set intervals.

Something to Think About

Now, information becomes obsolete quickly—and because it’s always retrievable at the click of a mouse, a well-educated person is not necessarily one who stores great amounts of knowledge, but rather one who knows where to find what he needs when he needs it.- Don Tapscott in Growing Up Digital

Resources

Why One Way Of Learning Is Better Than Another A new study from the Montreal Neurological Institute and Hospital (The Neuro) of McGill University reveals that different patterns of training and learning lead to different types of memory formation. The significance of the study, published in the Journal of Neuroscience, is that it identifies the molecular differences between spaced training (distributed over time) and massed training (at very short intervals), shedding light on brain function and guiding learning and training principles.



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