How Medical Students Learn

Objectives
Upon completion of this workshop, you will be able to: define learning describe how retention of memorized material can be improved describe how to help students improve clinical reasoning and problem solving skills describe the Skill Learning Cycle.

Case of Professor Click

Professor Click has been teaching for 35 years and prides himself in his ability to keep the attention of his students through a mixture of lectures and storytelling. His students find him immensely entertaining and rate him highly on the class evaluations.

Question
If the goal of teaching is to improve learning, how does Professor Click know that students are learning?

Educational Principle #1

Just because you said it, doesnt mean it will be remembered.

Definition of Learning
Learning is viewed here as developing a way of thinking and acting that is characteristic of an expert community. Such a way of thinking consists of three important elements: 1. the knowledge that represents phenomena in the subject domain 2. the thinking activities that construe, modify and use this knowledge to interpret situations in that domain

3. and to act in them.

Billet, 1996 Situated learning: bridging sociocultural and cognitive theorizing Learning and Instruction, 6

Memory
1. the knowledge that represents phenomena in the subject domain
Its only when your memory is engaged in the learning process that your brain is really challenged
Dr. Michael Merzenich

Working Memory

Long Term Storage

Memory Retrieval

Working Memory

Attention Rule of 7 Relevance

Focus attention Questions Change activity every15 minutes

Teach < 7 steps

Numbers aide memory

Importance
Make connections

Long Term Storage

If information is not stored as part of a pattern, it can be slow to impossible to retrieve. Expert Physicians have 100,000s of constantly renewed patterns that help them make decisions quickly.

Illness Scripts

Repetition

Wozniak, 2006

Memory Retrieval
1. Use Retrieval Devices Mnemonics, songs, rhymes, flash cards http://www.ichi2.net/anki/ http://www.medicalmnemonics.com/

2. Reinforce the Use of Illness Scripts http://www.medmaps.co.uk/

3. Repetition Games, questions, cases, connections
http://jc-schools.net/tutorials/PPT-games/

Educational Principle #2

Just because you remember something doesnt mean you understand it!

Clinical Reasoning
2. the thinking activities that

construe, modify and use this knowledge to interpret situations in that domain.
Learning depends on the transformation of information into knowledge
Dr. Frank Papa

CASE Curriculum Model

C ooperative A ctive S elf directed E xperiential

See http://medicaleducation.wetpaint.com/page/CASE+Curriculum+Model for more information

Top 4 Techniques
1. Cases, Cases, Cases
Cases Journal http://casesjournal.com/

2. Socratic Questions
http://medicaleducation.wetpaint.com/page/Using+Questions+to+Stimulate+Thinking

3. Intentional Role Modeling

http://medicaleducation.wetpaint.com/page/Intentional+Role+Modelling

4. 5 Minute Preceptor
http://www.practicalprof.ab.ca/teaching_nuts_bolts/one_minute_preceptor.html#

Acting Like a Physician

3. and to act in them.

A survey of 181 doctors, has shown that from ten of the procedures medics are officially required to be competent at, most are only confident of their ability to perform five.
-Graeme Baldwin, BMJ Journal

Skill Learning Cycle

New Challenges

Unconscious Incompetence

Awareness

Unconscious Competence
Practice

Conscious Incompetence
Conscious Competence

Explicit Teaching

Reassurance