FEATURE
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"IF A LEARNING METHOD IS CLUNKY AND SLOW,
SWITCH TO ANOTHER METHOD. AS AN EDUCATOR,
MENTOR OR PARENT, YOU SHOULD PRAISE KIDS
FOR BEING INTELLIGENT."
Learning for maximum retention is hard. Martin tells his kids it’s
good if homework “hurts your brain.” The brain is like a muscle.
Researchers have found that a slower apparent rate of accumulation
[leads to] greater accumulation of skill and learning over time.
Grit predicts success in education. This is why we should praise
children for working hard, not for being smart. This lays the foun-
dation for a “growth mindset.” Perhaps we should tell our medical
students: “you aren’t that smart, but you have a top one percent
work ethic!”
"JUST PUT IN THE TIME AND THE MATERIAL WILL
STICK. INTENSIVE WEEKLONG BOARD REVIEW IS
THE BEST WAY TO LEARN THE MATERIAL."
As noted above, one must work smarter, not harder. The 10,000
hour rule does not equate to mindless massed practice. Purposeful
practice involves goals, intense focus, feedback and leaving the
comfort zone. Deliberate practice takes this up one level by adding
a coach. You have to put in more than just time.
Weeklong board review right before an exam may add a few points
on a test, but very little of this information will be retained long-
term. This is the reason for the term “continuing medical education.”
Unfortunately many doctors take a recertification test once every
10 years and cram their annual CME credits in at the last minute.
"SOME PEOPLE JUST HAVE STRONGER MEMORY
RETENTION."
We intended to create a hyperbolic example of learning to jam
all of these principles into one exercise. But medical training already
invented such a practice in roughly 1628 C.E. Say what you will about
pimping, this [Socratic?] method of instruction utilizes just about
every aspect of effective learning. Retrieval is the cornerstone, it uses
testing to learn, one must generate the answer, one must elaborate
and potentially apply a rule to different examples, lessons learned
are by association with patients, interleaving and varied practice are
inherent, you might be interrupted (correct or not) and certainly
will have distractions, the group is standing and often walking,
providing both brain perfusion and different environmental cues.
And let us not forget about the feedback from your “coach” as she
employs desirable difficulties to euthanize your fluency illusions.
References:
Boster. U. (2017). Learn Better: Mastering the Skills for Success in
Life, Business, and School, or, How to Become an Expert in Just about
Anything. Rodale, Inc.: New York, NY.
Brancati, F. (1989). The Art of Pimping. JAMA, 262, 89-90.
Memory is highly trainable, its drastic improvement being truly
straightforward. Though a strong memory has fallen out of favor in
our era of information overload, ancient cultures assumed everyone
could form his own memory palace. Memory, like learning, is a
skill to be cultivated. Brown, P.C., Roediger III, H.L., & McDaniel, M.A. (2014). Make it
Stick: The Science of Successful Learning. Harvard University Press:
Cambridge, MA.
"WE ALL HAVE OUR OWN LEARNING STYLES. " Duckworth, A. (2016). Grit: The Power of Passion and Perseverance.
Scribner: New York, NY.
Contrary to popular belief, very little data support the existence of
learning styles. Howard Gardner proposed intelligence types in his
book, Frames of Mind, largely without evidence. Sternberg proposed
the following learning styles: analytical, creative, practical; still
with minimal evidence. Data seem to show that people learn best
with the method that matches the subject matter, NOT individual
learning styles. We learn music by listening, art by looking, and
math by doing. There is some evidence to suggest the idea of learn-
ing preferences (e.g., I like flipping through PowerPoints) but not
ingrained, biological ideas of learning styles. Importantly, a strong
belief in learning styles may divert some students from unfamiliar
methods of learning.
16
With full-time educators finally seeing these myths busted, it
is time for physicians to incorporate more efficient learning, aka
transference of knowledge for future application. We have the
responsibility to continue teaching ourselves, and to impart both
knowledge and wisdom onto the next generation. We should all
attempt to adopt more deliberate practice at work. Atul Gawande
gave a TED talk on hiring a coach to help him improve as a surgeon.
He is serious about the practice of medicine. When do practicing
physicians get feedback? How much deliberate practice do even res-
idents receive? Ten thousand hours represents a desirable quantity,
but quality is necessary for learning complex skills or information.
We challenge you to abandon these learning myths and actively
improve your knowledge and skills.
LOUISVILLE MEDICINE
Carey, B. (2015). How We Learn: The Surprising Truth about When,
Where, and Why it Happens. Random House: New York, NY.
Dweck, C. S. (2006). Mindset: The New Psychology of Success. Ballantine
Books: New York, NY.
Willingham, D. T., Hughes, E.M., & Dobolyi, D.G. (2015). The Scientific
status of learning style theories. Teaching of Psychology, 42, 266-271.
Dr. Huecker is a practicing UofL Emergency Medicine Physician and
Faculty Member.
Dr. Horn is an Education Learning Specialist for the UofL School of
Medicine Office of Medical Student Affairs.