A decade of education theory; the rise and rise of cognitive science of learning.

Education theory moves slowly – I could simply finish this blog with “Sweller has tweaked his Cognitive Load Theory a bit but it makes very little difference to the educator on the ground” – so instead, I’m going to look at what older evidence based ideas we have started to apply to teaching and learning and what we have abandoned.

What we have abandoned?

Learning styles/learning preferences.

These have finally had their day. The evidence simply does not support them as a valid learning theory anymore as they have been disproved time and time again. Despite this they keep rearing their ugly head, kept alive by out of data education courses, those with a financial interest in them and the general feeling we often have in that “I’m a [fill in one of the numerous different combination of learning styles] learner.” You’re not… an auditory learner didn’t learn to cannulate by listening to someone talk about it in the same way as a kinaesthetic learner didn’t learn about the clotting cascade by cutting themselves and really feeling it! – rant over.

Pendleton’s rules of feedback 

To be fair to Pendleton, his initial work on this wasn’t too bad. Unfortunately over the years practitioners evolved it in to the simplified shit sandwich of “what did you do well”, “what didn’t you do well”, “what else went well”.

What have we adopted 

Cognitive Load Theory 

Cognitive Load Theory
Cognitive Load

Proposed by John Sweller 20 years ago now but has come more to prominence in the last decade, Cognitive Load Theory is one of the most important theories in education. The idea that working memory is fixed in size and under 3 different loads when processing information. The intrinsic load, which is the load created by the essential information to be learned; the extraneous load, which is the load created by processing  the way in which that information is delivered to the learner; the germane load; which is the load created by the understanding of the information. By controlling the extraneous load through the way we teach we can try to ensure we leave enough working memory free for germane processing.

Dual Coding Theory

Dual Coding

This one goes back even further, to the work of Alan Paivio (amongst others) in the 70s but has had a new lease of life recently with the rise of the cognitive science of learning. The premise is that words and images are processed in separate areas of the brain, creating 2 distinct mental models of the same piece of information. When combined with prior knowledge of the subject it gives the learner 3 times the chance of recalling the same information. Imagery here means not just pretty pictures in presentations to support the words but the use of drawings, icons, flow charts and diagrams to demonstrate what the words mean. This improves the improves the computational efficiency of the information (reduces the extraneous load) when compared to words alone. In my opinion the application of this theory is one to watch in MedEd as it’s already proving to be a bit of a game changer in the school classroom.

Sleep

How learning occurs during sleep

It is thought that sleep has an important role in learning. During sleep we forget things we don’t need anymore [what we had for lunch 2 days ago]; we consolidate things we have recently learned; we make connections between new this learning and previous knowledge and we mentally rehearse new kinaesthetic skills.

The cognitive science of learning.

5 learning strategies that have stood up to testing so far.

Retrieval practice.

All the evidence over the past decade shows that easy learning leads to poor retention. Self testing through retrieval practice is the best ways of retaining information in the long term.

Spaced practice.

Rather than mass study sessions, using retrieval practice little and often is a far more effective learning strategy. One hour a day for 5 days is more effective than 5 hours in one day.

Interleaving.

We have a habit when studying to block study; 1 week cardiology; 1 week respiratory; 1 week gastro; 1 week MSK etc. A more cognitively efficient way of studying is to mixing up our subjects, which allows us to see potential connections between our areas a study (such as potential causes of chest pain in the above). I should be point out that in order for interleaving to work it has to be related subject matters.

Concrete examples.

This is taking a concept and providing and example and seeing how many different examples you can provide. In order to do this you need to have fully understood the concept.

Elaboration.

This covers a multitude of strategies but includes explaining connections or differences between different concepts such as between ascites and pleural effusion. In order to be able to do this it needs to be understood at a deeper level than the superficial.  

Feedback

Lots has been written at St Emlyn’s on the importance of feedback. I would summarise it as aligning your feedback to the type of feedback the leaner needs at the time, whether that’s appreciation of effort or a job well done, coaching to improve performance or evaluation of whether the learner is below, on or above the expected bar for their stage of training or career.

Take home

The Learning Cycle

There’s really no new theories but all the studies of the last decade show that we need to balance our learners cognitive load, use visuals to show rather than to tell, encourage sleep, encourage our learners to use retrieval methods at spaced intervals, and provide feedback on what they retrieve in order to know that they’re retrieving the right thing.

BW

N

@nickharveysmith

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Posted by Nick Smith

Nick Smith RN is a registered nurse and head of clinical teaching & assessments for undergraduate medical education for a hospital Manchester. He has a background in intensive care medicine, EM and resuscitation training. Nick is a technical guru who supports the St Emlyn's team with audio visual needs. He regularly wins awards for teaching excellence at the University of Manchester.

  1. I agree with much of what Nick has written here but would add two theories that continue to have resonance for CME: group dynamics and situated learning. The first of these has significant impact on our understanding of the complexities of team working, particularly in encouraging resistance to “buying in” of unproductive and unhelpful behaviours. The latter has a lot of explanatory power, particularly related to induction into communities of practice and how these can be encouraged to function as dynamic organisations rather than protectors of established, possibly ineffective behaviour.

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  2. Thanks for this overview, really clear!
    There’s a couple of spelling / grammar mistakes though where a few of the sentences don’t match. Makes the piece slightly less professional, could do with an extra proofread to fix these!

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Thanks so much for following. Viva la #FOAMed

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