I’d like to devote this blog article to our students and learners in our program.  They’ve been on my mind a lot lately for different reasons.
For example, Matthew Church, Meds 2015 was recently a Jeopardy star, http://meds.queensu.ca/announcements?id=648, Karen Chung Meds 2016 is a volunteer star http://www.thewhig.com/2013/11/22/a-special-birthday-meal, and Sophie Palmer, Meds 2017, is a writing star.  (Her winning entry for the Dalhousie Department of Psychiatry Annual Student Writing Contest, entitled EtOH,  will be posted soon at: http://www.medicine.dal.ca/departments/department-sites/psychiatry/education/medical-humanities/writing-competition.html.

Other stars in the firmament are Eric Blanchard, Meds 2015 who  is playing in the OUA singles badminton championships on March 7  and Eve Purdy, Meds 2015, who was selected as the inaugural recipient of the Samuel Wigdor Scholarship for pre-clerkship scholarly excellence and plans to attend the Social Media and Critical Care Conference (SMACC) in Queensland, AU from Mar. 15 – 23, 2014 .

starsAnd those are just five of hundreds of stars in our program—students who by their volunteer work, their work in student leadership, their work in interest groups, their application to their research, and their focus on their studies are shining, however subtly and quietly.

It’s a pleasure to work with our students and to help faculty learn more about learners, and so I thought I’d write about a few things that have cropped up recently to do with learners.

I’d like to visit  some learning theories that we actually use (and can always use more) in our curriculum:  Experiential Learning, Learning Retention, and Learning Styles.  You can dip into these as you like.

Experiential Learning:  What is it?  How can it help teachers and learners?  How can teachers be involved?

We had a challenge a few years ago, posed by our accreditation review team, and echoed by other pedagogical concerns.  Why are the first two years of medical school so lecture heavy, with little experiential learning and the remaining two years are heavy on experiential learning with little traditional but active classroom learning?

What is it?

Experiential learning involves concepts of internship, making discoveries firsthand, learning through observation and interaction, learning by doing, and shadowing as components of the learning. Formally, Experiential Learning Theory (ELT) seeks to pass on the legacy of those twentieth century scholars – notably William James, John Dewey, Kurt Lewin, Jean Piaget, Lev Vygotsky, Carl Jung, Paulo Freire, Carl Rogers, and others – who placed experience at the center of the learning process, envisioning an educational system that was learner centered. ELT is a dynamic view of learning based on a learning cycle driven by the resolution of the dual dialectics of action/reflection and experience/abstraction.  (Kolb & Kolb, 2012, 149)

I was influenced by David Kolb’s Experiential Learning Model (Kolb, 1984) years ago, and Meds students may recognize it translated into our sessions on reflection and critical analysis.   Kolb defined experiential learning as “the process whereby knowledge is created through the transformation of experience. Knowledge results from the combinations of grasping and transforming experience.” (Kolb 1984, p. 41). His model involves a cycle of concrete experience that looks like this:



Experiential learning involves skills as well as motivation:

  • The learner must be motivated to be actively involved in the experience;
  • The learner must reflect on the experience;
  • The learner must employ analytical skills to conceptualize the experience; and
  • The learner must activate decision making and problem solving skills to apply new ideas gained from the experience.

First Patient Program:  Our way of bringing experiential learning into the curriculum: 

One way to bring experiential learning into the first two years of our program was our First Patient Program, proposed by Associate Dean, Dr. Tony Sanfilippo.  This program, where students are paired with a patient from the community who becomes their teacher, has so many benefits.  Dr. Sanfilippo literally carries around reports from the students to show people what they are learning that they could not learn so early in a classroom.  Here’s an excerpt from a new one I know he will want to carry around from a second year student:

I think the biggest change in thinking for me was a better understanding that care for patients doesn’t end when they walk out the door, not matter what specialty they’re in..

This program has highlighted the strengths and weaknesses of our health care system for me.  One the one hand, I have gotten a better understanding of the ways health care professionals of all fields can cooperate in the care of a single patient.  On the other hand, I’ve also seen how that communication can break down and how difficult it is for a patient to advocate for themselves in a medical system that is very complex.

I’ve realized that advocacy doesn’t have to be all grand gestures and tidal waves of change;  even small things can make a big difference in the lives of your patients.

My overarching goal is to learn enough about the health care system to be able to help patients navigate it…One other goal for me is to have a better idea of the scope of practice of allied health care professionals…

Now you can be sure that the student has written extensively on all these points–I’m just giving you a taste…but you can image what she has learned!

How can faculty become involved?  Our learners need patient volunteers from the community, so if you can recommend a patient, please contact Kathy Bowes, so the students can continue to have these insights. (kathryn.bowes@queensu.ca)

How do learners retain learning? 

Meds student Rebecca Wang asked me recently to answer some questions for writers from the Queen’s Medical Review (http://qmr.qmed.ca/) about ways to enhance student retention of learning.  Here are some recommendations I had from educational and psychology literature:

Here are my top 4 tips for students to retain and retrieve knowledge:

  1. First is paying attention in class and that means no Facebook, games, etc. Multi-tasking is not what it is cracked up to be according to the literature—and we tend to delude ourselves about what we accomplish (Ellis& Jauregui, 2010). While I’m mentioning classes, I should mention pay attention to the learning objectives…either in MEdTech or on the slides—they will give you the outline of required knowledge which will help you study.
  2. Secondly, and there is some cool data to support this, take notes.  If a faculty member provides all the notes, and you “listen” only, you’re not embedding it into your memory well.  A great study on partial notes suggests that students who take notes not only do better on the assessment, but also do better on the higher order skills tested. (Cornelius and Owen-DeSchryver, 2008).
  3. Thirdly, review—and review through questioning.  Review on a weekly or “spaced” schedule and incorporate answering mock questions into your review.  I know many of you are in study groups.  If everyone built 1-2 questions after a session and “tested” your study partners and gave feedback about the answers, you’d be helping your retention and that of others.  Don’t forget to try short answer questions as well as MCQ.
  4. My biggest tip is to manipulate what you’ve learned.  My recommendation of this is   to shape information into a graphic organizer. You may recall Dr. Lee’s algorithm for hematapoeisis or some of the schemas for approaching a clinical presentation.  This is taking information and putting it into a systematic graphic figure or organizer.  Anything from a table or “T chart” which compares data, to an algorithm, or a “fishbone” chart (shows cause and effect) to a diagnostic schema or flowchart which you can fill in with what you’ve learned, or a “concept” map which show relationships, will help you retain and understand.

I’d like to say something about concept maps—I used them all the time in education and I don’t know why they’re not more popular in medicine– Complex concepts can be related to one another in numerous ways, and depicting correct relationships among concepts is central to all graphic organizing techniques (Halpern and Hakel, 2010).   If some of you try this and find it helps, I’d love to hear about it!graphic organizer fishbone

Interested in reading about this?  Here are three articles I recommended to the students:

Dunlosky, J. et al. (2013). Improving Students’ Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology.  Psychological Science in the Public Interest.  Association for Psychological Science.

Halpern, D. F. & Hakel, M.D. (2010).  Applying the Science of Learning to the University and Beyond: Teaching for Long-Term Retention and Transfer.  ChangeThe Magazine of Higher Learning

Bjork, R.A. et al. (2013). Self-Regulated Learning: Beliefs, Techniques, and Illusions.  Annu. Rev. Psychol.

And here’s something about graphic organizers: 

Hall, T., & Strangman, N. (2002). Graphic organizers. Wakefield, MA: National Center on Accessing the General Curriculum. Retrieved Feb. 2, 2014 from http://aim.cast.org/learn/historyarchive/backgroundpapers/graphic_organizers#.UvBGgfuwUR8

The Graphic Organizer: http://www.graphic.org/index.html, retrieved Feb. 2, 2014.

How can teachers help students retain their learning? 

Here are some suggestions that I’d like to invite you to consider for your teaching:

1.  Make your learning objectives apparent and specific (They should be one of the first slides in a slide deck and also on the learning event page.)  By the end of your session, what will students know, do, experience?

2.  At the end of a session, or at the end of a concept, give students a chance to formulate questions (short answer as well as MCQ) that they can use to quiz themselves and each other.  Share these among the groups, and within the class.

3.  Become part of a spiral throughout a course and throughout a curriculum.  So, refer back to relevant pieces of the course, or other courses.  Refer forward to relevant pieces of the course, and other courses. Use links to other events in our Learning Management System, MEdTech to make the spiral approach explicit.   In other words, situate the learner, and help them see relationships among the concepts.

4.  Use graphic organizers.  It helps students to situate material, and it helps them organize what can be a huge sea of learning.  It gives them a “life raft.”  OR give students a blank organizer and challenge them to fill it in through the class.

5.  Not all learning can be retrieved through multiple choice questions.  Sometimes a short answer question that requires students to think, evaluate, and put pieces together is a better test of learning.

Learning Styles:  What are they?  How can they help learners and teachers?

And speaking of learners, recently too, Meds 2015  student Eve Purdy wrote to me asking about learning styles.  She’s bumped into them on elective.   It’s a controversial topic in educational literature, because on the one hand, it’s so attractively intuitive and lends itself to so many ah-ha moments, but on the other, there are criticisms of learning style theory’s evidence base, its focus on matching teaching to learning styles, and the profit that is being made from many different companies that espouse learning style questionnaires, etc.

I don’t want to get into that debate here.  Pashler does it for us, in Pashler, H., McDaniel, M., Rohrer, D.;, Bjork, R. (2008). Learning styles: Concepts and evidence. Psychological Science in the Public Interest 9: 105–119.

What I would like to speak to you about is how you can use literature around learning styles.

Learning styles theories are all very intuitive and make people very excited.    I personally find the Kolb inventory based his experiential learning cycle, useful and probably the most evidence based.  Here’s a nice summary
http://www.simplypsychology.org/learning-kolb.html  and here’s a visual where the learning preferences are mapped to the cycle from above.

kolb's cycle


Visual Auditory Reading/Writing Kinesthetic (VARK) is another the other popular learning styles model: http://www.vark-learn.com/english/index.asp.  Gardner wrote about multiple intelligences as well.  And there are other theories.

This article summarizes some them and provides the counter argument.  http://chronicle.com/article/Matching-Teaching-Style-to/49497/  It has a chart that summarizes 4 main theories.

Educators have been told there is a problem with the evidence behind these theories.  Critics argue that there are almost no randomized control trials to support them except for Kolb’s original research.  Other criticisms are that accomplished learners switch styles/preferences due to needs and contexts, that money is being made from these theories as learning style questionnaires proliferate, to name a few.

But what teachers find helpful is that thinking about learning styles alerts them to the concept that learners tend to approach material in different ways, or enjoy/prefer learning in different ways.  Therefore it  is practical to include a variety of modes of learning to appeal to different learning preferences.  Learners approach learning in different ways depending on context, habit and training and most importantly topic. So focusing on the best way to teach a specific skill, concept, etc. is a good use of teacher planning time.

So what do I use learning theory for?  I look at is my own style as a teacher and determine if that is serving all students well. (I’m an R in VARK, and Accommodating:)  I think it’s safe to say that I need to fine-tune my teaching and add other styles, because I do rely on my own “style” a great deal.

I consider that some topics lend themselves more to kinesthetic learning for example.  So  I don’t try to lecture too much about skills–I get everyone to practise the skill.  I also try to ensure that I balance my different modes of teaching so that I’m not always engaged in one mode. Finally, when students are having trouble understanding, I know that I can switch to another mode or style to give them assistance.  And knowing that we all learn differently at different times is in itself very helpful.partner work

And meanwhile, asking students to take learning style inventories helps them become more “metacognitive”, more aware of their own learning, which is a key piece in developing active and self-regulated learners.

We’re at the end!

Whew!  From our learning stars to learning styles!  We’ve come a long way!
Thanks for sticking with me as we wound our way around some learning theories!  Let me know what your thoughts are about these concepts.
And please join me in applauding all our learners!