Transcript Technology and Education

Engaging
Health Professionals and
Trainees in
Online Learning
Graham McMahon MD MMSc
[email protected]
The World of Medicine is Changing Fast

Hard to anticipate how
this generation of
learners will be
practicing?
Our learners have changed:
Some Characteristics of Millenials






have never known a life without computers and the Internet
generally began using computers between the ages of 5 and 8;
almost all used computers by age 16
are more accustomed to using keyboards rather than pens or
pencils
generally prefer to read information from computer screens or
mobile devices rather than from printed texts
have more friends in social networking sites than in person
have spent more time playing games than reading books
More standardization?


Create new standards
Raise standards
Standardization  Conformity
vs.

Engage the heart


Engage the mind



Goal that is meaningful (task vs. knowledge orientation)
Interesting achievable task
Personalized feedback over time
Engage with others

Nurture collaboration
Information is Ubiquitous and Easily
Accessible
Challenges
The Challenge

Millenials don’t need information; they need





Prioritization
Context
Understanding
Feedback
The Challenge: Engage Learners



Variety
Style
Interactivity
Unique Issues

The technological forces that have affected this generation necessitate
 digital multitasking and

interaction in online communities

Individuals raised with computers deal with information differently
compared to previous cohorts: “They develop hypertext minds, they leap
around.”

Efficiency is very important
Issues for Learning





learn better through discovery and experiential learning
rather than by being told
want an immediate response
have the ability to shift their attention rapidly from one
task to another and may choose not to pay attention to
things that don’t interest them — attentional deployment
believe multitasking is a way of life and are comfortable
when engaged in multiple activities simultaneously
respond to visual cues and stimuli
The Decline of Experts


Millenials are interactors – creating and consuming information
Old Model:
 Reputation
Experience
 Access
New model:
 Crowd
 Someone with experience
 Anyone with an opinion


What are gamers getting good at?

Urgent optimism



Tight social fabric


Ability to engage immediately with a problem where there is a
reasonable hope of success
“always worth trying, and trying now”
Takes a lot of trust to play a game with someone
Blissful productivity

Happier working hard gaming than relaxing
Emotion and Learning

Students retain what they learn when the learning is
associated with strong positive emotion.


Dulay & Burt, 1977; Krashen, 1982
Stress, boredom, confusion, low motivation, and anxiety
individually, and more profoundly in combination, interfere
with learning

Christianson, 1992
Attributes of Engaging Games







Clear and consistent rules
Clear goal
Clear rationale
Mission connected to and dependent on your ability
Plenty of support
Lots of positive feedback
Shared experience
Educational technologies are
advantageous in providing:










safe, controlled environments that eliminate risk to
patients
enhanced, realistic visualization
authentic contexts for learning and assessment
documentation of learner behavior and outcomes
instruction tailored to individual or group needs
learner control of the educational experience
repetition and deliberate practice
uncoupling of instruction from place and time
standardization of instruction and assessment
perpetual resources and new economies of scale
Creating Engagement

Individualize the offering




Relevant and important
Build on prior learning
Personalized comparative
feedback
Develop and maintain a
longitudinal relationship


Curriculum for personal
growth
Make it rewarding




Goal oriented
Fun
Positive
Engage the social instinct

Collaborative models

Learning is facilitated when the
learner




is engaged in solving a real-world
problem.
is engaged at the problem or task
level, not just the operation or action
level.
solves a progression of problems.
is guided to an explicit comparison
of problems

Learning is facilitated when the
learner


is directed to recall, relate,
describe, or apply knowledge
from relevant past experience
that can be used as a
foundation for the new
knowledge.
is provided relevant experience
that can be used as a
foundation for the new
knowledge.

Learning is facilitated when





the learner is shown rather than told.
the demonstration is consistent with the
learning goal.
the learner is shown multiple
representations.
the learner is directed to explicitly
compare alternative representations.
the media play a relevant instructional
role.

Learning is facilitated when




the learner is required to use his or her new
knowledge to solve problems.
the problem solving activity is consistent with
the learning goal.
the learner is show how to detect and correct
errors.
the learner is guided in his or her problem
solving by appropriate coaching that is
gradually withdrawn.

Learning is facilitated when the learner

can demonstrate his or her new knowledge
or skill.

can reflect-on, discuss, and defend his or her
new knowledge.

can create, invent, and explore new and
personal ways to use his or her new
knowledge
Rationale: Learning Theory

Learning can be optimized if the material



Page 28
Activates prior knowledge
Is
 engaging
 relevant
 Integrative
 interactive
Facilitates elaboration
Online Simulations
Rationale

Learning is greatest when

The materials meet the learner’s needs



The learning process is active



Relevant
Sufficient detail
Problem solving
Making choices
Feedback is provided
Simulation to Enhance the Learning Experience



20 cases across many specialties
Flash environment
Recreate the physician-patient encounter





Reinforce learning and retention


Page 31
History
Physical Exam
Relevant clinical decisions
Real patient cases, actual data & media
Make decisions and receive feedback
“Learn more” links
Questions with Feedback
Page 36
Learn More
Article
Page 37
More Questions with Feedback
Page 38
Learning Element
Page 39
Learning Element
Page 40
Learning Element
Page 43
Total IMCs Initiated and % Completed
60,000
50,000
70.0%
550,175
60.0%
initiations
50.0%
40,000
40.0%
30,000
30.0%
Total Exams Initiated
20,000
% Completed
20.0%
10,000
0
Page 46
10.0%
0.0%
Rating of Interactive Cases
N=10,353
Ratings of 4 & 5
Mean score
(of 5)
Overall learning experience
96%
4.70
Ease of use
95%
4.71
Visual design
95%
4.69
Quality of the questions
95%
4.61
Level of detail
94%
4.59
Interactivity
93%
4.62
Amount of Information
Less
information
2.0%
Sufficient
86.0%
N=10,329
Page 48
More
Information
12.0%
How they will be used?
N=10,123
All
To test my clinical decision-making
80%
To learn about a topic outside my specialty area
58%
To learn generally about a topic in my specialty area
44%
As a teaching tool
29%
To obtain CME credits
28%
Recommend to Whom?
Physicians
Non-Physicians
Physicians involved in clinical practice
91%
72%
Residents or trainees
83%
75%
Medical students
69%
82%
Fellows
60%
50%
Physicians involved in research & teaching
48%
49%
Physician Assistants
32%
35%
Nurses or Nurse Practitioners
20%
28%
How Often?
70.0%
66% of the US physician respondents said
they would participate in the IMC’s on a
weekly basis
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Once a week
Once a month
Every 2-3 weeks
Less often than
every 3 months
How Valuable is the Comparative Score?
Not at all
valuable,
4.2%
Somewhat
valuable,
42.2%
Very
valuable,
53.6%
96% selected Very or Somewhat valuable
Adaptive Education
Hermann Ebbinghaus (1850-1909)
In 1885, he published "On Memory”
Forgetting curves
Learning curves
Spacing effect
Forgetting Curve for Web-Based Teaching Modules
100
Percentage Scores
90
Module 3
80
Web-based
Teaching Modules
Module 2
OC-1
OC-2
70
OC-4
OC-3
Module 1
60
50
0
10
20
30
Weeks
40
50
Spaced Education: the basics

Spacing effect
spaced
 repeated
 repeated at increasing intervals

- Increased efficiency of learning
- Reduction in the slope of the forgetting curve
► Improves neuronal longevity in the hippocampus of rats
► Phosphatase mediator identified in Drosophila
Sisti et al, Learn Memory 2007;14(5):368-375.
Pagani et al, Cell 2009; 139, 186–198.
Testing Effect
Roediger & Karpicke.
Test-enhanced learning:
taking memory tests
improves long-term retention.
Psychol Sci, 2006; 17: 249.
Karpicke & Roediger.
The critical importance of
retrieval for learning.
Science 2008; 319:966-968.
Interactive Spaced Education (ISE)
harnesses both the testing effect & the spacing effect.
How to Structure Spaced Education
Question
Answer & Explanation
Curriculum to be Covered
Spaced Education on GU Pathology
Percentage Change from Baseline
30
Spaced Education
Web-based Modules
20
10
0
-10
0
10
20
30
40
50
Weeks
77%; 580/583
SEPT: Study Structure
• University of Virginia School of Medicine
• University of Pittsburgh School of Medicine
• Harvard Medical School
• University of Alabama School of Medicine
SEPT: CONSORT Flow Chart
SEPT: 40-item assessment of retention
90
80
Percentage Score
2-week
cycled-review
LPTA
SEPT
6-week
cycled-review
p<0.001
effect size=0.95
70
60
Final cycle
to assess
learning retention
50
Items 1-40
initial presentation
40
30
0
10
20
Weeks
30
40
Adaptive Spaced Education
•Personalizes the content and spacing of the spaced
education course for each physician
• Example – 932 urology residents in US & Canada
–
–
–
–
–
Residents receive two spaced education questions every day.
Incorrect → repeated 2 weeks later.
Correct → repeated 6 weeks later.
Correct twice in a row → item is retired & is no longer repeated.
Residents complete the program when all are retired.
• Advantages:
– reduces the unnecessary repetition of mastered material.
– turns the spaced education course into a game.
– measures not only what physicians know, but how well they learn.
38%
Spaced Education Works
Increases knowledge & retention

-
Medical Education 2007: 41:23-31 --- UGME
-
Journal of General Internal Medicine 2008; 23(7):973-8 --- UGME
-
Journal of Urology 2007; 177, 1481-1487 --- GME

Journal of Urology 2009; 181, 2671-2673 --- GME

Annals of Surgery 2009; 249: 744–749 --- CME
Improves self-assessment of knowledge


American Journal of Surgery 2009; 197(1):89-95
Changes behavior


American Journal of Surgery 2009: 197(2), 252-257

Academic Medicine 2010
Is well-accepted by learners

-
Demonstrated in all trials to date
Online Lectures
Traditional vs. Online Class
Activity
Lecture
Traditional Class
In-class lectures
Online Class
Lecture recorded and stored online
Discussions
In person discussion
Online blog
Discussion board
Assignments
Paper submissions
Electronic submission
Tests & Exams
Written, person proctored
Online, digitally proctored
Group Work
In class or in a room together
Virtual meetings
Collaborative google documents
Training
Follow along to an onscreen demo.
Students complete a guided self-completion
exercise
Office Hours
In-office appointments
Online anonymous questions
Grading
Grades released on each paper
Grades released instantaneously online
Demos
Talk about your materials and work
Video vignette
Online Tutorials
“Headache & Heartache”



Learning Objectives:
 Understand the role of pituitary hormones in growth
and development
 Appreciate the emotional and physical effects of sex
hormones
 Recognize the challenges in providing care to financially
disadvantaged individuals and minorities
Case: 19yo woman with headache and primary
amenorrhea
Problem: Supra-sellar tumor, ultimately leading to panhypopituitarism
Student Preference for Learning
Strongly prefer
paper
5%
Strongly prefer
Visual
33%
Prefer Visual
26%
Prefer paper
10%
Not sure
26%
n = 658 surveys
Tutor Preference for Teaching
Strongly prefer
video
36%
Not sure
29%
Prefer video
35%
Strongly prefer paper 0%
Prefer paper 0%
n = 62 surveys
Student Data
4.0
**
3.8
*
**
Video
*p<0.05
Paper
3.6
**p<0.01
3.4
**p<0.01
*p<0.05
3.2
vs paper
3.0
Stimulation
n = 658 surveys
Learning
Scale
Used:
1
2
Strongly
Disagree
Time Usage
3
Neutral
4
5
Strongly
Agree
Integration
3%
Applicability
4%
Integration
3%
Identification
3%
Applicability
6%
Identification
5%
Description
31%
Description
32%
Exploration
56%
Exploration
57%
Video
Paper
Critical Thinking Ratio by Video and Paper
Cases
Video
Text
P
Problem Identification
-0.25
-0.35
0.001
Problem Description
0.53
0.61
0.001
Problem Exploration
0.78
0.87
<0.001
Applicability
0.96
0.98
NS
Integration
0.95
0.95
NS
Current and future technologies impacting learning
Happening Today
1. Mobile technologies are omnipresent, technology is mobile-first
2. Seamless integration and synchronization across devices and
platforms
3. Systems are user-experience driven – more human, less technical,
highly user-friendly
4. Smarter adaptive programs with instant feedback
5. Higher-fidelity simulations
6. Collaborative social learning and immersive experiences using
seamless communication
“No matter how sophisticated or robust the delivery,
the content must fundamentally inspire (people) to learn”
Source: MIT RELATE
Current and Future Technologies Impacting Learning
Happening Today
Future Horizon
Mobility
Learning On
The Go
Electronic
Books
Advanced
6th Sense
Devices
Holographic
devices
Ubiquity?
Intelligence
Seamless
Synchronicity
Visual Data
Analysis
Predictive
Suggestions
Predictive
Competence
Content
Case-based
learning
Serious Games
Advanced,
Simulations
Augmented
Reality
Delivery
Mind reading
of commands
Interactive
web based
learning
Collaborative
learning in
social networks
Improving
cognitive
performance
Direct
connection to
the brain
Key Messages from Online Learning
Experiments


Online learning is
 Acceptable
 Effective
 Efficient
Online learning is best when it is
 Relevant
 Interactive
 Uses a variety of programs
 Is spaced
 Is adaptive
 Provides feedback
Summary


The principals of gaming apply to learning the complexities
of medical practice online
Physicians and medical students welcome the opportunity
to learn online, and welcome



Page 82
High-fidelity decision-making simulations
Personalized feedback & comparative performance
Multimedia interactive learning elements
Graham McMahon MD MMSc
[email protected]
QUESTIONS?
Systemic approaches to creating engaging learning
and teaching experiences
The Value of
Expert Coaching
The Power of Setting
High Expectations
The Power of
Deferring Critical
Judgment
The Value of
Adaptive Teaching
Styles
The Value of
Progressive
Add Ons
Teaching
Learning
The Power of
Visualization & Visual
Association
The Power of
Being Observed
The Value of
Anchored Instruction
The Power of Removing
Hierarchical Boundaries
The Value of Fusing
Content with Process
The Value of
Structured
Sequencing
The Power of
Taking Breaks
Barriers to Physician Participation








Lack of motivation
Fatigue
Lack of time
Competing demands
Lack of awareness of
knowledge deficit
Personal reluctance to
change
Ambivalence
Group mentality

The “Dirty Dozen” of Human Factor Errors:
•
Lack of Communication
•
Complacency
•
Lack of Knowledge
•
Distraction
•
Lack of Teamwork
•
•
Fatigue
Lack of Resources
•
Pressure
•
Lack of Assertiveness
•
Stress
•
Lack of Awareness
•
Norms
EXAMPLE:
NEJM INTERACTIVE CASES
Focus Group Feedback




Learners want efficiency (permit saves)
Learning mindset vs. challenge mindset (range of difficulty)
Welcome mobile usage and ‘take home’ summary
Dependent Outcomes Model



Next outcome depends on your decisions
Learners worry it creates too much opportunity to fail; want earlier feedback for
incorrect paths
Probabilistic Outcomes Model


Page 87
Outcome in case reflects likelihood of that outcome in actual practice
Learners concerned they’ll miss the learning point with rare outcomes; they want to
know what’s common
Image Challenge
Image Challenge Votes






Over 200 images in directory
2006: ~2 million votes
2007: ~3 million votes
2008: ~4 million votes
2009: ~6 million votes
Most popular link from e-table of contents
Videos in Clinical Medicine
• 30 videos
• Popular learning tool
• 4 of top 10 downloads
from site in 20109
were videos
• Avg. 20,000
impressions/month)
Audio Summaries
• For the savvy, connected
physician
#3 most useful
podcast for
professional
purposes -- and the
only journal cited
(Manhattan Research ePharma
Physician® v8.0)
Thank
You!
Utility of NEJM.org Features
93
Task-Oriented
Clinicians
Who
Professional Profile
Where does he/she work?
 Works in a small practice or community health center/hospital, may have teaching/research responsibilities
 May work in a technologically-forward practice or employing institution (i.e. already utilizing EMR)
What does he/she value in his/her professional and personal life?
 Cares about patient-centered approaches to medicine and patient education: educates the
patient through websites, handouts and images
 Values structure and advance planning to ensure preparedness when meeting patients
 Enjoys interacting with co-workers or peers during everyday interactions or at conferences
 Values and makes time for family and/or outside interests
 Values practicality and real-world applications of learned knowledge (e.g., acknowledging different approaches
to medicine, allowing for medical uncertainty or workflow management teachings)
 Busy schedule, may take work home with him when needed
Task-Oriented
Clinicians
What
Behaviors Related to Learning
What are his/her preferences for learning?
 Prefers information and learning to be convenient and concise
 Wants to learn through information that is contextual and focused on practical tasks
 Enjoys listening to experts in his/her field, even if they do not always have the time
 Does not subscribe to NEJM because it is too scientific or is not relevant to his/her everyday practice
 Does not have sufficient time to extensively read journals
 Occasionally reads journals or specialty relevant information to review articles that discuss guidelines or
practice changing information*
How does he/she choose to complete formal learning requirements?
 Likes the convenience of online activities and events given by the hospital
 Attends conferences put on by major industry players, societies and boards
 Is price-conscious (e.g. goes to conferences that are closer, or does not subscribe to NEJM due to
price)
 Adheres to CME and MOC requirements as needed, but views them strictly as requirements*
 Relies on societies/boards to tell him where to go to complete MOC and CME*
 Puts off study for CME and then works intensively to acquire sufficient credits before the deadline*
* Denotes statements articulated by a minority of individuals within the segment
Task-Oriented
Clinicians
When & Where
Context in which Learning Takes Place
What is the context in which unstructured, informal learning occurs?
 Researches information at the time it is needed (e.g. for patients, other doctors calling with questions)
 Learns while doing - at bedside, while patient is getting dressed, in between patients
 Looks up diagnostic and treatment information to refresh memory or to confirm beliefs
 Looks up drug information for specific medications (i.e. dosages, interactions, etc.)
 Completes further research when faced with unusual situations
 Completes research when receiving incoming consult calls or patient e-mails
 With “spare” time will look further into unusual or interesting cases
What is the context in which formal learning occurs?
 Tries to fit bites of learning when possible in the day (e.g. listens to a CD while commuting, completes15-20
minute Epocrates sessions)*
 Due to busy schedule, needs to plan ahead or set commitments to ensure formal learning gets done*
* Denotes statements articulated by a minority of individuals within the segment
Task-Oriented
Clinicians
How
Materials / Media / Technology Usage
What types of electronic resources, tools and devices does he/she value?
 Likes multimedia sources such as video content, CDs or information posted after presentations*
 Enjoys ability to do 15-20 minute CME courses on a handheld device*
 Prefers Epocrates for drug information, and utilizes iPhone app for immediate access*
 Uses EMR for drug information*
What factors influence his/her choice of electronic resources, tools, devices?
 Utilizes UpToDate to look up information when under time pressure
 Relies on familiarity and reputation to ensure sources are trustworthy
 Uses computer to access PubMed for more in-depth and academic searches
 Uses computers in patient rooms to look up information with the patient*
 Uses Google to search for more specific questions regarding patients and cases*
 Accesses websites and journals through free hospital access or free websites*
* Denotes statements articulated by a minority of individuals within the segment
Task-Oriented
Clinicians
Why
Frustrations around Learning
What are his/her frustrations with unstructured, informal learning?
 Too busy to devote extra time to establishing a consistent schedule of reading journals
 Feels that there is an overload of information and would prefer sources to summarize relevant,
practical findings
 Finds it difficult to take the time to focus on professional growth or to reflect on informal learning
opportunities on a daily basis*
What are his/her frustrations with formal learning?
 Feels CME activities (e.g. question formats, topic choice, content) and curricula can be poorly
designed
 Finds it difficult to evaluate the quality of a CME activity or provider without the aid of a medical
association or peers
 Believes that completing MOC/CME requirements can be expensive
 Believes that CME and MOC impose requirements on learners that conflict with his/her own or
employers’ goals*
* Denotes statements articulated by a minority of individuals within the segment
Knowledge-Oriented
Clinicians
Who
Professional Profile
Where does he/she work?
 Works in an academic setting, or has additional, non-clinician responsibilities
 Works within a technologically forward practice, or institution (i.e. utilizes EMR)*
What does he/she value in his/her professional and personal lives?
 Feels responsible for educating patients through handouts, discussion and citing information in
medical records
 Creates his/her own informational material, if he/she feels what is available is insufficient (e.g. uses
patient websites, guidelines, diagnosis templates)
 Distrusts biases and sponsored studies/courses
 Values communications with peers/co-workers
 Is overloaded with clinician work and additional responsibilities
 Ends up bringing work home
* Denotes statements articulated by a minority of individuals within the segment
Knowledge-Oriented
Clinicians
What
Behaviors Related to Learning
What are his/her preferences for learning?
 Likes to listen to, or see information visually (e.g. images, video content, podcasts)
 Interested in building awareness of broader issues, but prefers materials that are focused on his/her
specialty
 Refreshes knowledge, or learns something new in preparation for presentations and/or lectures
 Consults experts/specialists/peers to gain consensus, learn new information, or feel confident with a
course of action
 Cares about the quality of articles and sources when researching information, takes note of study
methodology and/or looks at article references*
 Reads or shares articles with practice group and peers*
How does he/she choose to complete formal learning requirements?
• When studying for boards and doing CME activities, relies mainly on certifying board/specialty
society/academic institution for review materials
 Meets some CME/MOC requirements through institutional events or fulfilling institutional
requirements
 For CME activities, gets credit for current research efforts and/or likes to prep with questions (e.g.
UpToDate, journal articles, pre-tests)
 Likes learning through case studies or conferences
* Denotes statements articulated by a minority of individuals within the segment
Knowledge-Oriented
Clinicians
When & Where
Context in which Learning Takes Place
What is the context in which unstructured, informal learning occurs?
 Reads journals when he/she can squeeze it in (e.g. during lunch, or at night time)
 Due to busy schedule, will spend personal time preparing for presentations and on research projects
outside of working hours
 Shares information with peers/colleagues when it is interesting, or is needed to inform a
diagnosis/treatment (e.g. printing out interesting articles, consulting specialists, recommending a new
medication)
 Prefers to wait until the patient has left to follow up on relevant issues, or until he/she can sit at a
computer*
What is the context in which formal learning occurs?
 May study for multiple board exams*
 Likely to begin preparing for MOC and/or boards early*
* Denotes statements articulated by a minority of individuals within the segment
Knowledge-Oriented
Clinicians
How
Materials / Media / Technology Usage
What types of electronic resources, tools and devices does he/she value?
 Utilizes many different websites for learning new information and research (e.g. UpToDate, Medline,
Medscape, PubMed and specialty websites or journals)
 Currently involved, or was involved in forums for sharing experiences and answering questions
 Looks up drug information on Epocrates smartphone application
 Receives electronic alerts from journals and other websites to keep up to date
* Denotes statements articulated by a minority of individuals within the segment
Knowledge-Oriented
Clinicians
Why
Frustrations around Learning
What are his/her frustrations with unstructured, informal learning?
 Feels that he/she cannot always access information quickly enough
 Frustrated by his/her inability to complete an effective literature search with current online resources*
What are his/her frustrations with formal learning?
 Believes that preparing for boards/recertifications is a tedious process or a waste of time*
 Believes CME activities are not aligned with his/her interests and learning needs*
* Denotes statements articulated by a minority of individuals within the segment
Contents
1.
Current and Future Technologies Impacting Learning
2.
Systemic Approaches to Effective Learning and Teaching
3.
Teaching & Training Methods in Other Life Critical Professions
(Aviation, Military, Firefighting)
The Power of
Setting High Expectations Upfront
Individuals with poor expectations internalize their negative label, while those with positive labels
succeed accordingly. This is known as the Pygmalion Effect (also, Rosenthal Effect).
Experiments have shown that expectations about the competency level of a teacher, or one’s
own ability to learn, and learners’ assessment of how difficult it is to assimilate the material can
all positively and negatively influence learners’ test performance.
For this reason, the greater the expectations instilled in learners, the better they perform.
Learning opportunities can be made more effective by setting
appropriately high expectations at the outset –
both in terms of learning goals and teaching standards
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Source : Rosenthal, Robert and Jacobson, Lenore. Pygmalion in the Classroom: Teacher Expectation and Pupils' Intellectual Development.
Irvington Publishers: New York, 1992.
Learning while
Doing
Learning it in
My Own Way
The Power of
Deferring Critical Judgment & Self Editing
Adults have a tendency to self-edit their thoughts. They fear embarrassment and the
judgment of their peers. This fear causes them to be conservative in their thinking.
To improve problem-solving, Tim Brown, the CEO and president of design firm IDEO,
suggests that we must find ways to lessen self-editing and feel free to experiment, and
be more ‘playful.’
Problem solving consists of two very distinctive modes of operation: Divergence, a
generative mode where we explore and create many ideas, and Convergence, where we
look back for solutions. The Divergence mode is where we most need experimentation ad
playfulness.
Freedom to think, without fear of judgment, can improve
one’s ability to generate better solutions
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Source: TED Talks, Tim Brown on Creativity and Play
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Learning while
Doing
Learning it in
My Own Way
The Power of
Visual Association
After surviving a tragic collapse of a banquet hall and being able to remember where each of
the guests was sitting, Simonides of Ceos, a fifth century Greek, reasoned that anything
could be memorized by imagining a “memory palace,” containing imagery of what needed
to be recalled.
The tale of Simonides has been the basis for memorization techniques of the modern
professional memorizers. MRI scans of professional memorizers reveal that they rely on
regions of the brain known to be involved in spatial memory, in order to remember large
quantities of information.
This principle has been applied by Rosetta Stone, the popular language learning program
whose learning tools encourage learners to remember by visual association.
Visualization enhances our ability to memorize
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Source: The New York Times, Secrets Of A Mind-gamer
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Learning while
Doing
Learning it in
My Own Way
The Power of
Being Observed
People improve or modify an aspect of their behavior that is being experimentally
measured simply in response to the fact that they are being studied, and not in response
to any particular experimental manipulation.
This is known as the Hawthorne effect.
Productivity gains can be the mere result of the motivational effect of the interest being
shown in the people observed.
Knowing that one is being observed can increase
performance and productivity
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Source: Roethlisberger, F. Jules and W.J. Dickson. Management and the Worker. Cambridge, MS: Harvard University Press, 1939.
Learning while
Doing
Learning it in
My Own Way
The Power of
Removing Hierarchical Boundaries
Employees are often reluctant to share knowledge due to their fears of loss of control over
the ideas.
Equally, bosses are reluctant to accept those ideas because of the fear of becoming
useless, and consequentially loss of position.
Thus, French CPG firm, Danone has recognized that and has developed “Knowledge
Marketplaces” – events at which ideas are freely exchanged as products for “sale” at “idea
stands,” and participants must dress in such a manner that there is no visible way of
distinguishing their hierarchical rank.
Removing hierarchical constraints creates more effective
sharing of knowledge and ideas
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Source: Story-telling At Danone : A Latin Approach To Knowledge Management
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Learning while
Doing
Learning it in
My Own Way
The Power of
Taking A Break
Companies have embraced the power of time-off: 3M and Google allocate their employees
“personal time” – time out from everyday work, which they are free to invest in their own
projects. This enlightened approach to employee management has driven many of the
innovations that have emerged from these two organizations.
Ferran Adrià, the executive chef of world-renowned El Bulli in Spain would close his
restaurant for half the year to experiment and discover new ways of cooking. The result has
been three Michelin stars and recognition as the best restaurant in the world by Restaurant
magazine.
Every seven years, the two-time Grammy Award winning graphic designer Stefan Sagmeister,
closes his New York studio for a yearlong sabbatical to rejuvenate and refresh its creative
outlook. The result: “everything that we've done in the seven years following came out of
thinking that took place in the sabbatical year.”
Time out and freedom to invest in personal interests can play an important
role in raising motivation, and inspiring creative problem-solving.
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Learning while
Doing
Sources: The New York Times: The Google Way: Give Engineers Room; Wired Magazine: The 15 Percent Solution; TED Talks, Stefan Sagmeister: The
power of time off; The New York Times, Ferran Adrià
Learning it in
My Own Way
The Value of Teaching Through
Expert Coaching
‘Deeply smart’ people and experts in a particular field have been shown to make intuitive decisions
fast, and are able to spot problems and possibilities others miss.
Their wisdom is crucial to any organization’s success and can be an institutional loss when the
knowledge is not passed on.
To ensure knowledge transfer and retention, experts should be empowered to act as coaches.
Effective coaching spurs transfer and retention of vital wisdom, yields better solutions and more
efficient processes. To maximize the degree to which novices absorb this wisdom, knowledge
coaching should comprise a blend of guided practice, observation, debriefing, collective problem
solving, and experimentation.
Knowledge coaching allows the wisdom of experts to be
transferred to others. Effective coaching comprises:
Guided
Practice
+
Guided
Observation
+
Guided
Problem Solving
+
Guided
Experimentation
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Source: Harvard Business Review, Deep Smarts
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Learning while
Doing
Learning it in
My Own Way
The Value of Teaching Through
Structured Sequencing
Gagne posited that teaching actions should follow a precise sequence, to ensure alignment with
the cognitive processes that allow us to learn new intellectual skills. The sequence of teaching actions is
(illustrated with an example sequence of teaching actions for the skill “recognize an equilateral triangle”):
1.
2.
3.
4.
5.
6.
7.
8.
9.
Gain attention
Identify the objective
Recall prior learning
Present stimulus
Guide learning
Elicit performance
Provide feedback
Assess performance
Enhance retention
Show a variety of different triangles
Pose the question: "What is an equilateral triangle?“
Review the definitions of triangles
Provide the definition of an equilateral triangle
Show an example of how to create an equilateral triangle
Ask students to create five different examples of equilateral triangles
Indicate whether the examples are correct or incorrect
Provide scores and remediation
Show students various pictures and ask students to pick out equilaterals
Sequencing – aligned with natural cognitive processes –
can create more effective learning
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Source: Gagne, R., Briggs, L. & Wager, W. Principles of Instructional Design (4th Ed.). Fort Worth, TX: HBJ College Publishers, 1992.
Learning while
Doing
Learning it in
My Own Way
The Value of Teaching with
Progressive Add-Ons
According to elaboration theory, instruction should be organized in increasing order of complexity for
optimal learning.
A key idea of elaboration theory is that the learner needs to develop a meaningful context into which
subsequent ideas and skills can be assimilated.
Elaboration theory proposes seven major strategy components:
•
Elaborative sequence – by adding successive layers of complexity
•
Learning prerequisite sequences – via conceptual, procedural, or theoretical structures
•
Summary – through content reviews presented in rule-example-practice format
•
Synthesis – via presentation devices, diagrams, procedural flowcharts, or decision tables
•
Analogies – by relating the content to learners' prior knowledge
•
Cognitive strategies – by using a variety of cues (pictures, diagrams, mnemonics, etc.) needed for appropriate
processing of material
•
Learner control – by clear labeling and separation of instructional strategy components
For optimal learning, allow learners to develop meaningful understanding
before moving on to the next step
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Learning while
Doing
Source: English, R.E. & Reigeluth, C.M. Formative research on sequencing instruction with the elaboration theory. Educational Technology Research &
Development, 44(1), 23-42, 1996.
Learning it in
My Own Way
The Value of Teaching By
Adapting to Cognitive Learning Styles
Cognitive styles refer to the preferred way an individual processes information, a person's typical
mode of thinking, remembering, or problem solving. There are many contrasting styles organized
around context, content, and structure.
Some examples of cognitive styles are:
•
Field Independence vs. Field Dependence – Field independent learners tend to approach the problemsolving in an analytical fashion, whiles field dependent learners approach it in a global fashion.
•
Serialist vs. Holist – Serialists prefer to learn in a sequential fashion, whereas holists prefer to learn in a
hierarchical manner.
•
Leveling versus sharpening – in sharpening individuals tend to exaggerate selected characteristics of the
original memory and in leveling minimize the same. This affects a person’s account of what actually
happened and may not be the same as what actually did occur.
To achieve greatest effectiveness, teaching approaches
need flexibility to adapt to different cognitive learning styles
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Source: Kearsley, G. (April 19, 2011). The Theory Into Practice Database. Retrieved from http://tip.psychology.org
Patientcentered
Learning
Learning while
Doing
Learning it in
My Own Way
The Value of
Fusing Content with Process
Component Display Theory (CDT) classifies learning along two dimensions: content type and
performance. It also specifies nine presentation forms that are unique to each material and learner.
Performance
A complete lesson would consist of objective followed by some combination of rules, examples, recall,
practice, feedback, helps and mnemonics appropriate to the subject matter and learning task.
Find
Use
Remember
Rules
Examples
Recall
Practice
Prerequisites
Objectives
Helps
Mnemonics
Feedback
Fact
Concept
Procedure
Principle
Types of Content
To teach most effectively, consider both content dimensions
and applicable forms of presentation/interaction
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Source: Merrill, M.D. Instructional Design Theory. Englewood Cliffs, NJ: Educational Technology Publication, 1994.
Patientcentered
Learning
Learning while
Doing
Learning it in
My Own Way
The Value of
Providing Contextual Anchors
Anchored instruction theory requires putting the students in the context of a problem-based story.
The students "play" an authentic role while investigating the problem, identifying gaps to their
knowledge, researching the information needed to solve the problem, and developing solutions.
Anchored instruction is comprised of five principles:
1. Realistic task or event is presented in which the problem is anchored or focused
2. Students take ownership based on relatedness to problems and goals seen everyday
3. Deep development of knowledge structure that is highly transferable to other situations
4. Complex content presented in a narrative format
5. Generative learning context is created in which students identify with problem and become
actively involved in generating solution
Adding contextual “anchors” in teaching
improves learner assimilation and problem-solving
Applicable to?
Progressive
Learning
Make the Most
of My Time
Make it
Rewarding for
Me
Help Me Through
the Professional
Development
Process
Make it Real
Drawing upon
the Wisdom of
Others
Patientcentered
Learning
Learning while
Doing
Source: Bransford, J.D. et al. Anchored instruction: Why we need it and how technology can help. In D. Nix & R. Sprio (Eds), Cognition, education and
multimedia. Hillsdale, NJ: Erlbaum Associates, 1990.
Learning it in
My Own Way