I've always thought of myself as a visual learner. Mostly, because I feel like I don't understand and process information as well when I'm listening to it as when I have something to look at at the same time. For example, I've never been able to listen to audiobooks without getting completely distracted by what's going on around me, nor do I do well in lectures or presentations where there is no visual component. The more I think about it though, Learning Styles are not as straightforward as Visual vs Auditory... after all, I also remember things much better when I write them down, connecting it to my Kinesthetic traits as well as my Visual side, and I'm perfectly capable of remembering things when I'm taught at the bedside despite there being no written or pictorial component. As my colleague recently alluded to, this is much more 'Contextual' learning - I associate my memories with the patient's story, their environment, even the events that happen around the time of the teaching experience.
As I've been spending a fair amount of time immersing myself into Medical Education literature, my biggest motivation has been trying to understand how you would even come up with a Medical School Curriculum. Why would you choose small group settings over didactic teaching? Where did PBL even come from? What is the evidence for any of these and why do they work? I've soon realized, much of what has been done in the past has very little basis in evidence and has been thrown together more out of 'Common Sense' than any sort of previous experience.
A great paper by Geoff Norman entitled Fifty years of medical education research: Waves of Migration gave me a very succinct overview of the history of medical education. He has conveniently separated it into the successes and failures of the implementation of both Common Sense and Evidence Based education strategies in the spheres of Learning, Clinical Problem-Solving/Reasoning, and Assessment. Today I want to spend a bit more time in the Learning area, but stay tuned for posts about the other areas later in the week.
The biggest Common Sense intervention in the area of Learning was that teaching techniques should be directed at addressing the different Learning Styles that students have and 'match' the teaching to the style so as to optimize the learning for every individual. This makes sense on the surface, and in fact, as I've grown up thinking myself as a Visual Learner and thought of my active brother as a Kinesthetic learner who didn't do as well in a classroom as I did, I often wondered why teaching didn't take advantage of students' differences. To my shock yesterday, I learned that there has been almost zero evidence that targeting the teaching strategy to a self-identified Learning Style makes any difference whatsoever.
As I've looked into the matter further, I've noted several papers that have attempted RCT's to test this theory. While most of these studies have involved Web-Based learning exercises, the findings could certainly be extrapolated to other environments. Notably, two studies done by Cook et al. in 2005 and 2007 could identify no difference between learners both 'matched' and 'mismatched' to their particular Learning Styles (which were determined at that moment in time by a series of standardized questionnaires). In a similar study, Massa and Meyer were also fruitless in their search for a significant difference.
About the only Learning Style that has a moderate amount of evidence as being worth targeting is the 'Wholist-Analyst' spectrum identified by Cook in his 2005 paper. In review, he identified four 'axes' of learning styles, one of which being this wholist-analyst approach. In this case, a 'Wholist' will benefit more from a generalized overview of a topic to provide context as well as social interaction before diving in to more detail ("Broad before Deep"). Conversely, 'Analysts' prefer to have the details provided from the beginning, finding the connections as they go, and then have a summary at the end which provides the context ("Deep before Broad"). In his analysis, Cook noted that tailoring teaching in this way did provide a significant difference in aptitude post intervention.
When I think about my own experience in the medical school curriculum, I feel like most lecturers do provide an approach that is conducive to both wholists and analysts; that is "Broad before Deep before Broad". Most lectures give an overview or a Case example before diving into a topic, and then summarizing at the end. As well, having material taught in several different ways in a given week (ie didactically, then reviewed in seminars, and worked through in a PBL case) allowed for the social interaction wholist's crave, but self-directed depth that analyst's prefer.
And so, back to learning styles. A discussion with Dr Cavalcanti last week also reminded me that, despite having comfort in a particular learning style (visual in my case), to have succeeded in school up to this point, most individuals will have had to learn in many different contexts and in many different styles. We have each come up with our own techniques to 'translate' the way something is being taught into a way that is more in line with the way we understand. For example, I read lips at an oral presentation - it helps me understand what somebody is saying better. I also take handwritten notes, as it keeps my mind from wandering when there is less visual cues around. Perhaps this then is the reason the Common Sense approach has failed - in order to succeed we have to be adaptable, and so both matched and mismatched interventions will be equally as understandable.
~LG
No comments:
Post a Comment