A Cognitive Perpective on How People
Learn: Implications for Teaching
Geoff Norman, Ph.D.
McMaster University
The Cognitive Perspective
expertise
“The essence of intelligence is less a
matter of reasoning and more a matter
of knowing a lot about the world”
H.A.Simon, 1989
Teaching MUTES
 Memory and
 Understanding
 Transfer
 Exercises
 Skills
Some assertions about
learning




Learning and remembering results from
assimilation of new knowledge into existing
knowledge, and meaning is critical to learning
Transfer (applying old knowledge to new
situations) doesn’t happen easily
Structured, planned, practice with multiple
examples is key to transfer
General skills don’t exist – it’s all imbedded in
knowledge
Learning and Understanding

Learning is strongly influenced by the
meaning .


If we can understand what we are learning
in terms of pre-existing knowledge, better
learning and retention results
Meaning is a consequence of the
interaction between learner and ‘to be
learned’
Tomorrow, and tomorrow, and tomorrow,
Creeps in this petty pace from day to day,
To the last syllable of recorded time.
And all our yesterdays have lighted fools
The way to dusty death. Out, out brief candle!
Life’s but a walking shadow, a poor player
That struts and frets his hour upon the stage,
And then is heard no more. It is a tale
Told by an idiot: Full of sound and fury
Signifying nothing
W. Shakespeare, Macbeth, V, v
Sound is walking, stage struts and a
tale is heard. No more a poor candle,
frets life. A brief idiot, fury and shadow,
is in a dusty fool.
drswa gtrus hdrkl opono rluta
sflta dnaro lensa bfdoa radit
sogfv sonap vfhoe qpofs cpoas
Meaning is imposed by the
learner and involves an
interaction between existing
knowledge and new information
The procedure is quite simple. First you
arrange things into different groups. Of
course, one pile may be sufficient. If you have
to go somewhere else due to lack of facilities,
this is the next step. It is better to do too few
things at once than too many. At first it seems
complicated, but soon it just becomes a fact
of life. After it’s over, you arrange the
materials in groups again, then put them in
the right place.
Washing Clothes
The procedure is quite simple. First you
arrange things into different groups. Of
course, one pile may be sufficient. If you have
to go somewhere else due to lack of facilities,
this is the next step. It is better to do too few
things at once than too many. At first it seems
complicated, but soon it just becomes a fact
of life. After it’s over, you arrange the
materials in groups again, then put them in
the right place.
Evidence of the Role of
Meaning

Chess

Nephrology
How do you get to be a chess
master?
Is it:
- learning the rules?
- learning to think of
more moves and deeper
strategy? (process)
- learning to think better
moves? (knowledge)
Recall of Chess Positions

4 levels of chess player

mid-game positions

5-7 sec exposure
Recall after 5 sec. Exposure
(real positions)
25
20
15
/24
10
5
0
<1600
16-2000
20-2350
S kill level
>2350
Recall after 5 sec. exposure
25
20
15
/24
Random
Real
10
5
0
<1600
16-2000 20-2350
S kill level
>2350
It’s not just Visual Patterns

Lab data, nephrology problems

5 research associates
6 students
5 experts


Recall of Nephrology Data
14
12
10
/20
8
6
Random
Real
4
2
0
NOVICE
E XP ERT
E xpertis e
Basic science and meaning
Why do students need basic science?

Some docs use it a lot?


Many docs use it a little?


Nephrologists, anesthesiologists, intensivists
With difficult problems
It may provide meaning and coherence for
students…….
Basic Science and Meaning
(Woods, Brooks, Norman, 2003)

4 neurology / muscular diseases

36 medical students

Basic Science or Symptom/Disease
probability
Measurement

Diagnostic Test


15 cases, 4-6 features
Administered at 0, 7 days
Score on Dx Test
55
50
45
Feature List
Basic Sci
40
35
30
Immediate
1 Week
Score on Dx Test
55
50
45
Feature List
Basic Sci
40
35
30
Immediate
1 Week
Score on Dx Test
55
50
45
Feature List
Basic Sci
40
35
30
Immediate
1 Week

Basic science is used to
construct and reconstruct
coherent relations between
symptom and disease
Summary

Remembering for meaningful material is
enhanced because there are more links
or pathways to the memory trace
Implications for Teachers
How can we, as teachers, help students
impose meaning on what they’re
learning?
Implications for Curriculum

What are we doing now?



“Traditional”
PBL
Does PBL enhance learning”

MACRO -- no or maybe

MICRO:



Active Learning
Imbedding problem
Everyday analogy
Effect of active, problemoriented processing
(Needham & Begg, 1991)

Intro psychology students, 5 classic problems

“Try to solve these difficult problems”
( 27% successful)
vs.
“Remember the problem and solution so you can solve some
additional problems”
(21% successful)
Effect of Active Problemsolving
90
80
70
60
50
40
30
20
10
0
Problem-oriented
Needham & Begg, 1991
Memory oriente d
Imbedding Principle in
Problem
(Ross & Kilbane, 1997)
Practice and Test problems with:

SEQUENTIAL


Principle explanation, then problem example
IMBEDDED

Principle imbedded in problem, explanation as part of problem
“Reversal” = using original principle incorrectly
Reversal Errors
60
50
40
30
20
10
0
Sequential
Imbedded
Analogy in Learning Science
(Donnelly & McDaniel, 1993)

48 students, 12 concepts

Literal description of concept vs. description +
analogy in familiar domain


(e.g. pulsar star and lighthouse)
24 MCQs; 4/concept, 12 basic +12 inference
86
84
82
80
Recall
Inference
78
76
74
72
No analogy
Analogy
An application in Medical Education
Laplace Law:
Anybody remember LaPlace Law?
Anybody understand it?
Pressure and Tension on a Membrane
r
P
T
Law of Laplace
T=P*r
The “weight and string”
problem
T
a
T = W / 2 sin(a)
W
T = W / 2 sin(alpha)
T
T
W
a
W
T
T
t
t
Dual Explanations
(Krebs, Dore, Norman, 2006)

Three “Laws”


Intervention




Laplace , Right Heart Strain, Starling
Mechanical + Biological Active Comparison
vs.
Biological explanation only
Test
9 diagnostic cases
Sample -- undergrad psych students
Percent Correct
50
45
40
35
30
25
20
15
10
5
0
Explanation
Dual
Biological
Implications for
Teaching/ Curriculum

Arrange learning to integrate with prior
knowledge





Active learning
Problem – based learning
Imbed principle in problem
Everyday analogy
Sequencing of concepts
Transfer
using old knowledge to solve new
problems

As teachers, we act as if all the
knowledge we impart to students will be
available to them to solve problems in
the future

As teachers, we act as if all the
knowledge we impart to students will be
available to them to solve problems in
the future
Unfortunately….. it won’t
Views of Transfer
General Transfer (1900-1915….)
Subjects like Latin, algebra teach general “habits of mind”
(disproved by Thorndike, 1913)
Specific transfer (Behaviorism,1910--> Now)
Learned concepts can only be transferred if new behavior = old
behavior
(disproved by Judd, 1908, Wertheimer, 1959, Pressley 1990)
Intermediate / hybrid transfer
Learned concepts can be applied (with difficulty) to new, dissimilar
problem situations

A general wishes to capture a fortress located
in the centre of a country. There are many
roads radiating from the fortress. All have
been mined so that, while small groups of
men can pass over the roads safely, a large
force will detonate the mines. A full-scale
direct attack is therefore impossible. The
general’s solution is to divide the army into
small groups, send each down a different
road, and have the groups converge
simultaneously on the fortress.
You are a doctor faced with a patient who has a
malignant tumour in his stomach. It is
impossible to operate on the tumour. X-rays
can be used to destroy the tumour. If
sufficient rays reach the tumour all at once,
the cancer cells will be killed, but surrounding
tissue will be damaged as well. How can you
arrange the procedure to destroy the tumour
cells without severely damaging the
surrounding tissue.
Gick & Holyoak, 1980
Transfer and Context Specificity



The initial solution (multiple simultaneous
paths) was learned in, and stored with the
problem context (fortress and army).
To solve the new problem, must recognize
that the old problem was analogous to the
new, despite different contexts
To recognize analogy, we must recognize
similarity in deep structure
this rarely happens…..

Why not just teach them the principle?

Teach the principle, then give them an
example of the principle
“…during early learning, the principle is only
understood in terms of the earlier example… the
principle and example are bound together. Even if
learners are given the principle or formula, they
would use the details of the earlier problem in figuring
out how to apply that principle to the current problem”
Brian Ross
Effective Use of
Practice Examples

Multiple examples vs. “Principle + Example”

Active Compare and Contrast vs. Separate
(Gentner, 2003, Holyoak,1989)
Multiple Examples vs.
Principle + Example



MBA Students , negotiation problem
Factor 1
Two cases, implicit principle vs.Principle +
Case
Factor 2
Read case and principle (on successive
pages) vs. Compare Case and Principle
Loewenstein& Gentner, 2003
Effect of Examples and
Comparisons
70
60
50
40
Two Cases
Case + Principle
30
20
10
0
Compare
Gentner, 2003
No Compare
Implications for Teaching

Transfer can be facilitated by use of
examples during initial learning



multiple examples > principle + example
compare and contrast
Active search for deep structure
Transfer, examples and
practice


Critical to learning, transfer is the opportunity
to see the concept arise in multiple contexts
This can only arise with multiple practical
exercises
What can we do to enhance the value of
practice?
Strategies to Optimize
Practice

Mixed vs. Blocked Practice
(Hatala, 2002)

Distributed vs. Blocked Practice
(Schmidt &Bjork,1992)
What do you need to do stats?
An Observation:
With the availability of sophisticated statistical
software, the central issue facing the statistics
student is “ What test do I use?”
To learn this, students have to see data sets,
think of possible strategies, and get feedback
What do you get in stats
courses?

Instructional time occupied by equation
proving, formula remembering

Practice at end of chapter of the form:
“Do a t test on these data”
So when do you do a t test?
At the end of the t test chapter
The solution
Mixed practice
Mixed vs. Blocked Practice
In the face of ambiguous features
(which are subject to reinterpretation),
and multiple categories, students must
learn the features which discriminate
one category from another, not those
which support a particular category
Mixed vs. Blocked Practice
Hatala, 2000
ECG Diagnosis -- 3 categories
 6 examples / category
Blocked
Review, then 6 examples/category
Mixed
Review, 2/category, 12 (4 x 3) practice
TEST6 new ECGs

Accuracy -- %
50
45
40
35
30
25
20
15
10
5
0
Mixed
Blocked
Timing and Sequence of Learning

Would you rather learn to skate (type, play
violin, speak Spanish):

1 hour/day, biweekly, for 60 weeks = 30
1 hour / day for 3 days/wk for 10 wks = 30
3 hours/day, 1 day/week, 10 weeks = 30
6 hours/day, 5 days, 1 week = 30



Massed vs. Distributed Practice

Massed


All learning takes place at one time
Distributed

Learning takes place over multiple
occasions
Massed vs. Distributed
(Raman, McLaughlin, 2010)
20 GI residents
Nutrition course
- 4 hr, one 1/2 day vs. 1 hr. 4 1/2 day
Multiple choice test, 0, + 1 wk., + 3 mo.
Massed vs. Distributed
35
30
25
No of items 20
recalled 15
10
5
0
Distributed
Massed
Change 0-1 wk
Change 0 - 3 mo
Condition
Implications for Teaching

Practice is critical for learning and transfer




to impose meaning on concepts
to overcome “context specificity”
to enhance transfer
Some practice works better than others


Mixed >> blocked
Distributed >> Blocked
Exercises, Experience and
Expertise
The critical role of deliberate practice in
acquisition of expertise

Is practice just a matter of learning to
apply the rules?

remember the chess master!!!!


How long does it take to learn chess?

To learn the rules ----
10 hr.?

To become an expert ---10,000 hr. / 10 yr.
Experts know about 50,000 strategies
(Ericsson, 2004)
Age and Skilled Chess Performance
Ericsson and Charness, 1998
How long does it take to learn to play:
- Violin
- Piano
- Field Hockey
*
*
How long does it take to learn to play
doctor?
Age and Diagnostic Accuracy
Hobus & Schmidt, 1993
How many years after you finished
specialty training before you felt yoou
were competent?
Who do you choose?

Dr. JS. finished residency last year and was
in top 5 on cardiology RCPS exam?

Dr. KT finished residency 10 years ago and
was in top 1/3 on cardiology RCPS exam?
What does the clinician gain
from years of experience?
Years of experiences
Is Expertise Just a Matter of
Applying the Right Rules?

Experienced clinicians are poorer than recent
graduates on formal tests (of the rules)


But no one picks a recent graduate for their doc
Experience provides a storehouse of prior
examples
A DIAGNOSTIC TASK
What are all these things?
chairs,
(of course)
What makes something a chair?
What are the rules of chairs
(as distinct from sofas, stools, tables)
The rule describes this….
Does it cover these…?

We can recognize chairs quickly, accurately, and
effortlessly

But we can’t easily verbalize the rule

When we try, it’s incomplete
HOW COME?
Similarity and recognition of
everyday objects



When we recognize everyday objects,
the process is effortless, seemingly
unconscious.
We are not aware that we are eliciting
or weighting individual features
The process appears to occur all at
once (Gestalt)
Familiar Categories
 Rapid, effortless, accurate recognition
- despite massive within – category variation
- despite no overt understanding of rules
Unfamiliar Categories
 Slow, effortful, inaccurate recognition


Despite NO
within – category variation
Despite an explicit and simple additive rule
Exemplar Theory Medin, Brooks

Categories consist of a collection of prior
instances



identification of category membership based on
availability of similar instances
Similarity is “non-analytic” (not conscious), hence
can result from objectively irrelevant features
Ratings of typicality, identification of features, etc.
done “on the fly” at retrieval
Effect of Similarity
(Allen, Brooks, Norman, 1992)

24 medical students, 6 conditions
Learn Rules
Practice rules
Train Set A
Train Set B
(6 x 4) x 5
(6 x 4) x 5
Test (9 / 30)
Accuracy by Bias Condition
90
80
70
60
Correct
Incorrect
Other
50
40
30
20
10
0
Bias Corr
Bias Incorr
Hatala et al, ECG
Interpretation


Medical students/ Fam Med residents
PRACTICE (4/4 + 7 filler)


middle aged banker with chest pain
OR
elderly woman with chest pain


Anterior M I
TEST ( 4 critical + 3 filler)

Middle aged banker

Left Bundle Branch Block
RESULTS
Percent mentioning
Percent of Diagnoses by Condition
50
45
40
35
30
25
20
15
10
5
0
Bias
No bias
Correct
Prior
Diagnosis
Implications for Teaching

Practice with examples is critical in
ambiguous domains

Practice results in a collection of
exemplars as a problem-solving
resource
What happened to Skills?


Any measure of “problem-solving”,
“reasoning”, “critical thinking”, “clinical
judgment”, etc. correlates across
problems at about 0.1-- 0.3.
Process measures of the above show
no gradient with expertise
Recurring Themes
Learning
Human learning and remembering is
critically sensitive to the meaning the
learner imposes on the “to be learned”
Recurring Themes
Transfer of concepts to new, dissimilar
problem situations does not occur effortlessly
or frequently

Enhanced by active learning, search for
principles, multiple practice examples

Impeded by learning for memory, passive
learning, single example
Recurring Themes
Formal conceptual knowledge is
insufficient for expertise
Experience provides an array of prior
examples to draw from and reduce
memory load
Recurring Themes
Kinds of Knowledge
Expertise is more a matter of having
the right knowledge (both formal and
experiential) and being able to mobilize
it, than of any general skills

Thinking depends on specific, context-bound
skills and units of knowledge that have little
application to other domains….. The case for
generalizable, context-independent skills that
can be trained in one context and transferred
to other domains has proven to be more a
case of wishful thinking than hard, empirical
evidence.
Perkins & Salomon, 1989
Conclusion
“The problem-solving difficulties of novices can
be attributed largely to the inadequacies of
their knowledge base and not to limitations in
their problem-solving capabilities”
R. Glaser, 1984
We have discussed a number of strategies to
improve the knowledge base
The End
Thanks
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