Kids These Days: Generational Differences in Medical Education



okay welcome we'll go ahead and get started right on time I want you all to think about a question or several as we go through this talk it all centers around how do we learn more specifically how do you learn as an individual how do we learn as a larger group how do millennials learn and is that any different than the way other generations learn and finally how do we learn best because that question is central to the question of how do we teach best and on a larger scale how do we educate best I hope to approach this question two ways today one via the framework of generations do cohorts of learners learn differently hence the title of the talk very controversial kids these days and they can change based in the way I say it I could say kids these days and then roll my eyes or I could say kids these days with the excitement of the promise potential of the future and then secondly I think the first one got more laughs but secondly because I'm talking to an audience mainly of clinical neurologist some neuroscientists and it's a neurology departmental Grand Rounds I want to talk about the contribution of neuroscience to education its potential and its limitations I have no relevant financial disclosures I do mention a book I helped write but I get no money for it so there's no conflict there in the spirit of active learning I want you guys to participate as much as possible I'm gonna do that in two ways one this system so if you have not already engaged this and want to you can go to the website listed or text PK o RB two three seven six oh seven I've always wanted to say text my name to something that's quite nice I'm also going to do something a little bit different for us and I'm gonna explain what that is in just a moment I'd like to thank people up front in case we run out of time there's a lot of people that I owe this talk to in my career too I do want to point out specifically I'm a candidate for a master's of Health Professions education with Maastricht University and many of those people were my inspiration for doing this in a even site some of the faculty member I've had the privilege to work with I should mention my name for those that are walking in and are not from the Department for those that don't know me my name is Pierce Corbin an assistant professor with the Department of Neurology I'm the director of student education as well as continuing medical education so in some ways I invited myself here to Grand Rounds here are the learning objectives and really they can be summarized by the idea of taking some of the concepts of generational frameworks on education combining that with potentially the neuroscientific approach to education or the cognitive psychology approach to your teaching and larger educational goals now what's different the irony and potential hypocrisy of me giving you a 60 minute lecture on why you shouldn't give 60 minute lectures is not lost on me so I divided this into two major parts so we're going to start with the first part take a quick transition of reflection dovetail into the second part and use those hopefully have enough time at the end to have a nice robust discussion and question session I know there can be a lot of questions about the generational stuff so hopefully have a lot of time to discuss that and because there's a lot of neuroscientists and neurologists in the room I really hope it's kind of a brainstorming session for educational reform it's also not lost to me that only Monday the school medicine hosted a kickoff to their curriculum reform or they're really brainstorming how do we educate medical students and beyond alright here's the first audience response question hopefully this works it might select for Millennials and digital natives but the idea is which is your opinion of the Greatest Generation Tom broke I was describing through the traditional generation when you said that there's also the baby boomers Generation X and of course Millennials oh good I was worried about this part I didn't know how this would go you guys are seeing that progress as we go here oh it's what a nice group they're all great I do like that some people but I don't believe in generational literature that's okay skepticism is healthy good okay good I think we're getting a general trend here but the a lot of Millennials are also kind of in the lead if we count the own individual cohorts okay but here's the rule disclosure into those that didn't answer I don't believe in generational literature I can sympathize with that because I do think that generational stereotypes are just that they're stereotypes they describe large groups of people based on when they were born the other limitation is is they're usually based on us and/or Western culture in the first world and so it doesn't always apply and if you try to apply this to individuals if you're sitting there going now you're really a gen Xer or if you're thinking about your learner's going are they really Millennials and trying to apply some of the things we're going to talk about you're probably gonna fail now where it's useful I think is the questions that we asked part of this came up because I was invited to write a chapter on this so I had to very quickly get up on this literature and I think the really what's interesting is is it really makes you think about education under a microscope and the questions you generate are hugely important and I'll explain more what I mean by that okay people may have heard this quote this is included in a recent editorial by a very great person dr. goop dhaliwal at a UCSF and he was talking about generational literature and some someone know who might have said but the newest generation has luxury bad manners and contempt for authority disrespect to elders that sound familiar 1950s George Washington's era somewhere in the 1700s right the apostles say so what Richards closest killed masters in ancient Greece about their apprentices so this idea of the youngest generation of learners when they're talking about experts and novices this tension between generations is not necessarily new Time magazine famous cover the Me Generation the me me me generation often called Millennials kind of judgmental I love the subtitle though they're lazy entitled narcissists who still live with their parents and they're gonna save us all right all right just to counter that 1976 right so again not a new argument and it's about whether is it really generational or is it just a matter of experts and novices those with wisdom and those without here are the four major cohorts in academics today you've got the traditionals baby boomers Gen X and Millennials I'm going to talk about them briefly individually here the traditional generation in their 70s now also known as the Silent Generation whose influences include the Great Depression and World War two right now there would be a professor emeritus senior Mentors I have a senior mentor from where I came from who's certainly in the traditional generation the baby boomers are next in their 50s and 60s the rock-and-roll generation influences include the advent of television the Vietnam War the JFK assassination and they would be your CEOs your chair people and mid to late career faculty Gen X I picked for the celebrities and nice-looking people in their 30s and 40s known as the latchkey Generation this is the coin because this is the first generation where largely both parents went to work for the first time the MTV generation as well which talks about their influence as being the explosion of television maybe your fellows and your mid early to mid career faculty and then of course the Millennials in their 20s and 30s the internet generation Generation Y the Millennials influences include of course technology which I'm gonna get more into in a moment first attacks and their roles are a primary learning group medical students residents and fellows now some I ask me I don't feel like I'm in-between Gen X and Millennials I don't understand well fresh off the presses I got this by the way I got this from Twitter which tells you which side of this line I'm on but Zen yells is this group that really feel like they're between the digital and analog ages they grew up with VHS and the advent of blu-ray I also love that our Wars has now become the litmus test of what generation you belong to which trilogy did you grow up with essentially all right so having said that ask yourself a question do you identify with the stereotypes ascribed to your generation and this one's not going to show up live so I'm gonna reveal once I get enough response oh wow you guys are good okay wow I did not expect that okay well the literature is interesting on this is it you can imagine a lot of people don't identify with their generation but it actually is going down in terms of agreement so that you're more younger generations agree with the stereotypes less and less which I thought was pretty interesting okay why talk about generations will years idea of generational conflict and when we wrote the chapter on this for medical students the idea was we actually lumped it even further we talked about the older generations which I'm from the south so we call that advanced distinguished age but the older generations with traditionals and boomers lumped together and Gen Xers and Millennials lumped together and we did it in a framework of common educational issues or kind of spectrums and this is what we came up with based on the literature is that the preferred teaching model for the older generation is more teacher centric so again a little bit ironic that I'm just on the stage but the sage on the stage model now it's a little chicken or egg because this was all that was available if you look at the timeline of medical education and adult learning this is what they had was lectures and projectors and chalk talks so the question would be is would they preferred something else had they had it now now that we have other models it turns out the younger generations prefer student-centered act active models of learning so your problem-based learning your small group sessions the more student-centered weight of thinking and what would be a learning model itself and by the way any one of these things could take a positive or negative light and I try to take a positive light but I look at the balance of these things again because I'm not into being judgmental about a cohort learning model of authoritative so this was kind of I thought first negative when I read this this idea that they just take on information passively if I were to tell you this information you're just going to go home and be like oh it must be true dr. Korb said it and that's not necessarily nice do we think about skepticism as being healthy and science and so as medical professionals we think that I'm going to question what's coming in well the positive spin of being authoritative model is respect you got if you got dr. dhaliwal from UCSF telling you something you know and and and believing it it's somewhat an issue of respect and so the skepticism can be misinterpreted sometimes I like to say misinterpreted as disrespect of wisdom they're naturally more skeptical and they prefer that now what about expectations well this is interesting we often talk about expectations in the millennial and Gen X group as being high they have high ambitions high dreamers whereas the previous generations were more tempered in their expectations now the positive spin on that is humility versus ambition versus not having big enough dreams versus being narcissistic and sort of out of touch and then work-life all right this is one of the more controversial ones right how they feel but the work-life balance and professional education and professional duty well the previous generations reviewed as great dutiful patient care comes first second and third right and that's there's positivity in that right there's the idea that they're devoted to their passion they're devoted to patient care and people that are sick the negative side is at what cost right and then the other thing is balance this idea of work-life balance these newer generations wanting that balance and again the negative way of looking at that is like well they just don't care about patients as much as I do turns out that's not really true and I'm going to talk about that that that myth of Millennials and other younger generations not caring as much is not the reason this is their the positive spin on this too is given the issues of resilience and burnout it's huge to have good work-life balance and some people might argue being a good provider means that being a good holistic well-rounded person now for those neurologists in the room – I think it's tough – I'm going to be a little controversial here by the way I identify as any 'l that new term i'm on the cusp it's tough i think one of my mentors used to say he was able to quote books that were on the shelf in the same room that he trained he could say turn to page 312 of booba slovsky's uncommon causes of stroke and i'll pull it out and there it was and he talked about how he'd be here all night working working working really hard now it turns out I asked him later how many stroke alerts did he go to in his career how many hello pads did he have to go to right so it's very different so this idea of work-life balance can be very different from generation to generation all right I want to focus on Millennials and this is where it gets also very controversial because this really embraces the generational literature but they did take indices across time and sort of studied people as they came through to try to get an idea were people really changing now I'll start with the positive one they're actually more intelligent that's if you believe IQ is a single metric of intelligence sure but they are more intelligence and they get great emotional sub scores so their emotional intelligence is really high so I think it's too simple to say they don't care because they are actually very very socially engaged and in fact they're considered one of the most socially engaged generations now what about we've talked about their motives and the idea of work-life balance the desire for leisure already but let's talk about another more more controversial one and this one is this idea of external control and reduce self reliance now I'm gonna bring up this example because I think it ties this nicely together whether you believe it's a correlation or really an association but helicopter parenting right this idea that parents influence these generations by being they're constantly attending to most and if all to their needs well past developmental stages and into adulthood and so what's interesting about this conundrum are sort of almost counterintuitive is that they're highly ambitious they actually have a high self they actually they did a study in high school and asked him how many of you will get a graduate degree and half said they would earn a graduate degree and only 9% ultimately did two-thirds think they'll be in the top 20% of their profession right so right math doesn't work out so the problem is is that that high self confidence can be narcissism not narcissism capital and insight diagnosis but these indices of narcissistic traits are higher in this group because they have a high sense of self that may have came from the same helicopter parents but the disconnect is is that they have an external locus of control and so that can be damaging because they've shown that people with higher narcissistic traits do worse on tests the more confident you are typically the worse you do so it's something to address because as we think about this they're gonna look to us as teachers the other positive spin is that the external locus of control could be the teachers we could look at this an opportunity to influence a whole generation of learners despite this ambition this confidence that might explain the last one the higher incidence of mental health problems maybe not but I do think it nice ties together if you have a high sense of self the so-called narcissists golden balloon that gets popped right and from psychiatry that if you have high sense of self you don't achieve that you can develop anxiety and depression and where does this all come from so this is that part I mentioned about the question might be more important in the answer whether you believe those that intrinsic traits and Millennials are not I think the interesting thing is is what do we think caused it and this is one of them the idea of the on-demand culture okay and this came from really three different things the explosion of the internet on-demand purchasing you know basically uber post mates right you can to day delivery after one-click buying this whole thing explosion of the Internet and also the quantity the quantity and the availability they can get anything anytime anywhere and I think from from their developmental stages that's really what it is you can get anything anytime anywhere from your pocket I mean pocket computers is pretty wild for those that again grew up in that analog age this is affected electronic medical records obviously I would argue that EHRs are way behind most technology but it is there they're used to doing that as opposed to the handwritten notes write the simplest somewhat the simplicity of actually just going in and going from scratch we already mentioned helicopter appearances being an influence for that issue of ambition despite external locus of control and video games – if some extent there's emerging literature about video games what they call gamification that these learners are actually responding to gamification of their education a little bit of the competitiveness a little bit of the milestone markers that occur in video games sort of the high score for those I grew up in the 1980s that's becoming an issue – and then of course social media as an extension of this technology these are very social people and then the the sheer amount of connectivity that they have they're looking for social media outlets for their education ok so what does this boil down to when it comes to education in the book that we wrote we divided it into preclinical education and clinical education now this is a little bit flexion Arian it's a little bit out loaded there's a lot of overlap here but we tend to think about this as being the non clinical education and the clinical education too much information or TMI right the sheer firehose of information that's available is issues you can go on google and you can get incredible amounts of information and Google Scholar is getting better but arguably is that really the right way to go when I teach medical students how to search for materials and I think really in fact there's a there was a saying that there was a charged in a medical school commission met and they said we should probably get away from rote memorization and focus on critical thinking and an appreciation of lifelong learning does that sound familiar could that have been said on Monday coulda been said on Monday it was said in 1925 after World War 1 and the explosion of biochemistry they realized there was far too much information in the curriculum to memorize and that was 1925 and now we've got the Internet there's way too much information not on the curriculum if you've reduced the curriculum there's still too much information at their behest we need to help guide them in terms of how to search I know we at training in mesh search terming on PubMed and and how to then critically appraise that information that clinical point of care is much more important in my opinion than rote memorization but a lot of our curriculum a lot of our assessment is still based on this idea of how much can you memorize technological advancements but we mentioned the digital age is certainly upon us this comes up in two ways distance learning and computer assisted learning computer assisted learning is basically any computer-based learning module could be simple an e-book technically computer assisted learning it could be even virtual patients with high fidelity environments which there's a lot of emerging studies about as well but this distance learning is interesting anything anytime anywhere is the credo of Millennials whether they know it or not so here you go you're gonna go at 12 o'clock to auditorium be to listen to dr. Korb talk about a limited amount of topics in a certain amount of time it's antithetical to what they've grown up with right so what do medical students do and I do first the second year PBL see someone the audience here when I do PBL of my students they talk about whether or not they good a lecture if you have been to a lecture or given a lecture at the School of Medicine you look up like I'm looking up now by the way thank you for coming because when I look up it's usually half filled and everyone's on their laptops and and and essentially they're at home watching it at one point five or greater speed it must sound hilarious but the idea is that they want to consume information quickly on their terms so they don't want to be in a fixed place to fix time with a fixed amount information so they're creating active modes of learning like flipped classrooms even if we don't flip them they're gonna flip them themselves couple a thank you for that mm-hmm this other one is about multitasking when I look up in an audience and I see a bunch of laptops I'm Gil I'm as guilty as anybody else is the fallacy of multitasking because they're a culture of anything anytime anywhere mobile on-demand culture multitasking is something they actually embrace in surveys and it's been shown time and time again and learning studies that multitasking does not work and as neurologists we know that's right when we test attention in the clinic we always wonder when our our patients don't recall things it's like they weren't paying attention right okay and then social learning essentially teaming up into small groups they want to learn with each other they want to collaborate it's kind of an ironic thing we've created such a culture of lectures they don't show up to lectures to see their classmates because they're just going to sit there with pass information just being soaked in them but they would like to learn in social collaborative environments it's in their personality type if you believe that literature clinical education can be summed up a little more simply it's that external locus of control is the theme the helicopter parenting are we gonna be those parents now I don't know we could easily say I didn't get that kind of parenting I'm not going to provide that to a bunch of learners but I think also appreciating that that's the way they are again if you believe the literature they need feedback they need it frequently again on demand right on demand culture they need frequent feedback frequently and on their terms and because of the external locus and control that's why they want that concrete information despite being a creative generation despite being a socially engaged generation that's why you get if they get upset with you and their evals if you don't tell them what you want have to be very explicit and the need for context I think is huge we have to role model the behavior we want them to emulate communication wouldn't really talk about much but this came up a lot in the literature was how do we communicate one thing I think we need to recognize as older generations is that they don't necessarily believe in hierarchical vertical communication they want a voice at the table or a place to the table they want a voice in what's going on and so it's important to recognize that when you include them on committees and you include them on that and also give yourself a break they're not necessary disrespecting you when they come up to you and say why don't you return my email two days ago right it's like what in fact I thought I've had Millennials do that to me why did you return your email because they want it on demand they want it quick and they don't necessarily believe in that vertical communication they don't necessarily know it's disrespectful because they're not reckoned the reverse is also true I think younger generations also have to recognize the idea that there is a culture out there of more authoritative hierarchical control and different generations okay this is a lip of a reference slide I'm happy to send it to anybody wants this a part of that chapter that we wrote this was just more recommendations about what to do about these phenomena mostly in preclinical education but why does it matter sort of summarizing this part of the talk this has touched some points we already made but the death by PowerPoint again a little ironic given this is on PowerPoint but the idea is that we've got to move away from the stage and the stage model and answer our learners needs and wants and preferences by moving it towards more active models that are student centric I've done you know what I with audience response systems and splitting this up but we've got to find a way to flip that classroom and help the students learn on their terms because they basically sit there and I could do a graph of time to sleep you know there's sort of decreases as you go obviously mistreatment is a big one mistreatment we should have a zero tolerance policy there's many forms of mistreatment the one I think relevant to generational literature might apply to this mismatch between high self assessment potential performance and external locus of control there's one element when they do subtyping of mistreatment on this campus and other campuses humiliation embarrassment comes up a lot and I actually theorized that that may be because there's a mismatch between how what they think of themselves how they're performing and they're also sensitive to that praise and feedback and so something to be aware of now should you just get praise absolutely not they need to meet a measure and standard of performance we should know what that is we should explicitly tell them what that is and we should hold them to account we got to be aware of this potential issue of embarrassment as a potential issue of mistreatment what the interpreters mistreatment is also interesting too and then I'm going to skip down that we talk about the Google problem a lot but I'm gonna I'm going to talk about burnout again this idea of work-life balance and burnouts hugely important maybe we can learn something from Millennials in terms of their engagement of it and listen health care is not changing all that much the amount of stuff that the generation is gonna have to do despite their desire for work-life what they call balance which I know is not in vogue term anymore cuz the idea of balance is a little bit hard to achieve this idea of engaging a life of both work at home work and life sorry there's gonna be tough so gotta look to them to help them with that this is just a brief slide talking about the timelines and I think the interesting thing here is that generations have changed whether you believe the literature or not there's different generations coming through but we haven't changed all that much since fleckner's deflection errs report if you look at curricula across the country the majority have stayed pretty much the same now we heard about a lot of exceptions on Monday then is interesting the idea that schools are starting to listen and change their curriculum in a lot of different ways and I think as neuroscientists and neurologists we might have something to say about that so having said that during this quick transition and break what I'd like you to do is talk with your neighbors and ask each other how should we change this either based on generational literature or personal opinion how best do we learn and other impressions now what I think hope this will work what you can do is you can post your comments and they'll appear on the board here if it works it worked last time I tested it so you can text your opinions about the talk about how you think medical reform should move how do you feel about generational literature and go ahead and take about five minutes talk amongst yourselves as well as you post this and we'll regroup in just a moment to start the second part thank you yes thank you so the at the end have we don't have to raise our hands we can put them like this thank you what a boy's room yeah Jasmyn Pearson ice to ream each I know we've met before of it okay all right thank you buddy we're gonna restart part 2 part 2 as we regroup if you could answer this question for me hold that thought Richard it did just not in the way you thought but as we thank you for participating we again I'm gonna make sure we get through this and have a lot of time to discuss things at the end so I'll be talking quickly but those those answers are archived and I can send those back out to those are interested a lot of them were jokes and hellos I appreciate that but there were some interesting thoughts that I did take note of while I look at those and we'll discuss those at the end too there was a video that didn't work so we're gonna move right forward to this question starting part 2 what field do you think is most useful for how we learn obviously a little bit of a loaded question but you can answer none of the above if you want I'll wait for some responses to come in again this is part two talking about education neuroscience fad or future let's see okay good okay look at that so many of you feel like education psychology and cognitive psychology are the most useful with a good percentage in neuroscience which is not surprising given the crowd okay thank you for those responses I came upon this topic when I arrived at Maastricht and I was amongst giants in the field of cognitive psychology and extra education expertise and I have to admit I had a little bit hubris because I was the only neurologist in my cohort of classmates and so we started talking about cognitive neuroscience memory models I thought oh this is gonna be easy I was really wrong and I I had many conversations with my faculty one on one about the promise of Education and neuroscience and the overlap there in one faculty member in predicted particular dr. Bruin did some interesting work in this field but her biggest editorial was on this limitations and so this was a little bit heartbreaking to me and but also fascinating so I looked into this idea as someone who's interested in the classroom and by classroom in anywhere we learn I wanted to know more about how my knowledge of neurology and the brain could help inform my education practices and this is the world I entered into and you'll recognize some of these from psychology in college of course these are paradigms and learning theories and a whole bunch of terms that I was somewhat familiar with and a lot I was totally unfamiliar with starting with BF Skinner and Pavlov's dogs and behaviorism informing education via different models you know basically reward of different types affecting education outcomes up there and many of our lectures and testing classically has been based on this you give someone a reward or you give them a punishment and they should you know basically learn from that these conditional kind of things of course that moved on to where of course we neurologists are very familiar the brain our brain is a computer this paradigm of cognitivism became very popular the advent of computers you had cognitive load Theory Gestalt Theory metacognitive theory an expert theory which is very expertise theory is very important to adult education and professional education because we want to go from novice to expert and so a lot of literature's based on that and then there was vygotsky's zone of proximal development the idea of constructing because right learning happens in the brain right we neurologists know that right well the answer is actually much more complicated that because that model ignores the classroom and ignores other people in the classroom it ignores the environment for expertise learning and experiential learning and so basically study of scaffolding your current knowledge on previous knowledge and active formats was born with constructivism and now there's a whole bunch of new models in humanism and connectivism basically the advent of social media and the level of connectivity we have a lot of theories barring out from that area as well so you can see like digital age learning and of course there's some adult really fall in a meat category you guys probably know Bloom's taxonomy flipped classrooms active learning models as well and so where do we fit in as a neuroscientist in all this there's cognitive neurology education expertise and then neuroscience and the question is is it a bridge too far I like the way Mike my faculty member mentor put it was how do we take the brain scan to lesson plan and is that a promise that's way too far away so you know and in fact those who involved in research on the basic level translational level and clinical level understand this Stokes test on me and past years quadrant sorry but basically essentially look at basic research purely Applied Research the environment of interests and of course translational research so how does this fit into our paradigm neuroscience is really rooted in basic science when you look at education neuroscience and then education is often really in the field and how do we bridge that gap if ever well I do like to be optimistic and I'm a neurologist so I like to think that there's promise rather than limitations but what are the ways in which this is potential three ways supporting existing theory so what the cognitive psychologists have already done how do we give them credence and is that important there's argument that they don't necessarily even need that but it gives it a lot of credibility dispelling neuro myths is hugely important we're gonna get into that as well and then lastly informing future study and this is really we need to do a lot of work how do we actually take neuro scientific principles and then go back to the cognitive psychologists and say here's how to run an experimental design that means something in the classroom the methodology that we've done again these are familiar to those that are engaged in a lot of different types of basic science and neuroscience single-cell recording has been crucial in the sort of elucidation of cellular mechanisms of long-term potentiation of memory ERPs or event-related potentials have been important in studies I'm going to show functional MRI has been great at mapping connectivity and functional and structural events in the brain and then near-infrared spectroscopy as well there are others but these are just some that you run into when I did this lit review what I'm going to do is I'm going to take you through some key examples it's not an exhaustive review and I don't claim to be an expert in necessarily all these fields but I wanted to give you a taste of what's out there also to give you a scale of what the limitation is as well the summary of success is listed here a lot of it is based on pathology which again as neurologists we recognize we tend to focus on pathology and really if you've got a reverse our thinking is we're talking about how do we best learn non pathologically so there's genetic variance and learning disability a lot of focus on dyslexia and how to read because that's hugely important in development but it's also on development again not a lot here on adult learning and educational principles and then of course a lot of its mapping we neurologists really care about where things are right so what's interesting here is again the sampling learning to read so not a non pathological state how do we learn to read in 1925 Sam worden postulated that not only did acquire the language dominatus fear the deactivation of the right hemisphere this is he's a cognitive psychologist was not based on neuroscience but fortunately with fMRI technology were able to basically prove that that basically if activations in these areas in the dominant hemisphere and deactivations in the non-dominant hemisphere so again letting a lot of credence to what was already theoretically known sort of like going from learning theory to learning fact to moving on a spectrum maybe not exactly fact 100 percent is hard and science but how do we explain dyslexia and so there's been many models of dyslexia and and what causes it some are phonological like recognizing phonemes or audio processing of words as well as graphemes or basically iconic translations of physical words there's been additional information about just processing high contrast versus low contrast data rapid versus slow visual processing and these theories have been postulated many times over by cognitive psychologists and learning experts both fMRI they're able to prove the fact that this area is decreased with dyslexia actually regains function with remediation so again leading a lot of credence to things that were already out there in the classroom this is an example of that as well this is a pretty cool experimental design they used high and low contrast letters as well as in fast speed and what you can see here for those that know the magnocellular in parvo cell your pathway for those neuro scientists in the room magno is often used for low contrast fast so like harder things to read and what they were able to show was that this in the lower contrast opposed to high contrast there was decreased response and people with dyslexia of this type whereas there was a normal response with high contrast so again learning some idea to the theory about rapid letter processing and again they're the the basic science information informing this study was that these were different pathways and if you look at the the cellular area on autopsy is that it's decreased in people with dyslexia in this particular cellular line and again I'm not gonna belabor all these points again I just find these designs very fascinating again as sort of like neuroscience and forming cognitive psychology and vice-versa this is the idea that we have language dominance near birth so it's a neonate looking at optical tomography and you can see that there's decreased air sorry decreased areas of activation and the way they do this was is really cool they did were they did words said forwards and backwards and pre-linguistic babies so basically giving you words that mean something they may recognize and then words they that obviously mean nothing and there's decreased activations when they give you nonsense backwards words as opposed to activations and blood flow here so again just very neat with methodology there this is an interesting one there is a theory about bilinguals having better executive functioning and so if you learn two languages come orbitally they think they have better executive functioning again via behavioral studies not neuroscience but here is a neuroscience a way looking at basically differential activations in tasks given to bilinguals and monolingual z' when given a nonverbal task so again their activations are different between the two groups so again that's a little developmental that's all pathology and it's not adults Oh what about adult learning and/or advanced theory and so again there's tons of theories in education this is just one of many but the dual processing theory of clinical reasoning for those that are familiar with Danny Kahneman's work and Thinking Fast and Slow it's a great summary of this literature it's been around for a while but it's the system 1 and system 2 thinking and again just in brief the idea that system 1 is for experts so for those MS experts in the room that have seen MS patients for years and years and they come upon a new patient their ability to recognize to decide and make sort of clinical decisions and recognitions is super fast it doesn't necessarily need a drawn-out level of thinking because they've seen so many patients with MS before maybe that's not the best example but it's certainly illustrated there and then system 2 thinking reserve for the novice we get to go through the process very elaborately of trying to figure out what assumptions might be right or wrong there's been around for a while and I think in one of the better studies the it is a shout-out to monster University the the chair of that department is listed right there and again he's helping inform these studies about how to conduct them but essentially looking at experts taking a board examination of all things and activations when they get to a question they get incorrect they're given instructions about how to take it to make controls answer it quickly or forced reflection or just reading it and so they are they're able to design this fMRI data by looking at baseline baseline was just reading the vignette not an no expectation of answering the next level was forced sort of forced system to thinking and then forced or non forced system one thinking and basically they showed that there's activations in this medial prefrontal cortex here during when they get incorrect answers so the other it is is when day use system one when to use system two how do you know and so this idea of theory of governance between system 1 and system 2 exists but here's potential fMRI proof of that area because they're told to go quickly and this is what's activated when they get to incorrect answers theoretically or questions theoretically having more trouble with it and having to switch over so I thought was pretty fascinating there's similar there's there's deactivation of pre cuneus in the same area so again so fMRI data to suggest that dual processing theory has some anatomical credence this one I introduced now because it's just interesting this was instead of all experts they can experts in interns so theoretically non-experts in the same area and they showed increased activation in the interns and decreased activation comparatively speaking statistically to the experts so the idea is they have better efficiency in the same area if they're instructed use the same processes it has a common anatomy but they're more efficient and this becomes important and one of the last things I'll touch on which is cognitive load theory the idea that if you don't have to use as much cognitive load or space for answers you can use it for other things again I'm gonna touch this briefly because I want to make sure we have discussion time at the end again another clinical question what about exhaustion right what about burnout what about post call all that data it's very controversial what about the activations looking at experts with Amin Epworth sleepiness scale answering versus answering more than reflecting so again they're going quickly and they have decreased activation that same governance so when they get to that potential incorrect question or that question that's harder they need to switch over they actually have less activation if they're tired and exhausted this is that this is just actigraphy is another method of measuring that same thing and again interns here looking at scales of emotional exhaustion depersonalization occurring post call there's increased activation in that pre kunis area which was decreased in the previous one and then likewise decreased activation in the frontal cortex alright so how accurate are these statements we only use 10% of our brain okay good an exaggeration but illustrate nice okay all right I'm gonna go through a series of these how accurate is this statement left brain is in control of reason right brain control of creativity I get some water okay nope sorry oh geez Oh still they're good okay okay so a bit of a split there that don't know good 10% or 13% true okay teaching and a students learnings preferred learning style helps with their learning outcomes how true is that statement okay majority true some exaggerating in some false okay and then lastly there are critical periods of learning to be more specific that once you're outside this critical learning periods you cannot learn that thing anymore that might've been leading I'm sorry it's okay we still learn it right false true good split there okay good all right neuro myths so the other role that we can serve cognitive psychologists and educators around the world is by dispelling neuro myths that are common in the literature and in the media and here is just four of them that I think are some of the most important I'm gonna go through each one briefly here it's interesting one this is like to the least endorsed but here's the scary number 50 percent of polled primary school teachers believed in at least one neuro myth and certain ones up to 90 percent depend on the myth this one's around 50 it's probably the least likely endorsed neuro myth but the ideas of dubious orient William James apparently coined in the late 19th century but it became popular with Dale Carnegie's book how to win friends and influence people in the forward a cognitive psychologists Lowell Thomas in 1936 so pretty old said that you know sort of this is about potential right they want to endorse potential and it's a nice idea right the idea that we could have tap into our 90% be nice wouldn't it it's just not true he is basically a hundred percent of our brain left brain versus right brain we love classifications right it's easy it's nice it's fun we love pretty pictures like this too but night in 1844 Arthur Wigan talked about this is a new view of insanity the duality of the mind and it was basically popularized by Jekyll and Hyde okay the idea of and it comes from a real idea so people put exaggeration it's not unfair because we have strong left language dominance and spatial awareness from the right hemisphere so you know there is there is left-right differences but it has very little to do with reason and creativity and this just sort of got popularized for this idea that we can different people in different parts of the brain learning styles wow this one is interesting is probably the 98% of teachers believe this is true and it comes from the idea that we do have preferred learning styles there was even a comment by the way I don't when I caught that there's a comment on the board when I asked for commentary about I'm a visual learner spoiler alert we all are right and this got this got really popular it's vhe vak model we do have preferences we if you ask yourself I have a preferred model it does not affect outcomes I will say with one caveat there's a recent fMRI study forget the gentleman's name that may refute an anatomic difference between people who have different preferred learning styles but that's pretty much emerging and I'm not sure we can endorse that yet but a lot of attention was paid to this idea that we should individualize education based on someone's preferred learning style and it does not really work okay and why does this why is this important because of this there's a billion plus dollar industry and brain games this is one example of the idea that these myths can be propagated and used for commercial purposes and these educators who are prone to believe them can believe them wholesale and it could be detrimental to our credibility as neuroscientists if we want to possibly you know basically postulate and give ideas to educators we need to come as good arbiters of neuroscience I like that quote all right so lastly informing future studies so putting it together how do we inform future study we got any good stewards we can't propagate neural myths for sure we've got to really make sure it's a sound science but I think that the literature I read it's really got to be around the cognitive theories the cognitive psychology theories and the educational theories that already exist we must support that idea and not get lost in the brain I like that quote in one of the review articles talking about that we got to look at our ecology you know F MRIs are great it tells us where things are but does it tell us much about the classroom environment so think we need to rethink that idea of merging with our colleagues we're doing field science and work with them in terms of designing our studies okay so I want to make sure you've a discussion so I'm going to just touch on these last couple slides very briefly the counter to that is do we need neuroscience to back up cognitive psychology and educational science this is actually from an article that summarizes how we learn I think it's interesting you guys recognize some of these strategies highlighting and underlining right he does highlighting underlining when they read right whose summer out who brights notes and takes notes right right none of that works the only thing proven to work is practice testing what they call retrieval practice is a nice word to avoid test right but practice testing distributed practice it's better not to cram right that newsflash right it's better to learn things over time and interweave learning there's great graph showing that if you give people cramming material versus Innerspace if you get all at once they if I give you a test on this material right now outside the door don't worry I'm not going to do that you'll do really well if you got this information over time you would do a lot better at six months to a year and so a dr. Larson who's a pediatric neurologist at a Wash U there's a lot of this testing studies he's a neurologist none of his stuff is based in neuroscience it's all educational research so again do we need it and again I'm just gonna lastly touch on this because this was so gonna be part of the discussion part I want your ideas I want discussion I want questions criticisms etc but I'm a big I'm a big studier of neuro phobia talking to neurology specifically there's a lot of fear of neurology in the neurologic sciences has been proven since 1991 when the coin the term was coined but I want to know why and there's this theory that I've discovered and I'm sorry I had to discover it read about it wolf that's quite a claim that I think might apply the framework might apply the idea that we're giving people extraneous load cognitive load is this idea of a bucket of things that I can take on when I try to engage new learning and build on fundamental concepts and the task if I give a simulation at the Cape Center down it's down the street and the simulation you have to learn how to do the simulation the nuts and bolts that's the intrinsic task I want them to do the simulation I built if there's a whole bunch of other stuff like I pull the fire alarm during the simulation to give them like stress that's extraneous load is nothing to do with the learning objective itself and the idea is is I believe in a holistic sense that the effective load the extraneous effective load their emotions about and their fear about neurology prevent them from maximizing what we call the germane load the portion of the task learning ask that relates to the learning outcome and so I want to test this theory and that's one of the ways I'm using learning theory to inform educational practice ok now I can finally stop sorry is all about eight minutes left I was hoping for ten but we have a microphone being passed around so as you guys ask things all I may come out yep Richard you're a digital immigrant Richard I forgive you so to to comments totally here you see spanner flute in the chair of that department is like a the father literature of assessment driving curriculum and his idea is that if we don't watch that then then you're then you're a prisoner of assessment and then the second thing is is that there our ways around it people get creative for those that know Doug Gelb from University of Michigan he he was hamstrung by this core clinical conditions that the patient logger even Sharon poised on here did literature about how patient loggers really don't enhance the education mission or just a bureaucratic tool he's reduced his core clinical additions in neurology to three conditions a motor problem a sensory problem and a brain problem the idea being is that he's reducing the checkboxes to try to get at what the actual issue is in neurology and clinical neurology so I completely agree with you is that we have to be very careful how you a set you how do you select your assessment because you become a prisoner of that assessment you teach to the test right students will become very panicked if we go to small group learning that does not address step one right I completely agree well come on there's gotta be more comments than that yes oh thank you yes so it's a great question I think that it's a it's a double-edged sword is that the Socratic method if you look at the original Socratic method is all about thinking aloud and foundational knowledge so this idea of constructivism wasn't new but you have to do it right and there is an art to it I think all the literature talks about the bad word being pimping right you can do the exact opposite if you're not careful asking about the locus coeruleus on rounds is liable just to raise heart rates then achieve the outcome you want it right so that effective load in neurology specifically in other fields too if you're not asking the right questions and establishing what they know now I think the first should be always what do you know about epilepsy and listen to them a little bit here their thought process and then build from there it's a quick assessment of a learners baseline so you can construct and scaffold on that knowledge not an easy ask given all the things we do on rounds two and that's a different talk about health systems science and you know teaching in a busy world but I think the idea is that you've got to absolutely understand the art of the Socratic method is more about a back-and-forth about basically how do you think think aloud protocol yeah hugely important I agree because it's about critical thinking it's not about facts right it's how do we how you're thinking yeah other comments questions come on controversies Oh Richard please absolutely yes let me let me even take it further because again this is a plug for my longitudinal curriculum advocates the disseminated practice is hugely important and we have an interesting model here we have a dual model several students go into a longitudinal curriculum where they spend a half day every other week with a neurologist instead of every day for four weeks and then they take a test at some point in that late in that year early in that year and the argument is is that where are their exam scores but also what if sessemann are we're using and are they doing better with critical thinking in neurology it causes a lot of panic but I I'm a big fan of oral examinations not necessary for grading purposes but for understanding their thinking and that's a personal opinion and I usually get kind of body language about that right away but hey be careful he could structure oral exam to just the same idea of assessment you'll be very careful about how you construct your assessments yes yes yeah yeah yes and I actually I'm still not too missed about it I actually think there's I think there's a right ways to do it there's and we could burn that bridge if we're not careful but I can play with sound design ecological design that goes to the classroom would be very interesting yeah not specifically I think that you know again like any device it could be helpful and enhancing but it's all about cognition in the moment if it's distracting them from rounds and potential learning moments again multitasking does not work and it increases their cognitive load so again I love cognitive load theory because it really gets to you thinking about what is intrinsic to the task and also not only intrinsic what's germane which really pulls out what am I trying to teach here if you're trying to teach them to use point-of-care references an efficient manner so well they can like you at some point be efficient about their clinical rounds and using that technology that's great that's very intrinsic and germane however if it's Twitter or notifications or whatever else it's extraneous so I think I think it depends on how anyway – it depends on how you use it because that's that's the careful part is just adding on digital technology does not make education gains they've shown that low fidelity written cases do just as well as high fidelity cases and if those high fidelity virtual environments are written poorly they do poorly they're worthless they're pretty but they're worthless okay it says it's a related question I can answer that because I did the podcast interviewing Neil beyou sis and and others that wrote that article about the qualitative issues have burnout in Neurology specifically and you know listen if I have to attend another yoga class they add on for wellness I'm going to be sick because the idea they're not focusing on the right thing is that my talk was obvious about generations so I did focus on the idea of what individual characteristics can we address the idea of external locus of control and their embracement of work and life and balance such as it is it's not changing the fact that health care is actually getting much busier I think one of the the biggest stats is how many administrative you know how much does Ministry of salaries going up and how much administration there is so I don't necessarily agree that health care hasn't changed that call schedules have gotten better I'd actually argue it's all gotten worse and and it or at least it stayed the same in terms of his busyness and its administrative things and so it's these external things that cause burnout and that's not changing no it's the workload it's the workload what we do in our work right it's it's it's malpractice claims is doing notes at night it's futzing with meaningful use I just gave a talk on MIPS to the American Academy of Neurology and there's better Revolt in the audience I wasn't the I was just a messenger but I was talking about you know reform and Medicare and they were they were all there they're despondent about this and they're getting beat down more and more about reimbursement and administrative so that that that relates to external control I was more focusing on the external aspects but I think it's a small part of it I think the big part is institutional factors in brno that's that's a whole different 60 minute talk oh my goodness well thank you all for coming I really appreciate it I'll stay for question

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