Intro to adult learningHow our students think,

and how we can help them learn

Why have a resident-as-

teacher curriculum?

Scope• Residents estimate up to 20% of time devoted to teaching

• Residents recognize responsibility in teaching

• Residents spend more time with bedside teaching than do attendings

• Medical students attribute up to 1/3 of knowledge to resident teaching

Impact• Resident perceptions

• Focused and high impact interactions

• Satisfying encounters

• Gain enthusiasm for subject matter

• Medical student perceptions• Engage student not interested in pursuing field

• Resident experts in field

• Resident excellent teachers

Let’s start with some basic

principles of adult learning

Basic Principles of Adult Learning1. Activating a student's prior knowledge enhances learning

2. How students organize knowledge affects learning

3. Students' motivation determines how effectively they learn

4. Repetition is key to learning

Building on Prior Knowledge

Building on Prior Knowledge• Students have prior knowledge

• Advantages• Motivation

• Varying contexts

• Building on strengths

• Disadvantages• Inaccuracies

• Continuum of knowledge

• Time

How do we assess prior knowledge?• Ask the student to demonstrate a skill

• Ask the student to tell you what they know

• Pretest/Posttest

How Do We Do This?• Set very specific goals

• Encourage students to become active participants in the process

• Provide context

• Set aside time

• Strengthen connections with correct prior knowledge

• Faculty lectures

Let’s Practice!!

#2: How students organize

knowledge affects learning

Experts and novices organize knowledge differently• Novice learners: superficial, sparse connections

• Experts: complex, deep connections

ExpertExpert

Novice

Knowledge structures help• Deeper, more meaningful knowledge structures facilitate:

• Memorization

• Learning new material

• Solving problems

How can we help students organize knowledge?• Any ideas that worked or didn’t work?

• Provide an overall structure

• Streghthen connections

• Identify outliers

• Encourage understanding of multiple organizing structures

Summary• Experts organize knowledge in deeper, more complex ways

• This facilitates memorization, learning, and problem-solving

• Elicit your own and your students’ knowledge structures

• Provide a structure before teaching

• Ensure the structure will accomplish the right task

• Reinforce this structure throughout teaching

#3: Students’ motivation

determines how effectively they learn

What motivates students to learn?• What kind of goals do students have?

• How do students decide which goals are most important?

• How does the learning environment factor in?

• Discussion

Motivation

Learning environment

Values

Self-expectations

Motivation Goal-directed behavior

Learning and

Performance

So how can we improve motivation?• How can we improve the value they place on the material? Self-

expectations? Learning environment?

• Discussion

Summary• Students’ goals provide motivation to their learning

• Students might have a variety of different goals

• Motivation is influenced by self-expectation, value, and the learning environment

• We can use these factors to understand why students behave the way they do

• We can manipulate these factors to improve motivation

Repetition, Repetition, Repetition

Repetition is key to learning

Analyze Evaluate Create

Apply

Understand

Remember

Again, please• Massed distribution vs Spaced

• Massed distribution

• Ex: lectures, skills labs, conferences

• Advantage- high short term return

• Disadvantage – lack of persistence

• Spaced learning

• Ex: “Spaced Ed”, memory exercises

• Advantage – persistent memory

• Disadvantage – marginal time commitment

Repetition is Key!• Sisti et al. Neurogenesis and the spacing effect: learning over time

enhances memory and the survival of new neurons. Learn Mem 2007:14:368-375

Let’s Practice !!

What our students need to

know

APGO medical student educational objectives• https://www.apgo.org/binary/Final%20EDUC%20OBJ.pdf

• 17 broad educational objectives

• 58 educational topic areas (with associated Uwise cases)

• Intended learning outcomes

APGO medical student educational objectives1. Develop competence in the medical interview and physical examination of women and

incorporate ethical, social, and diversity perspectives to provide culturally competent health care

2. Apply recommended prevention strategies to women throughout the life-span

3. Recognize his/her role as a leader and advocate for women

4. Demonstrate knowledge of preconception care including the impact of genetics, medical conditions, and environmental factors on maternal health and fetal development

5. Explain the normal physiologic changes of pregnancy including interpretation of common diagnostic studies

6. Describe common problems in obstetrics

7. Demonstrate knowledge of intrapartum care

8. Demonstrate knowledge of postpartum care of the mother and newborn

APGO medical student educational objectives9. Describe menstrual cycle physiology, discuss puberty and menopause, and explain normal and

abnormal bleeding

10. Describe the etiology and evaluation of infertility

11. Develop a thorough understanding of contraception, including sterilization and abortion

12. Develop a knowledge of common benign gynecological conditions

13. Formulate a differential diagnosis of the acute abdomen and chronic pelvic pain

14. Describe common breast conditions and outline the evaluation of breast complaints

15. Demonstrate knowledge of perioperative care and familiarity with gynecologic procedures

16. Describe gynecological malignancies including risk factors, signs and symptoms, and initial evaluation

17. Provide a preliminary assessment of patients with sexual concerns

Resources• Bing-You RG, Tooker J. Teaching skills improvement programmes in US internal

medicine residencies. Med Educ1993;27:259Y265.

• Female Pelvic Med Reconstr Surg 2010;16: 268Y271)

• Brown RS. House staff attitudes toward teaching. J Med Educ 1970;45:156Y159.

• D Parnell Why do I have to lean this: Teaching the way people learn best; Waco, Center for occupation research and development, Inc, 1995

• Ambrose, SA et al. “How Learning Works: Seven Research-Based Principles for Smart Teaching.” 2010

• APGO’s Resources for Residents (Effective Preceptor Series, TALENTED lectures) https://www.apgo.org/resident.html