The field of adult education and thus continuing medical education, continuing education and continuing professional development is covered widely in research, literature, how-to books, peer reviewed articles and the lay press. The “Make It Stick”1 concept was top of mind at the ACEhp meeting, but do education professionals really know the tenets of adult learning? Are we just passing along the myths we’ve picked up along our own journeys?
To test our collective beliefs in myth or truth of adult education principles, we’ve recreated a bit of our January ACEhp Annual Meeting session, Let's Talk Adult Learning Principles and Bust a Few Education Myths. Please play/read along with us! The session was interactive and so is this article. Read the statement, make your guess and then look at the explanation.
Myth or Truth?
The best way to learn material is to concentrate on it until you have mastery.
Myth: Improved retention comes from “interleaving,” which means to study one subject for a period of time followed by studying a different subject before returning to the original subject. This concept is front and center in “Make It Stick.” Even though the “concentrate until mastery method” is frequently employed in school, it doesn’t actually lead to better retention. Cramming may help for short term, but it doesn’t lead to long term memory retention. [“Make It Stick,” pages, 49-50, 63-65]
Asking learners to solve a problem prior to teaching the concepts frustrates learners and leads to poor retention.
Myth: Although it’s easy to think this, evidence shows that grappling with a problem before teaching the concepts can increase retention. This grappling prompts a learner to think about what he/she already knows related to problem in order to apply existing knowledge. Once the concepts are explained, they can more easily be added to existing knowledge thus increasing the likelihood of being able to retrieve the information when needed. Since adults learn in context, presenting the content as a way to “solve” the problem also puts that knowledge into the context of how it will be used. [“Make it Stick,” page 87.]
Adults have a preferred learning style (auditory, visual or kinesthetic) and will learn material better if it is presented in that style.
Truth … and Myth: It is true that individuals have a preferred learning style which is the way a learner prefers to learn and be presented information. However, evidence does not support the idea that students actually learn better using that preferred style. In reality, all individuals learn in all ways and presenting content in several different formats increases retention. The content to be learned also should inform the teaching style. [“Make It Stick,” Chapter 6, page 131-160]
Asking attendees to write down what they will do after a presentation only helps with retention if it is collected and used for follow up.
Myth: The act of writing down an intended action itself increases the likelihood that the action actually will occur even without the reinforcement of the follow up. Reinforcement also helps, of course. Adult learners develop by filtering new information through existing information and experience. Writing down an intended action requires filtering to have occurred and ensures that the action being documented is attainable and realistic. As a Hobonochi techo planner fan [https://www.1101.com/store/techo/en/], Shelly was amused to read the timely March 3, 2019 quote from Tomoke Ono, public relations for the National Astronomical Observatory in Japan who said, “I memorize things as I write them in my book, so I can remember them without having to go back to look. Using my hands to write something down creates a memory of when I wrote it that sticks in my mind.” [“Make it Stick,” page 89.]
Highlighting sections of material for re-reading is an effective way to learn.
Myth: Although this is how many individuals proceeded through school, yellow highlighter in hand, highlighting is not an effective way to learn. In fact, highlighting and rereading those sections perpetuates “the myth of mastery” when, in reality, it is simply memorizing the words. While highlighting may help a learner regurgitate information, if he/she is asked for the information in a different way, in a different context or asked to apply the information, he/she is often unable to do it. As highlighted, since adults learn in context, couching content in the context of a problem is a more effective method for improving retention. [“Peak, Secrets from the New Science of Expertise,” page 15 and “Design for How People Learn,” pages 119-120, 232]
The goal of repetition is to prevent “forgetting.”
Myth: Although the semantics could be argued, retention is actually better if a learner does forget a little and then has to work to retrieve the information. Think of memory as a muscle: it is worked, then it rests to recover, then it is worked again. If a learner just keeps working his/her memory without letting it recover, he/she doesn’t gain strength – just exhaustion. [“Peak, Secrets from the New Science of Expertise,” pages 98-99.]
Repeating a concept several times during a presentation is more effective than repeating it the same number of times over weeks to months.
Myth: Spaced repetition has been shown to be more effective in retaining information than concentrated study. That’s why reinforcement is so important in learning. Assessing outcomes a few weeks after an activity not only assesses outcomes but also reinforces the learning. Much of the narrative up to this point reinforces this concept. [“Make it Stick,” pages 63, 205; “Design for How People Learn,” page 118.]
Professionals typically know what they need to know and what they don’t know.
Myth: This is well documented, and although educators know it about their learners, the learners often don’t know or agree. Professional practice gaps and needs assessment data confirm this as does the Johari window technique, if we apply its two-by-two cube process to help people better understand their relationship with themselves and others to educational theory. Every learner has blind spots about themselves and about what they do not know, per Johari’s Unknown to Self/Known to Others cube. [Peak, Secrets from the New Science of Expertise,” page 131-137] [Ingham, H. (1955). "The Johari window, a graphic model of interpersonal awareness." Proceedings of the western training laboratory in group development. Los Angeles: University of California, Los Angeles.]
Creating “flashcards” improves retention.
Truth: The key concept here is the creation of the flashcards. Using prepared flashcards doesn’t give the same benefit. The flashcards should address concepts and not just isolated facts as well as answer. Developing flashcards that address concepts requires additional work and lessens the “myth of mastery” since a learner is not memorizing words or facts. [“Make it Stick,” page 202.]
Practicing the same skill over, and over, increases the chances of mastery.
Myth and Truth: Research tells us that practicing a skill over and over again can increase our chances of successfully learning and mastering a skill. If we refer to the first myth covered in this article, you’ll recall that the key is not just the repetition but also the intentional, strategic repetition. Simple rote replication, without conscious engagement in the effort, will not increase mastery. However, repetition with intense concentration on the effort, performing the skill the best a learner can and endeavoring to improve each time, is called “deliberate practice” and evidence shows it will increase mastery. [“Make It Stick,” page 61.]
As education professionals with the mission to provide experiences for our learners that will improve their abilities and ultimately the care patients receive, not only must we engage in the tenets of adult education for our learners but also for ourselves. The authors welcome your feedback. Try a principle or two and let us know how they are working for you and the changes you make in your educational program for learners and for yourself.
Make It Stick, Peter C. Brown, Henry L. Roediger, III and Mark A. McDaniel, Belknap Press of Harvard University Press, 2014
Design for How People Learn, Julie Dirksen, New Riders Voices that Matter, 2nd edition, 2016
Peak: Secrets from the New Science of Expertise, Anders Ericsson and Robert Pool, Copyright 2016 and First Mariner Books, edition 2017.