This video is about current ideas in learning that can be used in dental continuing education programs.
In this presentation, we will review what is done well in dental education and critique what could be done better.
We will conclude that retrieval practice should be used in dental continuing education programs to help students learn.
Our learning objectives are that, upon the completion of the video, CE course designers will be able to define retrieval practice,
identify three aspects of retrieval practice that make it most effective, and list four ways continuing education providers can design
programs that use retrieval practice.
In dental school there are two different methods used to instruct students: passive learning for core
subjects and active learning for teaching hand skills.
Lectures are passive interactions where students try to listen, write, and understand all at the same time.
Clinical training is active where students are taught individually by clinical instructors and are provided constant feedback.
Although scientists have shown that the passive format is ineffective, not much has changed in the typical classroom
(Brown, Roediger, & McDaniel, 2014). While it might be many years before dental
schools can implement changes to make all
curriculum active and retrieval based, CE providers can implement design changes now that will help practicing doctors learn.
Much of what we do to learn is incorrect and can actually impede learning (Brown et al., 2014).
Most students are told that listening attentively, taking notes, and reading the textbook over and over
are marks of a good student.
Most students would agree, and 85% say they specifically use rereading as a study strategy (Karpicke, Butler, & Roediger, 2009).
However, rereading has not been shown to improve test performance, even in people with high
reading comprehension (Callender & McDaniel, 2009).
Listening, note taking, and reading may be necessary, but they are not interactive enough to make learning happen.
In clinical courses, instructors use active learning methods to teach hand skills.
They use a "tell-show-do" method and students are constantly tested and receive feedback regarding their progress.
Practice techniques like this, which use a coach or a mentor and follow a directed course for improvement, are called
deliberate practice techniques (LarryKing, 2016).
This type of active or deliberate practice embeds learning in the brain for later use and is an active learning method (Brown et al, 2014).
We know that this form of practice works because scientists who study expert performance tell us that to operate at a
continuous superior level, their definition of an expert, requires about 10,000 hours or 10 years of practice (LarryKing, 2016).
Clinical instruction demonstrates the type of active learning that embeds long-term memory and places students
well on their way to becoming an expert in their fields.
Dental educators can improve classes by adopting some active learning strategies
so that students can learn and master all of their material.
Dental school faculty could begin practicing active learning in lectures, but the change would take time to fully implement.
CE providers do not need to wait to implement better learning strategies because they design courses without all of the
constraints of the university setting. Practicing dentists are not novices and so basic material needs to only be
reviewed.
By following some simple learning methods, post-graduate dental education can be made-over.
To re-tool CE courses for dentists, we first need to commit to throwing out our old notions of learning and begin using proven strategies to
help students learn.
To do this successfully, we need to look at how human learning really happens.
Learning takes place in three phases so not all practice is equal for making lasting memory.
Learning is not just putting information into your brain, but involves the making of neuronal connections that, as they are used,
make memory more long-lasting and useful (Brown et al., 2014).
The encoding phase is the first phase of making memory.
Encoding puts sensory information into working memory for immediate use.
Practice that only involves encoding, the listening and rereading, is ineffective for when you need to make deep connections or
associate new information (Brown et al., 2014).
The second step in learning is consolidation, which is when the brain works to assess the importance of the new information and
determines its context and usefulness in the present situation.
The third phase of learning is recall or retrieval of information.
Retrieval is an active process in which learners search their data stores for the information using reflection and recall (Brown et al., 2014).
Testing is an excellent form of retrieval practice as it shows students what they know and what they don't know (Brown et al., 2014).
Retrieval is effortful and the effort improves test scores for students who practice it (Pyc & Rawson, 2009).
So, unlike listening or note-taking, which try to input information into your brain, retrieval practice focuses on getting
information out of your brain.
The retrieving serves to change the system and there is a linear relationship between how difficult the retrieval is and how successful later
retrieval will be (Bjork & Bjork, 1992).
Retrieval practice relies on a process called generation, which happens when students try to solve a problem before being
given the solution(Brown et al., 2014). Generation occurs in testing or quizzing or any
activity that makes a student search their brain for information (Brown et al., 2014).
Even when questions are answered incorrectly, the process of searching your brain for information is valuable.
Research on retrieval shows that the best results occur when it is practiced in a spaced manner over time,
allowing for some amount of forgetting (Bjork & Bjork, 1992).
Forgetting is helpful because the student must go to long-term memory over and over to find the needed information.
Each time the student retrieves, memory becomes more durable (Brown et al., 2014; Bjork & Bjork, 1992).
Teachers can assist with spaced practice by reviewing previously learned information through techniques like quizzing,
"write-to-learn" activities, or group discussions of past material.
When students learn a subject, they usually master one piece at a time, which is called blocked practice.
Blocked practice lets students rely on working memory and they can become distracted and lose focus (Metcalfe & Ju, 2016).
Varied practice keeps students concentrating on different aspects of the subject so they keep retrieving.
Teachers can vary practice by providing activities that eliminate predictability.
Interleaving practice is another retrieval method that aids learning. Interleaving is mixing related
concepts that help students find similarities and differences in items.
In interleaved practice, problem types are shuffled so that students must wrestle with finding a strategy for each different problem,
which helps them use discrimination.
This discrimination uncovers the why of a particular strategy and helps them when facing new problems (Brown et al., 2014).
Teachers can help with interleaving by teaching related concepts together instead of in a sequential order (Brown et al., 2014).
Students and instructors can feel that retrieving is slow and difficult, but studies show that these tools help learning (Brown et al., 2014).
They call this inconvenience in learning "desirable difficulties" (Bjork, 1994).
As previously mentioned, many CE opportunities for dentists are in a lecture format which only allows encoding to occur.
CE designers need to add retrieval practice to their courses.
One suggestion to implement retrieval practice into your educational courses is to slow down pushing content and, instead, offer short
quizzes or writing exercises that allow students a chance to see if they really understand the big idea of your lecture by practicing retrieval.
Participants will have better attention span and less mind wandering when they are stimulated to
participate in using content (Metcalfe & Ju, 2016).
As the day wears on, mixing in questions from previous sections or from basic knowledge will
give participants a chance to mix up their practice.
In our CE program for dental residents, we have just begun this practice and we were able to get the residents discussing
"big picture" concepts in dental implantology.
Suggestion #2 is that course designers re-tool their slides to a simpler format which puts small chunks of information in
front of the student and helps reduce cognitive overload (Atkinson & Mayer, 2004).
This strategy helps students keep their short-term memory free to make associations with the material instead of busy trying to make
sense of text and visuals.
Changing slide formats also forces presenters to keep content manageable. In some of our CE courses, we eliminate the
slides and move right into group discussions and quizzing which seems to increase interaction with the material.
A third suggestion for continuing education providers to use is to include hands-on segments
in courses that relate old skills to the new skills.
Instead of just focusing on the new skill, try reviewing a similar skill, which can act to interleave information.
We have successfully used this approach when teaching bone biology, implant placement and bone grafting to dental residents.
Finally, offer attendees a post-seminar review quiz to keep them retrieving.
After a little forgetting, they can re-connect with the material and test what they remember.
Be sure to include resources where they can find out more information on the topic so that their learning can continue.
We are excited to try this strategy.
During this presentation, we have looked at retrieval practice as a learning tool and have shown how using retrieval in dental CE courses
would maximize learning.
While encoding of information is necessary, the only way to take information from short-term to long-term memory is to
use retrieval (Brown et al., 2014).
Dental educators have a big challenge ahead to change learning, but using the suggestions offered in this video will bring your students one
step closer to mastering material.
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