Category: Ophthalmology

Short answer: Students perceive they learn more by lectures. However, students actually learn more by active learning!

I recently came across a PNAS paper comparing active to passive learning for college students taking an introductory physics course at Havard (Deslauriers et al. PNAS 2019) [1]. In short, active learning has long been known to be superior to passive learning (e.g. lectures); however, STEM instructors generally choose traditional teaching methods. To investigate this discrepancy, the researchers randomly assigned students (total n = 157) to active learning (group problem-solving session) and passive learning groups (lectures). Students tended to prefer passive learning and felt like they were learning more from lectures (higher perception of learning). However, students in the active learning group actually performed better on tests. The researchers hypothesize that the increased cognitive load of active learning may have led to decreased perception of learning.

Personally, this research was quite concerning. Most of my learning is passive – especially from lecturers who excel at addressing misconceptions (thus depriving me of the chance to actively clear up misunderstandings or construct my own opinions). This phenomenon may also explain why medical students tend to better remember diseases that they have seen in an actual patient, rather than only read about in a textbook. This gap between the perception of learning and actual learning is not only a problem for aspiring physicists and medical students, but also for patients.

It is not uncommon to hear a patient say, “He didn’t tell me anything,” when describing an encounter with their physician. So either the specialist did not explain things well, or the patient did not hold onto the details. Patients typically do a good job of following what is being said while it is being explained. However, they may not be able to recall the details of the discussion later.

Rishi Gupta, Reflections of a Pupil, Page 157.

This quote comes from Dr. Rishi Gupta’s book, Reflections of a Pupil, a compilation of life lessons from a vitreoretinal surgeon in Halifax. At first, the book may seem to only contain platitudes and obvious advice (treat patients like how you would treat a family member, constantly strive for self-improvement or you’ll be left behind, never operate on the wrong eye). Nonetheless, the book grew on me for the following reasons:

1. There is great value in reviewing life lessons through the lens of a more experienced surgeon’s perspective
2. The book helps one understanding implicit values held by senior physicians.
3. Obviously, I haven’t had the opportunity to reinforce each pearl in the book through real life examples – and while the specifics might differ for every trainee – these “missed” lessons are precisely the most important to pick up on! For example, I will never say “oops “again in the operating room…

If you don’t believe the perspective of a medical student, Dr. Uday Devgan of CataractCoach fame gives a glowing review of the book below.

Anyways, Dr. Gupta continues the quote above with an especially apt analogy: “I liken this to being driven through an unfamiliar area of town. We all follow the left or right turns as they are happening. However, when asked to drive that same route again on our own, many of us would have a tough time.” A few suggestions (from Dr. Gupta and other research) to combat this discrepancy between perceived and actual learning in patients:

1. Summarize every encounter with a few bullet points and a brief plan so patients don’t lose sight of the bigger picture.
2. Provide handouts that patients can slowly digest at home with the help of their friends/family/the internet.
3. Encourage patients to teach back what they have understood (this can be time consuming though!).
4. Reinforce the same concept multiple times. Don’t be afraid to bring patients back for a second visit.
   1. People tend to remember the gestalt of a visit (how they felt) more than the specific information given. Ensuring patients feel like their concerns are being heard at the initial visit 1) more likely they will return 2) less likely to file a malpractice claim

For those interested in other suggestions for promoting active learning for students in general, this Edutopia article provides suggestions such as:

1. highlighting the benefits of active learning to students
2. encouraging students to see the struggle of learning as productive
3. helping students develop metacognitive skills to more accurately gauge their own level of understanding.

References

1. Deslauriers L, McCarty L, Miller K, Callaghan K, Kestin G. Measuring actual learning versus feeling of learning in response to being actively engaged in the classroom. Proceedings of the National Academy of Sciences. Sep 2019, 116 (39) 19251-19257; DOI: 10.1073/pnas.1821936116
2. Gupta, Rishi. Reflections of a Pupil. Pages 155-158.
3. Huntington B, Kuhn N. Communication gaffes: a root cause of malpractice claims. Proc (Bayl Univ Med Cent). 2003;16(2):157-161. doi:10.1080/08998280.2003.11927898
4. https://www.edutopia.org/article/students-think-lectures-are-best-research-suggests-theyre-wrong

Note: I feel like my introduction to the Deslauriers et al. paper may have come from some popular STEM Youtuber, IFL Science, or just something random on Twitter. Apologies I’m unable to remember the exact source, but I won’t pretend I remember this paper from a careful perusal of the primary literature about learning.

Note 2: The research of Deslauriers et al. is similar, but not entirely the same as the illusion of explanatory depth (which is more just a metacognitive deficit/ bias).