Combatting the Forgetting Curve: Teach Students to Fish!
A recent post from the LearnDash blog reminded me that one of the biggest challenges content-rich veterinary curricula have is RETENTION. Putting aside that the LearnDash post focuses on online education, the learning brain functions in similar ways for all types of educational formats.
So, instructors need to engineer incentives and while creating a learning environment for students to enhance their retention. How might we do that in veterinary education? All that content for all of those species? We know that examinations are the prime motivating guides for primary learning of content for most students. However, we tend to compartmentalize our instruction for them, teaching anatomy or physiology or pathology or pharmacology, giving our individually crafted questions on exams, and rarely asking for accountability across topics. This approach leads to the same compartmentalization by students, and it also leads to the idea that the instructor giving a lecture is going to ask content only presented within their lecture. But is that how a real veterinary career works? We all know the answer is NO.
Let me give an example. I once participated as a cameo lecturer in a veterinary pharmacology course near the end of a quarter in a curriculum where all courses were to have a mid-term and final exam spaced at roughly a one month interval. In this course, I lectured on 3 topics, and contributed the requisite multiple choice questions for the final exam. Two weeks later, teaching a group of 8 students from the same class in a clinical rotation on pharmacology and toxicology, as it was relevant to a case we were discussing, it became appropriate for me to ask the students a question identical to one I asked on the exam 2 weeks beforehand. Performance on that exam question was quite acceptable. I even reminded them that I had asked the question and the majority once could answer it.
However, now, in a completely different setting of high clinical relevance, blank stares ensued, until one student piped up, “But Dr. Ferguson, that was 2 weeks ago!”
This is where I am thinking and sometimes tempted to say, “Life is cumulative,” meaning that the vet student needs to move towards mastery of topics and maintain and update that mastery as they head out into their professional endeavor, whether it be clinical practice or other paths. However, At the time, I proceeded to refresh their memory about the topic, but used the opportunity to frame the pharmacology around discussion of therapy in an *actual* case.
Of course, I had “forgotten” about the “forgetting curve.” Ebbinghaus, in 1885 first demonstrated the forgetting was an exponentially declining curve approximated by R= exp (-1/s) where R is retrievability, s is the stability of memory (how fast R falls without training), and t is time.
So, how then do we enhance the stability of memory the first time information is encountered? And, how often to we expect students to refresh their own memory? I once visited a European veterinary school whose faculty, I was told, as a whole, decided to put the responsibility back onto the student throughout the curriculum. As I visited a small animal endocrine specialty clinic, a student came back to the instructor with little idea about how to work up a dog with suspected hypothyroidism. Rather than “spoonfeed” the student, the busy clinician chose to ask the student to report back later that afternoon having reviewed lecture notes, texts and internet to help fashion a diagnostic strategy. In other scenarios, out of concern that students feel that they should be “given” the information yet another time, and due to expediency to move forward with the actual case discussion or workup, we repeat the mini-lecture. We feel like we are doing the students a favor in the short run (and certainly our student evaluation scores will be higher), but are we really doing the students a favor in the long run? However, taking a message from the European vet school, it is important to have all or most faculty on board with the philosophical approach.
So, this and other experiences led me to try a blended learning approach, where original content presentation was via short videos, self-review questions, and more, if not all of my time together with students in a classroom is spent showing them real clinical case examples of the importance of this information. I’d like to think that the case context helps students retain the content (when presented the first time!) and perhaps preview important clinical procedures and thinking associated with that content.
This story raises some of the issues pointed out in the LearnDash blog. I list them again, and note some examples of how we could introduce these to veterinary instruction.
1. Reviews and refreshers: Review content within a lecture series whenever possible.
2. Spaced repetition: Make all exams “cumulative” by asking questions on “old” and “new” material and showing such content is related. Thought and essay questions also encourage students to study the material in a broader more integrated context.
3. Relevance: Seeing why one needs to learn something is powerful. Clinical cases certainly should help demonstrate this to veterinary students, but the key is to provide adequate scaffolding of case-related content depending upon the students’ training year.
4. Interactivity: Small clinical rotations/rounds are great formats, but you can have students discuss concepts with each other even within a large classroom setting.
5. Social Network: Students learn from each other. Students often organize this on their own, but in a blended or online setting, encourage and facilitate discussion via online forums. As another example, Scholar (https://cgscholar.com) allows peer discussion and peer review of written multimedia works.
6. Mix it Up: Review content throughout course, but use different formats.
7. Digestible pieces: Facilitate review, particularly in online content, with short video, self-review questions, and a searchable platform. Note that this is the format favored on VetMedAcademy.org in an effort to facilitate faculty picking and choosing relevant content to their own instruction, and allowing students to refresh in a “just-in-time” manner later on.
8. Multimedia content: Present the content in a way that addresses all types of learners, textual, auditory, and visual. Online content allows the learner to search for content whenever they might need it, and also allows faculty to ask students to check out that “mini-lecture” on his/her own.
9. Push content for review (online strategy only?): While time-consuming, and difficult to consider in the context of all of the content courses in vet medicine, this strategy seems most appropriate for purely online learners. It can be accomplished by encouraging students to subscribe to discussion forums and receive emails of updated discussions.
Beyond the philosophical discussion of “how many times” one should “cover” something in a curriculum before expecting student understanding and competence, perhaps we should be asking what teaching and learning strategies lead to the best retention. Certainly, we should be putting away our “spoons” and craft learning experiences that “teach students to fish” both to discover something on their own as well as to prepare them refreshing their understanding “just-in-time.” And a unified effort would help.