We are asked to be teachers from the beginning of our training, but we are offered little to no instruction. We educate students, residents, fellows, nurses, and patients. Someone during the trajectory of your training tells you, you are a good teacher, and you accept the challenge. I remind you that teaching does not always come naturally; teachers train for years to learn how to educate others. The truth is every coach needs a coach. As I reflect on my career, a common theme that resonates is the presence of talented and resolute teachers throughout my journey. Each of them had different strengths and styles, yet all inspired curiosity, excitement to learn, and confidence in myself and my abilities. My aspiration is to be one of those memorable teachers. I believe there are qualities found in teachers that come from within, but there are also qualities that are learned and developed. My master’s in medical education gave me the opportunity to develop those skills as an educator.

As scientists, we are constantly searching for evidence. I went through years of training and only a few years ago during my master’s in medical education did I learn about the cognitive science of learning. It turns out there are better ways to learn. The cognitive science of learning teaches us about strategies that enhance the educational experience for learners. Below, I will describe some of the strategies that I use most frequently with my learners and how they have impacted my experience as an educator.

Cognitive psychologists have brought to light the importance of timing. They have studied the peak time of focus, the ideal length of time for teaching, and the relevance of the order of material presented in a lesson. We follow circadian rhythms that dictate our peak time of focus. In adult learners this time is 8am to noon. Each teaching session has a “prime or peak time” of focus. As you lengthen the time spent in a lesson the “prime time” decreases. This means the longer the lesson the less opportunity for retention. For example, a 40-minute lesson spends 30 minutes of its time in “prime time” versus 10 minutes in “down time” or decreased period of focus1. If you double this time to 80 minutes, you will increase “down time” to 30 minutes. The order in which you present learning material also matters. Learners remember best what is learned first and last. Teachers need to be intentional about how they use their time. They should take advantage of the introduction and conclusion of their lectures. This is called the primacy-recency effect. These strategies can be easily applied. Although they appear simple, their influence is significant.

To reinforce what I teach learners, I encourage ways for them to practice reviewing material they have learned through the practice of retrieval. When we retrieve information, we move it from long term memory to short term memory and therefore reinforce the concept and improve retention. I ask learners to reflect on one thing they have learned and one thing they have to look up after lectures. I encourage the use of flashcards and journaling. I also recommend interleaving subject matter. I believe the most important of all these strategies is psychological safety as it sets the stage for the other strategies to be most effective. A safe learning environment promotes retention and transfer of material. If learners find meaning or purpose behind the material, they are learning it is more likely to be retained in long term memory rather than exist as transient in short term memory. Behavioral psychologists and researchers in educational neuroscience report that a negative learning environment can lead to stress and release of cortisol leading to defensive behaviors, such as fight or flight.2 This leads to decreased activity in the frontal lobe, which is a key area functioning in memory retention.1 Why are these strategies relevant? Well, they have made my teaching initiatives more effective. My learners are engaged, enthusiastic, and I have seen evidence of retention and understanding of learning material through improvement in their testing ranging from low-stakes quizzes to in- training exams.

We are not born teachers nor doctors, for that matter. With the appropriate resources, we can practice and improve every day. It is a privilege and honor to teach future physicians and clinical providers of all disciplines. Applying the cognitive science of learning has greatly impacted my teaching philosophy and method. My joy as a medical educator comes from the interaction with learners, establishing trust, and creating a safe environment as I place the learners’ needs at the center of my teaching initiatives. It is a gift to witness their growth in knowledge and critical thinking.

References

1. Sousa, D.A. (2017). How the Brain Learns (5th ed.). Corwin SAGE Publications Ltd.

2. Cremer, A., Kalbe, F., Gläscher, J., Schwabe, L. (2021). Stress reduces both model-based and model-free neural computations during flexible learning. NeuroImage 229,117747.

3. McClintock, A. H., Kim, S., & Chung, E. K. (2022). Bridging the gap between educator and learner: the role of psychological safety in medical education. Pediatrics, 149(1).

4. Mayer, R. E. (2002). Rote versus meaningful learning. Theory Into Practice, 41(4), 226-232.