And Dr. Karen Barr, thank you guys so much for coming and your support for your learners and your dedication. I also wanted to thank the Academy. I was so thrilled that an educational topic had been chosen for Grand Rounds this month. And I think it's a nice showcase for AAPM&R's support of our continued skill development as educators. And I'm gonna introduce our speaker now. It's Dr. Colleen Kalanich. She's the Assistant Dean for Medical Education at the University of Florida, Florida College of Medicine in Jacksonville. She has extensive clinical and medical education research experience, has done many national and international lectures and is well-published. She has a particular interest in mentorship and instructional design. So I'm interested to see how she weaves those into her presentation today. And she has one of the best poster titles and MedEd portal titles I've seen in a while, which was Tuesdays are great for teaching tips. So although it's a Wednesday, I'm eager to hear what Dr. Kalanich has to teach us. Just a few quick points. I'll be monitoring the chat. So if you have a question or you wanna record a thought as she's going, I'll be watching for that. And then we'll do some interactive activities and take live questions at the end. Dr. Kalanich. Great, thank you. Thank you for inviting me to come tonight and spend some time with you. We'll have a couple of breaking points too, where we'll take a breath and see if there's any questions. So you can feel free to interrupt if you need to, do the chat or feel free to wait until we get to one of the breaks. So we will be doing some interactive aspects today using Poll Everywhere. And just to help me see where people kind of fall into the type of teaching that they do, I just wanted to ask what the role was and who do you primarily teach? Like, who are your learners? As most of us probably are doing the residents and fellows, but then we, it looks like it's about half and half now doing all types of students, which is great because all of the tenants that we'll speak to today will certainly fit any of those categories. So my other question to ask, and not only are you teaching, but how many of you are responsible for curricula in your programs? Woo-hoo, big one. Because it's an important part of making sure that we're connecting when we do our teaching, whether it's in the didactic session or whether or not we're in the clinical learning environment to make sure we're connecting to the overall curriculum and to make sure that we're meeting those learning objectives and competencies for our learners throughout. So having that connection too is a good part of understanding where you are in the part of teaching. All right, so with that, we're gonna get going and we're gonna talk today about learning and memory. And we're gonna discuss some of the strategies for faculty to utilize with today's learners. So our objectives are to recognize the importance of working in long-term memory when creating educational content. We're gonna talk about some strategies that will enhance the memory of your learners. And we're gonna briefly discuss the concept of digital natives in regards to today's learner and how they connect to some of those strategies. So I put some numbers up here. You're welcome to take a quick look at those numbers. You can write it down. You only have a couple of seconds to do that. You can take a picture, but we're gonna come back to these numbers in a little bit. Five, four, three, two, one, and we'll move on. All right, so generally in medical education teaching, we kind of have two really big buckets. We teach in more of the formal setting in the didactics doing lectures or doing that curriculum development. And then we also do a lot of teaching in the clinical learning environment where we're teaching while we're providing patient care. So some of the teaching strategies and learning things we're gonna talk about today can be utilized in either one of these buckets. And when we think about our overall goal for teaching, it's really important to think that our goal should be to impart useful information and skills to those learners to where they can remember those salient points and implement our key concepts or skills when that's needed. And that's really where the long-term memory and short-term memory come into play and how we can help with that process. So our plan tonight is we're gonna review some important tenets about learning and memory. We'll discuss some of the barriers that can interfere with effective learning. And then what are some of those strategies that we as teachers can utilize to assist in memory retention and to minimize the forgetting curve. And we'll talk a little bit about what that is. And we'll also take into account some of the things that our today's learners find helpful for their ability to learn that we as teachers can utilize. So your next question is for adult learners, what is the estimated retention rate after a traditional lecture? Would you say that your estimated retention rate is after all that work you've done to provide your lecture? So the bigger the number gets is the more that the people answer that question. So, so far we're kind of right in there, I think 15% might be leading the pack. All right, so you're about right on target, so somewhere between 5 or 25% is what adult learners retain, especially when talking about a learner in the educational lecture environment. When you think about 5%, wow, you know, you did all of this work and it can be very disheartening that you know your learners are only taking out of that 5% of what you put into it. So the forgetting curve illustrates how material we are presenting, particularly when we think about memorization, but not limited to the things that we do for memorizing. But this graph shows that really within 20 minutes, we've already lost 40% of what's being presented to us. And if we think about the long term, by the time we get out to 31 days, and we're last almost 80% of what that we taught that learner. So how does memory work in terms of the regard to learning? So when we first encounter information through our senses, whether it's provided visually, auditorily, or tactile, something we do with our hands. If it keeps our attention, then it's going to go into our short term memory, which is our working memory. If it doesn't keep our attention, particularly right off the bat, then we're already starting to see the decay of the information that we're providing to our learners. Additionally, the quality that we present on the information is important. The visual sketch pad, what we see in the tactile portions of which is also thought to be part of the visuospatial sketch pad, and the speech based storage, which is our phonological aspects. If we don't find, once we bring them into our memory, then the central executive processing allows us to take that information in our working memory and to start to process it. But our working memory only holds seven to nine bits of information at a time that they can process. And once that information is there and we're processing it, if we don't move on or store that information, then we're already going to start learning, decreasing our learning. So what kinds of things are going to help us get into that long term memory? So the more information that can be rehearsed, and this is the portion over here, from being retrieved from our long term memory through retrieval, it's going to really help with that encoding. So it's important that when we have information in our short term memory, that we have strategies that allow that learner to then retrieve, rehearse, retrieve, rehearse, that will allow us to start encoding it into that long term memory, which is ultimately our overall goal. But things can get in the way. So the learner's attention that provided can also have interference, things that are going to make it difficult, they're going to distract them, and some of them are ineffective teaching strategies that we use. Some of them are already in the learning environment that we need to take into account as already distracting factors that are going to be there when we're going to do our teaching. So we want to keep these things in mind when we think about what our learning goals are going to be for our encounter with our learners, whether it's in the lecture form or if it's going to be in the clinical learning environment. And even though we have lots of criticism about lectures, the basic premise is that lectures aren't going to go away. It's a staple of medical education, including graduate medical education, and it's not going to leave us. So we really have to be better about how we implement our strategies when we're doing a lecture and how we can learn to help them get their information transferred more in an active manner versus a passive manner. And in fact, when we transfer our knowledge and skills, it really isn't unique to the lecture hall or the conference room. Some of these key considerations and strategies are going to work in the clinical learning environment as well. So most of us recognize, right, the studies tell us that the typical learner's attention span is about 15 to 20 minutes, and this really isn't limited to the didactic sessions. It's also in the teaching environment, and it's not even limited to teaching. When you think about audience attention span, it's really only 8 to 10 minutes. Our society is just easily distracted these days. We're checking our inboxes, we're looking at our Facebook pages, we're looking at our text messages. On average, the Americans are looking at their phone 262 times a day. And that doesn't even, and this is more on the social aspect, this doesn't even count what people may be doing on their phone for work purposes or even for learning purposes that they may be using their apps for or even doing patient care. Additionally, we know that lack of sleep, the fatigue, the burnout, feeling overwhelmed, or the fact that we continue to try to multitask is also going to affect our cognitive performance. So how do we keep our learners' attention, and what other educational strategies can we use as teachers to assist our learners? So I had this on the screen earlier in the presentation. If you need to remember the sequence of numbers in the chat, what strategy would you use to try to remember this number? What would you do if you had to remember this number? Pretend I'm dialing it. Add meaning. Yes. Say it over and over again. Break it into bundles. Yeah, so you're starting to get that concept, right? Chunk it, there you go. So what we want to think about is chunking. Chunking is a very effective teaching strategy to help our learners. And this really goes back to the limited amount of information we have in our working memory. Those five to nine, really around seven bits of information. And so breaking up the information into important techniques are important. So this is why our phone number is broken up in that manner. And at least in the day when we used to have to remember phone numbers, right? Now everybody puts them in their cell phone and they don't even know what phone numbers are anymore. You probably have a better likelihood of remembering a childhood phone number or a friend if you're in that age group or when you had a home phone than you are to remembering numbers today. But this is also why our social security numbers are chunked in that manner. Again, to help us with our memory and so that we don't forget those things. But it's also why we have mnemonics, why we have acronyms and why we have cheat sheets and reference cards. It's the ways that we can chunk this information make it smaller bits of information for us to remember. And you find too that some journals are probably about 10 years ago started looking at how they can chunk their information in journals so that it was easier on the reader. If you look at any old journal articles or old papers they're just top to bottom texts, right? But now we're looking at even with abstracts that they're really looking at ways that they can chunk the information by clear formatting. Also adding salient points and takeaways and easy to read boxes. These are the key points. These are the things we want you to walk away from. And then really with tables too and how we're formatting and designing tables so that information that we want to be seen together are shaded and easier to read than if we had them all in just one box. So chunking and using strategies along those areas to reduce our cognitive load is really an important part of why we wanna use chunking. So one of the goals in a lecture in didactic should be your strategy on how you can also chunk your presentation because you can start at a very high level. Like my presentation is gonna be chunked or separated into three different sort of sections. And so you can kind of start that at a very high level and you can use your outline to help you do that and automatically chunk it into those sections. And then you wanna start thinking about how you can take away, put together these summarizing key points as takeaways. And then there are other acronyms or mnemonics that you could use that the learner may not know about or maybe you're creating them on your own. Sometimes when you can develop things that you thought, oh, well, that'd be a great way for us to think about how we can put that information together. And the more you can combine strategies, the more it's gonna be useful for that learner and again, reduce that cognitive load. Another strategy to utilize is something we call dual coding. Dual coding uses different senses to transmit information. It's been shown to, for instance, if you use a text information, but then use a picture that complements the information that you're giving, then that's going, the dual coding is gonna help that processing better for your learner. But it's important that that, again, that we think about cognitive load. So we wanna make sure that we're designing or utilizing pictures that don't add too much to our learner's brain. So you don't want a confusing graph or a hard to read picture or a blurry picture. You wanna make sure that it's easy for your learner to grasp that information and truly is complimentary. So the old adage that a picture is worth a thousand words is holds true. We find that times that pictures can also add emotion to our learner. And then that emotion in that picture can be an automatic image that gets imprinted into the long-term memory. And it's really useful for that. It's really useful for their retrieval into their working memory. Because remember what we're, our goal is to be able to have information in the working memory, but get it encoded to the long-term memory. So then it comes back, retrieved out of the long-term memory into our working memory as we need it. So I'm gonna show you examples of how we can use pictures to help with our stories. So we see a lot of presentations do a lot of texts like this. It helps the presenter in their mind to remember what they wanna say. So my message to you is it's really important to have your audience listen to your message instead of reading it all in a text box because then they are reading the slide instead of listening and usually they read faster than you can talk. Additionally, the brain can not efficiently attend to complex tasks at the same time. So if you're teaching something complex, the message might get lost, unless it's obvious and they can hear what you say and its impact. So with a show of your hands, it'll be difficult for me to see that maybe Dr. Barr can tell us how many, how many of you were trying to read the text with me? How many of you were ahead of me? I was slower reading it than you were able to do. How many of you just stopped listening? And you got distracted like what is all those words, right? So the point is, is that doing all this, it's just too much for your learner. They're not gonna pay attention. You're gonna lose them, but instead we can use pictures and chunking to help with that process. So what if I did and said this, using this slide and this picture really articulates what that whole text said, that it's better to listen to my message and listen to what I have to say than it is to read all the words that are on the slide. I can also use the slide to do dual coding because the more you have to listen to me, that's the auditory channel that you're gonna use and less that you have to rely on that visual. You only have to be in your visual spatial portion for a short time. And then you can switch to your auditory and listen to me. And it uses dual coding. Also the picture grabs attention. And again, it's gonna allow you to listen like what is she gonna say about that? And because it's an impactful picture, then it can also be one that's gonna be encoded into your automatic imagery and your long-term memory faster than it is for if you just had a blurry or a picture or a graph or something that tries to compliment your information. I can further add another strategy by chunking the key points. So here I've combined the picture with chunking where I'm giving you the key points, which is that the audience needs to listen to my message, that they can read faster than I can in talking. That's hard for the brain to handle two complex tasks. And then therefore the message is gonna be lost. Yeah, and additionally as presenters, we often ineffectively present our data, particularly during lectures. And typically we see these kinds of things on slides. A lot of times we feel like this validates our information because we've shown the seminal article. This is the article. And so I'm trying to transmit from in my lecture about this is that in 2016, drowning was in the top 10 causes of death for children and adolescents, particularly between the ages of one and 19 or 995 children died in that year. But there's a better way for me to present this data and to get your information because really my message is only that statistic. And there's only a few key points that I want to happen on this. And instead, this slide has a lot of noise. It has a lot of different things going on that isn't part of my message. And my learner is gonna be trying to read what else is on that abstract, maybe look at the other causes of death, which is not really what I want them to do. But instead I can do this. So in the chat, what do you feel like this slide does that the other slide does not? What does this slide do? Definitely brings emotion. Yeah. It's a point across, grabs the attention, vividly portrays, no competing messages, exactly. So presenting my information here does add emotion to my data, and it allows the audience to get the message quicker with less words, and it's focused. This then frees the learner to listen to any additional information that I might want to talk about that relates to this topic. And a slide like this can be easily processed in the working memory. It's not very taxing, so it's not going to overload my learner's senses in order to get the information that I want them to do. And again, because it's an impactful picture, it's going to allow it to get coded into the long-term memory faster. This is not going to be easily forgotten. So when we talk about the clinical learning environment, we want to consider that there are teaching models that can help us chunk our information during educational sessions and keep it focused, and also allows us to provide some short key takeaways and points or tips that are really important for our learner. So if we're in the clinical learning environment, we're not going to obviously use those other things. So these are different things that we can do to think about how we can chunk our information by using one of these models. So you want to think about utilizing the one-minute preceptor, using SNAPs, using AntMini. Since describing these in detail is really outside of the scope of today's session, I provided some links for you on videos on how you can learn more about how to do these, and they provide examples so that you can refer to them later. But another technique is using teaching scripts. These are really quick, very specific scripts that you create in advance for usually very common complaints that you are going to teach with most of your learners. By having these scripts in advance, it makes it super easy for you to make sure that your salient points are getting across. You can also add different things to them that you want to make sure they get those mnemonics, any kind of resources or apps that you feel like they need to go to, any videos you think that would help augment their learning, especially because that gives them an opportunity to start looking at that dual coding. I provided some links here, too, on how you can look at examples of teaching scripts from internal medicine, and then there are a couple of really good videos from the University of Washington that show you how to make the learning scripts for your specialty. So it's been about 15 minutes-ish, I think. So we're going to take a quick check-in to see if you have any specific questions. I have a quick question about your thoughts about learners wanting to use your PowerPoint slides as a future study aid. So I've gotten the feedback, well, you need to, I like when you put more information in your PowerPoint because I want to use that later to go through the material again or have it as a reference, and what your thoughts are about that. Yeah, so I think particularly for medical students, this is a strategy that they use, and you can use those in your notes. So you can add more detailed information in your notes section, where then they can go back to this, this will be in my notes section as well. You can go back and have more information, more detail. I didn't quite remember what she said. I don't know if I have time to go back to the recording, but they'll also be in the notes section. And then their references are, more references are in there, more of the links are in those notes sections too. But we tend to see that more of the medical students, undergraduate students, graduate students, those kinds of students are the ones that really like more detail in their presentations, unless it's really board related. Then that's a little bit different. Then they really want that whole case, and the whole series, and the whole information that's going to help them with the board questions. Does that help answer your question? Yeah, that's great. All right. So we're going to move on, and we're going to talk now a little bit about learning and memory and encoding a strategy when we talk about space education and space practice, which is one of my favorite things to think about when I'm working with learners and some related and reinforcing concepts. So the spacing effect, and it has several different names. It's also called space education. It's also called space practice. It's also called deliberate practice. So spacing is repeating information over time versus mass information, which is where we provide a block of information all in its totality without any deliberate repetition before we move on into new concepts. And there's really no planning for that. So we know that space education and repeating information is a much more superior way of teaching than mass learning. And when we overlay the forgetting curve with space education, it really becomes apparent how you can see how it works. So in the forgetting curve, which is the dotted line and which we looked at a little bit earlier, very quickly, the information is going to decay out of our learner's mind if there's no intentional opportunities to reinforce information. By using space education at different intervals, this allows the learner to revisit the information. And then because they're having to retrieve it out of their memory and rehearse it, retrieve it and rehearse it, then they're going to have it encoded into their long-term memory more sufficiently. So there's no studies out there that say exactly what those intervals are. But the closer you do it to their actual learning and then further out and then even further out has been shown to be more useful to the learner because you're giving them a rest period. And it's much more superior than actually restudying. And when you do space education, you're not reteaching the whole lesson. You're only visiting the key points and the key tenets and the things that you want to make sure that they're walking away with. If you reteach the whole lesson, then it usually becomes much more ineffective. And many times, they're not going to pay attention. Again, they want to get back, what are those points? What do I need to know? And what do I need to remember? And those are the things that you want to make sure that you're utilizing in your space education. Because you can see here, just at one week out, they're already at a high retention rate. Again, at 30 days, a high retention rate. And then by out 31 days, you're still 80% to 90% versus losing all of that very quickly. So further spacing out learning really helps our storage strength in our long-term memory. Whereas cramming for studies may temporarily increase the ability to retrieve information, it's not going to strengthen your storage capacity in your long-term memory. And it's really interesting because in the literature, you'll see that most learners still believe that cramming is the way to go. Unfortunately, it's not. But they have short successes. So cramming can often help with tests that don't really matter or they just have to pass that test to get to the next one. But it's not going to help them in retaining their information the same way that using spaced testing is going to do. So when we think about how we're going to look at that, or even for a high-stakes test, we or even for a high-stake test, the more you can do the spaced repetition out, the more they're going to retain that information for high-stake tests or for information that you obviously need them to have for their long-term like diagnosing and treating patients. It's just very obvious that space education and space practicing is much more superior. So some of the techniques you can use for retrieval, one of them is the testing effect. Testing is one of the most valuable retrieval processes we have for space education. And you can do that at the individual level. You can even do it through competition. We've known this for over 100 years that testing is effective. But it has to be proper testing. You can't just do like a big, long test that has no meaning for them or for facts that are inappropriate or ineffective for their learning. Even if doing short quizzes repeated over time is going to help them more than a big test that has information that's not useful to them. So you can use the testing effect, which is a great way to get that through. There are different ways to do it. And when you do testing, if they can get their feedback right away, that's really helpful for them, too. It's even more impactful. They know right away whether or not they got the questions right or wrong. And particularly, if there's some feedback as to why the question is right or wrong, will also really enhance their ability to keep that information through the retrieval, rehearsal, retrieval, rehearsal. There are tools out there that you can utilize for testing. Poll Everywhere has a fun competition aspect. I put the link here for you to be able to go back and look how their competition leaderboards work. You can, instead of have people put their names in there, they can create avatars. And they can see how they're doing longitudinally over their tests. It's a pretty cool program. So if your institution buys into Poll Everywhere, then you can utilize that. If you don't want to do a competition, they can just do quizzing individually. You can have those available for your learners. There are other tools you can utilize, like Google Forms can even have a way of doing it. Qualtrics, most universities have Qualtrics licensing. There's Kahoot. There's Quizlet. So there's lots of different things. And they're not really very hard to learn. So for the teachers, it's a lot easier So for the teacher, it doesn't make it that much more of an effort to do 10 to 15 questions, especially following up on a lecture. Or following up on those teaching scripts that you use already gives you a great guide on the things you can test, because those are the things that you want to teach the most about. One of the things I like to do is recall emails. I do this a lot with my students. I do this a lot with faculty development, because it's the same thing. People who attend our faculty development sessions can be really enthusiastic about the new information or new strategies we might be teaching them. But then you go back to life, and then you forget about them. And you don't remember exactly what may have been said, or maybe just forget that there was the opportunity to do something different. So after our faculty development sessions, I send out just key tip emails to people who participate. Hey, so glad you attended. These were the key points that we went over in that lecture. Here's the link to where you can watch this lecture if you want to, and you can fast forward to the point that you'd like to do. And I do that at intervals throughout the year and in different ways so that it gives them the opportunity to go, hey, yeah, maybe I want to do this strategy this time. Or Dr. So-and-so presented that, and I forgot that that was a really great lecture on competency based assessment. And then I mentioned earlier that another great way that you can use is your teaching scripts. Same thing. If you are in the clinical learning environment, and you went through your teaching scripts with a set of learners, then you can just use that teaching script as your quiz that you're sending out to your learners you had for that month. And just say, hey, we went over quite a few things this month. These are some of the key things I'd love to see you walk away with. At your leisure, take this test and see how you do. And you can send that out at three months. You can send it out in another six months just to let them see how they're doing. It also gives you feedback on how people are doing and whether or not they're walking away with important things that you want them to. Another great strategy are flashcards. That strategy never gets old. There are lots of different flashcard programs. There is, of course, Onkey, Flashcard Machine, StudyBlue, StudyStack, and then, of course, there's the PM&R flashcards. So you becoming familiar with these types of strategies, too, will help you direct them on how to do things. And you direct them on how best to utilize the flashcards as well. Like, hey, flashcards, so-and-so in this chapter would be great for you to review. Again, you can send those out at different times. Hey, I mentioned this flashcard chapter to you before. I'd love to see you revisit this in three months and then send out that email. Again, having them revisit this information often is going to really help it stick. Other important things to keep in mind when teaching are really just some of those core principal adult learning theory concepts. So adults are really gonna be more engaged when the learning is applicable, when they can understand how your information fits into their own learning. And this is where your learning objectives really come in. When you can let them know what you're expecting of them and what they should be taking away, then that really helps them to connect and see about their ability to reinforce that. When your learners are gonna be more engaged, when they know how your information is gonna fill educational gaps. Most learners know what's missing or what they may not be great at. They may not like to share that. Most of them kind of have an idea where their gaps are. So when they can see that you're filling that gap, then they're gonna, again, be much more engaged in that information. The more you can connect to prior knowledge, and this comes into play also to understand the curriculum as a whole. Sometimes we don't have great exposure to the curriculum as in its entirety. And just being able to take a glance as to what your program expects your learners to learn for the year that they're in training will really help see where you're fitting things in, whether you're teaching in the clinical learning environment, or if you're teaching a lecture. And that will help you augment that learning with the sessions that you have with them. Again, taking learning and memory into account when you think about the strategies you're gonna use is gonna enhance that for that learner. And then the more motivated you are for your learner to learn on their own, it's also going to help them seek out strategies to help them augment their learning. And it will also help them think about how they can implement those strategies that you're teaching them. So these are just, again, some key concepts to think about while you're going through adult learning theory processes. Okay, so that's the end of our second section. We're doing pretty good on time. I just have one quick final information to discuss, but I wanna just check in. I hope I'm not talking too fast. It's always hard to keep things in a manageable way, but we do our best. Okay, so finally, I just wanna mention briefly a concept or a theory that's kind of out there. It's always sort of on our minds about these learners. And that's this sort of concept about digital natives versus digital immigrants. So a digital native is purported to be a person who's born or brought up in the age of the digital technology, where they've been immersed in computers and the internet for a very early age. Generally, these are people who are born after 1980, and really in their entire lives, they've been surrounded by technology, social media, mobile devices, computers, internet. And these are the generations that they kind of get labeled within this digital natives. And I'll just throw it out there. Like anything else, it's important not to stereotype everybody. Again, this is just a concept. It's a thought. It's something to think about. But again, we're gonna talk about a few strategies sort of help mitigate some of that. So a digital native, Mark Prinsky in 2001 was the first person to sort of term this digital natives and digital immigrants as a way to describe in his mind sort of the disconnect between those who embrace technology outside the classroom and our lack of ability to apply some of those concepts in the classroom. So in general, he reports that a digital native has the ability to think of process information differently because of this immersion into the digital world, that their minds are very hypertext, that they like their information fast, that they have heightened cognitive skills, basically the enhanced ability to multitask, and particularly in the dimension of visuospatial skills that they're used to seeing things on their cell phones and videos through text messages and email. So their minds work faster when they can see things in that manner, that they thrive in instant gratification and frequent rewards, prefer games and creative interactivity, and that their brains are much more neuroplastic, right? That they can change quickly, adapt, and adapt to new thought processes. So in contrast to what we might call a digital immigrant is somebody who's had to adopt technologies. They didn't really grow up with them. They have to continually learn them, prefer to talk to people in person. They're very logical learners, prefer to focus on one task at a time, would prefer to interact with one or two people versus many, that their first way to seek information is very traditional, go back to the textbooks they have in their office, reference materials they probably have had for a very long time. These are comfort ways to go back to information they're used to, may go to the internet as a secondary source or for material that might not be available any longer, prefer reading a manual than watching some program that's gonna teach them. And certainly for me, I love to print documents. I'm still a paper person versus really trying to read everything on a screen. So these are kind of the landscape of what Perskinsey talks about, digital native versus a digital immigrant. Again, these are generalities and there's gonna be things in between. So if we think of some of our teachers being more digital immigrants or the majority perhaps maybe in the digital immigrant, there are some strategies that are being put forth as to how things that we can think about to help when we're teaching our digital natives. And one as a teacher would be to review our materials and to make sure that we're not utilizing outdated material. Sometimes we have a tendency to use PowerPoints or programs that we've had for three to five years. And it's important to update your material, think about how you can enhance the instructional design of your materials to speak to that digital native. When I think about how you can incorporate the technology to engage your audience, what can you use as your hook to get people interested? And if you're gonna use technology, you wanna make sure that the learner themselves are familiar with that technology, but that you are used to that technology, that you could manage that technology. Because this is really gonna help avoid distractions. If you have to figure out how to use it on the fly or it's not working, it's just like any presentation. If you go into it and it's just not working, then it's gonna take away from your learning opportunity. And it's important to make sure that whatever you choose complements your educational activity. And it's not just there just to use it. That somebody said, oh, hey, you gotta put technology in your presentation and then you just pick something that's not easy for you. You wanna think about active hands-on teaching strategies and you wanna think about how you can emphasize open discussions among your residents. And think about how you can be willing to change and learn because it can be fun, but you don't wanna overuse these technologies either. Sometimes it gets a little overused and then it gets a little tiring and it loses its appeal. So utilizing strategies in bits and pieces is much better than trying to do the same thing all the time. But having said that, it's really important to really understand that this does not replace our core principles in teaching. Pedagogy is still important and it really matters what strategy or what's your core educational theory or approach is, how you go about your teaching to meet your learners needs is really important to discover what lens do you bring to your teaching and subscribe to. And I'll give you an example about that in a minute. What strategy you use and technology should really reinforce your learning objectives. You need to know your learners as best you can and where your lecture and sessions are, again, fit in that overall curriculum. And it's not about entertainment. It's not. I know it seems like that when we go in there, it's like, oh, I feel like I'm going and I have to entertain my learners, but it's really about being intentional and adding quality to your lecture to meet the needs of your learner. So this is a case, it has lots of things on the slide just because it's a case. So for example, you're assigned to present to the residents or maybe you volunteer to do so, and you're gonna present to them the different types of misguided terrors and you want them to be able to recognize these different tears. So you come up with your learning objectives and you decide that you're gonna do a didactic and several active learning strategies. So you're gonna provide a short lecture, no more than 20 minutes, because we know that attention span is 15 to 20 minutes. And then from there, you're gonna use an audience response program to name that tear. You're gonna put a game in there. Additionally, you're gonna ask the residents in an open discussion forum after each tear to discuss the clinical features to identify that tear. This is to ensure that they're using their analytical skills and that they really got the information that you presented in that 20 minutes. You're gonna take the last five minutes to have the residents self-reflect, document three key learning points they walked away with and what three additional things would they like to learn on their own. And this is really important as part of self-directed learning. We have to really instill upon our residents and fellows, medical students that they can get their information on their own, but they need to be intentional about that. The biggest thing about the internet and all the technology is there's so much stuff out there that we often find that learners have a hard time discerning what is important and what's not. And they get lost in the weeds. And so being able to help them narrow down their focus is really important. And then how are they gonna go about finding that information? Now that is gonna do a couple of things for you as the instructor, right? It's gonna give you feedback. Did they come away with the points that you really wanted them to? And it's gonna tell you what they feel like is still missing or maybe what they need to strengthen. And then you can think about how you might wanna use that as part of your space repetition as well or for a future lecture. And then finally, your post-lecture, you're gonna send out maybe that 10 to 15 question quiz at most at one week, three months and one year as part of that retrieval and repetition process. So this is a way that you can think about how you're gonna plan your way of utilizing different strategies that's gonna really enhance that learner's ability to walk away with what you want them to. But let's kind of deconstruct that for a minute. So the pedagogy is, this is a constructivist lens. You decide, I mean, outside of the scope is really to talk about the different types of lenses that we can come at educationally. But a constructivist really believes that we don't learn things passively, that we have to learn them actively, that we construct new understandings and knowledge through experience and social discourse. And that we have to integrate the new knowledge with our old knowledge in order to make it make sense for us. So I subscribe very strongly to a constructivist lens, and therefore I think the strategies that we just talked about reinforce that, right? My didactic presentation is gonna build off prior knowledge or where I expect them to be. I'm gonna use active learning strategies, gamification, open discussion and self-reflection, again, to help bring about that constructivist processes. And then technology, I'm gonna use Poll Everywhere and you might like Kahoot, Quizlet for your gaming. And then for self-reflection, I'm gonna use Google Docs. The really cool thing about Google Docs is it can be a live document and you can put it up there on a screen and everybody can fill it out and it'll all come up on the screen and you can see what everybody's reflection is already, what their three things are that they took away, what three things they wanna learn and how they're gonna get that information. And that provides a great roadmap for you for the future as well. You can also use these things to email them back to them. This is what you said. How did you do? Did you find what you were looking for? And then we're adding that space repetition through quizzing again at that one week, three months and one year. So this really helps us think about our whole plan about how we were gonna come about providing an educational session for our learners. So just in general, thinking about that, what else do we feel the strategies we utilize will meet the needs of the digital native? So if we do all these things, how does that help our digital native? You think about what we said, their needs are. Feel free to unmute, put something in chat, gain confidence, maintain curiosity, go further, right? What else? Meet their gaming needs. Lots of variety. Questions during the lectures really help, too. And you can use those later, too, right? If you decide to use questions during your lecture. Yes, quick, immediate feedback. Very good. Yes. So now we're getting at it. So what we see that these strategies do is that switching techniques should keep their attention. It's very focused points to give them information they need fast. Remember, they want things fast. They can test their knowledge for quick feedback. That sort of instant gratification. Same with the games provide instant gratification and can make it a competition, which is very interactive. And it offers space repetition retrieval for us, which is really important. So again, we can kind of think about how all of those things sort of weave through what we want to accomplish. So we're just about out of time. And just to reinforce some of the things we talked about, we talked about the importance of working in long-term memory when creating your educational content. We listed some strategies that you can utilize as an instructor to enhance memory of your learners. And we discussed the concept of digital natives in regard to today's learner and how we can think about their needs in terms of making sure our educational session helps that process. Some of the key takeaways. Utilize space education or that space practice, a testing effect for retrieval practice. Think about ways to grab their attention and to hold it. More you can use dual coding or even try coding if you're using different methodologies beyond just two. And then how does that digital native needs kind of factor into it? It should not overset all of it, but it should cross your mind about how you think maybe you can incorporate some things would help with that. Some selected references. And I'm happy to hear your feedback, answer any more questions. Does the forgetting curve apply equally to salient points versus other points? I'm happy to hear your feedback. And I'm happy to hear your questions. And I'm happy to hear your feedback. So space reputation should always be about the things that you think are most important for your learner. Again, you don't want to overwhelm, you know, we have lots of information today, but we brought it back to what was important. What should you walk away with? But these are the things I thought were most important. Forgetting curve does apply equally to salient points and just information that you're providing. Yes, absolutely. I'm curious what your thoughts are about reading, giving people like articles to read or giving people pre-reading and how you sort of fit that into your constructivist lens. So what I think is important about reading is to reinforce with the learner cognitive strategies that help them learn. OK, so there are things actually I have a whole other lecture about that, too. So, you know, we do things when we are reading something. Right. In order for us to help memorize, we highlight, we underline, we put notes in the margin. Right. So there are things that we use, cognitive processes and strategies that help us remember things. But sometimes what you see is a like over like the highlight the entire article. Right. So learning and helping them understand about how they can more effectively read their articles is better. You know, and you see this with textbooks now, too. You can put, you know, key takeaway points, things that are shaded off to the side. So those are so read the text, but then go to the boxes and connect the dots. So if you want them to do pre-reading, sort of like as a classroom, then I would be very focused. I would tell them, OK, I want you to read these. This one chapter, don't, you know, give them 12 chapters. Right. And then, you know, read it and then tell me what you thought the key points were and how we can reinforce that in your learning. Yeah. I would love to hear other questions from the group if people want to try a shout out and if it gets too chaotic, we'll start hand raising. Furious. Do you have some more resources for sort of staying up to date with sort of tech and different interactive things? I think it's so hard as a teacher. That's not going to a lot of lectures that students go to. Right. So they're going to different lectures. They're seeing all these cool tools, different teachers are using. But often we're not seeing those. Do you have like a great go to source for those? I just sort of have my own list, but I can put something together for you. That would be fantastic. Because I kind of have like a list of like in my office I keep up like, oh, because, you know, I same thing here. There's new stuff coming out all the time. Right. And somewhere it's like, oh, I never heard of that. Yeah, I will. I would love to put that together for you. So if you send it out, if you send it to Brian and I and then we'll sort out how to get this posted along with the this session when it's on the in the portal, the educational portal for people to watch again online. So question is self directed learning after session is best done. How soon after the session. They can start right away. You know, like we did in our case is, you know, they should begin to to really think about where where is that learner dissonance for them. And then how can they think about how to find those materials to augment their learning to keep going. But a check in is good too. You know, if you know that you've done that with that learner, then coming back at it, you know, a few weeks later, hey, did you have a chance to do that. How can I help you get there is really helpful. why I appreciate the invitation to come spend time with you today and feel free. They've got my contact information if you have further questions. I'm happy to answer them, discuss. I love talking about all of this. We really appreciate you joining us today. We gave you such a hard job, right? Because we said, well, pick your topic. And then we started off very broad. So I really appreciate your effort. I thought it was amazing. All the good pearls. I'm sure it'll really help us. I look forward to next year's annual assembly where we're seeing each other's teach, seeing some of your pearls applied to the slides and things. So thank you very much. Thank you. Thank you so much. I'll have a great evening. Thanks for coming, everybody. Bye. Bye.

Dr. Colleen Kalanich

learning and memory

digital natives

long-term memory

educational content

active learning strategies

technology

quality instruction

engaging learners

constructivism