AbalaTips 101: Active Learning Strategies in Philippine Medical Schools

 Hello again dear friends, colleagues, future colleagues , Welcome and Thank you for reading AbalaTips

Disclaimer: This AbalaTip is not intended to invalidate or to mention that your learning method is wrong, but rather this is a guide and to emphasize the advantages of active learning in medical school

 a while back, I had shared topics about on the visual learnings, now aside from visual learnings let us learn about Active Learning which is very important in  Medical Schools now to differentiate active and passive learning let us define some terms

According to Cornell, 

 ACTIVE LEARNING are methods that ask students to engage in their learning by thinking, discussing, investigating, and creating. In class, students practice skills, solve problems, struggle with complex questions, make decisions, propose solutions, and explain ideas in their own words through writing and discussion

ACTIVE LEARNING needs timely feedbacks which is critical in this learning process

If there is ACTIVE LEARNING there is also PASSIVE LEARNING, now lets define what is PASSIVE LEARNING 

according to John Hopkins University:

PASSIVE LEARNING is instructor-centered. This means you as the student will attend a professor’s lecture and then internalize the material through re-reading notes or highlighting large chunks of information when reviewing. However, this often leads to a very surface-level understanding of the key concepts, creating an “illusion of knowledge.” This means you think you are familiar with the material because you have been exposed to it several times. In reality, you have done little to no further analysis on what you just learned, and the information is not stored in your long-term memory for you to recall during an exam. 

To simplify the thoughts 

PASSIVE LEARNING- you go to the classroom, you listened you reread the entire lecture however you just reread it in the end you retained a little

ACTIVE LEARNING- you go to  the classroom, you listened, however in rereading you have tried to apply what you have learned, then you simplify it in the words that you understand in your own language

Let us see the tabulation of Active vs Passive Learning

Criterion	PASSIVE LEARNING	ACTIVE LEARNING
PowerPoint slides	Print out and follow along during class. Highlight key slides as the professor goes through them.	Print out and read before class. Take additional notes in your own words during class. Condense each slide into a flashcard to repeatedly quiz yourself with.
Lecture notes	Write down exact words that the professor says during class. Look through notes a few times before the exam.	Summarize key points in your own words during class. Write questions you have in the margins and go to office hours asap to clarify. Re-write the same concepts in different words when reviewing.
Textbook	Look at examples from class as you complete problems. Write down what the instructor/MD professor tells you to write during office hours.	Try to solve problems on your own without looking at examples and take note of where you get stuck or make a mistake. Rework the problem by yourself after asking instructor/colleagues/MD for help. Try to “teach” a similar problem to the instructor/colleagues/MD so they can understand and correct your thought process.
Readings and Articles	Highlight headings and topic sentences as you read	Change chapter headings and topic sentences into questions and look for key points throughout the paragraph that address those questions. Summarize each paragraph in 1-2 sentences in your own words. Discuss the reading with a classmate and ask each other questions.

 **Taken and Modified from John Hopkins University Active vs Passive Learning (https://academicsupport.jhu.edu/resources/study-aids/active-versus-passive-learning/)

So as we can see the pyramid taken from NTL Institute for Applied Behavioral Science, Bethel, Maine , 1954

The Learning Pyramid take a look of listening and reading vs doing it the original version

Here is the modified version of the Learning Pyramid 

Modified Learning Pyramid, taken from education corner

Let us modify it in terms of what we are really doing in medical schools as medical students

Taken and Modified from Education corner

Here is the modified pyramid showing the difference of active and passive learning, the upper is the way that has the highest chance to  forget while the base has the highest chance to retain what we had learned, so clearly showing active learning has the best way to retain what we had learned.

Another way to see the advantage of Active learning, can be described also by knowing the Ebbinghaus curve of forgetfulness 

Ebbinghaus curve of forgetfulness taken from growthengineering.co.uk

 As days goes by, we tend to forget overtime what we have learned from the medical school or any courses but there is a way according to the same article leading to this type of graph

taken from growthengineering.co.uk

How to achieve this (taken from: https://www.growthengineering.co.uk/what-is-the-forgetting-curve/)
1. Reinforce training regularly via means that staging frequent training interventions as part of your learning campaign can help you to solidify new information through active recall.

As the biggest drop happens just hours after you learn new information, it’s always a good idea to go back to the training material within the next few days. The more you have studied the topic, the longer gaps you can leave between reinforcement sessions.

2. Improving the Clarity of Training  Instead, try to represent your information in a diagram, or create a video (if applicable) describing the learning objective. The clearer the information, the better your brain can focus on remembering all relevant information instead of only remembering how difficult the topic was to comprehend.

3. Make it More Relevant- this is what the authors called Epic Meaning. Epic Meaning helps you to create a sense of purpose. And how does this help in learning? Making your training more relevant has two main benefits. The more relevant the training, the is easier it is to recall, and the common focus continually encourages the behaviours that are important to your business (in medical school our learnings)

4. Make it Interactive, this has more retention than passive learners

**so in short ACTIVE LEARNING plays a role in better retention of what we have learned

According to Cornell, here are the BENEFITS OF ACTIVE LEARNING

• Opportunities to process course material through thinking, writing, talking, and problem solving give students multiple avenues for learning.
• Applying new knowledge helps students encode information, concepts, and skills in their memories by connecting it with prior information, organizing knowledge, and strengthening neural pathways
• Receiving frequent and immediate feedback helps students correct misconceptions and develop a deeper understanding of course material
• Working on activities helps create personal connections with the material, which increases students’ motivation to learn
• Regular interaction with the instructor and peers around shared activities and goals helps create a sense of community in the classroom
• Instructors may gain more insight into student thinking by observing and talking with students as they work
• Knowing how students understand the material helps instructors target their teaching in future lesson
• 
  

According to University of Melbourne, here are the ways that we can do Active Learning (Taken and Modified)

• Use memorization strategies- examples are MNEMONICS that you can see in First Aid USMLE review materials or in the medtwitter 
• Change the format of information- example a long paragraph in Harrison or Nelson or Katzung , or Harper turn them into diagrams, bullets, or tables 
• Write and Draw frequently- make summaries, glossary or picture taking (for example summary of your Physiology, or Draw for example what you had learned in Legal Medicine)
• Work with Friends (especially who like to be in groups)
• Add missing links or information gaps such as write on piece of paper memorize, then after memorized remove the papers (in my interpretation and experience, this is where PPC's "Vertical-Horizontal Learning with Clinical Correlations" comes into play pls click here for the link to the blog [credits and with Permission from PPCMD2])
• Practice Labeling, Diagrams- usually done in SGDs Case discussions, Laboratories, Practicals) [you can use the blog about visualizing your lessons in this blog here)
• Test your understanding- via Pre/Post test - without notes, this will help you learn your weaknesses, also for us medical students we may also practice to correlate, simplify, and use our mother tongue as if talking to a patient
• Create an Immersion Environment- such as flashcards, anki decks, sticky notes or Manila paper all over the room

Overall conclusion is that Active learning will help us to retain more information, both lectures,  reading textbook or transes