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Episode 5 − Learning to Learn: Uncut conversation with Geoff Norman

Effective Strategies for Improving Short-Term and Long-Term Memory

To improve short-term memory, some strategies include:

1. Repetition: Repeat the information several times to help it stick in your mind.

2. Chunking: Grouping information into smaller, more manageable chunks can help you remember it better.

3. Association: Associating new information with something you already know can help you remember it better.

4. Visualization: Creating a mental picture of the information can help you remember it better.

5. Focus: Avoid distractions and focus your attention on the information you need to remember. To improve long-term memory, some strategies include:

1. Rehearsal: Rehearse the information repeatedly over a longer period of time.

2. Elaboration: Elaborate on the information by adding more details or connecting it to other information you already know.

3. Contextualization: Place the information in a meaningful context that is relevant to you.

4. Mnemonics: Use memory aids such as acronyms, rhymes, or visual imagery to help you remember the information.

5. Retrieval practice: Practice retrieving the information from memory frequently to reinforce it in your long-term memory.

From Nuclear Physics to Psychology: A Journey of Learning and Adaptation

Retrieval practice: Practice retrieving the information from memory frequently to reinforce it in your long-term memory. Tell us about yourself. Yes. I have a somewhat unusual background. I started with a Ph.D. in nuclear physics but was never able to turn that into employment. So through a variety of random walks, I ended up in the new medical school of McMaster, doing research in medical education.

Pretty well unqualified to do so, but over time I’ve learned a few tricks of the trade, and over the last few years I’ve managed to call myself a psychologist. So nuclear physics—that’s quite a step. Yes, it was an easy step towards things like measurement and statistics because you had to know a little bit of mathematics to do physics, but learning how to be a decent psychologist and do decent research in psychology did take an awful lot longer and took a few very good mentors, like my dear colleague Lee Brooks. Yes.

Exploring the Complexity of Clinical Problem-Solving and Diagnosis in Medical Education

So part of the research that that you do—I suppose, in medical education, at a level, what it’s based on, is categorization, is diagnoses. How do people generally diagnose? I mean, it’s really kind of a categorization problem, isn’t it? What is categorization, more generally, and how do people do it? Well, before we get there, let me back up a second and give you an idea as to how we got into this mess. I was originally hired to look at clinical problem-solving, and the idea was the diagnosis was not a categorization task.

It was really a matter of some kind of problem-solving skill. Our initial quest was to go after some kind of general skills that people acquired as they became experts. What emerged even back then in the late ’70s was that in fact the general skill really wasn’t very general. At one level, it was too general, and everybody did it the same so that it didn’t discriminate experts from novices.

Exploring the Connection Between Concept Formation and Medical Diagnosis: Insights into Categorization and Communication

At another level, it was too specific because success on one problem had very little to do with success on the next problem. Right. That led to thinking about, well, maybe this isn’t the way to characterize it at all. Yes, you’re absolutely right—a diagnosis is a form of categorization. I think, for me personally, the breakthrough was to work with people at McMaster who were really into what is called concept formation or categorization.

Some of the models about everyday categorization really had enormous power in explaining medical diagnosis. So to go back to your initial question—historically, psychologists had been interested in categorization because it’s the basis of communication.I can’t talk about a tree or a dog or a cat or a butterfly unless I have some sense and you have the same sense as to what the term “butterfly” stands for.

Categorization Challenges: The Limits of Implicit Rules in Defining Objects

So categorization, I think, has a long history in psychology. I think it’s fair to say that, initially, the thinking was that there must be some implicit rules that governed each category, but a moment’s reflection on, say, a beanbag chair tells you that the implicit rules of chairs are unlikely to be necessary and sufficient.

Right. So what makes a chair a chair is normally, someone would think, four legs, maybe a wooden chair, but that sort of rule might not be all-encompassing. It might not define what everyone means by a chair, I suppose. No rule will encompass what everyone means by every kind of chair because you have to consider all sorts of possible legs, including none at all. Yes, or cats or dogs. Or cats or dogs and so on. I mean, cats include everything from house cats to lions. Dogs include everything from Chihuahuas to Mastiffs. To come up with any general rule simply doesn’t happen.

Prototype and Exemplar Views: How We Categorize and Remember Information.

The two more prevalent views—one is that, essentially, we average our experiences into a prototype, and that prototypes are distinguished as having more of the features of the category and fewer than the features of other categories. So we can play experimental games and find that a carrot is a prototypical vegetable and a robin is a prototypical bird.

And penguins, because they don’t look like, because they don’t fly and they have feathers, are very atypical. The older view is the prototype view, which essentially our experience gets averaged into internal prototypes. A more recent view, and one which seems to play out really, really well in medical diagnosis, is what’s called the exemplar view that essentially says, as you walk around the world, you gather examples, and every natural category, as you learn, you acquire examples.

Matching New Stimuli with Prior Examples: Understanding Memory and Diagnosis

The active conversation or the active diagnosis ultimately amounts to matching the incoming information with some prior example in memory that has many of the characteristics uniquely of the new stimulus. So applying that to dogs and cats, for example—if I’m trying to recognize the beast that’s running toward me, it’s probably not going to be on the basis of a prototypical dog or cat but instead on the basis of previous examples of dogs and cats that I have encountered before? Sure.

Glenn Regehr actually has a very nice example of that. He says, “Suppose you grow up in the Yukon, and all you see are huskies. How many Chihuahuas do you have to see before you recognize a Chihuahua as a dog?” The answer is one. In fact, I have a talk about this whole issue of medical diagnosis, and one of the key features, and the one that grabs the audience inevitably is the video of my year-and-a-half-old daughter where we show her playing with a Fisher-Price toy with dogs and cats, and B.F.

Early Classification of Dogs in Infants Raises Questions about Memory and Learning

Skinner would be happy as can be because what she’s learned is that if she puts that thing in that slot, then Mommy gives her a popsicle and tells her how wonderful she is. But then we show her this, an adult magazine, a house-and-garden magazine which contains a bunch of photographs, and two of them have dogs in them, and she points to the two dogs.

What’s interesting about that is that she can’t say, “Dog.”Right. She’s a year-and-half old. She’s preliterate. She can’t say, “Dog.” It is implausible that she would have a rule for “dog.” Yes. And yet she can classify dogs already from what amounts to a fairly limited experience. Probably helps that she has a family dog and they go to the dog park every day. She’s got a few examples and that’s all she needs to get by. Yes. So it only takes just a few examples to be able to get the job done. It seems so, yes. Obviously, the mystery would be what exactly is that similarity matching? How does that come about?

Connectionist Models of Memory and Medical Diagnosis: Understanding the Complexity of Learning

I think then you can invoke more fundamental models of the nature of memory, which is associationist or connectionist, which basically says that we are somehow, in a very rapid and unconscious way, matched in individual attributes and seeking connections that way. That’s far-too-basic science and psychology for me to play with, but that’s, I think, a pretty decent model. Yes. What about your doctors?

When we go from everyday classification or categories, like dogs and cats and tables and chairs, and you only need just a few exemplars to be able to get the job done, do docs work the same way? If you’re learning about skin lesions and mental disorders or more complex types of categories, is it just take a few examples there as well? Well, clearly, medical diagnosis is a bit more complex in part because the—yes, for skin lesions, we can imagine a picture that’s kind of like looking at a picture of a dog. But for something like multiple sclerosis, it’s much more abstract than that.

Expertise in Generating Hypotheses: Key to Accurate Clinical Diagnosis and Memory Retention

Secondly, self-evidently, the stakes are higher. We don’t want to make mistakes. So what you see coming about in the clinical encounter is what has been called, since the 1970s, the hypothetical deductive method which is, within a few minutes or maybe even seconds—we don’t know the time scale—a physician will advance a number of hypotheses as to what the diagnosis will likely be.

Then we’ll go on to a systematic search to gather information, by and large, to confirm one or another diagnosis. Clearly, what differentiates the expert from the novice is not how many hypotheses or how early, but what are the hypotheses, and expertise resides entirely in generating better hypotheses. Even going back to our original studies in the ’70s, we found that early hypothesis generation was enormously powerful. Basically, if you thought of the right diagnosis in the first five minutes, your chances of getting there were 95 percent. If you didn’t, your chances were 20 percent. Wow. Yes.

Exemplar Models: The Key to Efficient Diagnostic Decision-Making According to Researcher.

That then leads to the fundamental question that’s kept me interested all these years: where do those hypotheses come from? Right. And exemplar models are a very powerful way of thinking about that—that, essentially, prior experience is available to you. Sure.

The idea then is that, throughout your career as a diagnostician, you’re accumulating experiences of the sort… Yes. … like if I complain of a sore or a particular skin lesion, and you develop a bunch of those experiences, enough to be able to categorize new ones efficiently without any conscious effort? Yes, certainly in something like dermatology. We’ve actually documented a dermatologist looking at a skin lesion. If he gets it right, it takes him eight seconds. There’s not a lot of room for analytical processing in that process.

Expert Reveals Surprising Findings on Competency and Diagnosis in Emergency Medicine

One of the—couple of games I play with audiences quite often, is to ask them, “How long after you graduated before you thought you were competent?” Now to the average person on the street, you think that would be ruled out of order from the outset—they’re competent when we graduated them, aren’t they? Right. The answer’s no. The answer’s routinely five years, post-graduation.

You put that with five years of training, and then you say ten years and 10,000 hours, and everybody’s—this now has become common street talk. The second thing that really intrigued me, to illustrate the power of this method, is the diagnosis of the sick. Now emergency physicians are preoccupied with the diagnosis of the sick. This preeminent skill in the emergency department is to be able to tell the sick ones from the not-so-sick ones. Right. And yet there’s no textbook that has a chapter on how to diagnose “sick”. There are no signs and symptoms of “sick”.

Expert Emergency Doctors Can Accurately Diagnose ‘Sick’ Patients in Seconds, Study Shows

You might be too blue or too red; you might be too hot or too cold; your pulse may be too high or too low; your blood pressure may be too high or too low, and on and on and on. There are a number of conditions that run the pages that are all considered sick conditions, but a very recent study actually just published this year showed that if you turn to the emergency doc and say, “Is this one sick or not,” and he makes a judgment in seconds, and that has about an 85-percent accuracy in terms of predicting whether ultimately when they get to the wards, they end up with a very serious diagnosis. The doc with this experience can recognize “sick” from a mile away. You mentioned that the process of categorization and diagnosis and so on is fast and accurate. We can do it very quickly. Is that all there is? I mean, there seems like, as doctors, it seems that they should be able to. I mean, that’s what they do in medical school, isn’t it, is learning the rules?

The Importance of Deliberation in the Diagnostic Process: Overcoming Pattern Recognition Bias in Memory Improvement Strategies.

They’re very careful and deliberative in coming up with these diagnoses. Sure. I think in every clinical encounter, there are really two fairly distinct phases: the initial phase of hypothesis generation—it’s so effortless; it just seems to be too easy—and then a second confirmation phase where they go back to the rules, the 29 causes of anemia, the signs and symptoms of pernicious anemia, and so forth, just to confirm that that’s what they’re dealing with. Now because it seems so effortless, that first phase is often called just pattern recognition, and it’s kind of denigrated.

The role of rapid hypothesis generation in reducing errors: Challenging prevailing wisdom on memory strategies.

People sort of think you’re not really doing your work; you’re not working hard enough. In fact, that whole idea that that first system—and it’s called a dual-processing model and that’s called system one—that that rapid generation of hypotheses, there’s a kind of prevailing wisdom that that’s bad, that that leads to errors, and that what we should do is teach people analytical processes to correct those errors, and that the second phase is actually the fundamental phase in terms of reducing errors. This is been popularized a lot by a guy named Kahneman who got a Nobel Prize, a psychologist.

Slowing Down for Accuracy: Is System-Two Thinking Really the Solution to Reducing Errors?

He’s written a book that I think many people know—it was on “The New York Times” bestseller list for at least a year—called “Thinking, Fast, and Slow.” His claim is just that: that essentially fast thinking, system-one thinking, leads to errors and that we should be cautioning people, doctors, and everyone else to be more slow, rational, and thoughtful, and that that would reduce the errors that happen in human judgments.

I happen to believe that’s wrong, and I’ve accumulated a bunch of evidence to suggest that indeed that’s wrong. We encouraged one group of physicians working through cases to go fast. We encouraged a second group to go slow and take their time. We find that the group that goes slower indeed takes longer in each case, but study after study has shown that the accuracy is exactly the same in both groups. So the notion that simply by slowing down and being thoughtful and analytical you’ll solve the problem and the errors will go away seems to me simplistic at best.

The Paradox of Accurate Judgments: Slow Process More Error-Prone than Fast Process.

Sorry, I think we should wait just a second for that high-pitch. What was that? There we go. So if the goal then is for accurate judgments—I mean, we see this across a few fields, where the ideal is to slow down, take your time, and make sure that you’re doing it correctly. Yes. It seems fairly counterintuitive that that would actually—that wouldn’t be as good as making a rapid judgment, as the fast sort of judgment that diagnosticians are making, is as accurate as diagnosticians or decision-makers who take their time. Is that really—I mean, is that…

Yes, it’s almost like there’s a chicken-and-egg thing. If I ask you, “What’s 12 x 12?” The answer’s 144. It’s rapid and it’s accurate. If I ask you, “What’s 17 x 17?” The answer is I don’t know but I guess I can work it out. The answer’s actually 289, by the way—only statisticians seem to know this. But that’s an example where the slow process is actually more error-prone than the fast process.

The Reflective Practitioner: A Crucial Strategy for Improving Professional Development and Decision Making in Health Professions

It seems—I agree, and in fact, I think it’s safe to say that the majority view is that the slow process is going to be ultimately higher benefit in the long run, but that’s against the evidence. This has really been captured in medicine, where a book called “The Reflective Practitioner” by a guy name Schön was published probably 10 years ago and argued basically that if every physician learned to be reflective in the course of their process and at the end of the day looking back on things, that the world would be a better place. It plays out particularly well in health professions because, like any professional, they are basically autonomous.

They have clients. They make very serious decisions about those clients, and they have no peers, in general, looking over their shoulders to see whether they’re right or wrong. So there is undoubtedly a need for practitioners or any kind of professional to keep up, to recognize their strengths and weaknesses.

Self-Assessment Is Ineffective for Memory Improvement, According to Researcher Kevin Eva

The notion, therefore, that reflection—being able to reflect on your process—is somehow going to achieve that has real cachet. Sure. Unfortunately, it doesn’t have a shred of evidence. Right. It’s everything the opposite. Are people good at assessing their own abilities? I mean, I’ve read a little bit of it in the field. A colleague of ours, Kevin Eva, has done work on the role of self-assessment. It seems, at least given his preliminary work, that we’re not very good at it—that is, we don’t seem to be very good at assessing how well we can do various things. Is that right?

He’s published it … There’s nothing preliminary about it. Kevin should be here to speak to it, but I think I can pretty well paraphrase what Kevin would say. In fact, I’ll be blunter than Kevin ever would. Self-assessment sucks. Yes, yes. I think the evidence is utterly overwhelming. People can’t self-assess their way out of a paper bag. Sure. In fact, Kevin has a nice demonstration of this.

Expertise Illusion: Why Even Experts Struggle to Accurately Assess Their Driving Skills

If I think of all the people who are watching this video, I’m going to ask them all a simple question. Are you in the bottom half of your driving skills? Now half of you should say yes, but having seen this performed, having done this in live time, probably 1 out of 100 will say yes, and yet half of you, by definition, are in the bottom half of driving skills. Right. The evidence is absolutely crushing that people cannot assess where they’re at.

They basically start with a premise that they’re at about 70 percent and then go up and down from there: “You’re better than I am, but I’m about 70 percent, so you must be 80 percent.” It was captured by a psychologist whose name I sadly forget, but he said it so beautifully. He said, “How can I know what I don’t know when I don’t know what I don’t know?” Right. And it’s that simple. You have no way of judging what the universe of that domain is, and so your only guess is to say, “I guess I only got 70 percent of it.” Even experts?

Expertise Doesn’t Guarantee Perfect Performance: Evidence and Strategies in Medicine

Experts, of course, are the exception, because they do know the domain. Now at some level, know the experts fail, too, but in terms of judging your overall knowledge base—yes, the people who know it all are the ones who can accurately determine that they know it all. But that doesn’t help an expert judge his own performance on a specific case, for example. We have some evidence—yes, actually have a fair amount of evidence in medicine that physicians perform better than chance, and the more expert you are, the better you perform, but still, their hit rate in terms of “I’m confident in this diagnosis” versus “I turn out to be accurate in this diagnosis” is probably about 60 percent. They’re far from perfect. They’re better than chance but far from perfect. Yes. Yes, interesting. So how do they improve?

Expert suggests accumulation of experiences is key to improving everyday thinking.

As an expert, you mentioned that we—going slow doesn’t necessarily help, being deliberative, and there is this compounded issue of self-assessment, that we often don’t know how good we’re actually doing in any given case. What does that mean for improving practice? How do we get better? How do we—the goal of this course that we’re taking is called “The Science of Everyday Thinking.”

Given your experience in the field of expertise and in medicine, how do we improve everyday thinking? You improve by knowing more. So just the accumulation of experiences. Yes. It seems so tantalizing. It would be really nice if I could be very prescriptive and say, “Well, if you do this, that, and the other thing, then you’ll be much better.” At some level, I guess there’s got to be a bit of a germ of truth in that. This course wouldn’t exist if we didn’t think that there are some—that being explicit about everyday thinking and the traps in everyday thinking wouldn’t help people think better.

The Importance of Domain Knowledge in Improving Problem-Solving Skills

At some level that’s true, but that’s generally locked into what’s been called general problem-solving strategies, which are not very powerful. Sure, that’s going to help a bit. I suppose reflection is going to help a little bit, but it seems that all of these strategies, to sort of generalize horrendously, are good for about a 10-percent improvement. Okay. It’s not zero, but it’s not night-and-day or black-and-white either. Very clearly, the single best predictor of how good you are is how much you know about the domain, not what problem-solving skills you bring to bear on it. We began there. That was wrong. Yes. So then would you suggest, in getting more experience, in gaining any kind of accumulating knowledge, is it just a matter of studying the domain more, of getting more experience?

Experts in Educational Psychology Reveal Strategies to Optimize Knowledge Acquisition and Memory Retention.

If I’m a novice diagnostician, in order to become an expert, in order to become an expert in the true sense, is it just a matter of working hard and studying the rules and getting as much exposure to a wide variety of examples within that domain? Yes, we can, but we can do better than that. This really segues into a whole other branch of educational psychology. The question is: are there strategies we can do to optimize the acquisition of knowledge? Again, we’re talking about two kinds of knowledge: formal knowledge and experiential knowledge. We’re now beginning to discover—and I can’t take any personal credit for this one; this isn’t my domain— but people like Mayer, Bjork, and Roediger had been working hard on taking models of the nature of the mind—short-term working memory, long-term memory, associative—and turning that into very prescriptive and powerful strategies to enhance the efficiency of learning.

Psychological Strategies for Enhanced Knowledge Retention and Transfer

Things like—an obvious thing like mixing up the examples from across multiple chapters so that you have to try and figure out which is which—turns out to be an extremely powerful strategy for learning. The idea of transfer, which is being able to take the knowledge that you’ve learned in one context and apply it to another: one, it doesn’t happen at all as easy as we think it does; but, two, psychologists would devise strategies to make that happen better. I think this is moving much more into the instructional educational psychology end of things. There are things we can do to very much enhance the efficiency with which we acquire the knowledge we need to get the job done as a diagnostician or as a human. All right. Well, thanks, Geoff. That’s a good one to finish. Excuse me. Go away. My name is Geoff. I think about reasoning.

Read More: How your brain’s executive function works — and how to improve it | Sabine Doebel

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