Wednesday, January 16, 2013


Well, Here we go again. 

Last Semester, a few of you voiced the opinion that my opening post with a specific question limited  options for online discussion.  In response, I will try to write an opening post that brings up several issues that are on my mind, but will not expect that any of you will respond directly to those issues unless they are of interest to you as well. 

Today we had the second section of the "Instructional Design" mini-retreat.  Both Lily and I made small adjustments that gave our learners more time in the exercises that we prepared.  That seemed to work well and the evaluations were very positive.  When I think about how I plan instruction, I find that the theories I draw upon are now leaning more toward constructivism.  I still give some information, but now spend more time planning exercises that allow the learner to consult others in the group as they form their own opinions and apply the new understanding to problems. Of course I am always their to consult and clarify.  I don't think I ever will change my direction completely, but a good pre-reading with questions and purposeful discussion and exercises seem to give better results for my area of expertise.  Now is medicine different; as Lily pointed out in her discussion of Cognitive Load, the sheer density of the information shared in the medical lectures that I have heard makes one think that the lecture with high intrinsic load and low germaine and extraneous load makes sense......or does it?


Anonymous said...

Kathy Baker

Reviewing back on what we discussed in class and reflecting on the different definitions of intrinsic, germane, and extraneous loads really got me thinking about what Dr. Taylor posed. I think that if you are trying to get across a large quantity of information that the high intrinsic and low germane and extrinsic load makes sense. That will allow the learner to obtain a tid-bit of information and can follow up with it on their own. Now if retention and complete understanding is the goal without a lot of outside research, I think the opposite might be more applicable. On the job training seems more like the reverse, with low intrinsic and high germane and extrinsic load. This allows for the learner to view things in more than one way, to hopefully allow further understanding. Can this work in other aspects of medicine? Or are we at such an information overload that we can't steer away from the large quantity of information in a short time span due to not enough time in the day?

R Prayson said...

There is a tendency for many physicians in formally teaching or lecturing residents or medical students to feel the need to deliver large amounts of information, often using a powerpoint slide format. There is a sense of duty behind making sure all the necessary details are delivered (even if sometimes the learners can not even read everything on the slides fast enough to keep up with the instructor). There is a faulty premise that just because it was on the slide means the material was covered and learner is responsible for it in some way. It is also easier, to some extent, for the teacher in that it does not require him/her to prioritize the information or process it. Given the high intrinsic load one is trying to deliver, there is no effective way of getting the learner to remember all that information based on a lecture or class presentation. We’ve all heard about the studies that show students only remember a small fraction of material presented in a lecture. It took me awhile to come to terms with the notion that it is better to have the learner really learn a few things well (what is most important) rather than be overwhelmed by too much information, little of which is likely to be remembered. Textbooks and the intranet are wonderful resources for the details.
The tricky piece to the constructivist approach is making sure the learner has enough basic information to be able to somewhat confidently learn in a group. The process can become frustrating for learners, especially if the other learners are similarly uncertain. The teacher needs to be able to keep tabs on this.

Maged Argalious said...

The use of a constructivist approach for designing instruction requires advance planning. It also requires participants (students) to do their part in prereading, so that the instructional activity can focus on germaine (and extrinsic)aspects as well as on practical applications rather than on intrinsic load.
Very often, educational activities are planned at the last minute and powerpoint presentations to summarize the material(intrinsic load) become the default pathway.
I liked the Gagne instructional model and plan to use it as a checklist when planning instructional educational activities. Even though not all instructional activities require all nine steps, having a framework will likely improve the planning ane execution of those activities.

Zatarra said...

Miguel A. Morillo
Dear Chris, I seem to very much agree with Richard on this. Being a student for a long time (like all the others in this group) I have sat trough uncountable endless and painful power-point presentations with excessive amount of details. The intrinsic load blown way out of proportion to what any human being can process regardless of their germane capacity. Sometimes the teacher has just merely read the slides aloud. I have even questioned if they knew the material well enough themselves. The constructivist approach should be the future. I think that Maged is right on target when he says that that there is much more planning involved, because to get the most of the allotted time you have to have them ( the students) read beforehand so they have a certain level in order to participate in the activities that will cement and /or clarify the the concepts being taught. If I were to design an activity I would borrow some aspects of Gagne's events of instruction. Perhaps starting with a pre-self assessment activity to "gain attention" then some slides with relevant information followed with some small group activities were they would have to incorporate the knowledge into more practical aspects like solving problems or developing examples, etc. This way I would "elicit performance" and "enhance retention and transfer to the job" and last I would have them take another exiting self-assessment, this would help them visualize (hopefully) their progress and make them aware of the topics that need a bit more work. This retreat on instructional design was very useful to me I really enjoyed it.

Pilar Castro said...

The intrinsic load in this modern world grows and changes exponentially. In medicine and in general the knowledge and technology keep constantly changing. When designing a class or teaching activity one should focus on a few points that should be emphasized in different ways for the learners. Planning teaching activities in a well organized fashion and knowing who your learners are, is fundamental. I really liked the concept of decreasing the extraneous load.
When I was sitting in the retreat I started thinking of a few of the first lectures that I wrote for the residents that I think need to revised. Like Maged, I also think Gagne's 9 events of instruction seem very helpful when one has to plan a teaching activity.

Brian Johnson said...

I was struck by the comments of my fellow class mates here. I agree with Richard, Maged, Pilar and Miguel in the fact that constructivism needs to be our focus and that requires advanced panning not last minute instruction which will lead to the same old boring power point slide show. I think we must remember that the student must learn the key points and then how to use other resources to expand those key points. The constructivist approach and using Gange's 9 points for instruction and taking the time should help us do that.

Anonymous said...

David Wheeler

I feel it is important that we recognize the fact that we have several compelling forces that may be antithetical to the efficient balancing of intrinsic, germaine and extraneous load. It is incumbent upon any caregiver to become proficient in their discipline. There is no middle ground here as there is a greater moral imperative that we learn and adopt the most appropriate therapeutic options for our patients needs. Indeed, as my esteemed colleagues have mentioned, we have a technological as well as informational gap between current best evidence and clinical practice. This gap exists, to certain extent, because of the sheer velocity of new evidence is emerging on a daily basis. This gap also is a product of our inability to translate best evidence into clinical action. I believe a partial solution lies in the learner and the instructor taking responsibility for investigating and adopting new information in a highly context specific manner. The instructor or mentor or clinical guide most create and plan instructional opportunities that allow for maximal exposure as well as an opportunity for real confidence and competency. Additionally, the students or clinical neophyte must prepare themselves with pre-reading, simulation exercises or other preparation that allows them to be in the best position to learn the new material. Taking care of human beings is a contact sport. I think when we consider the balancing of load for both learner and instructor the constructivist have a lot to teach us. Adult professionals may burn more efficiently when the material creates new meaning in their clinical application. This discussion has created more questions for me than answers especially when dealing with allied health professionals with varying degrees of experience. How does one balance the load demand when the audience represents extremes in experience and exposure to the clinical scenario being presented? Is there one group that handles additional load better than another? Is there a critical point where additional load can actually enhance the learning experience? Is there critical point where insufficient load can detract from the learning experience? Obviously, I have no idea. I will leave it to my esteemed and very learned colleagues to lighten my load and point me in the right direction.

Karen George said...

While I think the Cognitive Load Theory-CLT-helps us understand the process of learning I found the terms of intrinsic, germane and extraneous counterintuitive from a semantics framework. I found myself repeatedly looking at the definitions. The instructional design based on CLT was more clear cut in defining in how to manage or manipulate load to provide maximum learning experience. Gagne's 9 events of instruction are easy to follow and a good guideline and checklist when creating instruction. While power points and slideshows are tools of the instructor - mixing it up with a variety of media will gain and retain learner's attention. Providing feedback is essential as well.

Christine said...

Reading your comments so far has been very interesting. For the most part your comments have been about the formal classroom. Think of all the powerful learning that goes on "on the job". If we are always thinking about increasing intrinsic load" we would just tell everyone the answers, yet I have watched many gifted teachers rarely if ever answer a direct question... What do you think about that and "load theory"?

Brian Burkey said...

Reading this discourse on cognitive load and different learning enviornments comes at a perfect time for me. I just finished reading a great article on designing multimedia learning tools with the concept of cognitive load in mind, which I did for the other class. If you want, the citation is: T. Grunwald, Academic Medicine. 81(3):213-223, March 2006.
The point of the article, is that to have an efficient multimedia learning platform, you must simplify the interface and navigational controls so that the learner can focus on the material to be processed. The article also brings up several other aspects of adult learning theory that we discussed last semester.
I believe that the article and supporting literature reinforces the concept that we utilize the cognitive load theory and its practical considerations in designing ANY curriculum, classroom didactics, internet-based learning or clinical OJT. Forget the glitz and focus on the key facts, and make sure the learner is playing an active role. The difference in how to acheive this depends on the level of the learner's mastery of the subject and not so much on the enviornment. At least, that's how I see it.

Heidi Gdovin said...

Whether looking at ways to do my job more effectively or efficiently or tips on how I can help others learn and advance their knowledge, it is helpful to learn new concepts and ideas to assist with those tasks. I felt Gagne’s 9 Steps of Instruction would be one of those concepts I can use and apply in my work environment as well as the ideas on Cognitive Load. For me as a supervisor, it is sort of a new way to think about how to do on-the-job training without just giving the answers sometimes. As the Intrinsic Load always seems to be increasing, sometimes I think we tend to just think it can be the easiest way, to give the quick answer. However this discussion has made me think about how I should or could possibly try not to just give out information and instead put more effort when working with others to help decrease the extraneous load and spend more time providing ways to improve processing by optimizing the germane load. In turn the learners would hopefully be more likely retain the new information for ongoing or future use.

Rachel Steines said...

What I can recall from the session is that when designing one's instruction, there are many things you have to keep in mind. If I am an expert on a subject and wish to teach and pass on some of what I know to my students, I need to be prepared to give it to them with a baby spoon. They cannot process all of the information at once, so I should not give it to them all at once. I need to realize who my audience is, narrow down the information to what is vital to be taught at that time, find the central problems to address, and realize that even out of the narrowed information I give them, they will not process and retain it all. Although it is important to narrow down information, it is also important catch the audiences attention. Overwhelming the audience with mass amounts of drone information will not lead to the best retention of information. Proper organization of the material can be more appealing to the audience because they can follow along with what is being taught, which is encouraging. Not only will this lead to a better learning experience for the student, but it will probably be an easier way to teach the material as well.

Elias Traboulsi said...

Hello from a late blogger ... but better late than never. One of my 2013 resolutions is to try and change the general way faculty members at the Cole Eye Institute conduct their educational sessions with the residents. As mentioned in other posts, these take the general form of a powerpoint presentation (with or wihtout stated objectives, and 99% of the time without pre and post-test questions). These "lectures" are often at 7 am and several of the residents are either late or actually fall asleep from tiredness or boredom.

A more interactive format is possible but requires preparation on the part of both teacher and students. What carrots and sticks can we use to implement a more robust system? and how can we make sure that the "curriculum" is covered?


Anonymous said...

Wow! All of my classmates have done an excellent job of drawing out their thoughts, ideas and experience about instruction and intrinsic load. I'll just try and draw together some key points that I have found useful in the past.
Powerpoint information (intrinsic load) is a tool just like any other. Useful or harmful (boring) depending on who is using it. The overcomplicated nature of some presentations gives an indigestible amount of information to our learners without the proper time for reflection or critical thinking.
As in all teaching, make it powerful and meaningful. Know your learner and what their needs may be. Give the learner information with chances to think critically, share their thoughts, and form their own opinions. Interactive lecture poses thought provoking questions to the audience about content covered. Diversify your media sources in presentations to prevent burnout or sleeping as Elias talked about. Employ problem based learning into your constructivist environment so that the learner makes their own meaning of the knowledge.
To reemphasize what Rachel said, do not overload them with information. I have found it best during instruction to keep what I expect them to retain to around 3 to 4 pieces of information. Just a few things to influence their behavior.
Useful models for application are very helpful in fulfilling the audiences educational needs. Everyone has referenced a model or theory discussed in class. It sounds like what we really took away from this session were models or tools to use in our teaching.
Finally, engage your audience. Sometimes a teacher must rely upon their abilities to persuade the audience to listen to them. We have all had a professor or lecturer that we genuinely enjoy listening to. Their information may be just as good as another person's but because they engage the audience, we would prefer to listen to then. Teaching can be engaging, pose problems, provide information, and create learning all in the same session.

Anonymous said...

Matt Celmar posted the last comment.

It is late and I am very tired. I apologize.

Anonymous said...

During the retreat I also found Robert Gagne's 9 steps of Instruction easy to follow and interesting. I feel most of what was discussed is what many of us currently do or strive to achieve as educators. During the exercise presented, I found the concept of the Germane load hard to follow. After further research, I beleive this to be helpful in enhancing retention and transfer of information with visual aids, projects,and interactive thought provoking lectures which would guide the learner and help them process the information you are giving them. In order to truly accomplish transfer of information I believe the learner has to be mentally prepared, well rested and willing to accept the information given.

Shelley Frost said...

Most educators appreciate that all learning is happening in a context and the context influences what we pay attention to. The constructivist theory of learning, where the learner constructs knowledge based upon what the learner deems important and selectively pays attention to, reinforces the importance of educators making knowledge relevant and relatable. Adult learners consider what they already know about a subject and then attempt to integrate or assimilate the new information into their existing knowledge base. Doing this will encode the new information into their working memory. If the learner cannot make a connection with the new material, they may disregard it because it doesn’t fit into their existing knowledge structure. Adult learners are not passive; they are active and problem-based. To effectively connect with our learners and optimize content that will become encoded into our learners working memory, we should change instruction to incorporate elements of Robert Gagne’s external conditions for learning that will help learners connect and relate to the new information. Presenting new material in an organized pattern or framework will help the learners assimilate the intrinsic content more efficiently and will reduce the mental effort needed to learn the new material. Chunking the material into organized schemas will allow the learners to develop a framework for future understanding and application. If learners are asked to explain what the new material meant to them and to write down a few thoughts, it will be easier to identify what they understand and will just as importantly highlight what they don’t understand. This will help guide where to focus more time and explanation in order for them to grasp the content and make it stick in their memory so they can apply it later on. Gaining attention, explaining course objectives, making connections with prior knowledge, then providing the content and interacting with the learners will maximize the chances of the learner connecting with an assimilating the knowledge. We are better at assessing performance and providing feedback then we are at properly introducing the topic and stimulating recall of prior learning. This paradigm takes more effort and time, but the outcome is also greater.
Shelley Frost