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Cognitive psychology and Procedural learning

Cognitive psychology and Procedural learning. Guy Bisson M.D., M.Sc., FRCP, ABNM Academic and Medical informatic Faculté de médecine Université de Sherbrooke. ‘ The art of medicine is to be learned only by experience, tis not an inheritance: it cannot be revealed.

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Cognitive psychology and Procedural learning

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  1. Cognitive psychologyandProcedural learning Guy Bisson M.D., M.Sc., FRCP, ABNM Academic and Medical informatic Faculté de médecine Université de Sherbrooke

  2. ‘ The art of medicine is to be learned only by experience, tis not an inheritance: it cannot be revealed. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice Alone can you become expert ’ Osler, 1919

  3. Pedagogical basis • Types of knowledge • Strategies to enhance learning • Memory Architecture • Clinical reasoning development

  4. Types of knowledge • Declarative • Conditional • Procedural

  5. Declarative knowledge • Theorical knowledge • Rather static • Must be translated into procedures or conditions to allow action • High quantity to manage and growing ! Specific learning strategies : * elaboration (add to personalize information) * Organization ( schematic, protocol,… )

  6. Procedural knowledge • Steps to do , knowing how to do it • Dynamic • Can be developped only when the action is accomplished by the learner himself and in the context of an action that will be realized in the real world • Specific learning strategies : • * proceduralisation ( automatic fluid sequence of movements ) • * composition ( links gradually between them every movements )

  7. Conditionnal knowledge • About the when and why • Correspond to classifications, categorizations • Are responsable for the transfert of what is learned • Create expertise in the learner AND the professsionnal Specific learning strategies : * generalisation ( action applies to multiple cases) * discrimination (‘ individualised action ’ )

  8. Memory architecture response generator emetters Environment Long Term memory sensory Receptors Working Memory

  9. Memory architecture Long Term memory Working Memory • Information treatment center. • 5 – 7 process units. • information are short live, about 10 sec.

  10. Memory architecture Long Term Memory * Working Memory * Supposed to be an infinite reservoir of information. Nothing is forgotten * Problem : establishing the links to bring it back !

  11. Memory architecture response Generator Long Term Memory Working Memory Where the task/problem is resolved Bottleneck of the human information treatment center

  12. To prevent the working memory overload response generator Long Term Memory Working Memory If the procedural and conditionnal knowledge are AUTOMATED in the long term memory, they can access the response generator directly, releasing that way working memory units to process more significant information

  13. To prevent cognitive overload Response generator Long Term memory Working memory Knowlegde organization will allow more information to be stored in every units of the working memory, releasing more space.

  14. ILLUSTRATION Indication to intubate intubation Trauma patient Respiratory arrest Hypoxia, shock, bleeding,… Definition, diagnostic, protocols, procedures,…

  15. Clinical reasoning ‘ indeed, the prime function of the physician is clinical reasoning ’ Kassirer, Learning clinical reasoning ‘ clinical reasoning is neither mastery of analytical rules nor accumulation of experience, it is both ’ Norman, The epistemology of clinical reasoning, Academic medicine ( 2000 ) 75: S 127-S135

  16. Clinical reasoning + and + evidence that support the importance of a well organized knowledge data base to become an expert and solve clinical problems

  17. Expert VS novice Cr Amyloïdosis Cr GMN CHF Pre-renal, renal, post-renal FeNa, Urea,….

  18. Clinical reasoning • Pattern recognition : based on knowlegde organization and experience • Hypothetico-deductive approach : acquire experience and build the organized knowledge database

  19. Can we teach how to become an expert ? • Studies show that it is useless to teach general strategies to think like an expert • Instead we must use methods that sharpen perceptual skills and give as much diverse experiences as possible to accelerate the development of expertise

  20. ‘ the achievement of expertise requires a large amount of experience, but simple accumulation of practice is not sufficient. ’ Seeing the invisible: perceptual-cognitive aspects of expertise. Klein and Hoffman

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