As we launch into our study of the science of
learning, we should start with defining
learning, and one of the most common
definitions is the act of acquiring
knowledge, skills, and behaviors.
These are the attributes which determine a
I would note that ability is often used to
simply denote knowledge and skills, but I
often remind my students that it is several
of the behavioral components of the ability
which are just as important to becoming a
good medical professional.
I like to refer to these as the three A’s,
accountability, and affability.
While these are crucial components which
affect one’s ultimate
ABILITY as a health care provider, one must
always start with a
good fund of knowledge and so our initial
focus of this course will be to
examine how knowledge is acquired, stored,
The concept of knowledge being foundational
for other learning has been well
characterized in the widely familiar Bloom’s
Taxonomy and its
stages of learning. It's been useful for a
number of years, but
actually, we know now that a linear
progression of learning, as is represented by
this taxonomy, is not completely consistent
with learning science.
In fact, all these various stages interact
reinforce each other.
And as we understand the neuroscience better,
we now know how axons and
dendrites, the components of neurons, link
as these stages of learning interact.
So I'd like to share with you in this lesson
some of the fundamental building blocks of
what a thought is or learning is, and it all
with a cell called a neuron.
The cells which make up all our organs each
have specialized functions.
A muscle cell squeezes, the liver cell helps
the kidney cells filter, the skin cells
protect- and the
brain cell link.
That's how circuitry is conducted around the
And that's how thoughts are stored in memory
and how they're retrieved by this process
of linking and unlinking.
This linking and unlinking is actually a
You actually learn very, very few things
Most of your memories are transient, and
we'll find out later in the course that
that's actually a very healthy and important
thing, how some memories are more
durable than others.
And these connections, whether transient or
durable, are made in
synapses that are potentiated by
As we get an understanding of these
neurotransmitters, we're becoming able to
help modify the process and potentiate it or
improve it to learn
more effectively. In the medical education
process, there are a
tremendous amount of knowledge to accrue,
skills to master, and behaviors to
learn before you have the
ability to perform in a certain role.
So, the culmination of all this learning for
me after four years of medical school and
nine years of surgical training was my role
as a cardiothoracic surgeon
specializing in open heart surgery.
And you see me here pictured in my first
year of practice, opposite
one of my mentors.
As you might imagine, heart surgery requires
using all of the levels of Bloom's taxonomy
at once. And this ability represents a
many years of acquiring knowledge, skills,
But acquiring all that knowledge was hard
work, and I wish I had known then what I know
now – not only about the heart but about the
brain and how we learn.
Just by taking this course, you’re giving
yourself a huge advantage in making your
learning more efficient and more effective.
And one way to make your learning more
effective is to understand how the brain
evolved to learn.
Let’s take a very brief look at the
evolution of the human brain and its early
development. In early infancy, migratory
develop rich synaptic connections.
And this peaks at about two years of age in
humans, thus in early childhood.
These synaptic connections are then pruned
and remodeled, and different parts of the
brain develop at different times.
So some of the basic functions of the visual
cortex and the auditory centers develop
sooner. In the prefrontal cortex, what is
referred to as the central
executive where more advanced thought is
located develops much later.
In fact, the development of this area does
not finally mature until late in
one’s teenage years or even a bit beyond.
And that can help explain some of the
unusual behaviors that teenagers have
been known to exhibit.
All through life, however, there is a
You can think of it as a rewiring of your
house to make improvements.
When you understand how these processes can
be improved, you can use that to your
own advantage for learning more effectively.
You can also apply that knowledge for
patients who have had a neurologic injury.
As a medical professional, you’ll always be
switching between teaching and learning.
Understanding how to leverage neural
connections in the brain can
help you learn, help you teach, and help you
access the knowledge you’ve
already acquired so that you can perform as
a medical professional to the best of your
abilities. So how can we better understand
these neural connections?
The way the human brain changes and learns
in early development is not terribly
different from the evolutionary process that
our species, the Homo sapiens, have
gone through for thousands of years.
Remember that for the majority of our
evolutionary process, things that were really
important for survival were hearing and
recognition, and linguistics.
These things were important to the
evolutionary process, so they are generally
easier to learn. For example, learning to
speak your first language as a
child was easy.
So what we understand now is that because of
this evolutionary process, there are things
that are easier to learn biologically and
things that are harder to learn.
As the brain develops into adulthood, it
gets harder for us to learn new languages.
But only relatively recently has Homo
sapiens had to master the skills
of reading and writing and really recently
that we had to understand how to
use computers, apply advanced math and
These things like reading and writing and
doing mathematics are called secondary
material, and they are harder for your brain
So there are different neurological pathways
which are utilized when you're doing easy
stuff or hard stuff – and we’ll talk about
the concept of
desirable difficulty a little later.
Throughout our lives, there's always a
recycling, a pruning, a regenerative
process of neural pathways, and this is very
important to remember as you care
for patients with neurological deficits or
you accommodate learning differences in
The goal of education is understanding,
leveraging, and reprogramming
these dynamic neural circuits in order to
accrue knowledge, master skills, and learn
behaviors that will
give them the ability to perform at the
highest levels in their fields.
And we'll find their ways to do that through
instruction and desirable difficulty and
through repetition and active
learning and student-based strategies.
You’re continuing a lifelong journey of
learning and the skills you'll develop in
this course will help you throughout this
journey, no matter what you decide to do in
the health care profession. You are giving
yourself a great advantage by taking this
course. A few tips as you proceed: Just
think of the
Why, What, and How:
Remember why you decided to enter your field
of study in the first place.
It may be helpful to picture yourself in
either a white clinical
coat, surgical scrubs, or whatever image you
see that you're hoping to become.
And that image may change with time, and
But it'll be very motivating for you to keep
your “why” in mind.
The what refers to the fact that many of the
effective strategies we will share with you
in this course may feel awkward and
difficult, but these are known as
desirable difficulties, and in the long run,
they will make your learning more
efficient and effective, and most
importantly, help you become a better health
care provider. We’ll talk more about
in a later lesson. The howrefers to just
how to use these strategies.
You'll find it's very important to space out
your learning, as this will make it more
durable, so try hard not to get behind in
It's very important to use the concepts of
learning science along your journey so that
you retain what you’ve learned.
Remember the previous video lesson?
You used retrieval to access the knowledge
about how quickly we
can forget what we’ve learned.
We forget 75% of what we learn - do you
remember how quickly?
Is it 1 week, 2 weeks, 3 weeks, or 4
weeks? That’s right - In less than a week.
But now you know that retrieval practice can
help you retain information instead of losing
it. But always remember what happens at the
cellular level, as
you learn and bring in new concepts, you
need to strengthen the pathways you
create - by helping the associated neurons
strong and effective links, so that you can
retain that knowledge, and
have it readily available for when you need
In order to create those links and then
strengthen them, you need to
retrieve the information and work with it.
Effective learning is rarely a passive
In the next section of our course, we're
going to go in-depth into this
“learn it and link it” process.