Procedural Learning Pathway

00:05 So, Barb we've talked a lot about acquiring knowledge and storing that knowledge in long-term memory. But in medicine, a big component of what we go through is what we call training and this always makes me think of you know how we train our athletes and I was wondering can you draw some analogies and maybe tell us about similarities and differences between how athletes are trained and how perhaps we could be trained as physicians. Absolutely. In fact, to do that I want to tell you about my favorite athlete of all time. And here you can see him right before us, his name is Julius Yego and he's from Kenya. If you know anything about Kenya, you know they're famous for their long distance runners.

01:03 But look at Juliuses' arms. He is not a long distance runner. In fact, he always wanted to learn how to throw the javelin. And the challenge was that he couldn't go overseas to study, there were no javelin coaches in all of Kenya. So how could he learn? He began watching YouTube videos. And it's all he could afford. And he watched those videos and go practice, watch, and practice and actually 98% of the time just watching and practicing on his own he became the world champion in throwing the javelin. So we should step back a little bit and look at the history of education. For thousands of years, people thought the only way you really learn is by listening to an explicit lecture. So, people would come, they would spend an hour or two hours all day in a classroom listening to a lecture and that's how they thought learning was most effectively conveyed. But then they began to realize that you know maybe that's not as good as it could be. In fact, maybe it could be that if we have active learning in the classroom that could be much much better. If we have our students always actively learning the material, they'll learn it even better. But what they didn't realize is there's actually a bit of a problem with that because you can actively be working with materials but how do you get those initial faint links of learning into Neo, the neocortex, in order to begin working actively with it. So, what they then decided to do was try out a mixture of lecture with active learning. They try different proportions, more lectures sometimes or more active learning. And ultimately this sort of mixture of active learning with lecture came to be called direct instruction, and this was found by copious research to be amongst the best of ways for you to learn material. So just as with Julius Yego, what he was actually doing was he was sitting at a desk and he would actually watch those YouTube videos and think about what he was learning, that was the explicit instruction part. And then he would go out and he would practice and that was the active learning part of what he was doing. So, he was very cleverly making use of direct instruction, that wonderful mixture of explicit instruction with active learning. But what does this really mean when we go into the brain and look at how the brain learns? As it turns out, there are, well I'd mentioned to you that there are sets of links in long-term memory in the neocortex and that's how we learn. But what I didn't tell you was there are 2 ways that we put those sets of links in long-term memory.

04:38 The first pathway is the declarative pathway. And that takes information from working memory through the hippocampus, your old friend Hip, and places those links in Neo. So that's the first pathway. The second pathway is a different one. It doesn't use the hippocampus, it instead uses a big cluster of nuclei known as the basal ganglia and this pathway is called the procedural pathway.

05:15 When you are learning, you learn both through the declarative pathway and through the procedural pathway. In fact, roughly, you can think of lecture as being a form of declarative learning and that active practice as being a form of procedural learning. Both types of learning are very necessary in order for you to truly learn the material. You need links that are both declaratively laid and procedurally laid in order for you to progress well with your learning. So, what is the difference between these 2 different pathways? For procedural learning, you're often simply not conscious of what you're learning. So, you're learning how to hit a baseball, you're not really conscious of how you're doing it, you just know that you're telling yourself to hit the baseball and then you see whether or not you've hit it but you don't really know how you're actually learning to do that.

06:28 Procedural learning develops through practice where declarative is more explicit.

06:34 And then procedural learning is kind of odd. You can't explain what you've learned a lot of the time. So if you learn how to solve a Rubik's cube, that's often something you learn procedurally and you can't explain how you do it, you just know you can do it. Similarly, you can tie your shoelaces but try to explain to someone using only words how you tie those shoelaces. It can be a little difficult.

07:06 The procedural pathway is not just for rote learning. We often make that mistake of "Oh that's just when you're memorizing things." No. It does help you remember things, but it also helps you analyze complex patterns. So it's a very very important pathway if you memorize the multiplication table and then I might mention to you 2 times 6 is 13. You'll say that's not right in part because you know it's 12 but in part because you know that 2 times anything is an even number and 13 is not an even number. You've learned that complex pattern just through the practice. So, procedural learning is kind of slow, you got to practice a lot, but that's a lot of what you're doing in medicine. It's very fast to use, however.

08:11 So, even something like learning how to type on a keyboard takes you a long time to do. But once you do it, it's very fast. Once you've learned it, it's very fast.

08:22 If somebody comes in and changes that keyboard though, it can be very inflexible in what you're learning because it took you a long time to learn that and then unlearning it and relearning something that you've learned procedurally is quite difficult to do. So, how can you learn both declaratively and procedurally? What different techniques can you use to help you with your learning? Retrieval practice will help you with both declarative and procedural learning. So, in other words try to pull those sets of links from long-term memory and that will help you with whatever type of links that you've deposited. Keep in mind what you deposit through the declarative system of the hippocampus is a different set of links than what you deposit through the basal ganglia, the procedural pathway.

09:26 Now, if you space out your lines, so you're using spaced repetition. That will help with both declarative and procedural learning. But if you want to learn declaratively for sure, explanation like what I'm doing right now, is one of the best ways to learn declaratively. Procedurally, if you want to learn procedurally better, the best way to do it is do lots and lots of practice with whatever you're learning. A little bit of interleaving is also exceptionally valuable for whatever you're learning procedurally. And what I mean by this is when you, let's say that you're learning some technique. So, I'll just give an example from statistics and probability. If you are learning the geometric distribution versus the binomial distribution versus the negative binomial distribution, the tendency is to do 10 problems of binomial, 10 of negative binomial, and 10 of geometric and you think you've learned each one really well but you haven't. You've only learned that the first couple of times you did a problem you kind of got the sense of how to do it and from then on you were just mimicking what you had learned before.

10:56 But if you mix up your problems, anything that is similar enough to be confused mix up those types of problems and you'll find that you actually learn it better.

11:11 You learn what kind of technique to use not just how to use that technique. So, interleaving is valuable and what's kind of sad is that when we're learning textbooks are not set up for interleaving. They will often be set up chapter by chapter, you'll learn the material, but you won't get problems that are mixed up, you won't get like information from chapter 4 or problems from chapter 4 and 7 and 9 all mixed together but yet that's what you want to be doing in your learning because ultimately you'll be getting mixed up questions on your tests and of course when you're actually meeting patients you'll get a variety of different things you never really know what to expect. So, remember there are both the declarative and the procedural pathways. Quite different, both deposit sets of links in long-term memory, but they each sort of have different good and bad aspects to them. Now, when you're learning anything, you can learn of course declaratively. Some people will have more of a tendency to learn declaratively.

12:36 For example, those with dyslexia it seems have more of a tendency to like to learn declaratively. Those who learn are perhaps a little bit on the autism spectrum, they can prefer to learn more procedurally. And if we put them in the box and say "Oh, you must explain everything you've just learned," it can sometimes be quite difficult for them because they can understand how to do it but they can't put it into declarative terminology to explain it. So, there can be very different ways that people can learn material and they can learn it very well. Ultimately, you want to try as much as possible to learn information through both declarative and procedural pathways because both will allow you to use the information effectively. Now, I do want to bring up the idea of driving home for the day. So whether you're driving home, walking home, riding a bicycle or whatever, however you get home you can do it so many times that after a while it kind of seems like you can do it in your sleep. Well, of course not quite in your sleep but it's so easy to do that you can be thinking about other things as you're going home. Why is that even though that that route home maybe very complex? You're using your procedural system.

14:15 Once you've done things a lot of times, you don't even need to think about what you're doing in order to be able to do it. For many things that you're doing in medicine and healthcare, you don't want to have to think consciously. You want to be able to react instinctively and intuitively with what you're learning. Barb this is so helpful to hear and as you cited so many examples about how relevant this is to healthcare, you really whether you're doing a history and physical and evaluating a patient and going through a procedure you do it over and over and I loved your analogy of driving home at the end on a busy freeway. If you think about it, that's really a dangerous risky event that we all take for granted because we've done it so often.

15:09 And that's really what we need to strive to do when we're learning medicine that this becomes second nature to you and then if something goes wrong you've got plenty of mental capacity to adjust and make sure that we get the right outcomes.

15:29 So this really helps clarify why training is as important component as all the knowledge acquisition that we pursue how those 2 things work together.

15:45 So thank you once again.