The Gunner Solution: Proven Learning Principles

Apply Proven Learning Principles

Although Spaced Learning is critical to efficient learning and long-term memory consolidation, it is only one of many proven learning principles that can enhance medical learning and retention. Unfortunately, these proven learning principles rarely if ever make it into the education setting. This lack in application of even basic educational science to medical education is what gets our team up early and keeps us working late into the night.

Gunner Training’s System and Content applies 19 proven principles of efficient and effective learning. We obsessively look for additional principles to apply and continually validate and improve our system based on millions of data points generated by our members and their direct feedback.

Step 1: Learn new material

Learn new material by studying high-yield and interactive flashcards.

Learning principles applied:

1. Contiguity Effect: Ideas that are associated should be presented contiguously in space and time. Example: Gunner has one flashcard per topic, rather than one fact per flashcard.
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Mayer, R.E. (2001). Multimedia Learning. NY: Cambridge University Press.

2. Dual Code and Multimedia Effects: Visual + multimedia form richer representations than do a single medium. Example: Gunner has hundreds of relevant images, e.g. gram stains, CT scans, X-rays, clinical photos.
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Mayer, R.E. (2001). Multimedia Learning. NY: Cambridge University Press.

Moreno, R. and Valdez, A. (2005). Cognitive Load and Learning Effects of Having Students Organize Pictures and Words in Multimedia Environments: The Role of Student Interactivity and Feedback. Educational Technology Research and Development, 53, 35-45.

3. Coherence Effect: Materials should explicitly link related ideas. Example: Gunner’s entire system links related concepts, not only with flashcards, but also with multiple-choice questions and open-ended questions.
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Kalyuga, S., Chandler, P., and Sweller, J. (1999). Managing split-attention and redundancy in multimedia instruction. Applied Cognitive Psychology, 13, 351-371.

Kozma, R. (2000). Reflections on the state of educational technology research and development. Educational Technology Research and Development, 48(1), 5-15.

Mayer, R.E. (2001). Multimedia Learning. NY: Cambridge University Press.

4. Segmentation Principle: Complex lessons should be broken down into manageable sub-parts. Example: Two levels of bullet points.
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Mayer, R. E., and Moreno, R. (2003). Nine ways to reduce cognitive load in multimedia learning. Educational Psychologist, 38, 43-52.

5. Manageable Cognitive Load: Information presented to the learner should not overload working memory. Example: Secondary bullet points are initially hidden.
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Pass, F., and Kester, L. (2006). Learner and information characteristics in the design of powerful environments. Applied Cognitive Psychology, 20, 281-285.

Van Merrienboer, J., Jeroen, J. G., Kester, L., and Pass, F. (2006). Teaching complex rather than simple tasks: Balancing intrinsic and germane load to enhance transfer of learning. Applied Cognitive Psychology, 20, 343-352.

6. Cognitive Flexibility: This improves with multiple viewpoints linking facts and deep conceptual principles. Example: Material presented in several locations, e.g. TB is covered under Microbiology, Pulmonology, and Immunology.
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Rouet, J. (2006). The Skills of Document Use: From Text Comprehension to Web-based Learning. Mahwah, NJ: Erlbaum.

Spiro, R.J., Feltovich, P.J., Jacobson, M.J., and Coulson, R.C. (1991). Cognitive flexibility, constructivism, and hypertext: Random access instruction for advanced knowledge acquisition in ill-structured domains. Educational Technology, 31, 24-33.

7. Anchored Learning: Materials are anchored in real world problems that you care about. Example: Gunner often associates learning points with their clinical correlates.
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Bransford, J. D., Brown, A. L., and Cocking, R. R. (Eds.). (2000). How People Learn (expanded ed.). Washington, D.C.: National Academy Press.

Step 2: Take a short test

Take a short test immediately after a learning session to uncover what you do and do not konw. This test is comprised of both multiple-choice and open-ended study questions.

Immediate testing, multiple-choice questions, and open-ended study questions embody eight more learning principles:

8. Imperfect Metacognition: We rarely have an accurate knowledge of our cognition and need assistance with calibrating comprehension, learning, and memory. Example: Gunner solves this problem through immediate testing.
References » Close

Azevedo, R., and Cromley, J.G. (2004). Does training on self-regulated learning facilitate students’ learning with hypermedia. Journal of Educational Psychology, 96, 523-535.

Maki, R.H. (1998). Test predictions over text material. In D.J. Hacker, J. Dunlosky, and A.C. Graesser (Eds.), Metacognition in educational theory and practice (pp. 117-144). Mahwah, NJ: Erlbaum.

White, B., and Frederiksen, J. (1998). Inquiry, modeling, and metacognition: Making science accessible to all students. Cognition and Instruction, 16, 3-117.

Winne, P.H. (2001). Self-regulated learning viewed from models of information processing. In B. Zimmerman and D. Schunk (Eds.), Self-regulated learning and academic achievement: Theoretical perspectives (pp. 153-189). Mahwah, NJ: Erlbaum.

9. Desirable Difficulties: Challenges make learning and retrieval effortful leading to improved retention. Example: Gunner’s multi-part questions are on par with or exceed USMLE question difficulty.
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Bereiter, C., and Scardamalia, M. (1985). Cognitive coping strategies and the problem of “inert knowledge.” In S. F. Chipman, J. W. Segal, and R. Glaser (Eds.), Thinking and learning skills: Vol. 2. Current research and open questions (pp. 65-80). Hillsdale, NJ: Erlbaum.

Bjork, R. A. (1988). Retrieval practice and maintenance of knowledge. In M. M. Gruneberg, P. E. Morris, and R. N. Sykes (Eds.), Practical aspects of memory: Current research and issues. (Vol 1, pp. 396-401). NY: Wiley.

Bjork, R. A. (1999). Assessing our own competence: Heuristics and illusions. In D. Gopher and A. Koriat (Eds.), Attention and performance XVII: Cognitive regulation of performance: interaction of theory and application (pp. 435-459). Cambridge, MA: MIT press.

10. Cognitive Disequilibrium: Deep reasoning and learning is stimulated by problems that create cognitive disequilibrium, such as obstacles to goals, contradictions, conflict, and anomalies. Example: Gunner’s questions are often “2-jump” or “3-jump” questions that require one to integrate disparate knowledge and/or answer multiple sub-answers before being able to answer the question.
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Chinn, C., and Brewer, W. (1993). The role of anomalous data in knowledge acquisition: A theoretical framework and implications for science instruction. Review of Educational Research, 63, 1-49.

Graesser, A. C., and McMahen, C. L. (1993). Anomalous information triggers questions when adults solve problems and comprehend stories. Journal of Educational Psychology, 85, 136-151.

Graesser, A.C., Lu, S., Olde, B.A., Cooper-Pye, E., and Whitten, S. (2005). Question asking and eye tracking during cognitive disequilibrium: Comprehending illustrated texts on devices when the devices break down. Memory and Cognition, 33, 1235-1247.

Graesser, A.C., and Olde, B.A. (2003). How does one know whether a person understands a device? The quality of the questions the person asks when the device breaks down. Journal of Educational Psychology, 95, 524-536.

11. Generation Effect: Learning is enhanced when learners must produce answers, not merely recognize answers. Example: Gunner employs open-ended study questions that don’t show answer choices.
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Butler, A. C., and Roediger H.L., III. (in press). Testing improves long-term retention in a simulated classroom setting. European Journal of Cognitive Psychology.

McDaniel, M.A., Anderson, J. L., Derbish, M. H., and Morrisette, N. (in press). Testing the testing effect in the classroom. European Journal of Cognitive Psychology.

Tulving E. (1967). The effects of presentation and recall of material in free-recall learning. Journal of Verbal Learning and Verbal Behavior, 6, 175-184.

12. Testing Effect: Testing enhances learning, especially when the tests are aligned with important concepts. Example: After any flashcard study session, you are immediately tested on the concepts you just covered. Moreover, Gunner’s entire system is constantly assessing/testing you.
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Dempster, F. N. (1997). Distributing and managing the conditions of encoding and practice. In E. L. Bjork and R. A. Bjork (Eds), Human Memory (pp. 197-236). San Diego, CA: Academic Press.

Roediger, H. L. III., and Karpicke, J. D. (2006). The power of testing memory: Basic research and implications for educational practice. Psychological Science, 1, 181-210.

Wheeler, M. A., and Roediger, H. L. III., (1992). Disparate effects of repeated testing: Reconciling Ballard’s (1913) and Bartlett’s (1932) results. Psychological Science, 3, 240-245.

13. Feedback Effects: Students benefit from immediate feedback on their performance. Example: After each review session, Gunner will tell you how you did and how you are doing overall.
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Pahler, H., Cepeda, J.T., Wixted, J.T., and Rohrer, D. (2005). When does feedback facilitate learning of words? Journal of Experimental Psychology: Learning, Memory, and Cognition, 31, 3-8.

14. Negative Suggestion Effects: Learning wrong information can be reduced when feedback is immediate. Example: Gunner tells you what the right answer is immediately after you answer a question.
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Anderson, J. R., Corbett, A. T., Koedinger, K. R., and Pelletier, R. (1995). Cognitive tutors: Lessons learned. The Journal of Learning Sciences, 4(2), 167-207.

McTighe, J., and OConnor, K. (2005). Seven practices for effective learning. Educational Leadership, 63, 10-17.

Roediger, H. L. III, and Marsh, E. J. (2005). The positive and negative consequences of multiple-choice testing. Journal of Experimental Psychology: Learning, Memory, and Cognition, 31, 1155-1159.

Shute, V. (2006). Focus on formative feedback. Unpublished manuscript, Educational Testing Service, Princeton, NJ.

Toppino, T. C., and Brochin, H. A. (1989). Learning from tests: The case of true-false examinations. Journal of Educational Research, 83, 119-124.

15. Deep Questions: Learners derive more benefit from answering questions that elicit explanations (e.g., why, why not, how, what-if). Example: Many of Gunner’s questions elicit explanations.
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Craig, S. D., Sullins, J., Witherspoon, A., and Gholson, B. (2006). The deep-level reasoning effect: The role of dialogue and deep-level-reasoning questions during vicarious learning. Cognition and Instruction, 24, 565-591.

Graesser, A. C., and Person, N. K. (1994). Question asking during tutoring. American Educational Research Journal, 31, 104-137.

King A. (1994). Guiding knowledge construction in the classroom: Effects of teaching children how to question and how to explain. American Educational Research Journal, 31, 338-368.

Pressley, M. et al. (1992). Encouraging mindful use of prior knowledge: Attempting to construct explanatory answers facilitates learning. Educational Psychologist, 27, 91-109.

Rosenshine, B., Meister, C., and Chapman, S. (1996). Teaching students to generate questions: A review of the intervention studies. Review of Educational Research, 66 181-221.

Step 3: Review concepts

Review concepts you are having difficulty with a higher frequency (shorter intervals/spacing) to ensure complete mastery and conversion into long-term memory, and review concepts you have already mastered with less frequency (longer intervals/spacing) to maintain your knowledge over time.

Step 4: Your personal review plan

Study new material and repeat this process to build your personal review plan—an adaptive review schedule that helps you determine when you need to review something (before you forget it) and what you need to study more to ensure complete mastery.

Adaptive review applies four more learning principles:

16. Spaced Effects: Like spaced learning, spaced schedules of testing produced better long-term retention than does a single test.
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Bahrick, H.P., Bahrick, L.E., Bahrick, A.S., and Bahrick, P.E. (1993). Maintenance of foreign language vocabulary and the spacing effect. Psychological Science, 4, 316-321.

Cepeda, N. J., Pashler, H., Vul, E., Wixted, J. T. and Rohrer, D. (2006). Distributed practice in verbal recall tasks: A review and quantitative synthesis. Psychological Bulletin, 132, 354-380.

Cull, W. L. (2000). Untangling the benefits of multiple study opportunities and repeated testing for cured recall. Applied Cognitive Psychology, 14, 215-235.

17. Goldilocks Principle: Assignments should be at the right difficulty level. Example: Gunner varies the difficulty of your review depending on your level of mastery. The more you know, the harder it gets.
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Metcalfe, J., and Kornell, N. (2005). A region or proximal of learning model of study time allocation. Journal of Memory and Language, 52, 463-477.

VanLehn, K., Graesser, A.C., Jackson, G.T., Jordan, P., Olney, A., and Rose, C.P. (2007). When are tutorial dialogues more effective than reading? Cognitive Science, 31, 3-62.

Wolfe, M.B.W., Schreiner, M.E., Rehder, B., Laham, D., Foltz, P., Kintsch, W., and Landauer, T. (1998). Learning from text: Matching readers and texts by latent semantic analysis. Discourse Processes, 25, 309-336.

18. Self-regulated Learning: Most students need to self-regulate their learning. Example: Gunner lets you choose what to study and when and empowers you with the right data to make educated decisions.
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Kruger, J., and Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology, 77, 1121-34.

Langendyk, V. (2006). Not knowing that they do not know: Self-assessment accuracy of third-year medical students. Medical Education. 40, 173-179.

19. Exam Expectations: Students benefit more from repeated testing and the expectation thereof. Example: Gunner is constantly testing you, so you will be ready come test or exam day—no exceptions.
References » Close

Szupnar, K. K., McDermott, K. B., and Roediger, H. L., III. (in press). Expectation of a final cumulative test enhances long-term retention.

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