There are many things that I would have liked to have known when I started my career (spoiler alert – delayed callback saves an incredible amount of time and effort). If I were forced to choose the two most important things, I would like to know that it is important to understand how memory works in order to learn more and to know what kind of learning to engage in and when.
So in this (medium-length) blog post I will explain my argumentation to you and hopefully apply it to physiotherapy and maybe save you some time in the future!
Received your micro and macro dose of CPD
Think of a “microdose” of CPD as a common small learning event that can be conveyed through various media and a “macro dose” of learning as a fixed, more traditional, longer form of learning activity. Both are absolutely acceptable learning methods and both are equally important for building a well-rounded competence portfolio. Both are normal forms of learning and are used at different times depending on the context.
Traditionally, "microdoses" were viewed by CPD as a lesser form of learning compared to "macrodoses", but things are not so straightforward. It's easier than ever to dive into and out of a virtual learning environment especially with social media platforms like Twitter and the Physiopedia app that are available 24/7 and dynamic environments for information or retrieval Colleagues offer to chat.
It is this accessibility that makes “microdosing” learning so powerful, as it is readily available and often free of charge with no paywalls. This is not an argument that all education should be free, it is clearly unsustainable, but it is an excellent way to check your knowledge or quickly check information.
There is a growing concern that, while we have access to all of this information, we are too reliant on instant information that interferes with diagnostic thinking and clinical understanding. There is also the argument that microdosing CPD and reference apps only enables superficial learning and knowledge is not stored in the memory. Personally, I am not sure if this is the case. What we see is an evolution of the way we work and perhaps formal physical therapy training should do more to incorporate information as part of the clinical reasoning process.
Technology-based learning – active recall
There are a number of different learning strategies that you can use to store new information in your long-term memory. Active recall is considered to be one of the best ways to enable long-term information retrieval. Great for this time, when you see an unusual medical condition and you remember seeing it on social media or in this team presentation a few weeks ago.
Think of active retrieval when you are actively stimulating your memory for information, essentially it is a retrieval practice for your brain. This is in stark contrast to passively reading or rereading your notes or a book where you don't reach into your brain to get the information out as it is in front of you.
Active remembering works because it relies on you strengthening the links between information and concepts. It's like with muscles, the more you train, the stronger you get – the same thing happens with the connections in your brain. The more you retrieve and retrieve the information, the stronger the connection becomes.
There are a number of delayed recall strategies, such as the Feynman technique, where the learner basically teaches someone new to the information a complex concept. Another strategy are index cards, which often add repeated repetitions when using an app.
The functionality of these apps with active recall and spaced repetition is quite simple. You will be shown an index card that you answer if it was easy to get it right, then rate it as easy if it was partially right or a little bit challenging, rate it as medium, and if you did it wrong , then difficult. Medium and difficult maps will reappear fairly quickly to strengthen your connection and the ability to remember the information by doing it all over again.
There are some great flash card apps out there, and the two top rated ones are Anki and Quizlet. Perhaps one day we will include this in the Physiopedia app.
Blended learning – just as good as face to face
Because physio is a practical profession, we have always seen personal learning as the only way to become a better clinician. When I was younger, I fell into this trap and couldn't have been more wrong. I wish I had realized that online, blended, and distance learning are great ways to develop both academic and practical skills.
Physiotherapy curriculums are characterized by a combination of theory, hands-on skills training and hands-on learning, and digital learning has not yet been fully adopted by our profession and digital learning has been criticized for not being well founded from a learning theory perspective.
Blended learning is ideal for physiotherapy
This is interesting because has long had evidence of the effectiveness of the use of digital learning for health education . Since the pandemic, there has been a boom in research evaluating digital learning for our profession. One example is a systematic review that aimed to test this balance by identifying and investigating the effectiveness of digital learning designs in physiotherapy training.
The most important finding from this systematic review is that blended learning showed at least the same, if not statistically better learning outcomes than conventional methods . Of the various blended learning approaches, the flipped classroom was used most frequently and also had the greatest positive effect on learning outcomes.
Interestingly, multiple choice questions (MCQ) have proven to be a useful and effective learning tool that is not to be equated with active remembering. In most cases, with MCQ you only do the answer that seems correct, namely recognize, not remember.
We saw some great examples of novel approaches to blended learning with Physioplus during the pandemic. Members of the St. Lucia Physiotherapy Association (PASL) selected a course to take individually and then came together to discuss the clinical implications and to reflect on the new findings as a group.
This adds an additional active learning dimension to the online learning element by reflecting and sharing different interpretations of the new knowledge and skills together. This maintains motivation and builds a culture of evidence-based practice within the group.
Reflections on learning
When I was younger, nobody really took the time to explain to me the importance of understanding how to learn and how I think about my own learning journey. Ultimately, we are all on the same journey, just at different stages. This is no longer obvious if you look at the Wired series "Explains", in which an expert explains a difficult concept in five levels of difficulty, starting with 5 years up to PhD level.
Ultimately, you will learn faster by understanding how you can learn and remember more efficiently. Once you understand this, you will take your understanding to a new level. I hope the way we create Physioplus courses enables you to do so.
