The Science of Successful Learning: Applications to Physical Therapy Education
By Leda C. McDaniel, PT, DPT
When I first read Make It Stick: The Science of Successful Learning—a book for the general public written by Peter C. Brown, Henry L. Roediger III, and my father, Mark A. McDaniel1—I did not realize the significant impact it would have on me. It not only greatly influenced my own study habits as a student, but it also shaped how I went about developing effective teaching methods and course materials in my role as an educator. The book was especially impactful for me because my reading of it and application of its principles coincided almost identically with my entry into a Doctor of Physical Therapy (DPT) program as a graduate student.
My re-entry into academics posed challenges. It had been nearly six years since I had graduated with a Bachelor of Arts in Psychology, and my study habits were rusty at best. Furthermore, the fact that I had never taken any natural science classes meant that virtually all of the subjects I was trying to learn were brand new to me. I was also tasked with figuring out optimum techniques of how to learn; this is where Make It Stick became crucial.
I am now in my first year of practice as a physical therapist, which reflects my success in meeting those challenges as a student. I have also had the opportunity to teach, first as a teaching assistant while obtaining my DPT and now as a Physical Therapy Orthopedic Resident, and have done so in various settings. During these experiences, I have consistently utilized principles from Make It Stick.
The following are three key techniques from the book that I have successfully applied to my own learning, and to teaching others to learn more effectively within doctorate-level physical therapy education.
Technique 1: Retrieval Practice
Retrieval practice, such as trying to recall key points from a recently-read passage, involves retrieving information from memory and is experienced as much more difficult than a simple rereading of information. However, retrieval practice is the best way to ensure durable learning.
It feels good to reread, because the fluency and familiarity gives one the sense of having “learned” the material, which provides a pleasant experience. Retrieval practice, such as trying to recall specific details from a recently-read passage, takes more effortful attention and is experienced as much more difficult. However, retrieval strengthens memory for the retrieved information,2 and helps guide subsequent study (eg, by identifying gaps in one’s knowledge).3 Therefore, it is important as a learner and an instructor to craft opportunities for retrieval practice.
A number of study techniques can emphasize retrieval. For example, students can structure retrieval practice with methods such as flashcards, free online programs such as “Quizlet” (where students can create digital flashcards or quizzes), and using study time to draw pictures of anatomy or biomechanical concepts from memory or with minimal cueing (eg, drawing diagrams of the brachial plexus to learn nervous-system anatomy or drawing force diagrams for movement-analysis problems).
Memory techniques such as mnemonics and “chunking” can also be helpful. There are a plethora of medical mnemonics such as those for remembering muscle groups based on common insertion sites (eg, Pes Anserine attachment muscle group as: “SarGenT”: Sartorius, Gracilis, semiTendinosis muscles). These techniques can improve recall of information and facilitate remembering.
As indicated in Make It Stick, part of the tendency to eschew retrieval practice is because it is harder than rereading or “recognition” practice. However, this difficulty is often necessary and desirable. We can think of this similarly to how we advise our patients that they need to push just a little bit past their comfort zone or experience symptoms of discomfort (eg, muscle soreness, joint stiffness, or mild symptoms of vertigo) in order to see improvements in muscle strength or to reduce symptoms such as dizziness or imbalance that may indicate vestibular dysfunction. Just as our patients require these minor stresses to promote positive adaptations, as physical therapy students and physical therapists, we can optimize learning with some necessary amount of struggle.
Technique 2: Teaching as a Means of Building Deeper Understanding
Along with retrieval practice, there is also a need to integrate target information into a coherent mental model (an organized representation of how the information is interrelated). Such deep understanding facilitates retention much more than memorization. One superb way to encourage this deep encoding is via the practice of teaching. There is great power and utility in teaching as a part of medical (and physical therapy) education (eg, “See one, Do one, Teach One”).4 Teaching stimulates retrieval practice, requires the learner to reach for a deeper understanding of information, and provides a “learning check” for the student.
With this principle in mind, I have sought out teaching opportunities for myself that encourage learning, and have also created opportunities for students to teach within the courses that I have helped to instruct. One example is to set up a teaching and learning exchange in gross anatomy or neuroanatomy labs in which students are tasked with preparing and then teaching on different body area sections within groups. Each student can present on a body area for 15 minutes and discuss all of the muscles, nerves, and blood supply to that body area including details such as muscle actions and attachments. I have used various iterations on this basic theme. First-year DPT students (as part of their final exam review) can teach third-year DPT students (as a study review for the National Physical Therapy Examination [NPTE]) in neuroanatomy labs, third-year DPT students can teach physical therapists as part of continuing education courses on anatomy, and first-year DPT students can teach within their own lab groups. Feedback from students participating in these various teaching exercises has been overwhelmingly positive.
Technique 3: Low-Stakes Testing: ‘Practice How You Want to Play’
“Practice how you want to play” is the best representation I know to explain why practice quizzes and tests are so valuable: we are replicating performance conditions. Whether the performance is for a physical therapy student taking an exam to demonstrate knowledge (eg, on the NPTE) or whether we are trying to replicate patient care situations, simulating these conditions can be useful in successful learning. I believe we can set up all sorts of quizzing and testing conditions to support learning, as long as we remember that the testing is a learning exercise (“low-stakes”), not a summative assessment. For example, as a student learning how to perform physical therapy evaluations, I would regularly study with classmates by acting out patient cases and performing evaluations on “mock patients” (ie, fellow classmates). In pairs, one of us would role-play the physical therapist and one of us would role-play the patient.
As a teacher, I have led and structured similar exercises for students—creating patient cases for students to act out and helping other students practice their evaluation skills by interviewing these simulated patients. Other ways in which practice quizzes can be effective are in anatomy and neuroanatomy labs, where I have participated in and organized practice “pin exams,” in which students identify anatomical structures and functions based on colored pushpins fastened to these structures; in orthopedic labs by providing assessment and feedback during “skill checks,” in which students are asked to perform hands-on techniques for assessment and treatment; and by writing and discussing “knowledge review,” quizzes and practice test problems from a variety of subjects found in DPT curricula (eg, biomechanics, orthopedic examination techniques, and nervous system physiology).
Tools for Overcoming Learning Challenges
I have found the three evidence-based learning techniques reviewed above to be especially useful for the learning challenges I experienced as a graduate student and for assisting my students with similar challenges in acquiring foundational knowledge and skills needed for PT practice. Of course, these learning techniques are not exhaustive, and others may also be potently applied within DPT education settings. For a more comprehensive overview of evidence-based learning principles, please consult the full text of Make It Stick: the Science of Successful Learning.
- Brown PC, Roediger HL III, McDaniel MA. Make It Stick: The Science of Successful Learning. Cambridge, MA: Belknap Press, Harvard Univ Press; 2014.
- McDaniel MA, Masson MEJ. Altering memory representations through retrieval. J Exper Psychol. 1985;11 371-385.
- Roediger HL, Karpicke JD. The power of testing memory: basic research and implications for educational practice. Perspect Psychol Sci. 2006;1:181-210.
- Rohrich RJ. “See One, Do One, Teach One”: an old adage with a new twist. Plast Reconstr Surg. 2006;118(1):257-258.