Critical Thinking in Teaching Learning_ The Nonintuitive New Science of Effective Learning

Prévia do material em texto

CRITICAL THINKING IN
TEACHING AND LEARNING
The Nonintuitive New Science of Effective Learning
 
 
 
 
FELIPE FREGNI
CRITICAL THINKING IN
TEACHING AND LEARNING
The Nonintuitive New Science of Effective Learning
 
Book Author:
Felipe Fregni, M.D., Ph.D., M.M.Sc., M.P.H., M.Ed.
Professor of Physical Medicine and Rehabilitation, Harvard Medical School
Professor of Epidemiology, Harvard T.H. Chan School of Public Health
Director, Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital
 
Book Contributors (creation and development of figures, tables and
cover page):
Kevin Pacheco, M.D.
Alejandra Cardenas, M.D.
Ines Messia, M.D.
Paulo Teixeira, P.T. (chapter 7 only)
 
 
 
Copyright © 2019 Felipe Fregni
All rights reserved.
 
 
DEDICATION
 
 
“ Education is the most powerful weapon which you can use to change the world ”
Nelson Mandela
 
This book is dedicated to the teachers that we all have inside us; from the mothers who have the
noble mission to shape the minds of our future generation to the professional who finds extra
time and passion for passing along the knowledge to their colleagues.
 
To my wife who has been the superb teacher to our son and to my father who has inspired me to
learn the art of teaching.
CONTENTS
 
 
INTRODUCTION: THERE IS NO MAGIC PILL FOR LEARNING
CHAPTER 1 - THE NEURAL BASIS OF LEARNING
CHAPTER 2 – ENGAGING THE ATTENTIONAL SYSTEM TO ENHANCE ENCODING OF NEW INFORMATION
CHAPTER 3 – UNDERSTANDING OUR MEMORY SYSTEM FOR LONG-LASTING LEARNING
CHAPTER 4 – WHAT WORKS IN MOTIVATION AND LEARNING: CARROTS AND STICKS OR A HIGHER-
LEVEL PURPOSE?
CHAPTER 5 - STRESS AND SOCIAL CLIMATE: HOW DO THEY AFFECT LEARNING?
CHAPTER 6 – TEACHING METHODS: THE TEACHER-CENTERED VS. THE STUDENT-CENTERED METHOD
CHAPTER 7 – ONLINE LEARNING: CHALLENGES AND OPPORTUNITIES
CHAPTER 8 - TEACHING FOR UNDERSTANDING: ENHANCING CRITICAL THINKING IN YOUR
EDUCATIONAL PROGRAM
CHAPTER 9 - ASSESSING AND GRADING STUDENTS: AN APPARENTLY EASY BUT CHALLENGING TASK
EPILOGUE: TEACHING OUTSIDE THE BOX
REFERENCES
ABOUT THE AUTHOR
 
Introduction: There Is No Magic Pill for Learning
 
Human beings are wired for learning. Our species would not have been so successful if not for
our learning skills. Our civilization progress is a result of the rapid accumulation of knowledge,
especially in the past century. On the other hand, schools (or educational programs) do not seem
to be taking advantage of our innate ability for learning. Many students see courses as only a step
away to get their diploma and start working. Also, students are usually bored with educational
programs. It is not surprising that students' reaction with a traditional educational program.
Indeed, courses that are designed for unloading a significant amount of content on students using
endless one-way format lectures are highly ineffective. In these courses, students do not usually
do anything else besides cramming at last minute before the final exam.
Why does a good number of teachers keep doing educational programs in this traditional
way? Because we are used to that. Because since our first years in the school system, we learned
that a good student needs to get good grades in the exams. Because it is a relatively easy system
in which the teacher has much more control of the classroom. Because although neuroscience
has advanced in the past 30 years, this knowledge has not passed to the teachers, at least not yet
for the majority of them.
The goal of this book is, therefore, to look at teaching methodology in the light of the neural
mechanisms associated with learning. My almost 20 years of experience in researching the
mechanisms of neural learning in patients with brain lesions have helped me to see learning in
the classroom a bit different. Besides, I was fortunate to be involved early on designing an online
program that is offered by Harvard on clinical research methodology. This program has
expanded and currently is offered to about 450 students in more than 50 countries. This program
has also helped me to put in practice many of the learning and teaching methodologies that I
have researched in these past 20 years.
In this book, I discuss the main mechanisms of learning, starting at neuronal level regarding
how neurons change when we learn and then reviewing and discussing some critical neural
systems that need to be taken into account (and indeed used by teachers) during learning such as
our attentional system, long-term memory, motivation, stress, and emotional system. In the next
part of the book, I apply the concepts from chapters 1 to 5 into teaching methodologies,
discussing teaching methods such as the student-centered vs. teacher-centered methods. I also
discuss online learning, discussing the pros and cons of this strategy, and finally, explain how to
enhance critical thinking skills in the classroom. The last chapter is about grading and
assessments, discussing a new way of looking into it.
Although you can choose to read the chapters in a random order, I do recommend following
the book order, especially for the first five chapters. I also welcome feedback on the book and
questions and comments, please do send to felipe.fregni@medicaltli.org.
 
Felipe Fregni
Boston, June 2019
Chapter 1 - The Neural Basis of Learning
 
Neuroscience has advanced significantly in the past 20-30 years with the use of better tools to
understand neural function. This progress has allowed us to gain important insights into the
neural mechanisms of learning that can be applied to education. However, this publication is not
a book on neuroscience—it is a book on how to teach more effectively by understanding how we
learn.
Should an educator care about the neural mechanisms of learning? Absolutely. For instance, a
physician who treats blood pressure needs to understand the mechanisms of an anti-hypertensive
drug to select the best option for his patients, based on individual characteristics and clinical
expertise. Merely memorizing, for instance, that drug A can treat blood pressure in younger
patients and drug B in patients with diabetes would not be efficient, because such information
would be difficult to memorize and because this habit would limit one’s critical thinking with
regard to the use of blood pressure-lowering agents.
Intuition and self-reflection are significant components of education, meaning that we learn
how to teach effectively naturally. It is true that a teacher, if he is a reasonable observer, will
notice that a long 50-min lecture with no breaks and a large amount of content will be
ineffective. Next time, this teacher might test alternative methods, such as shorter mini-lectures.
However, this process is inefficient, because many years of observation will likely be necessary
to develop the ideal best teaching practices. Most teachers will not have the time or the scientific
mind for such a trial-and-error strategy. Further, on understanding the neural basis of learning,
we can choose strategies, based on the theory of learning—not on the intuition that comes from
natural observation and thinking—which might save years that are spent on a trial-and-error
process. One final advantage of understanding how we learn is that it might be easier to convince
administrators and educational policymakers to replace educational methods with novel, better
strategies.
Another important issue in education is that most educational theories and methods were
developed before the birth of the neural basis of learning or in its infancy. Thus, the traditional
classroom style, wherein a teacher spoke for one hour (or more) in front of students, became the
principal method of education. Although this approach might be an effective method for training
teachers and providing education on a large scale, this design for learners is far from being ideal
as this is not how human brains are wired to learn.
As I will discuss several times in this book, learning comes from within . Learning cannot be
forced. Students often learnhow to pass a test or how to (unfortunately) cheat on a test to pass.
They might spend hours learning the strategy of an exam and how to maximize their chances of
passing it. Therefore, to break this current paradigm of teaching and learning, it is important to
understand the neural basis of learning to truly develop educational programs that result in long-
lasting and meaningful learning.
In this Chapter, we will discuss the main principles of neuroplasticity and how they constitute
the first important foundation in understanding the process of learning.
 
Basic Concepts of Neuroplasticity for the Educator
 
The history of neuroplasticity has not been linear, with phases of tremendous development
and stages of little progress. We still observe the notion among even neurologists that the brain
can change very little and that learning is only the result of functional changes and is not
associated with structural changes.
Throughout history, there have been several authors who understood that the brain is a highly
plastic organ that can undergo significant structural changes during life, providing meaningful
insights regarding this model. Over 100 years ago, the Nobel Laureate Cajal elegantly discussed
this concept. He grasped the structure of the brain during his anatomical studies, observing in his
book, “Recollections of My Life” (y Cajal and Cano 1989) that:
 
“By comparing the morphology and relative abundance of axonic and dendritic collaterals of
the cerebral pyramids in the vertebrate scale, the conclusion was reached that intellectual
power, and its most noble expressions, talent and genius, do not depend on the size or number of
the cerebral neurons, but on the richness of their connective process, or in other words on the
complexity of the association pathways to short and long distances….Adaptation and
professional dexterity, or rather the perfection of function by exercise (physical education,
speech, writing, piano playing, mastery in fencing, and other activities) were explained by either
a progressive thickening of the nervous pathways (suggestion made by Tanzi and Lugaro)
excited by the passage of the impulse or the formation of new cell processes…”
 
In this passage, Cajal introduced two important concepts: that the brain changes structurally
with activity (electrical impulse) and that such alterations result in structural brain modifications.
Approximately 50 years later, this concept was developed further by another neuroscientist,
Donald Hebb.
In 1949, Hebb summarized the main principle of plasticity when discussing connectivity (see
below) (Hebb 1949). His concept was later encapsulated in a simple sentence: “Neurons that fire
together wire together.” This adage has a profound meaning, especially with regard to learning—
that when we receive new information (for instance, when we hear or see a new concept), we
give meaning to it by connecting the brain area that initially processed this concept with other
brain areas (with concepts we know). When this happens, several neurons fire simultaneously,
leading to structural changes that strengthen the connectivity of this circuit, thus wiring together.
 
This axiom, used as one of the main principles of neuroplasticity (Neurons that fire together wire
together.), came from Donald Hebb, who concluded in his book that ‘when an axon of cell A is
near enough to excite a cell B and repeatedly or persistently takes part in firing it, some growth
process or metabolic change takes place in one or both cells such that A’s efficiency, as one of
the cells firing B, is increased.’ (Hebb 1949). Simply, this means that when, for instance,
someone is learning to play the piano and learns a sequence of movements, then neuron (or
network) A excites neuron (or network) B, and so on. This spread of electrical impulses leads to
modifications between cells that will ultimately facilitate activity between them, and thus, the
next time that circuit A is activated, it will be easier to activate circuit B.
 
An important consequence of this principle is that: to maximize learning, the teacher needs to
enhance the ability of students to connect concepts, which can be achieved by increasing student
reflection. Yet, many teachers make a significant mistake: they are anxious to provide as much
content as possible. It is not the amount of content that matters but how it is reflected on and
processed by students. Long-lasting learning is associated with the connectivity of content.
This issue can be understood visually below in figure 1.1. In a simplistic manner, imagine that
we can isolate 8 areas of the brain and call them by the letters A, B, C, D, E, F, G, and H. Now,
let us suppose that a teacher provides content for his students and defines A as being equal to B.
In addition, this teacher requests that students remember this definition and repeat on an exam
that A is equal to B. Several months later, when a student is engaged in other neural activity that
triggers the activity of C, D, E, F, G and H, she will never remember the meaning of A, because
it was never connected in the first place. Remember the Hebbian law: “Neurons that fire together
wire together.” Thus, because this teacher did not encourage broader connectivity, the firing of
C, D, E, F, G, and H will not fire A or B, because they are not wired together (not connected).
Figure 1.1 Diagram of a simple and extended neural circuit (classic vs. connected learning).
 
At least this situation is not as dire as when this student needs the information that A is equal
to B—she will remember it when she thinks of A. However, an important idea must be
introduced here: the human brain is dynamic, meaning that just as neurons can wire together,
then can also uncouple. In fact, we can add another critical principle here: when A and B stop
firing together, they will begin to unravel.
If this model is true, why does it matter that A is connected to B but also with C, D, E, F, G,
and H? Because then, the chances of accessing this network are not limited solely to A and B,
whereas when the information is encoded in a more distributed network, the likelihood of firing
this network increases, and thus, long-lasting maintenance of this structure increases
significantly.
 
Why Does Neuronal Firing Lead to Neuronal Wiring?
(Or, why does the student create brain changes every time he reflects actively about a topic?)
 
Recent and significant advances in neuroscience have allowed us to respond to this question.
We now better understand what happens when two neurons fire together. Most of the changes
that lead to structural changes (i.e., wiring) occur in the space in which two neurons
communicate— synapses . When an action potential is transmitted through a neuron to reach
another neuron, neurotransmitters are released into this very small space (the synapse), which, in
addition to generating an electrical impulse in the second neuron, induces a series of changes in
the synapse—for example, altering the receptors that bind to these neurotransmitters. In a simple
analogy, the receptors act as gates between two neurons when there is firing between them; the
gates become larger (for instance, expanding to a 4-lane highway), and thus, information passes
easily. When there is little or no activity, this gate narrows (narrowing to a small door that allows
only one person to pass).
Another consequence of this concept is that the student is primarily responsible for generating
activity between two neurons. The teacher is a motivator and can guide this process but can
never force it. A teacher must encourage students to fire the neurons as much as possible to
construct this network. Using the analogy of gates and highways, the goal is to create wide
freeways to process information easily and more efficiently. Therefore, the student is the one
who actively builds the roads of knowledge.
 
How to Enhance Brain Wiring with More Firing
 
Learning is a direct product of guided neuroplasticity. In thiscontext, certain conditions can
facilitate neuroplasticity (or “wiring,” as discussed in the principle of neuroplasticity). This
aspect will be discussed in subsequent Chapters. The educator must therefore ask how neuronal
firing can be enhanced (associated with the learning that is aimed to be induced)—not only in a
restricted circuit (such as A and B in the example above) but from A to H.
There are many ways to improve neuronal firing in a distributed circuit. A basic approach is
human interaction and conversation. These activities are how human beings learn naturally and
how they have learned during most of human evolution. The great advantage of conversation is
the dynamic nature of this process—concepts can be tested and adapted during the conversation.
During a conversation, the meaning of concept A may be developed through several versions
that will certainly encompass much more than “ A is equal to B .”
Similarly, a conversation with multiple people will be richer. Some will connect A with B and
D with E, and others will say A, B, F, and G and so on. The more points of view we present to
try and understand A, the richer the connectivity of A will be (again, here, A is the concept that
is trying to be learned–it could be the concept of a statistical test, the biology of the disease, etc.).
The richer the connectivity of A, the better the circuit that is developed will be and the more
likely that this learning will be long-lasting, as discussed.
Harvard Engineering Professor Eric Mazur has noticed this issue in his students. He has
observed that they performed very well on exams; however, when they were assessed concerning
real-life problems about the topics that they learned, most could not solve them. In other words,
they were able to understand what Prof. Mazur explained to the extent of replicating the
information perfectly on an exam but were unable to correlate this issue with a deeper meaning.
This pattern is a classic example—that they could say A is equal to B but could not correlate
them with C, D, E, F, G, and H.
He hypothesized that because he knew so much about the problem, he was unable to identify
the Cs, Ds, Es…Hs networks of his students. He then created a system in which current students
helped explain the topics to other students. He developed an elegant electronic pooling system in
which he proposed a problem to the class, to which all students had to respond simultaneously.
The outcome of the responses of each member was projected onto a screen with a map of the
seating arrangement. Next, students who were wrong were paired with those who got the correct
answer to hear the explanation from the latter. He noted that this method significantly enhanced
their understanding of the topic. In summary, he was able to improve the connectivity of A and
H using other students’ points of view.
 
If Greater Wiring Can Induce Deeper Learning, Can We Assess the Extent of this Wiring with
Educational Assessments?
 
In the last Chapter, we will discuss assessments and grading; however, it is important to
present them briefly in the context of this first Chapter. Because the goal is to help students
connect new concepts or information with other concepts to enhance the network that is being
fired, is it possible to administer an exam, for instance, that measures the connectivity of circuits
A-B-C-D-E-F-G-H rather than A-B?
Although it is not impossible, it would be difficult for several reasons. Primarily, although a
teacher can standardize the definition of A and B, the other circuits that the student will connect
will depend on many factors, such as previous learning and previous experience. In other words,
C-D-E-F-G-H will likely differ between students. Perhaps a long essay that asks the student to
analyze topic A connect it with other circuits as extensively as possible would provide some sort
of assessment; however, in practice, this approach would be difficult to grade and troublesome to
ensure that students would be able to complete it in an exam format.
In summary, how to design an effective exam is one of the challenges of our educational
system. Students usually have one goal during their schooling: to get As or passing grades.
Therefore, the educator must also keep in mind students behavior regarding exams when
designing it; in other words that students are interested in getting As rather than expanding their
neural network connectivity to result in effective and lasting learning.
What is a good assessment then? There isn’t any. Instead of assessing concept knowledge, the
educator should consider grading activities that lead to expanding this network, such as activities
that are associated with reflection—for example, group discussions, assignments, and team
projects. Thus, students would be measured on the process and not on the outcome, which is not
easily assessed.
 
The Wiring of Neurons Is an Active Process, Although Most Teaching Strategies Are Passive
 
As discussed for the main principle of plasticity, learning requires active firing in specific
groups of neurons (as in the example A-B-C-D-E-F-G-H). This firing will alter synapses,
ultimately leading to the development of a novel brain circuit that is associated with a behavior,
such as playing the piano.
Thus, as with any other process in our brain that involves changes, learning requires direct
effort for these changes to be made. In a simple analogy, consider someone who is trying to
improve muscle tone and strength. This person can undergo several sessions of passive
movement—for instance, physical therapy that moves the arm repeatedly or performing a series
of exercises himself. Which one will induce significant changes? Here, there is no room for
dispute (active exercising is the answer).
Let us now compare a teacher who passes along information to students in a traditional one-
hour lecture, thus trying to fire the neurons in students passively (similar to the physical therapist
trying to fire the nerves of the muscles in the passive intervention), or one who gets students
involved in mental thinking, making them fire their neurons and do the mental exercises. Which
one will be more effective in building novel brain circuits? Again similarly to above students
actively involved and reflecting the material.
However, one can argue that a teacher who is highly effective in engaging the audience for
roughly one hour will get students to think and reflect. This is true; however, it also depends on
the complexity of the subject that is being taught. The more complex a topic is, the more time
that will be needed to encode that information in a reflective process.
If students are not actively processing and firing the specific neurons that are related to the
new concept or information, the learning will be very limited. One could then argue that some
students prefer self-learning strategies and can catch up with the content and do well on exams.
This type has been discussed above. Self-study can be efficient for certain students, but this is
not how our brain is wired to learn. Usually, students who do not enjoy discussions in class are
those who master learning how to study for an exam using strategies for short-term success
instead of creating novel brain circuits that will be associated with much longer-term learning.
During development, our brain has evolved for survival; in a classroom situation, “survival”
means maximizing short-term exam success, not long-term learning. We will discuss in Chapter
4 how to use motivational tools to change what students’ brains will see as important.
 
How to Fire a Specific Circuit of Neurons and Compete with 80 Billion Neurons
 
Specificity is another important issue of which the educator must be aware. Brain activity is
characterized by intense competition between neural circuits. To activate a specific neural
network, it is important that the information that is presented (or the sensorial experience) be
relevant (we will discuss this issue in Chapter2) and interesting to the student.
Therefore, the student needs to be interested in the information before it is given. Preparation
is essential, because it will activate other related circuits. It will be easier for the student to
connect A-B with C-D-E-F-G-H, because these other networks will be primed. Several
neuroscientific studies have shown that when a network is primed with something as simple as a
statement that the information is coming, the processing of the stimulus that is imminent is much
stronger (i.e., more firing and more structural changes). The discussion in class should be then be
anticipated by reading activity or discussion by students, or the live class should prepare students
for the material that is to be read or discussed.
A counterargument here is that this approach (students reading or discussing by themselves
before a formal discussion that is held by the teacher) may lead to errors. Students might learn
the incorrect concepts and make wrong associations during this process. In point of fact, this
method is not a problem, and it may be valuable to make these mistakes if they are corrected
during the process. When students learn that they have made a mistake, a circuit that shows that
that pathway is not correct is activated. To some extent, the student who learned with mistakes
might form a larger circuit than those who did not. Part of reflection and experimentation is to
explore different pathways.
Based on the goal to increase connectivity between neurons—limited (as in the example of A
and B) and extended (such as A to H)—the learning process should also allow the student to
explore other pathways. Learning how to cook is not synonymous with memorizing recipes
(which would be A connecting to B) but learning the properties of ingredients to allow students
to make all potential connections between the properties of a carrot, such that the student will
connect this knowledge with the use of carrots for appetizers, main entrees, and desserts. When
we aim for this type of learning, a more distributed signature will result that is more long-lasting.
Solely memorizing a recipe and repeating on an exam will be easily forgotten, especially given
all of the other tasks and experiences to which we are exposed every day.
 
The Goal of Teaching Is Therefore to Find How to Connect A-B with the Rest of the Students’
Network or to Find C-to-H Networks
 
Teaching is not an easy task. As with any other profession, it requires mastery. Teaching is
mistakenly seen by many teachers as providing students only with the correct definitions and
explanations. A teacher may have a false sense of accomplishment after preparing a 60-slide
lecture, exposing all of the theory on the topic, and speaking about it for one hour to a group of
students. This is a small (and, in this case, inefficient) part of the teaching process.
The teaching process needs to connect this new knowledge with what students already know.
The teacher must be a facilitator of that process and find out what the previous knowledge is that
can be connected; otherwise, it will become abstract knowledge that will not be used in the future
by students. As Cajal concluded more than 100 years ago, “ Intellectual power, and its most noble
expressions, talent and genius, do not depend on the size or number of the cerebral neurons, but
on the richness of their connective process.”
 
 
Chapter 2 – Engaging the Attentional System to Enhance Encoding
of New Information
 
We discussed the main principles of neuroplasticity extensively in Chapter 1. To induce
structural changes during the learning process, the student must fire neurons together to make
them wire together . When this wiring is strong, we are more likely to learn something that will
be retained for decades. This model now raises an important question: How can we initiate firing
in neurons? The response is simple: Merely provide a stimulus to the brain. This stimulus can be
auditory stimulation (a teacher explaining something orally), visual stimulation (a teacher
showing a slide or drawing on a whiteboard), combined visual-auditory stimulation, or,
depending on the educational program, even tactile or kinesthetic stimulation.
However, it is not only the content of the stimulus that matters but also how the stimulus is
presented. The teacher is likely aware of this tenet, but it is essential to explore how the stimulus
is presented to students because it will be critical in understanding how our attention system
processes this stimulus. It may be easier to explain this concept by presenting a simple example.
Suppose that a biology teacher wishes to teach the properties of the cell membrane so that
students learn that the cell membrane controls the internal environment of a cell, regulating the
substances that enter and exit. This teacher may present this information in the following
manner:
Scenario 1: Good morning, class. Today, we will continue our biology class, and I will teach
you the structure of the cell. First, the cell has a membrane. The cell membrane is important,
because it controls the internal environment of a cell, managing the substances that enter and
exit. The cell membrane has several functions: it can help you to fight infections…, etc.
Scenario 2: Good morning, class. Today, you will learn something very important to keep you
alive, something that helps you fight infections, control your body homeostasis, and helps you to
fight the nasty flu. It is a simple structure, billions of which all of us have in our body. Think for
a minute: What is this “magic structure” that we have in our bodies that is so vital for keeping us
alive?... It is the cell membrane!! The cell membrane is important, because it controls the internal
environment of a cell, regulating the substances that get in and out.
Scenario 3: Good morning, class (the instructor starts to walk around the class). Today, you
will learn about this…[the instructor then shows a big pink balloon, representing a giant cell]…
[the instructor pauses and continues to walk around with this big pink ball]…You can feel it…
[and the instructor walks among the students while they touch the ball]…This is a cell, and this is
the cell membrane [pointing to the pink elastic surface of the ball]. Now pay attention… [the
instructor draws a large needle and blows off the ball. A loud bang is heard, and candy bars rain
down from the ball] …What did you see [The students will say, “Candy bars”], and how was this
possible? Because of the “cell membrane.” The cell membrane is important, as it controls the
internal environment of a cell, coordinating the substances that enter and exit. In this case, this
cell membrane kept the candy bars inside…
Which scenarios will be more effective for students in firing neurons in relation to this new
knowledge: the cell membrane properties? Intuitively, you likely guessed correct. Scenarios 2
and 3 are more effective for most students. As discussed in Chapter 1, instructors can learn over
time what works and what does not. However, it is essential to understand why these methods
work and why they do not work to improve their implementation and create new tools.
As you probably surmised, the reason that Scenarios 2 and 3 are more effective than scenario
1 relates to our attentional system. The attentional system is critical for learning and can be the
teacher’s best friend or worst enemy. As we will discuss in this Chapter, Scenarios 2 and 3
engage our attentional system in different manners compared to Scenario 1, allowing students to
process the information that is provided by the instructor more effectively. The level of attention
that is engaged by students will also determine the quality by which the stimulus is processed
(more attention increases firing, which in turn forms more and stronger neural circuits).
Before we discuss the main differences between Scenarios 2 and 3 and how they engage
attention, I will briefly explain the attention system mainarchitecture.
 
Understanding the Attention System: A Critical Neural System for Educators
 
The attentional system is not confined to a specific brain area, such as the occipital cortex
(which is responsible for vision) but is instead a group of neural areas that engage our neural
resources to process a given stimulus as efficiently as possible.
The attentional system is critical for survival and thus developed during evolution to become
a powerful tool to maintain survival. In a classical example, imagine that you are in a jungle and
hear a noise in the trees, which you think might be a snake. You then devote all of your energy to
look around very carefully and begin thinking of ways to escape, the type of snake it could be,
and so on. At this point, you will certainly not think of anything else other than a potential
encounter with this snake. The attentional system is keeping you focused on this possible threat.
Imagine now that you are in a classroom, and the instructor is speaking for about 35 minutes
nonstop on a topic that is not interesting to you (although there will be an exam in a few weeks,
you know that you will be able to catch up using your classmates’ notes, the slides, or the
textbook). In this situation, your attentional system is likely off, and your mind is likely to
wander, creating internal thoughts about what you will do on the weekend, the bills that must be
paid, etc. It will be even worse if you can access your smartphone—then, you will not even hear
one word from the speaker.
The attentional system is sufficiently powerful to orient us to new information, but how does
it do so? Let us examine the neural structures that are involved in this system.
To understand the anatomy of the attention system (which, coincidentally, is not fully
understood by neuroscientists), we consider a simple scheme, in which it involves cortical areas
(especially the prefrontal cortex and parietal cortex), the thalamus, and the reticular formation (in
the brainstem). Figure 2.1 shows a simple model of the anatomy of the attention system.
Figure 2.1 Anatomy of attention system – panels A and C shows top-down attention, and B and
D shows bottom-up attention.
 
One aspect that can help you understand the mechanisms of attention is to remember that
attention is about filtering sensory information that comes to us, focused into a single specific
stimulus. We constantly process great amounts of information [sounds, tactile experiences (you
are likely not paying attention to the sensory information that comes from your legs if you are
seated), the position of your body, smells, etc.], and, thus, to function in this world, it is
important to have filtering systems. A good example is the filtering of sounds when we are at a
party with many guests—it would be impossible to focus on a single conversation if it were not
for our attention system.
In this context, the thalamus is one of our main filters. The thalamus is a structure in the
central area of the brain and is considered part of the subcortical system, meaning that we are not
consciously aware of processing in this area. The thalamus receives most of the sensory
information from our body, filters it, and passes it on to cortical areas for further processing (for
meaning and connections). It is, therefore, an important filter for our sensory processing.
Another area that functions as a first filter is the reticular formation in the brainstem. The
reticular formation is a large group of neuronal cells in the brainstem that receive input from
several parts of our nervous system (such as the sensory system, cranial nerves, thalamus,
hypothalamus, and cerebral cortex) and send projections to the thalamus and cerebral cortex.
Thus, it can also modulate what the thalamus and cerebral cortex receive. There is no direct
conscious awareness of this area (this means you cannot control or monitor this area with your
thoughts).
Why is it important for the teacher to know about these two neural structures in the central
part of our brain? As the teacher, he must understand that these areas automatically process a
large volume of sensory information and filter it. This filtration system has interesting
characteristics. Usually, our system filters out whatever is constant and repetitive. A classic
example is a ventilator that runs in the background (also called white noise), which is filtered
without one’s conscious awareness. Because the goal of the teacher is to get his sensory stimulus
absorbed, the sensory stimulation (visual or auditory) need not be constant—i.e., change over
time. This can be accomplished by varying the tone of one’s voice, moving around in class, and
showing slides with contrasting pictures (instead of lots of text!). This approach to enhancing
attention is called the bottom-up method (in bottom-up mode, the system is triggered—in this
case, a stimulus triggers the attention system from the periphery to central regions). This is
Scenario 3 in our example above (bottom-up modulation): a visual stimulus (a big pink balloon)
and auditory stimulus (the balloon being blown up). We will later discuss the duration of the
stimulus—another critical factor.
Is this the only way to engage our attention system? No. We still have the prefrontal cortex to
consider. Thus, another method of enhancing attention is what we call top-down (coming from
the central nervous system to the periphery). In this case, our conscious decision can modulate
our attention, of which there are several examples. If you know that the information (or sensorial
exposure) that is to be received is essential for your survival—to give you pleasure or to avoid
pain—then, consciously, that information is filtered in and reaches the cortex to be encoded and
processed. This is the case of scenario 2, in which the instructor says, “What you will learn next
will be critical to… (and gives a real-life example).”
Top-down processing begins in the cerebral cortex. The prefrontal cortex, an area that is
associated with decision-making and executive control, has important top-down control in our
attention system. For instance in the example of the snake in the jungle, if you consciously think
that a snake may be close to you, your prefrontal cortex will: (i) activate the FEF (frontal eye
field) – this is an area of prefrontal cortex that connects to several regions in the brainstem
(nuclei of oculomotor nerves) that control our gaze and thus ensure that the visual field is
directed toward an essential incoming visual stimulus. Also, the parietal cortex plays an
important role as this area is an association processing area of sensory stimuli. Finally, the
prefrontal and parietal cortices connect to the thalamus and reticular formation to change and
modulate our filtering system to what is important to us (as assessed consciously) and, through
the latter, to enhance our alertness.
 
Using our Bottom-up System in the Classroom: How to Engage this System
 
Now that we understand that the stimulus itself (auditory or visual) can trigger the attention
system to filter it in and transport it to the cortex, the educator can and should use this powerful
tool in the classroom. Our sensorial system has a larger response to contrast as compared to
constant information. For instance, if you stay in a bathtub for a few minutes in water at 28 C
(82.4 F) (slightly cold), you will get used to. But if you are taking a shower at 40 C (104 F) and
then change suddenly to 28 C, your sensory system will quickly react to it. In another example,
there is a classical test in neuroscience, called the odd-ball paradigm, in which subjects hear a
constant beep, except that 10% of the time, another beep with a different frequency and intensity
comes randomly—this “odd” beep generates a large cortical response, meaning that we filter this
stimulus (the odd beep) to be processed in our cortex.
For auditory techniques, the instructor should truly change the tone and speed of his speech,
makingpauses and, if possible, even alternate with students speaking to vary the auditory
stimulation. Another critical technique to enhance our filtering-in is the conversation mode,
wherein several people speak in short bursts, constantly changing the sensorial stimulation.
For visual techniques, contrast is also important, as are color contrasts and movement. Here,
the visual stimulation should be considered carefully and selected. For instance, showing written
text to students is the easiest way for the thalamus to filter out what is being received unless the
text is limited and is written in large letters to summarize an important concept. Let us assume
that you are giving a class to your students (on this chapter) and create a slide that shows the
following text: “ Two main neural areas for sensory filtering: The thalamus and reticular
formation. ” And that is it for the slide: nothing else.
A brief discussion on PowerPoint slides (or similar software) is necessary here. Despite its
necessity in many circumstances, in most cases, it encourages the thalamus to filter its contents
out. Usually, an instructor teaches a 50-min class and prepares a presentation with about 50
slides (the classical idea of 1 min per slide). To make matters worse, the lights in the class are
turned off, forcing students to lose visual interaction with the teacher, who in certain cases,
spends most of the time looking at and reading the slides. This is a recipe for getting the
thalamus to filter out information—for the thalamus, this type of class has a similar effect that
the ventilator running at the back of the room has in our auditory system (meaning: it gets
filtered out).
Ideally, slides should be used for figures and limited text and, like the odd-ball paradigm,
presented over 10% to 20% of class time. Slides should not be a guide for the teacher to
remember what to say.
 
Using our Top-down System in the Classroom: How to Engage this System
 
You likely agree with the example of the snake above: if you think there is a snake close to
you, your attention system will use all the resources to monitor the environment. Wouldn’t it be
wonderful if your students devote the same level of attention to you during class spontaneously
and willingly? How to do that? Using the top-down system. The top-down system is another
powerful method for enhancing our attention to processing information and can be used to boost
our attention system. Remember scenario 2: students will focus their attention on the incoming
stimulus if well primed. But remember, the priming itself must call the attention of the students.
Teaching is not a mystery novel—meaning that it is not about surprising the students
(although it may be interesting in some cases if tension develops). Rather, students should be
prepared to receive information: the more you can prime students to receive that information, the
better the chances will be that it will be encoded meaningfully. Remember Chapter 1: if you can
prime networks B to H when you provide stimulus A, it can then be easy to connect the dots.
Several strategies can be used here. The classical one is to tell the students that the
information that they are going to learn is important for their life because X, Y, and Z (and then
give reasons). The more you specify X, Y, and Z, the more they may drive their attention toward
what is coming, especially if X, Y, and Z are essential to them. An important comment: teachers
may view touting the importance of the new learning as a waste of time—this is a big mistake.
Classical experiments in neuroscience have demonstrated the importance of priming the brain.
For instance, a subject is shown an arrow before a picture appears. If the arrow points up, the
subject knows that a picture with positive content is presented (such as food, a nice view,
beautiful people), and if the arrow points down, the picture has negative content (such as a car
accident or violence). In these studies, researchers analyzed the amount of neural activity,
comparing when arrows preceded the picture versus when there were no arrows. The results
from these studies are unequivocal: the amount of brain activity was significantly higher when an
arrow appeared before the picture. My German colleague Felix Bermpohl, myself and a few
other colleagues have shown this effect of expectancy in a functional magnetic resonance study
with healthy subjects (Bermpohl, Pascual-Leone et al. 2006). More interestingly, we also showed
in another study that expectancy is associated with activation in a specific neural circuit that
includes areas of emotional procession (Bermpohl, Pascual-Leone et al. 2006). What does that
mean for the educators? When you use this technique, your student’s brain activates different
areas that can enhance learning.
One technique that sometimes is used here is extrinsic motivation. For example, the instructor
says, “What we present here will be asked on the exam. So, you had better pay attention to that.”
Although this approach might appear to be effective, it is not a long-term solution, because
students will encode solely based on the stimulus of an exam, not applying learning to real-life
applications.
 
Attentional Competition: How to Compete with Smartphones and Connected Computers
 
Attention is all about competition for resources. For instance, your bottom-up and top-down
strategies will be more efficient if there is less competition. Suppose that you are teaching in a
public park with significant noise and visual stimulation and that students are allowed to use
their cell phones. To make matters worse, it is the World Cup Finals, and your students are
soccer fans. You will probably lose this competition!
The more that you can turn off distractions in the classroom, the better the results will be.
Here, the instructor needs to think about how to set up a “contract” with students at the beginning
of the class, explaining why it is important to avoid distractions. This should be accompanied by
a good explanation of learning and our attention system, telling them that their learning will be
significantly impaired and them that the idea of multitasking is a delusion—meaning that
multitasking while learning is often associated with poor learning outcomes.
On the other hand, as the teacher engages less of his students’ attention systems, the easier it
will be to drift to other sources that engage their attention. In this context, techniques that engage
the student actively, such as cold calls and surprise quizzes, will naturally get the student less
engaged in other forms of distraction. As discussed, the lecture is a passive, unidirectional
method to pass information, and it is very likely that attention systems will not be engaged, even
if you block the use of cell phones and computers. A simple example: if you are in a stimulating
conversation in a group of friends in which you feel engaged and participate, will you take out
your cell phone to check messages?
 
Telling Stories to Engage Attention
Stories are an effective method of engaging our attentional system. We use stories to pass
along a message or information. We can stay connected for 2 hours or longer while watching a
movie, following a story that has a beginning, a middle, and an end. Stories help with the
concept of priming (in this case, it is a bottom-up strategy) and emotional engagement—an
effective method of boosting our attention system, as discussed below).
Another example: compare the following two passages.
 
(i) A boy who was handicapped improved significantly after rehabilitation.
 
(ii) A few years ago, I met this beautiful 3-year-old boy. This boy had a great smile and a
passion for life [the more characteristics that are given, the more engaged the emotional system
is]. Until one day, while the boy was playing at the playground, a terrible accident happened….
[here, the students are primed and engaged to learn what happened to the boy and whether he is
all right now]….[you continuedeveloping the story – what happened, how he was treated, how
he was initially handicapped]…[and then when you say]…this boy improved significantly after
rehabilitation…[your students will certainly be more attentive then].
 
Also, you go on to discuss his therapy and why it worked. In this case, adding emotion and
priming are strong methods to engage our bottom-up and top-down attentional systems.
Human beings are wired to learn by stories. This is how children learn and, for a significant
part of human evolution, how knowledge was transmitted. The typical scene of learning around
the fire through stories shows the significance of storytelling as a method of passing along
information throughout evolution.
 
Emotional Engagement to Drive Attention
 
In this Chapter we discussed two methods to engage our attention and modulate our sensory
filter, meaning what gets to be processed and the intensity of it. We discussed top-down
(meaning triggered by our conscious thinking) and bottom-up (meaning triggered by sensory
stimulation) strategies. There is a third one triggered by our emotional system. Our emotional
system has an important role in engaging our attentional system.
If you are asked where you were during the 9/11 terrorist attack, you would probably
remember, even if you are not American (or living in US). This tragedy engaged our attention so
strongly that the encoding led to a long-lasting memory. This example has been shown in many
studies and elegantly demonstrated by a neuroscience study. Researchers presented several
pictures to subjects in the study and measured their brain responses via EEG (using a method
called event-related potential). They found that pictures with a negative meaning generated a
larger brain response and that this response was related to attentional processing in the brain (this
is possible to measure according to the timing of the response). (Carretie, Mercado et al. 2001)
At the beginning of this Chapter, we discussed the neural structures that are associated with
attention, and although we did not consider specific areas that are associated with emotional
processing, it is important to understand that all brain areas are interconnected. In fact, the
emotional system is highly intertwined with the attentional system. There is one area in particular
that appears to be a bridge between these two systems: the anterior cingulate gyrus. When a
stimulus activates the neural areas of our emotional system, this system arouses areas of our
attention system to engage the processing of information that is related to this emotional state.
 
Duration of Attention: For How Long Should Teaching Sessions be?
 
Here, there is no magic number. The benchmark of classes that last for 50 minutes to 1 hr is
not based on scientific evidence but what is likely to be convenient when planning teaching
sessions. The duration for which someone can focus on a stimulus depends on a series of factors
—for instance, whether the subject was sustaining attention toward something before. In fact, the
difficulty of the material being presented and the intrinsic motivation of the student towards it
play an important role in the attention span.
Another critical factor that determines the duration of attention is the type of stimulus. If a
class has limited attentional triggers (for both bottom-up and top-down approaches, as discussed
above), the attention span will certainly last much shorter. Finally, the cognitive load is
significant, because the more difficult the content is, the more likely it is that the attention span
will be shorter.
There is no recipe for the duration of a lecture or class; however, the instructor needs to
constantly change the type of stimulus, such as a class discussion, group discussion, and mini-
lectures. In addition, having small breaks with help with the attention span of students.
 
Attention and Cognitive Load
 
The final essential issue of this Chapter, as discussed briefly with regard to the duration of
attention, is cognitive load. Students must connect new knowledge to what they learned before.
If the content that is being discussed is too difficult and if students have a hard time to connect it,
they will likely stop paying attention or their attentional system will drift toward something else
internally or externally. This happens as the cognitive load is so intense to the brain, that literally
the brain becomes exhausted.
The instructor needs to then monitor and if needed go slower or provide more examples. Here,
a useful strategy is to engage students in helping to explain a more difficult issue to colleagues.
When they do that, they usually use less complex concepts that the other student can grasp more
easily (see this discussion in Chapter 1).
Finally, the stage of learning is important. Students with less background on the topic must
engage their attentional system more than those with greater knowledge. For beginners, the
teacher should be careful in pacing the concepts properly and allowing time for reflection. In this
case, the course must go at a suitable speed at the beginning to prepare students to receive new
information and connect it appropriately.
 
 
 
Chapter 3 – Understanding our memory system for long-lasting
learning
 
This may be a common experience for teachers: students understand the concepts that are
discussed in class and are able to encode the information well (see Chapter 2); however, they
quickly forget what they had apparently successfully encoded (i.e., what they understood). Here
enters our memory system, or the ability to remember what was learned.
The first important aspect to bear in mind when learning about our memory system is that
memory is not a binary (yes or no) system—that information is stored or not stored in our
memory. Instead, it should be viewed as a continuous process. For instance, think of your
memory system on a scale from 0 to 100, where 0 means nothing of that information is stored in
our long-term memory (for instance, if I ask you “How many glasses of water did you drink 3
months ago?”—considering that drinking water for you is common and something that you do
every day in variable quantities – you will likely say I have no idea) and 100 means that you
remember that information or fact perfectly (you likely remember well where you were when
you heard news of the 9/11 attack, or when you received an important award, or got married).
Or, you could have some memory of that information or fact (thus would be between 0 and 100).
Thus, the issue arises with regard to storing new information in the memory system and the
accuracy of that storage.
Another important issue is that memory is a dynamic process, varying over time in terms of
its magnitude and quality. This property is an important evolutionary advantage, because old
learning can be shaped by new learning. However, memory modification is less desirable for
factual memory, for which the memory of a fact should not change. The classical example is
false memories, wherein memory is gradually changed by actual experiences. Several colleagues
and I ran an interesting experiment to measure whether the amount of false memories could be
modified when brain activity is changed with a noninvasive form of brain stimulation. We
showed that it can be modified: fewer false memories are observed after the anterior temporal
cortex is stimulated. In this study, our hypothesis is that brain stimulation created stronger
synapses and thus stronger memories (Boggio, Fregni et al. 2009).
In this chapter, I will discuss memory as a dynamic process that is constantly modified and
shaped. Thus, I hope that readers of this chapter will learn that a student’s strategy of
memorizing content before an exam is extremely inefficient, because for memory to be long-
lasting, it must be built and maintained over time. You can liken memory to, for example,
building a house: as more time and effort is put on the foundation and structure, the longer
lastingit will be, and the more that it is maintained, the more functional it will be.
In this chapter, you will notice that I am interested in exploring the relationship between
memory and learning. Learning is the acquisition of a new skill or knowledge or a behavioral
change after exposure to stimuli, whereas memory is the power of retrieving what was learned.
The discussion of memory in this chapter is related to long-term learning—essentially, the ability
to retrieve what was learned.
 
To Forget: A Blessing for Human Beings and How to Overcome It for Long-lasting Learning
 
The dynamic nature of our memory system has an important consequence: we can learn new
concepts constantly, but we can also forget learned concepts. One might initially say, “Imagine
how good it would be not to lose any memories and keep storing new memories!” Although this
would seem beneficial at first glance, it is not. The main reason is that it would significantly
affect our retrieval system. It is critical that more important memories are retrieved first and
strongly. Remembering what you ate 10 days ago (assuming that it was an uneventful meal)
would not be adaptive and would add noise to your brain processing.
Thus, the issue is not avoiding the loss of memories but strengthening what is important to us
meaningfully. It is interesting that we likely have mechanisms to delete what is not important, of
which sleep may be one. One theory on sleep and memory consolidation posits that during sleep,
synaptic strength generally decreases (see Chapter 1); thus, only memories with strong
connectivity “survive” this process, highlighting the significance of making durable synaptic
connections (Rauchs, Feyers et al. 2011).
If forgetting is part of the evolution of our brain and neural system, how can it be overcome to
create long-term memories? The answer is simple: strengthen the memories that have already
formed. There are two important aspects to consider in enhancing memory and learning in
educational programs:
 
(i) Activating the brain area that is associated with learning in separate occasions (ideally
separated by days and weeks)—i.e., retrieving that information. As discussed, this is contrary to
what students attempt: learn everything on the day before the exam, which might have short-term
efficacy but is inefficient in the long term, because in a matter of days, the synapses in the neural
circuit that are associated with this memory will weaken (remember that our brain has daily
mechanisms to wipe out what is considered expendable).
 
(ii) New learning should be connected with previous knowledge and have direct practical
application to the individual, because the more that new learning is connected with neural
circuits that are activated daily, the more that it will be constantly activated, thus rendering it a
strong neural circuit.
 
Memory and Implicit Learning: Learning without Being Aware of Learning
 
Implicit or procedural learning is well known to all of us. A quick example involves motor
learning. Someone who learns how to play the piano is learning implicitly. What is the main
difference between this and other types of learning? Implicit learning involves little direct
conscious thinking of the learning process. If someone tries to explain all of the steps that must
be performed to catch a baseball, for instance, he would have a hard time doing so. This is in
contrast to explicit memory, such as when you learn that the US has 50 states and memorize all
the capitals.
 
Another classical example of implicit learning comes from an experiment by Bechara and
colleagues, published in Science in 1997 (Bechara, Damasio et al. 1997). In this experiment,
participants were exposed to two decks of cards with differing odds of winning—one with poor
odds and the other with favorable odds—which they did not know. Notably, only after about 80
rounds of cards were they able to consciously distinguish the good and bad decks. However,
after roughly 10 rounds, using a device to measure skin conductance, the researchers noted that
their autonomic nervous systems were reacting differently between decks—i.e., their nervous
system learned to differentiate the decks of cards quickly but took several rounds to inform their
conscious awareness.
Is it important for a teacher to understand that learning how to play the piano and learning the
US capitals involve different neural structures and have disparate characteristics? Absolutely.
There are two important insights for teachers who are interested in implicit learning. First,
manipulating the sensory input is critical for this type of learning - implicit learning. The
instructor must understand that to enhance learning, it is important to vary the sensory
conditions. For instance, someone who learns baseball should vary how the ball is thrown, the
lighting conditions, the differences between bats, etc., to train the neural structures to adapt to
change.
The second insight is that implicit learning can be used during explicit learning; for instance,
teachers who work on explicit learning with their students can use gestures when speaking.
Several studies have shown that this action drives our attention and thus maximizes learning.
Gestures can activate our motor system in what is called motor resonance, meaning that the
structures that are associated with such movements are activated and help one understand
something, especially when the gestures have a meaning (for an interesting review on this topic,
refer to From hands to minds: Gestures promote understanding ((Kang and Tversky 2016)).
The final important issue in implicit learning is memory consolidation. Here, sleep is critical
for consolidation, but it appears that the stages of sleep that are associated with learning
consolidation differ. Implicit learning consolidation correlates with stage 2 sleep, whereas
explicit learning is linked to REM sleep. Although these findings remain debated (regarding the
sleep stage), the role of sleep is essential.
 
Modification of Memories
 
One important concept in memory formation is that memories are constantly modified. In
contrast to a computer, in which the files that are stored are not modified when you open and
read them (unless you intentionally save a different version), in our memory system, every time
that we retrieve a memory and think about it being retrieved, the memory may be modified if we
are thinking about it differently. Naturally, this does not happen if it is done only once but will
occur if performed several times.
For instance, suppose that you attended a party one year ago that you enjoyed and of which
you had good memories. But, every time that you think about the party, you begin to imagine
that you met someone who was not there, and the more that you think about this, the more
certain you become that the person was there (when he or she was not). Why does this happen?
This is the natural mechanism of memory formation, because you are now associating that event
with the person being there: you are creating a new neural connection.
It is important that the teacher understands the concept of memory modification, because
everything we learn can and will be modified (perhaps slightly or significantly) over time. This
adaptability is advantageous, because it means that we can improve our previous learning by
modifying certain concepts that might not be entirely correct or might be too superficial. This is
the reason why connected learning—trying to correlate new learning with past experiences—is
so valuable.
 
How to Make Memories and Learning more Long-lasting
 
One of the challenges for the education system is that the real value for an individual and
society is long-lasting connected learning. However, educational interventions and the school
system is designed primarily with blocks of independent learning and for short-term success. For
instance, a sixth- grade student will learn the layers of the atmosphere for several weeks. He will
learneverything about this topic and then be tested on it. He might not encounter this topic for
the remainder of the school year (or even future years). Even if this student scored 100% on the
test for this subject, what is the long-lasting learning? It could be nearly nothing. Here, one can
argue that while the student was learning he was creating connections, which was thus beneficial.
However, ideally, connections would be created to effect long-lasting learning.
The real challenge is creating connected and long-lasting learning. Based on key principles of
neuroscience, the learning should be as connected as possible, newly learned material should be
retrieved periodically, and the health of the brain must be maintained (sleep, diet, and exercise).
Learning and memory formation are about relationships (see diagram, as shown in Chapter 1).
If you learn a new concept that is completely disconnected from your reality, you will likely
forget it due to the lack of representation to what you already know. There will be no keys to
retrieving this learning, which is why reading and re-reading or highlighting only the material
has little to no efficacy with regard to learning, because they do not lead to connections to what
is already known for students. It only reinforces that A is equal to B (i.e., the definition that is
given by the teacher).
How should more connections then be made? By reflecting about what was learned (what was
read) and try to make connections. When a teacher leads a discussion and provokes students to
think, more connections are established. As we discussed in Chapter 1, it is not only A that
connects to B: A-B connects to C-D-E-D-F-G-H to form a large circuit (go back to Chapter 1
and figure 1.1).
The role of the teacher is to make students think about the topic to develop these other
connections. Merely presenting the content has little efficacy. The goal of the teacher is to get
students to reflect on the topic. This is the true art of teaching, which is not easy. But, when it is
done correctly, the results are fantastic, because students start changing as they begin to expand
their neural circuits with this new learning. In summary, the goal should be to learn not only that
A means B but that A means B because C and is similar to D, which also has an example in E,
which leads to F…and so on. The letters here represent the knowledge or learned nodes of a
neural circuit.
The second key important issue is retrieval. As a classical biological system, neural networks
adapt to activity, meaning that the strengthening of a memory (or long-term learning) depends on
the activity of the neural network that is associated with the content of that memory. The critical
step is to activate this circuit by thinking about and reflecting on the learned content. Every time
that you reflect on or think about what was learned (the retrieval process), you are strengthening
the connections in that neural network. By metaphor, you are making the gates in which
information is processed in the brain wider. Figure 3.1 shows synapse formation (during initial
encoding) and strengthening (with retrieval and real-life application).
Figure 3.1 Formation of a neural circuit associated with different phases of learning (encoding,
reflection/retrieval and application).
 
Retrieval is therefore an exercise that students must be aware of and constantly do. Also,
teachers should dedicate a portion of their teaching to exercises that will retrieve, instead of
merely giving new material to be encoded. It is important that teachers set a balance between
providing new information and exercises and activities for retrieval and analysis. Another
important concept is the quality of retrieval. Retrieval should involve deep analysis instead of
merely repeating the capitals of US states, for instance.
Our education system is partially responsible for the obsession with providing content and
spending limited time on activities for retrieval. In a sense, educational programs are set up to
provide content for several weeks (usually in twice-weekly 2-h lectures and dozens of pages to
read) and then administer one (or two) exam that will be used for retrieval (but that are designed
primarily for short-term assessment). Usually, programs are not designed for students to spend
time discussing the material and exercising retrieval. Also, students view course-related
assignments as tasks to complete and usually focus on quick completion. They see completion,
rather than the time that is spent on reflection during the assignment, as the outcome. For
students, completion in a short amount of time is desirable.
 
Keeping the Brain Healthy: Sleep, Diet and Exercises to Enhance Learning and Memory
 
The final aspect of enhancing memory is keeping the brain healthy. As with any biological
system, the components of this system must be maintained and ready to adapt to environmental
and internal changes. Much research has examined how to improve the health of the brain and
optimize it for learning. Several factors that have been proven to be consistently associated with
the health of the brain, including sleep, exercise, and diet.
Likely, if you ask 100 students whether sleep is important for learning, all of them will agree
that it is; however, if you then ask whether they are sleeping enough to enhance their learning,
they will answer, “We do not have time to sleep, because we need to study!” Here is the big
contradiction: sleep is one step of the learning process and not a competitive factor. One analogy
is a company that aims to sell toys. The company then decides that they will not spend time on
marketing, because it would take energy and resources from them to manufacture the toys. The
result is that over time, this company will be unsuccessful, because it is ignoring an important
step: marketing. This is the same for learning. If we block one step, the final result will be poor.
If we are devoting less time to sleep and more to encoding (learning new information), an
imbalance will arise that results in less effective learning.
Traditional students will then argue: staying up all night studying with no sleep and merely
memorizing facts for an exam the following morning will result in a great score. For the student
who has not touched the material for the entire semester, studying for only one or two hours and
having 8 hours of sleep will certainly result in a poor grade. The two points here are true.
However, a high grade is not equal to learning (more discussion on the topic of grading and
assessment in Chapter 9). This is the main problem. From Day 1 of school, students learn that
grades are what matter. In fact, these all-nighter/last-minute students will experience poor or
even no residual learning after months or even weeks. The final point to the teacher is this: if
these models are true, an educational program should not be set up to place all of the weight of
an assessment on a final exam and should instead emphasize reflective activities (discussed
further in the chapter on Assessments).
Another challenge in teaching is to show the importance of effective and lasting learning to
students. If students continue to focus on grades as the benchmark for academic success, learning
outcomes will continue to be poor. I agree this issue has not an easy solution. However, our
education system should have better ways to provide credit for long-lasting versus immediate
learning. Thus, changes must be system-wide to decrease the weight of standardized scores and
academic success by grading that originates from multiple-choice exams.
There are two other topics that I will discuss briefly that are related to keeping the brain
healthy to enhance our memory (and plasticity): exercises and diet. Referring to our question to
100 students: Is exercise important for learning? Most, if not all, will say ”yes.” Then, a follow-
up question is posed question: Do they exercise regularly? Although students may say they
exercise morethan sleep, few or perhaps none of them will say that they exercise for learning
(reasons could vary from fun to keeping in shape).
As with sleeping, they will likely say that exercises use important reading time and can affect
learning significantly. Again, this is the wrong perception. Exercises are critical to learning. No
one knows the precise mechanisms by which learning is enhanced by exercise, but it appears to
increase the synthesis of important proteins (or neurotrophic factors) that are associated with
enhanced plasticity. The most well-studied such factor is BDNF: brain-derived neurotrophic
factor. A good book to learn more about the effects of exercises on our brain function is the book
from Harvard Psychiatrist John Ratey ( “Spark-The Revolutionary New Science of Exercise and
the Brain” ) (Ratey 2008).
Finally, I could not conclude this chapter without at least a brief alert on the effects of diet on
memory and brain plasticity. This will likely be the most difficult argument to make to our
students—that what they eat affects their learning. There exists a paradox: it might not affect
short-term success on a multiple-choice exam significantly, but it will certainly have a significant
effect on lasting learning. With regard to diet, students are in an untenable situation, given that
they are usually exposed to cheap and easy-access empty calories, such those in fast food. Here,
price and convenience likely play a role, because processed food is usually the cheapest option
can be eaten anytime and anywhere.
How does diet affect our brain? Several mechanisms contribute to low-grading inflammation,
including the health of our gut microbiome, inflammation of our intestinal lining (changing the
health of our intestinal lining allows the passage of substances that cause constant low-grade
inflammation, which is responsible for fatigue, low energy, and brain fog) and excessive sugar
content, which causes rapid fluctuations in blood sugar, leading to even more fatigue and low
energy. A favorable diet for the brain and overall health consists of good fat (e.g., extra-virgin
olive oil), the elimination of processed food, legumes and fruit (especially those with low sugar
content, such as berries), and good sources of protein (e.g., fish with low mercury content,
pasture-fed beef). An excellent book for those who are interested in learning more is “ Genius
Foods: Become Smarter, Happier, and More Productive While Protecting Your Brain for Life”
(Lugavere and Grewal 2018).
 
 
 
Chapter 4 – What Works in Motivation and Learning: Carrots and
Sticks or a Higher-level Purpose?
 
The subtitle of this book is The Non-intuitive New Science of Learning . This chapter is
dedicated to motivation. You may be wondering what is non-intuitive about the motivation for
learning. Everyone agrees that motivation is essential for learning—one must be motivated to
learn. Learning does not come passively as in Hollywood science fiction movies, such as “The
Matrix,” in which you can upload packages of information into your brain.
Although it is clear that motivation is essential for learning, this tool has been used
inconsistently and suboptimally. The main reason is that educators do not know how to use it,
which is the focus of this chapter: to understand the components of human motivation for use in
educational programs.
There are several components in the domain of motivation. Our motivation can be divided
into extrinsic and intrinsic motivation. The first issue concerns how motivation is often used in
educational programs: most teachers use solely extrinsic motivation. Basically, our school
system is heavily organized and structured to provide “carrots and sticks” to our students. If they
perform well on a test, they receive a good grade and advance to the next level (or obtain a
certificate or diploma)—this is the “carrot.” In contrast, if they fail on an exam, they are
punished by receiving a low grade and failing the course: the “stick”.
Although, at first glance, this method is efficient, especially when considering public
education, systems that use the “carrot and stick” approach—or, extrinsic motivation—alone are
destined to generate poor learning outcomes. When a student is told that the “carrot” is
important, he will do everything possible to get the carrot—i.e., doing well on an exam—instead
of learning the content. Regardless of how well thought out and designed an exam can be,
students will do all of the work for the “carrot” and not for the learning.
Does this mean that instructors should eliminate extrinsic motivators? Not really, in my
opinion, and I will explain why in this chapter. A degree of extrinsic motivation is necessary.
The key is to balance it and, most importantly, to stimulate intrinsic motivation. Combining both
elements is never easy because students might quickly assume the mindset of pursuing extrinsic
motivators and forget about how to make their learning more effective. However, there is a linear
relationship between effort in enhancing intrinsic motivators and improved learning outcomes.
In this chapter, I will first discuss what happens in our brain when motivators are introduced.
Then, I will explain the differences between extrinsic and intrinsic motivation and how to use
them in education and, finally, discuss whether students have more of an intrinsic or extrinsic
motivation type.
 
Neural Mechanisms of Motivation
 
The neural circuit of motivation is not fully understood. Most of what we know comes from
studying primitive behaviors, such as eating and appetite in humans, and examining how mice,
into which electrodes have been implanted in brain areas that are related to reward, modify their
behavior to receive stimulation in these regions. The understanding of neural mechanisms (at
least the basics of what we know so far) will help you design your educational programs.
I will use eating as an example to explain the motivation system. There is one area in our
brain that receives constant humoral (i.e., hormones and other substances via blood flow) and
sensorial information from our body, called the hypothalamus. After a big meal, there is an
increase in the hormone leptin, which is secreted by fat cells. This hormone stimulates the
hypothalamus, which in turn prompts the pituitary gland to release two hormones: ACTH and
TSH. These hormones enhance metabolism and sympathetic activation (the neural system that is
responsible for the stress response (which we will discuss in the next chapter). This response
decreases the somatic motor stimulation to seek food.
During fasting, the opposite response occurs, altering our behavior to look for food.
Therefore, the hypothalamus is an important area that controls our behavior: most of this
processing happens without our awareness which means that our behavior changes without our
conscious immediate desire. Most of our emotional system (for instance, the amygdala, cingulate
gyrus, and other areas in the brainstem), which drives our behavior, is controlled without direct
conscious oversight.
This example showing how the amount of food influences our behavior is critical to
understand that our conscious thoughts do not fully control our motivational system. They, of
course, help and are important but remember that a good amount of brain processing occurs
without your conscious awareness. In fact, learning is highly affected by our emotional state and
modulated by our sensory environment. However, in the next sections of this chapter, we will
learn how to modulate motivation to enhance learning.
Another important circuit that is associated with motivation lies in the reward system, as
examined by classical studies in mice and on brain stimulation. Scientists tested various areas
onto which self-stimulation electrodes were placed in these animals. In these experiments, the
animal could control stimulation (for instance, by pressing a lever or going to a specific area of
its cage). They found that electrodes thatwere placed along what is called the ventral tegmental
area, which connects dopaminergic neurons from the midbrain to areas of the prefrontal cortex,
marked where the animal had the highest rewarding experience. In some of these experiments,
animals stopped eating or sleeping to receive stimulation (the initial studies from the 1950s show
this effect – an example is the important study of James Olds and Peter Milner of McGill
University published in 1954 (Olds and Milner 1954)). In humans, critical reward neural areas
would be the Ventral Tegmental Area (VTA) and the Nucleus Accumbens. These areas are
highly modulated by internal structures in our brain (also called subcortical areas), which can be
modulated by external stimuli but do not reach our conscious awareness. Similar to the point
above, how can learning be made to be emotionally connected and also rewarding?
We will discuss the two main components of motivation and how they affect this complex
circuit of motivation that involves various brain areas.
 
Extrinsic Motivation
Let us start with extrinsic motivation. Extrinsic means “from the outside.” A quick analogy
here is the expression “carrots and stick:” the reward and punishment of doing an activity. In
education, in the classic example, “carrots” are good grades, a “pass” on a course, and a degree,
whereas a poor grade is the “stick.”
Extrinsic motivation refers to outside incentives that enhance the motivation to complete a
task. Let me start with two basic questions for this discussion:
 
- Does extrinsic motivation work? It depends on how it is used (more below).
- Can it be abolished in educational programs (meaning that students would no
longer be graded)? My opinion is that probably not.
- 
Extrinsic motivators are potent motivators, but extrinsic motivation has a limited impact with
regard to durable learning outcomes. If you pay 100 dollars to have your lawn mown, you can be
confident that you will get it in perfect shape. However, if you pay someone to learn a
mathematical concept deeply, the results will be likely poor. So, the first observation here is that
external rewards (or punishment) work for simple tasks but have limited effects for more
complex cognitive tasks. The reason is simple: our brain focuses on how to achieve the task to
get the 100 dollars, expending the least amount of energy possible. The focus shifts to making an
extra 100 dollars instead of the goal of learning a concept thoroughly. 
Let me give a typical example in the education field. Students know the rules of the game on
Day 1: if they do the assignments and do well on the exams (regardless if they learn), they pass
and get good grades. So, what does our brain do? It tries to find a way to complete the course
tasks with minimal energy. If ignoring the book for the entire course and staying awake the night
before the exam to memorize everything works, then many students will adopt this strategy.
Some students may indeed experience meaningful learning in this process, but this is not what
happens for most students.
Conversely, can we abolish extrinsic motivation (i.e., grades)? Would it be possible to design
a program without extrinsic motivators, such as exams, graded activities, and some official
assessment? The correct response is not categorical (yes or no) or simple. However, this drastic
measure would not work for most students. Extrinsic motivators are important to maintain a
rhythm and create a routine for them. The issue that we will discuss at the end of this chapter is
how to use extrinsic motivators effectively instead of merely administering an exam at the end of
the course. Extrinsic motivators are necessary but cannot be the only type of motivato r —
intrinsic motivators must be used together.
 
Intrinsic Motivation
 
Intrinsic motivation is the motivation that comes from within: the desire that drives one to
stay awake to work on a project and skip meals solely for internal reasons—not external forces.
One crucial point here is that intrinsic motivation is much stronger than extrinsic motivation.
Suppose that a travel machine exists, allowing you to meet great minds of the past (Thomas
Edison, Albert Einstein, etc.) before they develop their breakthrough and that you offered a large
sum of money to them to work on a different scientific discovery. The likely prediction is that it
would not work if they did not have an inner passion for the new project—the intrinsic
motivation to make it.
Significant discoveries are not a product of extrinsic motivation. The Wright brothers had a
minimal external incentive to build the first airplane (on the contrary, they had reasons not to
spend their time on this project). Yet, they made it, based mostly on their inner passion, whereas
another group that had more money and prestige and other extrinsic motivators did not build the
first successful airplane.
The next step is to understand how we can modulate our intrinsic motivation. This is not an
easy task. In his book “ Drive: The surprising truth about what motivates us,” Daniel Pink breaks
down intrinsic motivation into three main components: autonomy, mastery, and purpose (Pink
2011) that I will discuss below.
 
Autonomy
For us to feel motivated in a project, we must be in control of the project and our resources
and learn how to manage the time to accomplish it. Lack of autonomy can significantly hinder
creative processes. When the individual does not control the process, his main goal becomes to
complete the task quickly, causing his intellectual effort and involvement to decrease
significantly.
With regard to autonomy, we should not avoid guiding students or assigning them tasks.
Students should indeed know that they must progress from A to B, but they should be free to
choose the best path through which they want to navigate. If students follow a map to find the
shortest route from A to B, their attention will concentrate on following the directions rather than
learning to find the answers themselves.
 
Mastery
Mastery can be defined as the feeling of reward that we experience when improving on a task.
Suppose that you are learning how to play tennis. You spend hours and hours hitting the ball
until you can perform a perfect backhand. This “perfect backhand” would generate an immediate
feeling of reward. Alternatively, you are learning math and finally learn to solve a complex
equation.
This mastery has an interesting effect, making the learner willing to advance to the next step.
What happens in your brain is that when a task is accomplished (e.g., the backhand or complex
equation), there is an immediate release of dopamine in the reward system. However, for mastery
to happen, the student must be interested in learning the specific skill. If someone who does not
care in learning a backhand learns it, there will be no release of dopamine. Therefore, a third
component is essential: purpose. We must feel that specific learning affects our lives.
 
Purpose
The purpose is associated with the meaning of the activity. For instance, one wants to learn
mathematics and other skills to be able to draw low-cost housing blueprints to provide an
affordable home for the poor. Or, one’s purpose could be to ensure that one has a good job and
provides for his family. Purpose is indeed an important motivator. A sense of purpose has a
significant effect on triggering our emotional neural circuit. However, it is paramount that the
individual genuinely understands why learning a given topic is critical for him.
 
Although the purpose is a critical component, it might not be essential, because it is possible,
for instance, that someone spends hours learning a skill that will have no impact on his future.
We all have experiences doing something and being highly motivated. What happened to us
for this intrinsic motivation to be triggered? Can intrinsic motivation be triggered externally? The
answer is yes. One factor that can come from outsideis the purpose. In education, if teachers
remind and give real-life examples of the significance of learning and how it can affect students
lives, the learning then becomes more important. The learning shifts from completing a task to
absorbing something that will have a true impact. When students realize what is important and
are then provided with autonomy and mastery, learning happens naturally.
 
I and X Types
 
One of the challenges in education is to design a program that affects an entire group of
students. How can all of them be motivated significantly? The main obstacle is that students
respond differently to motivation-related interventions. In fact, students might have a more
extrinsic or intrinsic type of behavior.
In his book (Pink 2011), Daniel Pink defined individuals with type X behavior as those who
work or learn for a reward. For these individuals, the “carrot and stick” is the main drive that
determines their behavior. For type I, according to this author, intrinsically motivated individuals
work or learn to reach an internal goal, usually to reach a goal that has a great purpose, also
aiming to achieve mastery. Autonomy is also an important component for these individuals.
Can an individual who exhibits more of a type X behavior migrate to type I? The answer is
not simple. A series of factors determine whether an individual has more characteristics of type
X or type I behavior, some of which can be associated with personality traits. However, it is
possible to try to shift the balance toward X or I. In a program, if the instructor provides students
autonomy, promotes mastery, and ensures that students understand the purpose of the learning, it
is more likely students can shift slightly to I. In fact, all of us have the same brain circuits, and
one’s ultimate behavior is the result of which components are activated and how they do so.
 
Flow
 
You likely have heard the expression “ achieving a flow state when doing a task. ” It means
that someone can spend hours on that task, enjoying it and but barely noticing how much time
has passed. Flow can be seen as a result of our intrinsic motivation being highly activated. When
there is autonomy, someone can be engaged in a task for hours if it is associated with the
achievement of mastery or is associated in achieving a goal that has a high purpose.
Can we enhance flow? Absolutely. Flow can be improved if intrinsic motivation is enhanced.
The secret here is to decrease the weight of extrinsic motivators and promote more intrinsic
motivators. For instance, suppose that you are writing a paper for a course. This is a boring and
painful task for you. What must you do then?
 
First, understand why doing this task will bring something important to you (meaning, do not
focus on the extrinsic motivators only (grading, payment (if this is for a job, etc.)). Focus on
what you can learn on that task and how it can improve your life. Second, as you do the task, try
to learn something beyond accomplishing the task. List what you can learn, and as you achieve
these goals, the feeling of reward and mastery will start to increase your motivation. In fact, it is
interesting that the component of mastery develops as the student begins learning something and
achieving his goals. The start of the task may then be challenging.
 
How to Enhance Motivation in Educational Settings
 
As we discussed throughout this chapter, motivation is an essential component of learning.
Teachers use this component regardless of whether they identify it as such. The most common
example is exams and grading (extrinsic motivators). In my opinion, the main goal should not be
to measure learning or standardize learning—because exams do not do either (or do it poorly)—
but to ensure that students are at least somewhat focused on the content that is being discussed.
In other words, using grades to get students working on the course material will give students the
initial push to read the material and know what is being discussed.
We have also considered that although it can be seen as a “necessary evil” in education and
difficult to remove, we can transform grading into a “good angel” by changing the weight that it
is given and use it to encourage students to think about and reflect on the material and attempt to
trigger other mechanisms in them, such as mastery. Extrinsic motivation must be used early on in
a program as a trigger (i.e., to get students to think about the material and get them involved in
the content). When a student then first learns something and sees that he can learn, he will
gravitate toward the intrinsic motivation domain, which is how teachers can then delve into this
domain.
Extrinsic motivators must then be used, especially at the start of a program. however, like a
fire that needs a starter to begin, it then needs wood to keep burning. The analogy fits well here
— after getting students interested in a topic with extrinsic motivators (not necessarily exams
but, for instance, graded discussion activities that get students involved in the task rather than the
outcome), the teacher must then enhance their sense of purpose in the material. The teacher
should constantly discuss what its real-life application is to keep the fire going. Finally, grading
students on their participation would keep some of their autonomy if they are free to read and
research related material in which they are interested instead of merely what the instructor is
going to ask on the exam. Figure 4.1 shows how teachers can use extrinsic and intrinsic
motivators in a cycle to enhance learning outcomes.
Figure 4.1 Application of extrinsic and intrinsic motivators in the cycle of learning.
 
The critical point for any teacher is to ensure that learning is constant over time. Teachers
should work with tools to enhance motivation throughout the program (both extrinsic and
intrinsic). Also, intrinsic motivation is a process and not an on-off switch. As with any neural
area in the brain, constant activity will strengthen it. Therefore, do not expect that if you hold an
intensive one-day workshop that your students will be highly intrinsically motivated. The best
programs consider longitudinal designs that include motivational tools throughout the program.
Chapter 5 - Stress and Social Climate: How do They Affect
Learning?
 
Our main intuition tells us that learning occurs best when we are in a fully relaxed state
because stress is always detrimental to our learning performance. We imagine that ideally, one
wants to be in a calm state, in a silent room without any distraction, to have a fully optimized
learning environment. We feel that internal and external noise will hinder on our learning
performance.
This intuition is wrong. Stress has an interesting effect on learning that appears to be dose-
dependent: a little stress is beneficial, but too much is detrimental. This is the famous inverted U
shape that has been proposed by many scientists. A group in Lausanne, Switzerland, showed this
effect by exposing mice to various water temperatures. They found that mice exposed to low
stress (defined by a temperature of 25°C) and high stress (16°C) had a poor learning outcome.
But mice exposed to medium level of stress (temperature at 19°C) had the best learning outcome.
Learning was measured as to how they learned to solve a water maze (Salehi, Cordero et al.
2010).
We will address several questions in this chapter, such as what is too little and what is too much
, what the mechanisms of stress in learning are, and in which phase of learning might stress be
more beneficial. Finally, we will discuss how to use stress in education as an efficient learning
tool.
The second topic of this chapter is the social climate and learning. This is an important issue
in education, because students and teachers sometimes view group discussion and group work as
an inefficient use of time, arguing that an individual task or activity can be completed faster than
as a group assignment.They might see group discussions as prolonging the duration of the
activity.
As discussed in the initial chapters: the importance of enhancing students’ interaction lies not
only in the result of a project and task in an education program but also in the thinking and
discussion that are associated with this activity. As presented in the chapter on memory, retrieval
is critical for learning. Group discussions are an effective tool for such retrieval: they motivate
students to summon the content and produce more encoding. Social interaction has a powerful
effect as a motivator to discuss a topic from several points of view and thus connects what is
being learned in a wider neural network. Also, the more diverse that the student group is, the
richer the discussion can be. 
The final important point that I would like to make before starting the discussion is to
underscore that our brain does not respond as we would like—i.e., stress and social climate can
be positive or negative, depending on the “dose” and the individual. Having students connected
by Facebook or stressing out students by pushing them to study more will have certainly a
detrimental effect on learning.
 
Mechanisms of Stress in Learning
 
You have likely heard of or read the typical example of a stressful situation that triggers the
“flight or fight” response: someone being faced by a tiger. Basically, this encounter leads to a
series of neural and endocrine changes to optimize this “flight or fight” state. In summary, after
the recognition of danger (encountering a tiger), there is a neural response that starts in a brain
area that recognizes a stimulus as a source of stress (a sound, an image, or even a smell—for
instance, a yellow Post-it note that shows that you have a big exam tomorrow that you forgot).
This initial response leads to activation of the amygdala (an important center of emotional
control) and then the hypothalamus, which stimulates the pituitary gland, a major endocrine
gland that provides the brain with greater control over our body response. This gland releases a
massive amount of the hormone ACTH (adrenocorticotropic hormone) and prompts the secretion
of cortisol by the adrenal glands. In addition, the sympathetic nervous system (which you can
think of as a set of neurons that are distributed throughout our body that regulate what we call a
visceral response to stress) is activated. Consequently, epinephrine is released, which will
stimulate organs that help the “flight or fight” response, such as enhancing muscle activity and
metabolism, decreasing blood flow to the digestive tract (to limit the energy that is spent in our
digestive tract), increasing heart rate, and dilating the pupils, among other reflexive responses to
boost success in this “flight or fight” situation.
Notably, for this discussion, noradrenaline has a critical effect on neural circuits by improving
attention and releasing an important neurotrophic factor: brain-derived neurotrophic factor, or
BDNF. This protein has a significant impact on enhancing neuroplasticity. It affects presynaptic
and postsynaptic neurons, meaning that it optimizes the connectivity between two neurons, thus
promoting learning significantly. Also, low levels of cortisol (such as when released acutely)
appear to enhance activation of the mineralocorticoid receptor, which increases synaptic
excitability, thus facilitating learning (however, chronic stress has the opposite effect, as I will
discuss below).
The amount of stress is critical, as exemplified by the famous inverted U-shaped curve for
stress. Too much stress can lead to an extensive biological reaction that disrupts any attempt to
learn, whereas stress in moderate amounts (especially if related to the learning task) will
undoubtedly lead to neural changes that enhance learning.
Another important issue when considering whether stress is beneficial to learning is its
relation to learning timing. Remember the learning phases that we have discussed: (i) encoding,
(ii) consolidation, and (iii) retrieval (and updating). Stress that occurs before and immediately
after encoding—i.e., during the initial processing of new information—will be beneficial.
Conversely, stress during retrieval and updating the memory of that learning can be detrimental.
 
Parameters of Stress that Need to Be Considered: Intensity, Relatedness, Timing, Duration,
and Mindset
 
The art of teaching includes grasping the factors that affect learning deeply; in other words, it
is essential to understand all parameters of stress and learning. The relationship of stress and
learning has several factors, such as (i) relatedness (intrinsic or extrinsic), (ii) timing, (iii)
intensity, (iv) duration, and (v) mindset (individual ability).
 
Relatedness
For stress to be associated with learning, it is best if stress is related to the learning
experience. For instance, if there is a deadline that is associated with studying a topic or a reward
for doing so, the relatedness nature has a positive effect. In contrast, if the source of stress is not
related to the educational program, there will be a negative effect. For instance, if someone is
stressed over leaving the car unlocked and open to theft, then it will likely be difficult to
concentrate on a study topic. The main reason for this relatedness is the attention system, which
will direct us to the source of stress.
 
Timing
As discussed, stress is beneficial when it happens immediately before and after the encoding
of new information but not during retrieval. The main reason is that stress induces the release of
factors that promote plasticity and thus helps to create new neural networks that are associated
with new learning; however, it can be disruptive during consolidation phases. Figure 5.1 shows
the relationship between stress, learning, and timing.
Figure 5.1 Relationship between level of stress, phases of learning and learning outcomes.
 
Duration
Stress that lasts too long will have detrimental effects—one of the hormones that are
associated with stress is cortisol. When stress is chronic, levels of cortisol increase significantly.
High levels of cortisol disrupt sleep, digestion, and ultimately, brain function. Therefore, stress is
best when it is transient.
 
Intensity
Too much stress leads to dysfunctional activity, that hinders someone’s ability to work or
study. One clever experiment that my colleague, Leonardo Cohen, at National Institutes of
Health, conducted on motor learning shows the effect of excessive stress. In this experiment,
participants were stimulated under two conditions (in addition to the control condition): 1) a
reward condition, in which they started with 0 dollars and earned money according to their
performance on a motor task ( low-stress condition ) and 2) punishment (which can be considered
a high-stress condition ), in which they began with 72 dollars and lost money if they made
mistakes. Cohen and his group designed the experiment such that the groups would finish with a
similar amount of money (around 40 dollars).
The interesting result was that the punishment group (high stress) had worse motor learning
scores (although this was not significantly different from the neutral group), especially at long-
term assessments (long-lasting learning gains) (Abe, Schambra et al. 2011), showing that low
stress (giving a reward that does generate a low level of stress) provides the best results.
Dan Ariely has also conducted a nice study that shows this effect. He offered participants
three levels of a monetary reward (low, medium, and high, with high corresponding to 5 months
of salary; the experiment was conducted abroad). What happened to their performance? Similar
to the other studies, those who received the high monetary reward had a decrease in performance
as the stress became excessive and interfered with gains (Ariely 2009). The study demonstrated
that when stress levels are too high, activity is disrupted.
 
Mindset
When stress is viewedas a negative factor, it has a detrimental effect—i.e., when an
individual is “stressed about becoming stressed,” this mindset will lead to a vicious cycle that
will keep increasing our body’s reaction to stress (leading to chronic stress), which rises to levels
that will disrupt activity. Studies have shown that individuals who do not develop coping skills
with regard to stress more likely experienced the negative and detrimental effects of stress as it
becomes chronic, thus likely having a negative impact on learning outcomes. If stress is
considered a part of life, then coping with it becomes more natural, and stress can become a
positive factor. 
 
Mechanisms of Social Climate in Learning
 
One of the pillars of the Harvard Business School MBA program, one of the world’s best
programs, is its student discussions. Students are divided into small groups and are encouraged to
discuss cases before they go to the class. The school is actually designed to provide an
environment that facilitates student meetings and discussions, housing many lounges where
students can be comfortable for such interactions. In addition, in class, conversations among
students continue. There is hardly any time that is spent on PowerPoint presentations, and
students do not have much time for individual learning. Some may say, “Why to go through the
trouble and spend the money to go to Harvard Business School (or other top schools with the
same model), where I am learning mostly from my colleagues?” A response to that question is
that the level of interaction among students has a significant and beneficial effect on learning.
The time that is spent discussing and interacting nurtures important skills in argumentation
among groups of people (which is critical for a businessman) and, most importantly, enhances
learning.
The neural mechanism associated with enhanced learning when exposing students to
interactive activities (such as case discussions in Harvard Business School) has a component
related to the activation of our stress and reward systems. Human interaction may then be useful
to stimulate two systems: motivation and stress. Most of us have experienced the social pressure
of speaking in front of a group of people—strangers and even friends. This stress, which can be
pathologically high (and thus not beneficial), activates our attention system, which helps us focus
and think about the information that is being encoded due to our natural desire to impress our
peers. Indeed, peer pressure is a highly effective method of enhancing our attentional system.
Also, social interaction is associated with the activation of our reward system. In meaningful
conversations, when someone makes a comment that is approved by peers, there is a release of
dopamine, which activates our reward system and makes the individual feel good. This also has a
significant effect on our learning systems because learning then becomes enjoyable.
There is no dispute that someone who studies alone would manage his time more efficiently.
However, learning, in this case, would only be improved if this individual is extremely motivated
and focused on his studies. Human interaction helps with motivation and attention. As
discussed, our brain is wired for survival, of which social interaction is a critical component. We
have a well-developed emotional system that has a huge impact on our learning outcomes.
 
Social Interaction as a Mediator for Stress
 
Social interaction can then be an important mediator for stress that is related to participation
in educational programs (which can be beneficial if used wisely!). Although it is difficult to
modulate social interactions and in fact it can have a positive or negative effect, peer interaction
and peer support can definitely help students who feel overwhelmed in accomplishing their
program goals and maximizing their learning. Human brains are wired to not only learn from
interaction but also to get comfort (and thus decrease stress) from human interaction. The
classical experiments from Harry Harlow in the 1950s with baby monkeys have shown the
importance of social interaction in decreasing stress. When baby monkeys that are separated
from their mothers are given the option of a metal wired structure with a feeding bottle versus a
cloth that is shaped like a monkey, they gravitate toward the latter directly for comfort (Harlow
1959).
 
How to Use Low Stress and Social Interaction in Education
 
The final topic in this chapter is how one can modulate stress and social interaction positively
in educational programs. Here, we are discussing educational program-related stress—i.e., the
stress of accomplishing all of the tasks of a given program. But is stress really needed?
Our students are already exposed to so many sources of stress, and one more source would
make them even more anxious. However, as discussed in Chapter 4 (motivation), extrinsic
motivators such as graded program assignments and graded group activities are necessary to get
students connected to the material. Leaving students with only their intrinsic motivation would
be insufficient, at least for most of them. It is, therefore, important to have a set of tasks that
students must accomplish. The challenge is to balance between too few or too many activities to
generate long-lasting learning instead of having students merely finding methods of
accomplishing it quickly. The teacher needs to titrate the right “dosage” of activities based on the
observations of students’ motivation.
This issue should indeed be considered carefully. The difficulty lies in designing a program
that has the necessary push to get students interested in the material without overdoing it to avoid
alienating students. This is not an easy task because students are different and respond
differently. One important universal strategy is to have good communication with students
regarding expectations—in written form (in the course syllabus) and discussed, ideally at the first
meeting of the program and reinforced throughout it. Again, learning comes from within. It is not
enough only to give content: the teacher must get the content analyzed by students as to optimize
learning; therefore students should have enough time for an in-depth (or as deep as possible)
analysis.
It is important that the reasons for the course tasks be explained—in other words, how they
would be helpful for their learning. They need to be an active part of the learning process instead
of merely a professional exam-taker. In fact, learning outcomes can significantly be improved if
students understand that being engaged in course activities help their learning. Otherwise, they
might quit the program or do the minimum amount of work that is necessary to pass the course.
Teachers should also give the option of being contacted if a student is overwhelmed while
reinforcing that the proposed work is manageable (which it should be; here, teachers must weigh
the amount of work with whether it is feasible) and emphasizing that the anxiety at the beginning
of the program will likely decrease over the first few days.
As discussed, social and peer support should be used as an active tool by instructors.
Instructors must get participants connected as soon as possible so that they can help each other
with new tasks. Several tools can encourage students to interact early on in the program, such as
ice-breakers. For instance, ask students in small groups to introduce themselves, say where they
are from, and reveal something about themselves to their peers.
If the class is small, the students can do this for the entire period; in fact, this would be an
excellent start, allowing everyone to get to know his colleagues. Also, if a group project fits into
your program, consider using it as a basis for group interaction. What is the best size for such a
group? This issue is debated. For live interactions, a group of 4-6 is appropriate, versus perhaps
10-15 online, depending on the goals of the program.If there is group work, participants can give an identity to the group by naming it. This can be
a good icebreaker, too. In one of the educational programs that I run, participants identify with
their group so well that at the end of the program, they design t-shirts or mugs with the name of
their group. Interestingly, in group communications, they always begin the message with the
name of the group.
Finally, one alternative to enhance social interaction among participations is the use of social
media in educational programs. Social media can be used as a powerful tool in education, but
only if properly used. Participants must have some ground rules for using it during an
educational program. Also, the platform should consider whether, for instance, participants are to
have private profiles for the program. A good alternative that I have used in some of my
educational programs is a commercial platform for project management. There are several
currently available. At the time this book was published, two platforms I tested with good results
were as Slack and Ryver. We will continue the discussion on the use of technology in the online
learning chapter (Chapter 7).
Chapter 6 – Teaching Methods: The Teacher-Centered vs. the
Student-Centered Method
 
First, let us go back to Chapter 4 on motivation. Try to remember the discussion on intrinsic
motivation and extrinsic motivation and how they are essential to learning. Now, let us consider
the traditional classroom. A professor comes and speaks for about 1 hour (more or less,
depending on the format, but usually more than 30 minutes) on content that is predetermined by
the instructor. Lectures are generally hardly interactive. Based on what you learned in Chapter 4
on motivation, do these lectures trigger or enhance our learning-related motivation system?
Before I respond to this question, another question to you: what is the method of teaching in this
example?
This is the typical example of a teacher-centered method. In this method of teaching,
information is conveyed mostly in a one-way fashion, meaning that teachers spend most of the
classroom time speaking and also give assignments and exams that have a “one-way” format
(i.e., questions are asked to students, and it is expected that they answer based on what was told
to them). In this method, there are very little opportunities for discussion and interaction, and in
fact, students learn mostly on their own.
Going back to the first question ( is this method effective? based on what you learned in
Chapter 4), let us first analyze intrinsic motivation, to which we ascribed three components:
autonomy, mastery, and purpose. It is clear that there is little autonomy for students during the
lecture because they must listen to what the teacher has decided to present—not what interests
them. However, you might see a potential contradiction, because the teacher has the knowledge
and should be the one to determine what is being discussed in classes. Yes, this is true; however,
students should also have input with regard to part of the content that is being discussed (as
detailed later in this chapter). Thus, a traditional lecture does not provide autonomy to students.
Nevertheless, perhaps students improve their mastery during a traditional lecture. This is
unlikely—unless one writes down what he knows about the topic before the lecture and checks
whether he was correct as the teacher speaks, which would not be likely to happen. To have
mastery, students should be provided with ways of testing their knowledge and analyzing the
results.
At the very least, students might be inspired for the meaning of learning to their lives. This is
one of the remaining components that teachers can use; however, it might be more relevant for
the first 5 or 10 minutes of the lecture. Unless students are reminded of the meaning of that
learning to them, they will quickly lose interest.
What about extrinsic motivation? Students are interested in passing the exam; therefore, they
pay attention to lectures, because this would provide the content that they need, right? Not really.
There is a difference between doing well on exams and learning during a lecture through
reflection. A student who is interested in the exam will know that (i) it may be irrelevant to
“waste” his time during the lecture because he can review the notes of a friend the night before
the exam and (ii) the content of the lecture might be irrelevant to the exam. So, again, exams will
not work as a traditional extrinsic motivator for a traditional lecture.
You now agree that the method of a teacher who speaks for about 1 hour will have little effect
on motivation, and without motivation, there is limited long-lasting learning. This approach,
called the teacher-centered method, is frequently used, despite it having a limited impact on
learning. What is the alternative? The student-centered method.
In this chapter, I will discuss the reasons why these two main methods are being (and not
being) used in teaching practices and how to use (or not use) them effectively. Finally, I show
how to improve these methods and future alternatives.
 
Understanding the Teacher-centered Method
 
The teacher-centered method is the classical method of teaching—the one that has been used
since the Industrial Revolution when education started becoming more standardized. In this
method, the teacher stands at the front of the room and speaks for about 1 hour, with his students
facing him. The students are supposed to be quiet, stay seated, and avoid any distractions.
But, based on the 5 previous chapters, you know that this is not a good method for our brain
to change and learn (at least not to the majority of students). We do not learn by staying still for
one hour and receiving information without any pause for reflection. Basically, reflection can be
inhibited as new information arrives. Our brain works by first receiving information and then
reflecting on it and connecting it in the search for meaning and understanding. Thus, this cycle
would not complete itself if someone speaks for a long period with no pauses. The cycle of Kolb
exemplifies well this need for reflection and experimentation to complete the cycle of learning.
In fact, the author argues that receiving information (or having a concrete experience) is only one
part of the learning process (Morris 2019).
Why is this method so widely used in schools worldwide? Because it is relatively easy to
implement. As long there is one person – the teacher – who knows the topic and is willing to
speak for about 1 hour on the topic and there is a space with chairs, everything that is needed is
there. Also, this method is less demanding for the teacher (compared with the alternative,
discussed below). The teacher has full control of the time and the content that is being discussed
using this one-way strategy.
Also, this method covers the national curriculum well, because classes are organized to cover
the material that is dictated by a national educational policy. With this method, it is possible to
present large amounts of information in a limited time. Further, the instructor is satisfied that he
did his job and that the student has learned a great deal being just by listening to the lecture.
Therefore, this method seems to be excellent for policymakers, teachers, and students because
everyone’s needs seem to be met. Why do we want to change, then? Because it has limited
learning effectiveness.
Further, technology can make this method worse. PowerPoint slides (although they are useful
when used correctly) have become a script that is to be read during class for many.
Consequently, teachers then switch to more of a role as an automatic slide reader than a scholar
who discusses a topic with his students.
In this method, when students do not learn (as expected), the blame usually falls on them
instead of the teacher. Students are the ones who “did not listen,” because the instructor “ gave all
of the content. ” Thus,this method creates “slow or limited-learner students” and will damage
them further in the future, because they might start believing that they have a learning issue.
 
The Teacher-centered Method: Why Does It Fail?
 
I will start this discussion by providing research data that show that this method does not
work (compared with the student-centered method). There is one point that must be made as a
prelude: I am categorizing teaching methods as student-centered only or teacher-centered only,
but, as I will discuss below, there are usually components of both methods in a teaching program
(with one predominating in most cases). However, in this discussion, these methods are
considered separately.
Several studies have shown that this method has low learning efficacy. One example is a large
cluster-randomized study with over 2000 students that was published in the journal Science—
one of the most prestigious journals in science. In this study, the authors randomized students to
a student-centered or teacher-centered approach for teaching science to 4 th and 5 th grade students.
In the student-centered group, students were required to discuss the material using evidence to
support the discussion with age-appropriate methods. The class was formatted to center around
student discussions. Conversely, the teacher-centered method was structured primarily with
lectures and readings. There was limited discussion in class, mainly associated with the recall of
facts and no critical thinking. The results were unequivocal: there was a statistical significance
for better learning outcomes in the student-centered approach (Granger, Bevis et al. 2012).
There are several reasons why this method has low efficacy (as demonstrated in many
scientific education studies). First, students need time to process the information and connect it
with previous learning. Think of your brain as a huge storage facility that keeps receiving
shipments. When it receives a “package” (i.e., information from the speaker), your brain must
find a shelf for which it is appropriate. This may be an easy (if the content is known) or more
difficult task (if the content is unknown). Now, imagine that your brain keeps receiving one
package after another: as a result, there is no time to store all of them. But, your brain has an
excellent cleaning crew that eliminates packages if there is no storage space for them. This is
what happens when your brain is bombarded with new information without enough time to
process it.
We must give students time to process this new information.
However, I do not mean that a teacher should not be allowed to lecture or speak in front of the
class. The issue is only doing so 100% of the time in a teacher-centered method. The key here is
short lectures with breaks and periods of discussion in between lectures so that students can
process the information, and as in our example above our brain has time to label and find great
spots for the packages that are arriving to be properly stored for long-term use.
The second issue has been discussed before. Long lectures break the autonomy of students to
find their pathway to connect new information using their mental models and not the path that
the teacher chooses for them. This is one of the main issues in teaching: all of us have different
mental models for processing information, but students must be allowed to use their mental
process to go from A (unknown) to B (known). Making the student learn through the pathway
defined by the teacher is limited as it will not be effective to all students.
Finally, long lectures take a significant toll on our attentional system. To maintain your
attention during a lecture, you must focus on the lecturer for an hour or longer, which entails
spending a great amount of energy to ignore everything around you from your sensory system.
Also, sitting still worsens the situation, because moving (and activating our motor system) helps
provide additional energy for our inhibitory drive.
There is an interesting phenomenon that occurs in our nervous system, wherein when the
amount of novel sensory stimulation (or motor stimulation) decreases, it reduces the activity of
brain inhibitory activity (i.e., it becomes more difficult to inhibit for instance excessive external
noise). I have demonstrated in experimental studies that this, paradoxically, makes us more
sensitive to any distracting stimulus – internal and external – leading for instance to decreased
pain threshold (i.e., the same amount of pain stimuli become more painful after reducing sensory
stimulation) (Volz, Suarez-Contreras et al. 2013).
What is the perfect duration of lectures? There is no answer for this because it depends on the
student (level of tiredness, mood state, level of stress, etc.), the topic, the instructor, etc. But
usually, 15 to 20 minutes is a good number that we like to accept.
 
Student-centered Method: The Most Efficient Strategy
 
At this point, you should have a good idea about the advantages of the student-centered
method for learning efficiency. The student-centered method is indeed an efficacious method to
enhance long-lasting learning. In this method, the focus is shifted to students. For instance,
instead of lectures, students spend the classroom time in discussions among them and with the
teacher. Assignments are usually done in a group and the course is designed to stimulate
students’ reflection. Figure 6.1 summarizes the main characteristics of these two methods
discussed in this chapter (the student-centered and teacher-centered method). If the student-
centered method is more efficacious, why isn’t this method used more frequently? In short,
because it is more difficult—more difficult for students, more difficult for teachers, and more
difficult for the institution. Let us first discuss the student’s perspective.
 
Figure 6.1 Main characteristics of student-centered method and teacher-centered method.
 
If you are a student who is going to class: think of the two scenarios ahead:
 
(1) Scenario 1: You will enter a large classroom, no one will notice what you
are doing, and even better, it is a bit dark and the chairs are comfortable. You are then
comfortably seated and can also browse your cell phone from time to time, and on a
few occasions do you pay attention to the speaker.
(2) Scenario 2 : You enter a small classroom, and everyone knows your name.
You know that you will be called on to discuss the material that you had to read
before class. The class starts, and from the beginning, you are called into action,
being called on to discuss topics in front of your peers. In addition, you keep breaking
into small-group or pair discussions and must interact with different people on the
topic.
 
Our brain is wired for survival and to keep the energy as much as possible. Students will
undoubtedly find Scenario 1 more comfortable and think, “I can learn on my own if I miss the
content of this lecture.” This is the problem: in addition to it being more comfortable for
students, they have the perception that more can be learned if they sit in a hall with a professor
who shows a deck of 120 slides.
For the teacher, the situation is similar. The teacher has two options. Option 1 is to prepare a
set of slides (most of which are usually ready from previous talks), walk into class, say good
morning, and go over the slides. There is minimum preparation because the slides will give him
the script. Then, the teacher can answer questions at the end and leave class with a sense of
accomplishment.
Option 2 would be to prepare the material for discussion, anticipate what the students will
discuss, and try to pose questions in the best way possible to lead the discussion. Then, arrive to
class and do everything possible to keep students focused on the discussion, hoping that they will
be participating. The teacher knows that the class might not turn into what is expected: the
discussion could go in the wrong direction,the students do not say much, and motivation and
energy could wane. There is a real risk that the class will be a failure.
For teachers, therefore, the student-centered method is a riskier and usually more laborious
method. However, this is usually so only for those who have not experienced and practiced this
method. This is an important observation: the more that this method is used, the more that
students and teachers start feeling comfortable and enjoying this method. But, the beginning is
not easy.
 
The Student-centered Method – Why does It Work?
 
There is a hypothetical paradox. Many students and teachers enjoy the teacher-centered
method more and might also perceive it to be more efficient, but research data show the
opposite: the student-centered is a better method with regard to learning efficacy. As we
discussed in the paragraph above, the main issue is that the teacher-centered method is more
comfortable, and thus, our brain might “prefer” this method rather than one that spends much
more energy—which is why this is a hypothetical paradox, not a real one. I will explain the
reasons why this method is better for learning efficiency.
A famous quote by Confucius [which has been adapted by (or ascribed to) Benjamin
Franklin] summarizes the reasoning below: “ Tell me and I will forget, show me (or in the
adaptation: “teach me”) and I may remember; involve me and I will understand. ” (or variations
of this, according to the source).
This saying summarizes our fundamental principle of learning: if the information or a concept
is provided unidirectionally, there will be no lasting and significant learning (“ tell me and I will
forget ”). This is, in fact, a positive characteristic of our brain. If information is not processed
further, there is little reason to spend energy to store that information. How does this translate to
the classroom? This is when the speaker or instructor provides a great deal of new data and many
new concepts in a one-way manner, with no time for students to process the information.
On the other hand, getting the student is involved—meaning that he is not only getting new
information but also applying it and creating a model to the new data that are important to him—
is an important process for lasting learning. Remember from the previous chapters: when
students apply a new concept by testing or mentally thinking or discussing it with their
colleagues, they are creating and modifying neural connections, making them stronger.
In a simple analogy, think of muscle contractions: if you contract your muscle passively
(someone contracts it for you), the result in terms of building muscle power is limited or even
absent. But, if you contract your muscles with exercises that are led by your brain, then there is
an increase in muscle mass. The reason here can be distilled to the fact that it is not only the
contraction that is important (this is one component) but also a combination of factors:
contraction, changes in the brain during exercises, hormonal changes during exercises, vascular
changes during the exercises, and so on.
This is similar to receiving information only passively, seated, and relaxed in a comfortable
chair. This situation might be enjoyable but does not lead to lasting learning. Students must
process new information and engage in conversations with other students to try new mental
models. Learning occurs when all items take place—not just one.
In previous chapters, I discussed the molecular basis for learning to occur: the release of an
important factor for learning: brain-derived neurotrophic factor, a protein that is associated with
alterations in neural connections. This factor is released with intense brain activity. When
someone is only relaxed while listening to a presentation, the amount of brain activity is small,
and few changes usually take place in the brain (except when the information is not new, and the
student can process the information against what was learned before).
The student-centered method is used frequently in child education. In elementary schools in
the US, you will see children seated in small groups, facing each other and involved in activities,
testing what they are learning. You may argue that children are not disciplined to watch lectures.
This is not the case. True, it would be more difficult, but this is not the main reason. We
maximize learning in children, based on their needs, but do so for adults based on convenience.
 
How Can We Transition from a Teacher-centered to Student-centered Method? 
 
There is no easy answer. I could provide a general answer—that it depends on a series of
factors, involving policy changes, cultural and economic changes, or the basic need for a
multicomponent strategy. Although this is true, let us analyze each factor. I will discuss several
issues for such a transition separately: the (i) student, (ii) instructor; (iii) course design; and (iv)
school (or online environment) structure.
The student is one of the major factors in this transition. As discussed, a shift from a teacher-
centered to a student-centered method will take students out of their comfort zone. Remember
that students do not spend too much energy with the teacher-centered method, except for one or
two days of intensive cramming to make up for the entire semester. It is critical then that from
Day 1, when considering the student-centered method, students be given the rationale for why
this new method will be most beneficial for them. All of the reasons are discussed in this chapter
and other chapters, and the teacher must explain them to persuade students. In the initial
programs that I offered, the main reason that some students gave up was that they wanted the 1-
hour PowerPoint lecture and an exam at the end. They thought that the student-centered method
was a waste of time.
Another critical issue is that when the school offers other programs that are teacher-centered,
students might be more resistant to changing to a student-centered method. But, as a consolation
for teachers in this situation, students usually appreciate the new method, which focuses on them,
after they perceive their learning. The first meeting with students is critical. Spend as much time
as you can explaining the new method and what will be different. In the courses that I teach in
Boston, this constitutes my entire first lecture. Also, as an exception, in the introductory lecture,
you can rely more on slides and one-way interactions, as because it is about the program in
which they are participating and should not overload them.
The second critical factor is the teacher. Moving from a teacher-centered to a student-centered
method is not a top-down process; in other words, teachers must fully understand the value of the
student-centered approach. This is also a gradual process because it requires the teacher to learn
how to use activities to increase interactions between students and to change material and
activities to promote interaction and reflection. This can be a smooth or difficult transition,
depending on teaching style.
Finally, changes in infrastructure [the school (or online environment)] are needed but are not
usually trivial. For in-person programs, the classroom is critical. Chairs (and/or desks) should not
be organized in a “school” style (i.e., lined up one in front of the other one), because students do
not see each other. One option is the semi-circle, which some schools use, such as Harvard
Business School, because students face each other and because the instructor can walk and get
close to students in an easier way. But, the best system is that in which students can walk and
arrange chairs and create small groups for discussion.
Similarly, there is also a need to make changes in online environments if the student-centered
method is adopted, because it must be prepared to promote interaction—not only to be a
repository of articles, PowerPoint presentations, and videos. This is one of the reasons why
onlineprograms usually still lack good outcomes because they are designed primarily as a
teacher-centered method (more on that in the next chapter).
As you can see, the structure for a student-centered method is more complex (and likely more
expensive), which is one of the reasons that change is difficult, because students and teachers are
comfortable and because changing toward a student-centered method has significant costs (for all
aspects, including training and structure). Therefore, administrators and policymakers should be
convinced of the need for such change. I hope that this book (and books like this) will help bring
supporters to this side.
 
 
Chapter 7 – Online Learning: Challenges and Opportunities
 
The internet has changed our lives profoundly. This statement is obvious, but it is less evident
how it has impacted education and whether such changes have been positive, negative, or mixed.
Before delving into this topic, some of the failed predictions on the role of the internet in
education should be discussed. Harvard professor Clayton Christensen had predicted, in his book
Disrupting Class , for instance, that by 2019 (by the time this chapter was written), half of all
high school classes would be delivered through online learning (Christensen, Johnson et al.
2010).
One can argue that the overall pace with which the internet has been adopted has been slower
than predicted. This is not true. Several examples to the contrary can be seen, one of which is
print media. Current data show that since the beginning of the internet (1990s), there was a total
decrease in printed newspapers of about 30 M (or half compared with a peak of 60 M), and
conversely, current estimates report approximately 12 M online readers (this number is likely an
underestimate, due the difficulty to count) (source: http://www.journalism.org/fact-
sheet/newspapers/ ). Similar trends can be seen with online shopping and online movies, etc.
The internet “revolution” has not taken place in the education field. Although there are
options for online colleges and online masters and PhD programs, most are still offered through
the traditional campus environment. Similarly, traditional professional conferences continue to
be strong. One interesting story is the MOOC (massive open online course). There was a great
deal of media attention, especially when Stanford held its artificial intelligence course in 2011
for about 160,000 students. For many, this event was the magic pill for education. Finally, a free
education model was created that could reach all corners, and students who lacked resources
could take advantage of a course offered by one of the best universities in US.
Unfortunately, the predictions of free and effective education to the poor did not materialize
—by a good amount. Although these courses are a useful source of information, they did not
have a meaningful impact on education. Even the large websites that were designed to offer these
courses [such as Udacity, Coursera, and Edx (a consortium between Harvard and MIT)]
experienced more failures than successes in terms of long-term impact.
But why did they fail? Especially when there was a potent online platform that provided a
course that was taught by great instructors? Some of these universities actually recruited their
finest teachers to show the world their best. Everything in these courses was done greatly: the
platform, videos, lectures, and assignments. In my view, they failed because education cannot be
transformed into a small commercial product (even if it is free) and shipped to millions with the
promise of miracles.
Education is not a one-way street. In fact, the reason for failure was related to the end-user of
these courses: they expected that it would be easy, they would be motivated, and they would
finish the program. However, the result differed, as discussed in our motivation chapter. These
MOOCs saw that on average, only 4% finished the courses and that only 50% logged in to a
lecture (NYT source: https://www.nytimes.com/2013/12/11/us/after-setbacks-online-courses-are-
rethought.html ).
Perhaps we should not dedicate an entire chapter of this book to online learning, given the
first few paragraphs. Not at all. Online learning does offer great resources, but it should be used
well. If someone wants to use online learning to provide mass education or increase profits, then
the outcomes will likely be poor. Low cost online learning programs poorly designed may work
http://www.journalism.org/fact-sheet/newspapers/
https://www.nytimes.com/2013/12/11/us/after-setbacks-online-courses-are-rethought.html
in the short term but rarely for long-term outcomes. Online learning must come from specific
educational needs, and when they are present, the program should be designed appropriately. A
final word of caution: online programs might end up being more expensive when done well, at
least in the short term.
 
My Experience with Online Learning
 
Before I start this discussion, let me share my experience with online learning. In 2007, when
visiting my home country, Brazil, some colleagues approached me and asked whether I could
design a course from Boston to teach clinical research methods. By that point, I was a junior
faculty member at Harvard Medical School and had completed two master’s degrees in clinical
research and understood the impact of methodology training in my scientific career. I wanted to
take some of the experience I had here to my colleagues in Brazil.
We started a small online program in 2008. One of the main characteristics that I understood
were essential for its success was the online live component (live lectures via video conference)
and weekly activities and interaction in a forum. The first year was a profound learning
experience for me—encountering the challenges with technology (both in class and offline), the
time that was spent following online discussions of my students, developing a novel platform,
and jumping into a field that was new to me. Despite these challenges, it was rewarding to
develop great connections with my students, located 5,000 miles away.
Twelve years later and after the use of many platforms, significant changes in their design,
travel, and interaction with many students, the program has been more successful than I initially
imagined. We learned how to keep students motivated, enjoy the learning, and maintain their
connection. I will discuss then the great opportunities and also challenges to run an online
learning program.
 
The Power of Online Learning: Discussing the Pros
 
Online learning has several important benefits in enhancing learning, especially in our digital
age, in which many participants use and are familiar with online environments. The question that
the instructor needs to ask before embarking on this journey of online learning is whether it is
feasible in terms of cost and time. Even if the instructor has access to unlimited funds and time,
he must consider whether the benefits would warrant the design and creation of an online
program. The main advantages of an online program are the ability to: (i) connect students from
different regions; (ii) create a virtual 24x7 classroom, in which connections can be made
anytime; (iii) tap into an almost limitless world of online resources; and (iv) offer flexibility to
students in participating in the activities.
 
The first and more obvious advantage of online tools is its ability to connect students from
different locations to enhance access to a given educational program. In fact, this is the most
compelling reason for the boom in online educational programs. However, as discussed below,
there are significant challenges to this method. One interesting aspect of connecting students is
that online programs can even use social media platforms for participants to connect and enhance
interaction. However, the use of these platforms must be well planned to avoid being a source of
distraction to students. It is important to adaptsuch platforms to focus on communication on
course content between students.
One important advantage of online programs (or hybrid programs that use online and live
interactions) is the possibility of increasing the time window of students’ interaction as compared
to traditional courses. Basically, students can interact in online platforms anytime during the
program (instead of only when they are in schools for traditional programs not using online
components). This is especially beneficial for large programs, which are more likely to have a
few students who are connected at any given time. A feature that we developed in one of our first
online platforms was a tool that showed who was online, allowing the possibility of starting a
conversation with those online students. This tool has similar features as commercial online chat
programs.
It is possible to use commercial platforms, such as Skype, Whatsapp, Slack, and Ryver.
However, participants might not want to use the more frequently used platforms, because they
would become distractions. Slack and Ryver (and, recently, Google Chat) are also potentially
good platforms that ca be explored to enhance interaction between participants. I use Slack and
Ryver to enhance communication in my online programs (as of 2019 when the first edition of
this book was launched).
Another objective is to get students working online while interacting with their peers as a part
of an educational task. For instance, in a homework assignment, I ask my students to find related
references to the material of the week (e.g., videos and open online articles) that they can share
with their colleagues, providing a small summary. This practice has a dual benefit: increasing
their motivation in working on the material and helping others—for example, by finding an
interesting reference that generates good discussion, involving the student who posted that
reference.
The final advantage is that online programs offer participants flexibility with regard to when
to interact with their colleagues. In a live group activity, students would need to schedule
meetings, posing a significant challenge, especially in adult programs, in which students have
work, family, and other course commitments.
One piece of advice for those who have no experience in running online programs: full
flexibility is not advantageous, because students might lose the rhythm of the program. I strongly
suggest holding a live meeting (of course, this could be online)—ideally once per week, because
schedules are usually defined weekly to keep the rhythm of the program. This live online
meeting can be a short discussion to review the main points of discussion and plan for the next
week. This design is important to get participants connected. Then, the other tasks can be
asynchronous, and again, with a large group, it is always possible to have meaningful
connections constantly between participants.
 
The Challenges of Online Learning: The Negative Aspects
 
In contrast to other areas of our life that have been affected by online tools (such as online
shopping), the initial predictions for online educational programs have not come to fruition. The
main issue with these predictions is that some of them attributed the wrong benefit to online
learning. Online learning was considered by many to be the chief solution for our education
problems, whereas in fact, they can worsen educational outcomes if poorly used. Thus, it is
important not only to consider using this method but also to implement some of the methods that
are discussed in this book. An article in the New York Times (
https://www.nytimes.com/2018/01/19/business/online-courses-are-harming-the-students-who-
need-the-most-help.html ) has shown that online programs (when they are not well designed)
https://www.nytimes.com/2018/01/19/business/online-courses-are-harming-the-students-who-need-the-most-help.html
cause more harm, especially for students with poor academic histories.
The main negative aspects of online programs that I want to discuss here (all of them can be
addressed) are: (i) keeping students connected to the program, (ii) the costs for setting up and
maintaining an online program, and (iii) keeping participants motivated in the program.
The first challenge is keeping students interested in and connected to the program. Here, the
design of the program is critical. One common mistake is to presume that the design of an online
program is the same as that of a face-to-face program, the only difference being the recorded
lectures of the speakers (or live broadcast). This is one of the main reasons why online programs
fail, due primarily to the lack of interaction between students, leading to a lack of interest in the
program.
Many online programs have great resources, videos, and assignments and fancy online
platforms and even be financially successful. Yet, they still fail to achieve significant educational
goals, because students feel isolated and unmotivated to continue. Interaction between students
and between students and faculty is critical for the success of a program. Our brain has been
wired to learn through human interaction.
A major recent neuroscience discovery came from research on the mirror neuron system,
showing the importance of human interaction in learning. An Italian scientist, Giacomo
Rizzolatti, found that a set of neurons in the premotor cortex in monkeys was activated when
observing another monkey performing a motor activity. Notably, this set of neurons was not
activated when the monkey watched a video or looked at an object (see a review paper on the
topic (Rizzolatti and Craighero 2004)). Although we can argue that one needs face-to-face
interaction, communication between humans is not limited to it and that other circuits also
participate in other methods of interaction.
If this model is true, then it is critical that programs be designed to include interaction
between participants. This assumption is the Achilles heel of many programs. Creating online
platforms that stimulate interaction is not an easy task. First, it requires a more sophisticated
platform, because it is not trivial to develop a system with rapid and fast two-way
communication. Further, the educational design of the platform must be considered—in other
words, what are the activities that are designed to promote interaction between students? Again,
this is not trivial, because instructors need to plan the activities and how students will be
evaluated in their interaction as to stimulate their extrinsic motivation system.
Here, the instructor has few options in terms of the platform. First, he can develop his own
platform that has interactivity components. This is not simple and may require significant funds
and time. Unless it will be used for a school or in several programs, there is not much
justification to develop a platform for a single program.
The other option is to use commercially available software, for which there are 4 options:
1. Open LMS (learning management system), which usually offers all of the
resources together, such as Moodle and Open-edX
2. Paid LMS, which is similar to open systems but is usually more user-friendly and
require no programming (open LMS may require installation on a server) and no
advanced computer skills to manage. Examples are Blackboard, D2L, and ClassRoom.
3. Open Apps that can be used to connect students, such as Skype, Wiki, and
GoogleDocs (if using a private Google account)
4. Paid apps that can be used for specific goals in online courses, such as Slack and
Ryver. See Table 7.1 with some examples of platforms.
 
Table 7.1 Examples of online platforms that can be used in online educational programs.
 
The decision to choose the platform is based on the number of students, funds for the
program, and the educational plan.
Most of these options have nice features, such as the ability to create specific channels or
forums for different discussion topics. This is an importantfeature. In fact, this important issue
precludes the use of more widely open communication platforms, such as Whatsapp and Skype
(or any other messaging system). If someone wants to create discussion in Whatsapp or Skype,
for instance, it would not be easy as this platform does not have a good structure for long
discussions (i.e., between a large number of students). In this case, it would be difficult to follow
a logical thought to learn from the discussion.
An analogy would be to have 100 students in a large open room with everyone speaking
whenever he wanted and randomly. As you can imagine, it would be impossible to learn
anything. Now imagine that these 100 students are in a big room but that to speak, they need to
choose the subject and walk to a smaller room with specific conversation topics. One could argue
that if the group is small, then this would be possible. In fact, it is true that a group of 6-8
students would be ideal in a general messaging platform. This is the reason that the architecture
of the online platform is important to allow students to communicate and learn in an effective
way.
The second negative point is the cost for setting up online programs. The cost is an important
misconception, because the general impression is that online educational programs are relatively
easy to implement and have low cost compared with traditional courses. This is true for someone
who works outside of an institution and thus would need to rent space and pay for all of the
maintenance. In this example, the online option is a good one. However, it does not mean that it
would be significantly less expensive.
The online platform is not main cost, especially if someone chooses a free, commercially
available platform that does not need customization. If one plans to develop the platform, the
costs will increase significantly, and given the current state of technology, it will be difficult for
the platform to be cost-effective if it is for a single course (rather than an institution), due to the
cost of development and maintenance.
The cost of maintenance might be the highest cost for someone who develops his own
platform. Online platforms become outdated easily. New versions of browsers and the software
with which the platform was developed are constantly being updated, necessitating updates to the
online platform, the costs for which are usually not accounted.
Another high-cost item is the server. If a program has limited interaction, this cost will be
likely low. But, considering the need for constant communication between students, this cost will
increase, because there will be a need for large capacity—usually underestimated but likely to be
expensive. Some current server options allow one to reduce and increase capacity, depending on
use, but the costs in this category are not trivial, which include the need for a specialist to
maintain this infrastructure.
In summary, I highly recommend a commercially available platform, unless a customized
developed platform is for a large institution. Usually, a large institution already has a platform
that it developed or paid for. If you are an instructor of an institution that has a license for one of
these platforms, you can simply add a new, second platform to assist with specific features.
Motivation is the last potential obstacle in online programs. One of the main issues with
learning, as discussed in Chapter 4, is motivation. This topic is also related to interaction.
Without interaction, it is difficult to truly motivate a student.
Of the intrinsic motivation domains that have been discussed—autonomy, mastery, and
purpose—only autonomy can be applied easily in online programs. For mastery and purpose, this
is not easy. Mastery comes with constant feedback from peers and the instructor. Interaction with
other students and the instructor gives feedback to students, and they feel motivated to continue.
In addition, a sense of purpose comes from interaction with instructors and peers, because in the
program, conversation helps address questions and doubts about the program.
Finally, for extrinsic motivation, online programs are challenging, because there is less
usually tracking and grading for student activities. The lack of extrinsic motivators and social
presence (as seen in many online programs) will certainly increase the dropout rate from online
programs and decrease their educational effectiveness. Several studies have estimated dropout
rates from online programs of over 30%, which is significantly high, and for those who stay in
the program, the effectiveness is likely to be low.
In this context, the instructor needs to design a program that ensures feedback and rewards for
each activity that is completed. This constant monitoring of students might add additional
challenges, because it is not easy to track students and perform constant assessments of them,
considering the distance learning component, thus adding to the costs above. One of the main
assessments that I use in my online program is a discussion forum that keeps students in the
rhythm of the program, and our teaching assistants read all of the students’ comments to provide
feedback and grades.
 
Is an Online Program Viable?
 
As with any novel method, an online program is not for everyone. The costs and
disadvantages and benefits (financial and educational) must be carefully considered. There is
usually an underestimation of costs for running these programs. Further, there is a misconception
that the classroom model be adapted (which is not ideal in many cases) to the online
environment, which does not work. For example, MOOCs failed, because they were not
optimized for learning but for massive recruitment of students instead.
This chapter is meant to be an introduction to the main aspects of running an online program
(other books provide in-depth analysis of all of the aspects, which is not the goal of this chapter;
see another book for additional discussion: (Sosulski and Vai 2015)).
My final insight to the readers interested in designing and running an online program: I have
been running an online program for the past 12 years (as of 2019), and it has evolved
significantly. Likely if I knew the amount of work and dedication beforehand, I may have not
started this online program (PPCR program). However, it has been one of my most gratifying
academic and educational experiences, especially considering the impact that it has had on
students globally. But I also want to emphasize that most of the work was not devoted to the first
year—it has been constant over these 12 years. As long as there is a special reason for an online
program, go for it and enjoy this experience, but be prepared for the amount of work ahead of
you.
 
 
 
Chapter 8 - Teaching for Understanding: Enhancing Critical
Thinking in your Educational Program
 
To start this chapter, I pose a question to you: Do we really need a chapter on critical
thinking? Isn’t it what all of us teachers do in class every day?
Not really. Remember in Chapter 6 that we discussed the teacher-centered model. Indeed, this
model of teaching, which is still very prevalent, is based on passing on information and having
students essentially repeating it in exercises and on exams. For instance, let us say that I am
teaching a large class using a teacher-centered model and give the definition of a statistical test,
the student’s t-test: This test is a statistical test to compare 2 means in data that are normally
distributed . I may stop here and continue with an explanation of other statistical tests. Then, I ask
students to read their notes and take an exam, on which I ask the definition of t-test, to which the
students repeat: “ it is a statistical test to compare 2 means in data that are normally distributed. ”
They get the maximum grade.
Did they learn? Not really. They only learned the definition of a concept that will have no
impact on their life if they cannot make meaningful connections to this definition.But, as I teacher, I have done my job, because the students can repeat what was said, right?
Again, some may consider this learning , but I consider this to be transient memorization, which
is a form of learning but irrelevant for future life. If learning is not meaningful and long-lasting,
there is minimal gain in spending energy and effort on it. Society does not need people to repeat
information but to analyze it. In fact, students learn how to memorize and be successful on
exams; then, academic success ends up failing to measure long-lasting, meaningful learning but
instead developing skills for short-term memorization (we will discuss assessments in the next
chapter).
The solution, then, is to ensure that critical thinking is being exercised during the learning
process. There are many definitions of critical thinking. For learning, critical thinking may be
understood as the process in which students reflect on new content and adapt it to their mental
models, thus creating new neural connections. During critical thinking, students test concepts
and analyze the information from different angles and points of view. The process of critical
thinking may be viewed by students as a “waste of time,” because learning the definition of a
new concept and repeating it is much easier and requires less energy. Thus, many students may
be impatient during prolonged class discussions because they do not see any value in doing it.
There is another essential aspect of critical thinking: students must understand the need for
critically thinking about what is being taught and be involved with it. Critical thinking cannot be
done as a “top-down” process—i.e., forcing it on students. Students need to participate actively
in the process. In this chapter, we will, therefore, discuss the need for critical thinking learning,
the difference in brain mechanisms between critical thinking and “non-critical thinking,” how
critical thinking in educational programs can be enhanced, and what students should do
differently in educational programs.
 
Does Critical Thinking Enhance Learning Outcomes?
 
Absolutely. Critical thinking has a significant impact on learning outcomes. As discussed in
Chapter 1, learning is about creating and strengthening neural connections.
Furthermore, learning is about applying what is learned to real life. When this happens,
learning will have a long-lasting and meaningful impact. In the example above, learning only the
definition of the student’s t-test (comparing 2 means that are normally distributed) will have very
little impact on a student. However, learning the application of the student’s t-test and
understanding how to use it to interpret clinical trial results and how this knowledge can impact
one’s interpretation of clinical results would have a significant impact. In this manner, this
knowledge would be continuously used, and thus, neural connections would continue to be
active and strong. Critical thinking can thus make learning long-lasting.
One important concept here is whether one could apply something later that was not truly
critically analyzed. Potentially, but likely, something that was learned superficially without
critical thinking would be forgotten and, even worse, students would have a misconception of the
previous learning, claiming that “ it is a difficult topic ” and that “ it is boring, ” etc. In fact, when
concepts are not truly analyzed and learned in a meaningful manner, there is a contrary effect,
because students may create a block to that topic.
A good example here is teaching biostatistics to medical students. Medical students usually do
very little critical thinking with regard to statistics for various reasons: (i) biostatistics is usually
not given enough time in the curriculum; (ii) students are not interested in the topic and do not
realize its importance in their clinical duties; (iii) statistical course are usually taught by non-
clinicians; thus, the language does not align with medical students’ interest; and (iv) medical
statistical courses are usually taught using the traditional teacher-centered method.
This is a recipe for students to create negative feelings toward statistics. They view it is a step
to graduate from medical school instead of something that will be critical for their future.
Students indeed can score 100% on the exam and receive an excellent final grade but continue to
hate the topic and forget everything several weeks later. The connection of statistics to clinical
life is not easy to see and understand, but there are many ways to make this possible and engage
students in thinking critically about the topic, enjoying and learning significantly. Here is where
a good teacher makes a difference because he can form this bridge and get students interested in
truly experiencing medical statistics.
Critical thinking is not as frequently used (or used as it should be) in educational programs,
because it takes time and extra effort for students to engage in critical thinking activities.
 
Does Learning with Critical Thinking Change the Brain Differently than Learning without It?
 
Also, absolutely. Critical thinking can do one thing that only the student can do himself:
understand the new concept using his mental models and connecting it with previous learning.
How does this change the brain differently? We discussed this in Chapter 1. When the
information is connected in a widespread neural network, the information is stored in a larger
neural network that can be retrieved more easily.
Different brain areas are activated during critical thinking as students test different
connections; yet, non-critical thinking uses only a limited network to process that information.
The model of Daniel Kahneman can help understand this concept. He proposed that cognitive
thinking can be divided into two systems. System 1 is fast thinking, meaning automatic intuitive
subcortical processing (in which awareness is not involved), and System 2 is slow thinking, in
which cortical awareness is present and which involves reflection (his book “ Thinking Fast and
Thinking Slow” provides a good reference on this topic (Kahneman 2011)).
An example of System 1 is when you make quick decisions without analyzing them; for
instance, when you are driving, understanding simple sentences, or even quickly responding to
emails in an automatic mode. Usually, System 1 is activated for skills that are often used and
learned. System 2, in contrast, is activated when there is a need for additional thinking and
reflection. Typically, System 1 uses fewer resources than System 2, because the networks that
are involved are neural networks that are consolidated and usually located in more subcortical
areas. System 2 uses a larger network to understand new information and activate a widespread
network of activation.
A good example from Kahneman’s book Thinking Fast and Thinking Slow is the question “If
a baseball bat and a ball cost a total of $1.10, and the bat costs $1 more than the ball, then how
much does the ball cost?” Your System 1 will respond, “10 cents.” But this is the wrong answer.
The correct answer is 5 cents. If the ball costs 5 cents and the bat costs $1 more, then it should
cost $1.05, totaling $1.10. Why did we make that mistake? Our System 1 jumped into this
calculation and performed a quick subtraction: $1.10 – $1 = 10 cents. However, this is wrong,
because the bat would then cost 90 cents more than the ball, not $1. In summary, System 1
processed the information quickly, as one is accustomed to doing, with a simple subtraction
operation. But, your System 2 is needed to check that the answer is not 10 cents.
The important concept here is not necessarily that we should always use System 2. In point of
fact, System 1 is a very efficient and important system that we should continue using. However,
during new learning, System 2 should be used primarily. System 1 can come in at a later phase
when the student has learned and trained with his new skills.However, if an educational program
only uses System 1—for instance, through memorization of information (repetition of
information)—then learning will be limited and likely transient.
In summary, critical thinking is associated with brain activation in a large neural network and
thus helps make different and new associations that will lead to long-lasting learning. Another
example: suppose that you learn that a special condiment (one that you do not use often) is stored
in a cabinet that is not frequently opened in your kitchen. You would quickly forget this
information, and the next time that you need to use this condiment, you will not find it; you will
have to open all of the cabinets and drawers, because you forgot where the condiment is stored.
But now, let us say that you made associations of the location of the condiment with several
objects in the kitchen. Any time that you are in the kitchen and see those objects, you will
remember where the condiment is stored. This is the power of a larger and more distributed
network.
 
How Can Critical Thinking in Educational Programs Be Enhanced?
 
This is the critical question in this chapter: what educators can do to enhance critical thinking.
There are several methods. Before we start discussing these methods, it is important to
understand that all of them aim to enhance reflection on the material; thus, the methods must also
engage students’ curiosity of and motivation with the topic. In this context, merely telling
students to “reflect” to get good grades will obviously fail. Figure 8.1 summarizes these
strategies discussed below.
Figure 8.1 Strategies to enhance critical thinking in educational programs.
 
The first strategy: Engaging the students . Critical thinking only works when it comes from
within, meaning that students need to understand its benefit to be fully engaged. Critical thinking
is not a task in which there are a clear start and finish (as students are used to). It is the reflection
and thinking about a topic and enjoyment of the thinking. Forcing critical thinking will have very
little effect. Of course, the teacher must provide guidance, exercises, and group activities to help
the process, but students need to be engaged. Otherwise, he will not be able to elicit System 2
and make new associations and analyze the topic.
The second strategy: Less is more . One of the issues in educational programs is overestimating
the content that students can learn meaningfully in the period that is dedicated to the program.
When there is too much content, there is not enough time for reflection and discussion on the
topics. Therefore, the course becomes a marathon to complete the curriculum instead of a
program focused on critical thinking about the topic. To make matters worse, teachers usually
think they did a “great job” if they covered a significant amount of material. The teacher should
select what is essential and use fewer topics to delve into.
The third strategy: Promote interaction . Interaction is another critical factor that enhances
critical thinking, the main reason for which is that it promotes intrinsic motivation: when you
speak with someone, you usually are interested and reflect on what the other person says, and in
addition, if the other person asks you a question, you will make extra effort to answer it.
Encouraging interaction in a guided exercise or discussion can be rich because students are
focused on the discussion and learning other points of view.
The fourth strategy: Promote diversity . Having a diverse group (with different backgrounds
and experiences) helps enhance the amount and quality of the discussions. Students from various
backgrounds process information differently and bring a new component to the discussion and
learning. But, it is also important to create an environment that promotes discussions with
different points of view. Remember: the goal is not to get students to repeat what the teacher said
but to process and understand it using their mental models.
The fifth strategy: Promote deep thinking . This is related to Strategy 2 (less is more). The goal
is to delve into a few subjects instead of skimming over more topics. Students should promote
in-depth discussions, looking from different perspectives, and performing different analyses.
Students should continue thinking about the discussion for a few days and bring their comments
to the next class.
The sixth strategy: Stimulate students to ask questions . Asking questions is a fundamental step
during critical thinking. When a student asks a question, it demonstrates good reflection, because
the student is trying to fit the new content into his mental models and connect it with other
concepts. By asking a question, the student is trying to make new connections. The answer to the
question is not as relevant—the exercise of asking the question is the most important part. One
strategy that I use in my global clinical research program is to request that each student post a
question about the discussion during class. This is a requirement for their final grade. Even
though I can only select a few questions to respond to in class, having them post questions is a
valuable exercise.
The seventh strategy: Allow students to make mistakes . This is an important point.
Unfortunately, some teachers, consciously or unconsciously, like and “reward” students who
repeat what they have said or what they consider to be correct. This is a recipe for ruining critical
thinking and creativity. If this is the case, students will engage in a mental model of pleasing the
teacher instead of thinking for themselves and thus participating in critical thinking. Of course, I
am not advocating overlooking students who give the wrong conclusion. The teacher should
acknowledge the student for making a comment. After that, the teacher should try to get the
student to understand what is wrong in his comment.
The eight strategy: Give autonomy to students . Although students should receive guidance
during the program to direct their attention to the topic of the program, within some guidelines,
students should have autonomy in looking for materials that they feel are interesting. Students
then should share their self-selected articles with their colleagues, and develop a discussion
based on them. This strategy is actually easy to implement due to the enormous amount of
information that can be mined from the internet. You do not want the student to spend hours to
find something, but you can provide guidance. For instance, you can give certain websites on
which information that is related to your program can be found. In the educational program that I
teach, one of the weekly activities is to find related material (for instance, a video or an article)
and share it with colleagues from their discussion group and comment on it. Other students reply
to the material. In doing so, it enhances intrinsic autonomy and thus critical thinking, especially
when the material generates a rich discussion.
The ninth strategy: Provide feedback . This is related to the third strategy: “interaction.” When
teachers provide feedback to students, they stimulate their critical thinking by (i) enhancing their
motivation (giving students the sense of mastering the content), (ii) helping them to expand their
knowledge by commenting on their work, and (iii) providing reassurance. One important issue of
feedback in critical thinking is that feedback is not negative (meaning a grade of 0 on an exam ) .
Students should not see thinking as being right or wrong, but whether they are going in the right
direction of the program or getting off-topic. However, they should correct their mistakes when
needed.
The tenth strategy: Use meta-cognition strategies . Meta-cognition is the use of strategies for
students to understand their cognition or thinking process. Explaining the issues that we have
discussed in this chapter to students would be a good strategy itself because students would
understand andvalue the activities that they are doing. They could also monitor their thinking
strategies and improve their methods. This is particularly important because students may have
different strategies for engaging their critical thinking skills. This may be the most difficult
strategy because teachers do not want to use up their class time to discuss an off-topic issue.
However, this practice would have a significant impact.
 
What must Students Do Differently?
 
The simple answer here is that students should prioritize critical thinking and long-lasting
learning instead of receiving the certificate. Critical thinking, as discussed, requires more energy,
and our brain does not necessarily want to be involved in the pathway that involves spending
more energy. On the contrary, students prefer the path of least resistance, which is memorizing
and repeating information without understanding and making meaningful associations.
Teachers must explain to students why critical thinking is essential for learning. I spend an
entire lecture in my clinical research program giving a tutorial about learning and underlying
mechanisms and why we are so interested in discussions and interaction. I say to my students:
there is no magic pill for learning—learning requires involvement and dedication but, in the end,
is rewarding. Indeed, gaining knowledge is rewarding.
Another critical aspect is grading. Students need to be graded in activities that are involved in
critical thinking. If students are assessed based on one final exam that asks them to repeat the
main concepts in the course, they will take the easier path and memorize the information.
Instead, they should be graded on participation in activities that involve critical thinking. For
instance, in my clinical research course, students are graded according to their participation in
the forum (number and quality of comments). This method of grading requires someone to read
all of the comments. We have a large group of teaching assistants (1 TA for every 5 students).
Here, there is no easy way, because it requires the participation of TAs or the teacher to grade
activities that are involved in critical thinking.
Finally, the instructor should create an environment that stimulates students to think and
discuss. Examples from peers will also prompt students. Class time should be used for live and
active discussion between students, which also requires training for the teacher to moderate the
discussion and ensure balanced participation from all students. Students who engage in critical
thinking enjoy this process when they start to learn more.
 
Chapter 9 - Assessing and Grading Students: An Apparently Easy
but Challenging Task
 
In the standard method of education, teachers explain all of the content during the educational
program. They then give an exam at the end of the program, asking students to recapitulate the
concepts they heard or read during the program. If students do well, it means that they “learned.”
If they do not do well, they did not “learn.” Also, if most students do well, the teacher did an
excellent job. Because this is the last chapter, you have likely guessed that I do not support this
method—this is what should not be done.
Should teachers then not apply exams at the end of a program to assess student performance?
It depends. If this final exam is linked to the final grade – i.e., this final exam indicates whether
students will pass or fail, then no, they should not. But if these final exams will be used by the
teacher to improve the program and provide an opportunity for students to review concepts -
rather than the main factor by which students pass the program - then it could indeed be helpful.
One of the main factors in making assessments is to understand the specific goals of the
assessments. In fact, assessments may be used to measure and understand students’ backgrounds
on the topic of the educational program before the program. This is called formative assessment .
One of the challenges of formative assessment is knowing how to use that information and what
it means. On the other hand, as discussed above in the example, the summative assessment
(performed in the middle or at the end of the course), which measures students’ learning through
multiple choice questions or even open questions, is usually ineffective and not a driver of
critical thinking.
Several studies show that simple exams that measure students’ performance and future
success often fail. For instance, a study by a group from Ontario, Canada investigated the
predictive factors of academic success of a pharmacy program. They analyzed the multiple mini-
interview—which measures non-academic domains, such as communication, motivation, and
problem-solving skills—and the PCAT (Pharmacy College Admission Test) and pre-pharmacy
GPA (grade point average). The results showed that the multiple mini-interview was the only
tool that predicted several benchmarks of success in the program (Cameron, MacKeigan et al.
2017). Mini-interview was thus superior to the PCAT and GPA.
Another important concept that will be discussed in this chapter is that assessments (including
exams) are not the same as grades. Assessments can be used to grade students, but there are
many other methods of grading students, and assessments can be used without grading. In this
chapter, therefore, I aim to discuss the main types of assessments and their advantages and
disadvantages. Finally, I will discuss strategies for grading and how they can affect learning.
 
How Can Learning Be Measured?
 
Perhaps the title of this section should be, “ Can we measure learning ?” I am confident that
most educators are aware that multiple-choice or open-question exams are not proper tools to
measure learning. Some teachers even apologize in advance to students: “Class, tomorrow is the
exam, but do not be discouraged if you do not do too well; it does mean that you are not a good
student.” Indeed, the teachers’ intuition is correct: learning is not easy to measure.
If the definition of learning (a broad one) is the acquisition of a skill or knowledge, then it is
easy to measure this knowledge. But how can knowledge be measured? Knowledge can also be
classified as the acquisition of facts, information, and skills. So, if you are interested in
measuring the learning of facts, then it is easy. Referring to the example in Chapter 8: the
definition of a statistical test. If you want students to learn the definition of the t-test (comparing
two means in two independent samples), then the exam can ask for it, and if the student
memorizes and repeats it, he receives a good score and passes the course. But then, you measure
the memorization of facts. Still, it is a form of learning, but a type of learning that likely will not
result in any meaningful change in the student’s life.
If the teacher is interested in deep learning, then he should measure it. In other words,
learning that results in the creation of a large brain circuit that thus connects several concepts.
This is the type of learning that results in meaningful changes in students’ lives. But it is not easy
to measure, because each student will make different associations and connections.
One could suggest measuring brain activity using modern tools, such as functional resonance
imaging (fMRI) and high-density electroencephalogram (EEG), to see whether new brain circuits
are created after a student participates in a course. However, even with these tools, it is not
possible to measure learning. A few reasons explain why it is not possible. First, the brain circuit
is small in relation to the resolution of these techniques. Second, these networks are dynamic and
depend on activation to be measured, complicating measurements further. Furthermore, even if
these methods were accurate, it would not be feasible to use these sophisticated brain
neurophysiological assessments in educational programs.
Therefore, measuring deep learning is not an easy task.Certainly, a simple assessment will
not be able to measure deep learning accurately. My suggestion is to assess the learning process
and not the learning product or at least do both. The process of learning means the activity in
which students are engaged to learn a topic critically. We will discuss this more in the sections
below.
 
Types of Assessments
 
Different types of assessments can be used in educational programs. It is essential to be aware
of them and know how to use them appropriately. I discuss some of them below. Figure 9.1
summarizes types of assessments in educational programs.
 Figure
9.1 Types of assessments in educational programs.
 
Self-assessment
 
Self-assessment is a useful technique that is not often used in educational programs. The idea
is that students reflect on their learning and complete an assessment. This assessment might be a
written open assessment with questions that ask about their learning and challenges and whether
they want to change their strategies for the duration of the program. Students can grade
themselves and justify their grading.
This exercise of self-assessment helps provide additional feedback to the teacher. This
feedback concerns whether students are learning in the program according to their perception.
Self-assessment can guide grading—i.e., not by using students self-grading but the information
students provide. For instance, you can ask your students to give examples of what they learned
and how it applies to their life.
As with other methods, self-assessment depends on the student being committed to providing
a real assessment of himself. Students should be honest and provide real examples (not only a
copy of the material) of their learning. One possibility is to have an oral self-assessment, but this
would demand more time from the teacher.
One interesting aspect of this technique is that this can increase scores and the dedication of
the students in later phases of the program. In a study from the University of Brasilia, Brazil,
students who reflected on their learning experience had better scores in other assessments later in
the program (Sobral 2000). In fact, self-assessment is an essential technique of meta-cognition to
enhance learning.
 
Peer assessment
 
Peer assessment is another useful method to assess students. Peer assessment is an assessment
that is done by one’s peers. In programs in which there is a significant collaboration, this
becomes particularly useful. Peers can assess how a particular student contributed to the
discussion and thus indirectly assess the critical thinking of students. 
The main issue of this type of assessment is that students overestimate assessments of friends
and underestimate those who they do not like. Thus, it is vital to have objective questions during
peer assessment, such as asking students about specific examples to support their assessments.
Also, you can create special categories for assessments, such as comments that helped students
understand the topic and comments that led you to do more research on the subject.
 
Exams 
 
Exams are the most widely used and traditional method of assessment. They can be used in
different formats, such as multiple-choice assessment, open questions, and short questions.
Obviously, the multiple-choice exam is the format that assesses more factual knowledge and not
as much critical thinking. On the other hand, open-question exams allow for a more objective
assessment of students’ thinking. However, they are also limited, because even open-ended
questions ask about specific concepts. Exams are usually cross-sectional assessments and thus
are highly influenced by acute interventions of students, such as cramming before a final exam.
 
Progress Testing
 
Progress testing is a compelling variation of the traditional exam. Instead of having cross-
sectional assessments, which are more affected by cramming, one strategy is to use a similar
exam longitudinally and repeatedly through the program. Obviously, this is more applicable to
programs with a longer duration. The idea is that the same type of exam that measures one
domain of knowledge is repeated throughout the program. The students can then focus on that
knowledge and reflect on it throughout the program. Although this may lead to students
concentrating only on this domain, it also helps them be more connected throughout the course
concerning the content.
 
Student-customized Assessment
 
One possibility is that the learner is responsible for designing his assessment in the program.
There are several methods of doing this. One method would be to have the student choose some
domains in the program about which he aims to learn more. A list of domains is provided by the
instructor and defines specific aspects. His exam would be based on these learning goals. A
study from Northwestern University Medical School (Chicago, US) showed that when students
defined their learning goals at the beginning of the program, they were more motivated to pursue
those goals (McDermott, Curry et al. 1999).
 
Group Assessment
 
Another useful method for assessing students is the use of group activities. This method was
used creatively by a group from University of Southampton (UK). In a locomotor course at this
university, students were divided into groups of about 6. Each group received one problem on
which they were instructed to work and present a poster at the end of the course. During this
presentation, students were assessed orally. Besides, during the development of the discussion,
there was a course staff member who followed students to help organize their work and assess
them on the project. The author who described this experience concluded that students were able
to work effectively in groups and learn “on a basis of curiosity and the exploration of knowledge
rather on its passive acquisition” (Peel 1998). Therefore, this method helps assess students and
enhances their learning.
I use this method in my global clinical research course, in which students are divided into
groups and work on a clinical research proposal that they develop (including choosing the topic).
In this group project, there is at least one teaching assistant who follows the group. Teaching
assistants help with the assessment and organization of the work. In the final workshop, students
spend an intensive period revising the project with faculty and then make their final presentation.
Using this method, I find students to be really involved with the project, being able to apply what
they learned to it, and gaining confidence in designing a clinical research project together.
 
Real-life Scenario Assessments
 
One of the goals of educational programs is to prepare students for the job market and real-
life situations. Therefore, one alternative for exams is to mimic a real-life scenario to assess how
a student would do in a real mock case. Medical schools have been using more of this form of
assessment. They call them objective structured clinical examinations (OSCEs). The goal is to
assess students’ clinical performance in situations that mimic clinical scenarios. Actors play the
role of patients, performing from a script. Students have limited time to examine the “patient”
(actors); look at additional information, if given (for instance, some laboratory exams); and then
make the diagnosis and write a plan for treatment and investigation. A study of 1131 students
from 32 German medical schools concluded that this type of examination changes how students
spend their study time, shifting from memorizing information to training clinical skills (Muller,
Koch et al. 2019).
This method can be used for different specialties and fields of study. The main advantage of
this method, based on what the researchers from Germany found in their medical school
experience, is that assessing students in real-life scenarios changes their mindset and study
strategies. This method brings learning closer to what is important for students ratherthan having
them only memorize the material.
 
Grading 
 
As discussed in Chapter 4 (motivation), grading is an essential aspect of educational
programs. Grading usually triggers extrinsic motivation. It is, thus, important to keep students
engaged in the program. However, grading can have deleterious effects on learning if it is not
planned accordingly.
One of the issues concerns how students view grading. For many students, grading takes
priority over learning. In fact, although it should be the opposite, the priority for students is to do
well with regard to grades (and not necessarily learn). This is a problem in programs in which
teachers only assign a final paper or administer a final exam, into which students are going to put
their energy. To make matters worse, students learn methods to do well on exams and end up
cramming one night before the exam.
How about changing students’ priorities, explaining the importance of learning? The intention
is good, but the result is poor. Students usually think that they can learn the content in the future,
which rarely happens. Thus, instead of changing their priority, use it (of getting good grades) to
make them work on specific aspects in which you are interested. For instance, the process, not
the grade, should be the outcome: grade participation in group activities, class discussions,
projects, and activities in class.
This method is effective, but it is time-consuming for teachers or teaching assistants to follow
activities and grade students on participation. One option is to trust in self-assessments (as
discussed above), but also as self-assessments as mentioned earlier may likely be unreliable. On
the other hand, online programs are helpful in this context because the interaction occurs online,
and it is possible to monitor it by electronic means. For instance, in my online clinical research
program, students must post and interact with their colleagues at least 5 times, and the comments
are read by the teaching assistant and graded.
Although grading the process to ensure student participation is a good method, some students
may still try to do the necessary minimum. Thus, students may fail to participate properly in the
tasks. To ensure good participation, grading should involve not only participation in the tasks but
the quality of the participation. This step adds more work for the course’s staff but can produce
better learning for students.
Another important point is to decide whether grades are a simple Pass/Fail or a quantitative
score from 0-100 (or 0-10) (that may also include A/B/C/D/E letter grading). Providing only a
Pass/Fail grade may remove some of the unnecessary stress from students but still ensures their
participation in the program. It has been proposed that the Pass/Fail system decreases
competitiveness between students and promotes collaboration. For instance, a colleague who
passes the course will not affect the outcome of a student who falls in the top 5 percent of the
class.
In fact, the instructor must be very conscientious of the level of stress that the grading system
can impose. Too little stress on grading (meaning no grade or an easy scoring system) will lead
students to lack the initial motivation that is necessary to become engaged in the program.
Whereas too much stress on grading will lead to burnout, anxiety, and a drop in academic
performance. In a study of 2056 medical students at seven medical schools in the US, the use of
grading scales with several categories (which can cause students to focus on having the top grade
as the most important goal) led to significantly higher levels of stress, emotional exhaustion, and
depersonalization (Reed, Shanafelt et al. 2011).
In fact, a grading system needs to fulfill two major goals: (i) provide extrinsic motivation for
students to participate in the program, and (ii) allow students to have a margin for not completing
some of the tasks and still do well and feel accomplished. When grading from 0 to 100 or using
the A/B/C/D/E system, if students are not close to 100 or an A (some schools even award
A+/A/A-), they will feel frustrated, which will affect their learning.
One strategy for grading is to use a grade that is based on class distribution instead of absolute
values. For instance, the mean class performance is used as a reference, and students are
classified according to the SD (which would be higher or lower than average). This method has
some advantages: it can be adjusted to class performance, and it removes the stress of not being a
high performer on a difficult exam. Also, as discussed, the instructor can adjust the variance to
decrease the difference between a top performer and a poor performer. This method avoids
reducing students’ motivation, as would be less stressful when a student did not perform well on
an exam.
In summary, grading is a valuable tool that teachers should use in their educational programs
to provide extrinsic motivation for students to participate in course activities. Grades should
reflect more participation than learning outcomes, because, in reality, learning outcomes are
challenging to measure, especially when considering short-term learning. Furthermore, when
learning outcomes are measured, students develop strategies to know what to respond to effect a
good learning outcome that is not necessarily real. Finally, grading should not be a measurement
of a student’s worthiness or intelligence. On the contrary, teachers should remove the stress that
is associated with grading and use different strategies, such as categorical pass/fail and standard
deviations instead of absolute values. In this chapter, I have discussed assessment methods and
grading, which can be a starting point for reflection on how to use these tools to improve the
effectiveness of learning.
Epilogue: Teaching Outside the Box
 
The goal of this book is to question the current teaching practices based on how we learn.
Learning has to be seen as a natural human skill and something enjoyable when it is a result of
someone's internal desire. Learning is not about developing skills for memorization to do well in
an exam. Meaningful learning improves one's ability that can ultimately benefit our society.
A good number of concepts that I discussed in this book is likely to challenge your current
teaching strategies as it would for me if presented several years ago. When reading one more
time this book before publishing, I found myself questioning even some specific points of my
teaching and realized that it is not easy to change our teaching habits. Indeed, changing our
habits requires extra effort.
My suggestion for you is to honestly think about how your students are spending their time in
your educational programs. Are most of their time dedicated to listening to you in class and
reading the material you suggest at home? If the answer is yes, then learning of your students is
likely superficial. You need to ensure your students are thinking and reflecting on the content
you are teaching. Deep learning happens with reflection.
If you decide to change some of your teaching practices, you will be likely going against the
traditional standards of teaching, which may not be easy. First, you need to convince yourself
that you are going in the right direction, especially when you take a route that is not the one most
teachers choose. Something that I highly recommend in this journey is to look for research
evidence validating innovative practices of teaching, which there is a large body of literature.
There is a large number of databases that can be easily accessed. If you are from the medical
field, for instance, you are likely used to PubMed database from the US National Library of
Medicine (https://www.ncbi.nlm.nih.gov/pubmed/). For example, if you type there "teaching and
learning," you will get (as of 2019) about 32,000 references or if you type "teaching methods,"
you will get about 250,000 references. It is true that although a number of thesereferences are
not relevant for teaching in the classroom (a reasonable amount is about teaching patients or
disease community groups), most of the references will be highly useful to you. There is also a
specific database from the US Department of Education called ERIC (https://eric.ed.gov). There
you can find references from most educational journals (you can also select whether you want
peer-review references (recommended), or all the references).
However, if you are not interested in research in education, do you need to care to be teaching
based on evidence? Yes, for two reasons. One is that it will provide the best-proven practices
instead of what you usually do in the classroom based on your school system or how you were
taught or from what you have observed from your colleagues. Second, evidence-based education
will provide the support to change your current teaching practice and especially if you are
breaking with the norms and going outside the box of current methods of teaching.
Let me give a simple example. After reading this book, you may realize that you spend too
much time in class, speeding over your PowerPoint slides to cover all the content. You decide
then to decrease the time you present PowerPoint slides but feel that perhaps students may not
learn as much as you think. You then chose to search for literature investigating the use of
PowerPoint. You go to ERIC database (https://eric.ed.gov) and find these two articles
(Incorporating Active Learning with PowerPoint-Based Lectures Using Content-Based
Questions) and (The Effectiveness of PowerPoint Presentation and Conventional Lecture on
Pedagogical Content Knowledge Attainment) (Gier and Kreiner 2009, Cosgun Ögeyik 2017).
These two articles show better learning results towards active learning (i.e., active discussions &
question-based discussions). These studies may help you not only to support your changes but
also to provide additional ideas.
This book is, therefore, a start point for optimizing your teaching journey as it does
summarize a good number of recent studies on the topic. I hope this book helps you to think
outside of the traditional teaching box, providing you support to use new methods and tools.
Current practices are not providing the best learning outcomes. I do not think that changing
teaching process is easy and especially when it is done at the teacher level only; however the
discussion in this book may help you to keep planting stronger learning seeds that will mature in
stronger knowledge trees as to nurture the life of learning.
 
 
 
 
 
 
References
 
Chapter 1
Hebb, D. O. (1949). The organization of behavior: A neuropsychological theory , Wiley.
y Cajal, S. R. and J. Cano (1989). Recollections of my life , MIT press.
Chapter 2
Bermpohl, F., A. Pascual-Leone, A. Amedi, L. B. Merabet, F. Fregni, N. Gaab, D. Alsop, G.
Schlaug and G. Northoff (2006). "Attentional modulation of emotional stimulus processing: an
fMRI study using emotional expectancy." Hum Brain Mapp 27 (8): 662-677.
Bermpohl, F., A. Pascual-Leone, A. Amedi, L. B. Merabet, F. Fregni, N. Gaab, D. Alsop, G.
Schlaug and G. Northoff (2006). "Dissociable networks for the expectancy and perception of
emotional stimuli in the human brain." Neuroimage 30 (2): 588-600.
Carretie, L., F. Mercado, M. Tapia and J. A. Hinojosa (2001). "Emotion, attention, and the
'negativity bias', studied through event-related potentials." Int J Psychophysiol 41 (1): 75-85.
 
Chapter 3
Bechara, A., H. Damasio, D. Tranel and A. R. Damasio (1997). "Deciding advantageously
before knowing the advantageous strategy." Science 275 (5304): 1293-1295.
Boggio, P. S., F. Fregni, C. Valasek, S. Ellwood, R. Chi, J. Gallate, A. Pascual-Leone and A.
Snyder (2009). "Temporal lobe cortical electrical stimulation during the encoding and retrieval
phase reduces false memories." PLoS One 4 (3): e4959.
Kang, S. and B. Tversky (2016). "From hands to minds: Gestures promote understanding."
Cogn Res Princ Implic 1 (1): 4.
Lugavere, M. and P. Grewal (2018). Genius Foods: Become Smarter, Happier, and More
Productive While Protecting Your Brain for Life , HarperCollins.
Ratey, J. J. (2008). Spark: The revolutionary new science of exercise and the brain , Little,
Brown.
Rauchs, G., D. Feyers, B. Landeau, C. Bastin, A. Luxen, P. Maquet and F. Collette (2011).
"Sleep contributes to the strengthening of some memories over others, depending on
hippocampal activity at learning." J Neurosci 31 (7): 2563-2568.
Chapter 4
Olds, J. and P. Milner (1954). "Positive reinforcement produced by electrical stimulation of
septal area and other regions of rat brain." Journal of comparative and physiological psychology
47 (6): 419.
Pink, D. H. (2011). Drive: The surprising truth about what motivates us , Penguin.
Chapter 5
Abe, M., H. Schambra, E. M. Wassermann, D. Luckenbaugh, N. Schweighofer and L. G.
Cohen (2011). "Reward improves long-term retention of a motor memory through induction of
offline memory gains." Curr Biol 21 (7): 557-562.
Ariely, D. (2009). "Predictably irrational, revised and expanded edition."
HarperCollingsPublishers, London .
Harlow, H. F. (1959). "Love in infant monkeys." Scientific American 200 (6): 68-75.
Salehi, B., M. I. Cordero and C. Sandi (2010). "Learning under stress: the inverted-U-shape
function revisited." Learn Mem 17 (10): 522-530.
Chapter 6
Granger, E., T. Bevis, Y. Saka, S. Southerland, V. Sampson and R. Tate (2012). "The efficacy
of student-centered instruction in supporting science learning." Science 338 (6103): 105-108.
Morris, T. H. (2019). "Experiential learning – a systematic review and revision of Kolb’s
model." Interactive Learning Environments : 1-14.
Volz, M. S., V. Suarez-Contreras, M. E. Mendonca, F. S. Pinheiro, L. B. Merabet and F.
Fregni (2013). "Effects of sensory behavioral tasks on pain threshold and cortical excitability."
PLoS One 8 (1): e52968.
Chapter 7
Christensen, C. M., C. W. Johnson and M. B. Horn (2010). Disrupting class , McGraw-Hill.
Rizzolatti, G. and L. Craighero (2004). "The mirror-neuron system." Annu. Rev. Neurosci. 27:
169-192.
Sosulski, K. and M. Vai (2015). Essentials of Online Course Design: A Standards-Based
Guide , Routledge.
Chapter 8
Kahneman, D. (2011). Thinking, fast and slow , Macmillan.
Chapter 9
Cameron, A. J., L. D. MacKeigan, N. Mitsakakis and J. A. Pugsley (2017). "Multiple min i ‐
interview predictive validity for performance on a pharmacy licensing examination." Medical
education 51 (4): 379-389.
McDermott, M. M., R. H. Curry, F. C. Stille and G. J. Martin (1999). "Use of learning
contracts in an office-based primary care clerkship." Med Educ 33 (5): 374-381.
Muller, S., I. Koch, U. Settmacher and U. Dahmen (2019). "How the introduction of OSCEs
has affected the time students spend studying: results of a nationwide study." BMC Med Educ 19
(1): 146.
Peel, S. (1998). "An innovative problem-solving assessment for groups of first-year medical
undergraduates--Think Tanks." Med Educ 32 (1): 35-39.
Reed, D. A., T. D. Shanafelt, D. W. Satele, D. V. Power, A. Eacker, W. Harper, C. Moutier,
S. Durning, F. S. Massie, Jr., M. R. Thomas, J. A. Sloan and L. N. Dyrbye (2011). "Relationship
of pass/fail grading and curriculum structure with well-being among preclinical medical students:
a multi-institutional study." Acad Med 86 (11): 1367-1373.
Sobral, D. T. (2000). "An appraisal of medical students' reflection-in-learning." Med Educ 34
(3): 182-187.
 
Chapter Epilogue
Cosgun Ögeyik, M. (2017). "The effectiveness of PowerPoint presentation and conventional
lecture on pedagogical content knowledge attainment." Innovations in education and teaching
international 54 (5): 503-510.
Gier, V. S. and D. S. Kreiner (2009). "Incorporating active learning with PowerPoint-based
lectures using content-based questions." Teaching of Psychology 36 (2): 134-139.
About the Author
 
FELIPE FREGNI, M.D., Ph.D., M.M.Sc., M.P.H, M.Ed., is an Associate Professor of Physical
Medicine & Rehabilitation at Harvard MedicalSchool and an Associate Professor of
Epidemiology at Harvard T.H. Chan School of Public Health. He has designed and has been
leading one of the most successful interactive online programs in clinical research: the Principles
and Practice of Clinical Research offered currently by Harvard T.H. Chan School of Public
Health. He leads a large research center at Spaulding Rehabilitation Hospital that investigates the
neural mechanisms of learning in rehabilitation.
 
 
 
 
	Introduction: There Is No Magic Pill for Learning
	Chapter 1 - The Neural Basis of Learning
	Chapter 2 – Engaging the Attentional System to Enhance Encoding of New Information
	Chapter 3 – Understanding our memory system for long-lasting learning
	Chapter 4 – What Works in Motivation and Learning: Carrots and Sticks or a Higher-level Purpose?
	Chapter 5 - Stress and Social Climate: How do They Affect Learning?
	Chapter 6 – Teaching Methods: The Teacher-Centered vs. the Student-Centered Method
	Chapter 7 – Online Learning: Challenges and Opportunities
	Chapter 8 - Teaching for Understanding: Enhancing Critical Thinking in your Educational Program
	Chapter 9 - Assessing and Grading Students: An Apparently Easy but Challenging Task
	Epilogue: Teaching Outside the Box
	References
	About the Author