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Skip to 0 minutes and 0 seconds The human brain is the most complex thing in the known universe, but as trainers we don’t always appreciate how much new information it can absorb at one time. Long-term memory is almost unlimited in its capacity but working memory, that’s the part we consciously think with and what you’re using now, is very limited and can be as little as four new items at one time. Although working memory is small it does have two channels by which it can process information language and images. If we meaningfully employed both of these routes in learning we know it results in an increase in processing capacity among learners. It’s a little like using our hands for a practical task.

Skip to 0 minutes and 38 seconds We can achieve more if we use both. I’m employing both routes of your working memory now by talking and showing you this visual analogy of Road tunnels. In the 1990s the notion of visual learners and auditory or kinesthetic learners appeared, but in 2004 a wide-ranging UK inquiry carried out by Sir Frank Caulfield found this theory to be unreliable and although it still occasionally heard the idea now resides outside of academic literature. We’re all able to learn through the visual medium, but the key point is that images should be educationally purposeful. Simply showing a relevant picture would not necessarily help.

Skip to 1 minute and 23 seconds In 2005 I carried out research in which I showed groups of NHS managers presentations supported by either text-based slides or images. The images were relevant to the topic but had no educational function. I asked participants how highly they rated the visual aids and tested their retention ten days later. The groups that saw images rated the visual aids much more highly than those who had text support, however when I tested their retention ten days later there was no significant difference. Somewhat worryingly for those who deliver mandatory training, neither group recalled anything significant about the topic.

Skip to 2 minutes and 1 second The importance of using visual support that is educationally functional is illustrated by a practice employed by some American lawyers who have been found to deliberately use PowerPoint in courtrooms in order to fill the processing capacity of jurors with irrelevant items and thus disable their working memory and their ability to engage critically with the evidence. This effect is not limited to unscrupulous lawyers. Ironically some well-meaning trainers and lecturers also do it, albeit unknowingly, by presenting text slides while they speak, thereby forcing two forms of content simultaneously through one route. Similarly elearning designers sometimes present spoken narration with on-screen text. It’s like texting while driving our limited working memory won’t allow us to do both properly.

Skip to 2 minutes and 52 seconds An important point within the dual route principle is that imagery can be just as effective as images for learning. In the study I mentioned earlier some respondents from the image groups described a slide which I hadn’t shown. I had in fact told a short story and they had produced an image in their own minds which they later recalled as a picture they’d seen. This links with what we know from functional MRI scans used in research that similar parts of the brain are employed if we imagine an image as when we see a scene. If we construct an image in our minds it’s often more lasting a phenomenon known as the imagination effect.

Skip to 3 minutes and 31 seconds In clinical training many doctors and nurses hear an emotive poem called the crabbit old woman about the isolation felt by an elderly lady in hospital. Delivered with no pictures or text on a screen the poem nonetheless leaves lasting images with all who hear it. The poem was actually written by a nurse who wanted other nurses to appreciate older patients more than they did. It’s a fine piece of teaching and it truly uses both roots of working memory. Metaphors analogies and similes work in the same way. The simile that managing senior clinicians is like carrying frogs in a wheelbarrow employs the visual channel as one mentally pictures green amphibians hopping off the Barrow in all directions.

Skip to 4 minutes and 18 seconds In 2010 I compared four different visual modes in support of a learning session about the values of an NHS trust. Groups comprised mixed grades and professions and saw either images which were educationally purposeful, brief text of five words or less, traditional text summaries of forty to sixty words or guided imagery in which they were asked to imagine clinical situations. Significant differences were recorded both in appreciation and recall 14 days later. The guided imagery and purposeful images were found to be more highly rated and produced more lasting learning after 14 days. A surprising and disappointing finding of my research has been that many teachers trainers and lecturers have received no tuition in the educationally functional use of the visual medium.

Skip to 5 minutes and 12 seconds Some have received guidance in the functionality of PowerPoint, others in creating aesthetically pleasing visual design, but few in the UK received guidance in the cognitive benefits of tasks appropriate images and imagery. This course aims to resolve this.

EXTRA: Dr Nick Napper is Lead Learning Advisor at Musgrove Academy, Musgrove Park Hospital in the UK

Nick Napper, who has contributed this video presentation to our course, trains healthcare workers and managers in the UK NHS and has conducted research into the benefits and challenges of visual learning.

Watch Nick’s video and consider the following questions

  • When are images helpful for learning about a topic?
  • Can you think of situations when images have been distracting?


Research into visual support for learning in an NHS Trust
Napper, N. L. (2014). An investigation into the impact of visual aids in post-compulsory education (Are text-based slides the optimum?) https://ore.exeter.ac.uk/repository/handle/10871/16561

Dual route theory of Working Memory
Mayer, R. E. (2005a). Cognitive theory of multimedia learning. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (pp. 31-48). New York: Cambridge University Press Schnotz, W. (2005). An integrated model of text and picture comprehension. In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning. New York: Cambridge University Press.

Using visuals to increase effective working memory capacity
Schnotz, W., & Bannert, M. (2003). Construction and interference in learning from multiple representation. Learning and Instruction, 13, 141-156. Mousavi, S. Y., Low, R., Sweller, J, (1995) Reducing cognitive load by mixing auditory and visual presentation modes. Journal of Educational Psychology, 87(2), 319-334

The Imagination Effect
Leahy, W., & Sweller, J. (2008). The imagination effect increases with an increased intrinsic cognitive load. Applied Cognitive Psychology, 22, 273-283.

Teachers’ and lecturers’ visual literacy
Eilam, B. (2012). Teaching, learning, and visual literacy: The dual role of visual representation New York: Cambridge University Press Napper, N. L. (2014). An investigation into the impact of visual aids in post-compulsory education (Are text-based slides the optimum?) https://ore.exeter.ac.uk/repository/handle/10871/16561

VAK Learning Styles and their position with regard to educational practice
Coffield, F., Moseley, D., Hall, E., & Ecclestone, K. (2004). Should we be using learning styles? What research has to say in practice. London: Learning & Skills Research Centre. Pashler, H., McDaniel, M., Rohrer, D., & Bjork, R. (2009). Learning styles: Concepts and evidence. Psychological Science in the Public Interest, 9(3), 105-119.

Presenting text and speech simultaneously can produce cognitive overload
Kalyuga, S., Chandler, P., & Sweller, J. (2004). When redundant on-screen text in multimedia technical instruction can interfere with learning. Human Factors, 46(3), 567-581. Chandler, P., & Sweller, J. (1991). Cognitive load theory and the format of instruction. Cognition and Instruction, 8, 293-332.

Unscrupulous lawyers found to deliberately attempt to overload jurors’ working memory
Sherwin, R. K. (2008). Visual literacy in action: "Law in the age of images". In J. Elkins (Ed.), Visual literacy. New York: Routledge.

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Designing E-Learning for Health

The University of Nottingham