Healthcare training: How are knowledge and skills stored?

We possess a vast number of mental models in our long-term memory. These have grown and developed from our life experiences and our education. They are what make us unique individuals.

How are knowledge and skills stored?

As children, we probably believed many things that were not accurate. Then, as we attended school and college, we gradually modified existing models and built new ones that were more in line with others in society.

Even as adults, however, not all our models are necessarily correct or accurate because we are subject to cognitive biases. For example, if we have only ever experienced the common cold in a mild form, we may have a mental model which suggests its symptoms are always mild.

If we then meet someone who suffers heavy symptoms when they have a cold, we may adjust our belief to include the idea that for some people a cold can be more onerous.

Alternatively, we might choose to believe this person is exaggerating their symptoms and that our model of the common cold is correct.

Seeking to adapt mental models

Training often seeks to change or adapt mental models in some way. For example, the reason we have training courses in Assertiveness Skills is that some healthcare staff have mental models which suggest they should always be polite and never disagree with others.

In this instance, a trainer may design activities in which participants practice standing up for their rights while respecting the rights of others.

As they experience ways of doing this which are comfortable and achievable for them, learners begin to adapt their mental model. This process continues when they try out the new skill in real life; if it is successful the model is further strengthened.

Physical skills

In physical skills, CPR training seeks to add an exception to an existing mental model that we should never use physical force on a patient.

If a particular mental model is absent, for example, a healthcare recruit with no experience of mental illness, the training seeks to build up a fresh model of how the world can seem to someone with a mental health problem, and how healthcare services can help.

How easy is it for a trainer to change an existing mental model?

The answer to this question depends on the strength of the existing model. For example, in the world of training, many practitioners have a mental model that suggests talking at the same time as displaying similar words on a screen reinforces learning.

There is reliable evidence to show that it doesn’t and that large amounts of text while talking can actually harm learning. Whether we are successful in this quest will depend on how strongly the model is built. If a learner has experience of being bored by long decks of text slides we may not experience much difficulty in adapting their mental model.

On the other hand, if they had a lecturer who used lots of text slides, but was also instrumental in getting them through college with good grades, we may struggle to change their mind. (Even though his slides were probably not what got them the grades!)

Analogies help to learn by linking with existing models

An analogy is a comparison between one thing and another for the purpose of explanation. In the video, we used one to explain the concept of mental models. Analogies help us understand new topics because they quickly connect with things we already know.

When you first learned about electricity at school, it may have been explained in terms of water flowing along a pipe (the origin of the term electrical ‘current’). As you learned more about electricity the analogy ceased to be helpful (it isn’t like water really). But by then, the comparison had done its job of helping to embed the idea in your memory.

Another example comes from teaching respiratory anatomy. A tutor might explain that alveoli (tiny air sacs at the end of the bronchioles) are shaped like bunches of grapes.

In reality, alveoli are empty spaces and a hundred times smaller than a bunch of grapes, but the comparison quickly creates a helpful mental image.

What does this mean for trainers and learning designers?

As trainers, it is enormously helpful to be aware of differences in knowledge and beliefs among our learners. The more we know about their mental models, the better able we are to design experiences pitched at the right level and pace for them.