Nick Napper
With over 30 years’ experience of creating innovative training, Nick passionately promotes evidence-based education in healthcare. His research specialism is visual support for learning.
Location UK
Activity
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@MohamedAwadAlkareem We might broaden this concept a little, and suggest that almost certainly you are a visual learner, but also an auditory learner and a kinaesthetic learner.
A significant factor is how effectively teachers utilise each modality. -
@MohamedAwadAlkareem Absolutely; this is a key tenet of evidence based education.
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@MuhammadAli We hope that by the time you have completed this course, you will have answered this question.
For now, perhaps share stories of successful, and less successful, management of acute pancreatitis? -
@WendyMolefi-Youri Many educationalists believe that the application of a label as a 'type' at a young age can prevent children exploring other approaches to learning - and discovering that visual and auditory approaches are also enjoyable/effective.
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@KerryO’Brien Re your last line, 'How can you find out?', we're not sure what you're asking?
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Nick Napper replied to Amana Turner
@AmanaTurner Thank you for sharing this sensitive and illuminating story.
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@RehabWali Re ‘they had gotten words not actual concepts’, in a recent podcast the psychologist Steven Pinker describes a similar experience with his undergrad students. He had explained the concept of classical conditioning, and his students were able to define it. However, they were unable to identify that was what had happened to the character Alex in the...
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@ShomikBhattacharya We would agree. That said, it's often worth sharing with trainees that thinking hard to recall something is one of the most effective ways to strengthen a memory as not everyone is fully aware of this. But as you suggest, mention of an associating factor can be a helpful way to bring a fading memory closer to the surface.
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Nick Napper replied to Pat Jones
@ShahidKalim It's not as cut and dried as your question implies; as you might imagine there are many potential variables. For example, carefully created PowerPoint slides are likely to be more efficacious than the 'edited transcript' type. The main difference seems to arise from be the spontaneity of writing live (assuming it's legible) and the way in which a...
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@LauraMcAughtrie This is something of an elephant in the room in training because many people are aware of its transience. So many in fact, that the situation has been described as a 'conspiracy of convenience' https://bit.ly/3W0VQf1 . We wouldn't go that far, but there is undoubtedly a degree of 'looking the other way'.
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@LauraMcAughtrie We can't say for certain, but it seems likely that a large proportion of those involved in teaching and training still believe this. For example, it appears on some university websites (although not those with Schools of Education) in advice to students for planning learning, and astonishingly is still taught on some Cert Ed courses.
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@DikshitaKarunanidhi This is a continuing dilemma; initially described by Bloom in 1984 where he describes it as 'The 2 Sigma Problem' (because matching teaching to needs in one-on-one tutoring, followed by regular testing & feedback, resulted in performance 2 standard deviations (sigma) above average of the control group)...
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@EsmeSwift Neurodiversity takes so many forms that, beyond guidance such as WCAG (Web Content Accessibility Guidelines), it's not really possible to create a single lesson form that suits everyone well. The inclusive approach is to establish individual learning needs before a course commences, and in that way accommodate all learners. Within an organisation,...
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@DikshitaKarunanidhi It could be either, and is likely to also depend on the learners' level of knowledge/skill before the session. The important point is to ensure understanding before moving on to the next chunk; ideally by having learners explain in their own words and not always relying on an affirmative answer to the question, 'has everyone understood?'
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@SwapnaVijayan The most commonly employed method is a test or exam set in the future, which encourages learners to revise. Online learning in which the assessment is separate and delayed can also work this way. Many successful teachers start a session with learners recapping from a previous session(s).
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@GemmaHarris It's situations such as you describe that lead some educationalists to promote the alternative term 'feedforward', in order to emphasis its formative purpose.
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@RüdigerPittrof There is scant evidence to suggest we can unlearn anything as such. Generally the advice is to overwrite in some way. You mention loving a good story – one technique involves changing the story of the now out-of-date knowledge, perhaps by adding something ridiculous which acts as a flag if it should come to mind.
Other participants here have... -
@LucyFoster We would agree with your appraisal of that rather 'left field' approach. It is possible that others had felt similarly in the past, but you were the first to say so.
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@HelenPreston What you describe is a common issue in some areas of performance, and is not always a training problem. Julie Dirksen addresses such issues in her 2023 book 'Talk to the Elephant'. We highly recommend this book, and would suggest that every healthcare facility could benefit from making a copy available to its trainers....
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Nick Napper replied to Waqar Qayyum
@WaqarQayyum In the next Step
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Nick Napper replied to Rüdiger Pittrof
@RüdigerPittrof An interesting point re copying; it is quite possible that unconscious mimicry of teaching methods experienced in school is a factor in the overuse of screen text.
Nonetheless there are established benefits for adult learners if a teacher physically writes as they speak. The resulting synchronicity can avoid a clash of speeds, as well as... -
@AnwarMuhammadQureshi Absolutely - we discuss later in the course how there are clear cognitive benefits to learners who witness key points being written by a trainer as opposed to text simply appearing on a screen.
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@RüdigerPittrof Graphs and charts are essentially pictures, especially when used in a simplified form to convey a trend or relationship (as we do with the Forgetting Curve in Week 4, Step 4.3). When studied in detailed form such as in a research paper, the language channel is also likely to be employed.
For more complex graphs shown as visuals in a teaching... -
Nick Napper replied to Laura karran
@Laurakarran Possibly not, or at least relatively little - because such a question may only require recognition; 'System 1' thinking (Kahneman, 'Thinking Fast and Slow').
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@MatthewJenkins I wonder whether (having read several comments about the storyboard concept here) I've been unintentionally ambiguous in explaining its purpose... The aim is essentially to share an idea for a new teaching session with colleagues, plus perhaps a representative sample of learners, with a view to obtaining feedback which will inform the eventual...
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Nick Napper replied to Lucy Foster
@LucyFoster Ouch! Sounds awkward, of course you would remember an experience like that. The approach generally accepted as best practice for a learner query the trainer may be unsure about is to say they'll find out and get back to the learner.
As a point of interest, was the item you queried in fact incorrect? -
@BlessingArimie One might argue that carefully designed single best answer questions have the potential to measure 'shows how' in some areas, but unlikely to apply to 'does'.
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@MatthewJenkins Reminds me of survivorship bias and the story of the initial plan to put armour in the places where surviving B17s had the most bullet holes.
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@LucyMcGuire @LucyMcGuire First time we've heard of this happening - I wonder if a rogue participant could have done it. In view of this I'll be happy to provide feedback on your lesson plan. Please use the contact us form in Step 5.14
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@BlessingArimie In a way, the challenge is similar to that faced by the producer of a quality television documentary. We would suggest it is not automatically an ‘either or’ situation, although is likely to require more thought and planning than something aimed at a clear demographic. If a large number of participants are to be targeted, trialling storyboarded...
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@OwenEvans On a course of this size we unfortunately don't have the space to address outcomes beyond a basic introduction to the concept. We mention Bloom's Taxonomy elsewhere in the course, its higher levels address skills such as creativity, problem solving and so on.
The way you have framed the question above could provide a basis for a higher level... -
@MatthewJenkins Re values, we haven't included affective objectives in this course as we didn't have the space, but it's a challenging and fascinating area. Sessions which aim to imbue values into new starters run the risk of being more like a sermon than a learning experience. We would agree that such a topic is likely to have more impact shared at a team...
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@SamiraDavalbhakta If the learner creates notes in their own words, draws mind maps, etc (i.e. processes the new information) then yes. If they simply copy text that is displayed on a screen, then it's much less likely.
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@AnnieBenton We agree - unfortunately FutureLearn currently only allow that particular mode.
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Nick Napper replied to Liz Horrocks
@LizHorrocks On the theme of recall vs recognition, do you see how much you can recall before you open the notebooks?
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@LucyMcGuire On one level it boils down to lecturing being easy while teaching requires significant thought and preparation. This doesn't justify poor teaching, but many (perhaps most?) are allowed virtually no preparation time.
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@LucyMcGuire We would agree. We don't know the proportion of Hyflex teaching done well to that which simply comprises a broadcasting webcam plonked in the corner of a room, but anecdotal reports suggest that the latter happens quite often.
It is possible that, as with teaching videos in general, some hyflex facilitators do not realise the preparation and... -
@BlessingOkon A trainer's key role is to ensure learning takes place in a lasting and educationally purposeful way. Ensuring the learner 'does' may require input from managers, mentors, clinical supervisors, appraisers, etc.
We visit this again later in the course, and discuss how evaluation of training also includes the degree to which learners 'do'. -
@RachelRolfe Many people do have difficulty when asked to imagine a scenario, and may employ alternative strategies. Powerful as the 'imagination effect' is, we need to bear in mind that at least 5% of the population are believed to have some degree of aphantasia (inability to create mental imagery).
That said, in the situation you describe, if you are able... -
Nick Napper replied to Matthew Jenkins
@MatthewJenkins Good to read you in course comments again Matt. Sorry to hear about your change of circumstances, I hope there is a glimmer of light somewhere.
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@RachelRolfe Agreed; it's telling, not teaching.
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Nick Napper replied to Alison Saban
@AlisonSaban In an evidence-based course such as this, we are keen to highlight the difference between individual learning 'needs' and preferred learning 'styles'. The former are an essential component of differentiation, particularly so for neurodivergent learners. Conversely, adherence to styles theories was discredited in 2005, not least because at times,...
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@JaveriaAsim We would agree, one might argue that the term active learning is in itself a tautology
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@AchaAchi In the course of a day we use most our brain for much of the time. One argument suggests that otherwise we would not have evolved a brain of such a size.
We offer this example of making a morning drink from neurologist John Henley in Scientific American: 'Take the simple act of pouring coffee in the morning: In walking toward the coffeepot,... -
@RiaTaylor Re simulating appraisal scenarios, when accompanied by peer and tutor feedback we'd suggest it's gold standard.
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@ShwetaDandekar The images we used have different purposes depending on the setting.
For example, the helicopter view over city buildings was chosen to bring the mental models analogy to life; to ‘dual code’ the concept by using both language and images.
The long-term memory dendrite growth (and working memory chemical links and dissipation) was simply to... -
@ShwetaDandekar We discuss later in the course how patient stories, analogies, metaphor etc. also employ the visual part of the brain.
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@ShreyashChaudhary The term ‘passive learning’ is something of an oxymoron, and such a teacher-student ratio relies almost entirely on students undertaking the active element of their own volition after the event. Such an approach may serve as a form of selection or ‘weeding out’ for following semesters.
That said, in a situation as you describe, some... -
@AchaAchi Some researchers have suggested three, however this recommendation is based on empirical findings that many question writers struggle to find three plausible alternatives.
It would appear that many writers of multiple choice questions are required to do so having received no training in assessment. -
@MoutazZakkar For some compressed programmes, a driving factor can sometimes be a desire to maximise sales of course places. For example, in the UK there are many companies offering 3-day ‘fast track’ courses for the Level 3 Award in Education and Training. It is possible the companies concerned are unaware of the evidence regarding spacing, reflection, sleep,...
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@HeatherWhite It's frankly astonishing - and why we continue to promote evidence-based teaching - hoping to trigger the consciences of professionals who may be unaware that some of these beliefs have the validity of humoral theory.
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@AliNawaz We would agree. In a situation such as you describe it may be more appropriate to inquire what (if anything) it is the individual wishes to achieve. This can be made even more difficult if previous trainers/mentors have avoided the issue.
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Nick Napper replied to Acha Achi
@AchaAchi Re [practicing clinicians (health personnel) are better teachers or trainers than full-fledge teachers or trainers], this is an interesting question, although it's not really an either/or dichotomy because there are so many potential variables.
For example, a practicing clinician is likely to have many engaging stories, yet one teacher may select... -
Nick Napper replied to Acha Achi
@AchaAchi Assessment in itself can produce a significant impact on retention. However, in the case of exams which take place some time after the original learning, their efficacy depends a lot of whether the student crams near to the exam or spaces revision over the intervening period. The former can work for exams but the latter results in more lasting learning.
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@AchaAchi Yes; Rich Mayer has carried out a lot of research in this area (see his Modality Principle and Temporal Contiguity Principle). Undertaken using complimentary modalities it does help learning (as opposed to similar modes which may clash such as text and speech).
The key thing is that trainers & teachers select modes appropriate for the learning... -
@MoutazZakkar We would agree; that sentence was included chiefly to illustrate the futility of attempting to divide the world into three 'styles'.
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@MoutazZakkar Most assessments of this type are likely to have some form of observer effect, although not necessarily positive as suggested by the Hawthorne study (we’ll leave aside the issue of academics debating its existence and/or reproducibility from the original study). For example, some participants may underperform due to exam-related stress, while...
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@JoshuaGotom Within professional healthcare training, earlier selection procedures usually ensure we do not see the wide variety of of abilities and cognitive capacity that might be present in say, a secondary school classroom.
For most teachers and trainers in healthcare, an informal conversation at the start of a session often provides sufficient... -
@JoshuaGotom Re how the limitations of working memory are assessed, this 2010 paper by Nelson Cowan explains in more detail https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864034/
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@JoshuaGotom Re using visual illustrations for topics such as maths, this often requires some creative and/or lateral thinking, but can be enormously helpful to students. See for example this 1970s Open University video, in which the lecturer uses the streets of Edinburgh to support understanding of the binomial theorem...
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@JoshuaGotom We'll respond to your questions in separate comment sections below.
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@janepearson The 1960s research we refer to used text that was already created.
Writing in front of learners, on a whiteboard or flipchart for example, has been shown to have a positive impact on learning. A trainer can emphasise as they write, underline, circle key words, etc. As you suggest, in this way the text presentation rate is much slower.
That... -
@janepearson A valid point, although as adults they are not like primary school learners whose knowledge of the world is sufficiently limited they often need images. You likely use stories such as the stroke scenario above, and analogies such as 'dinner fork deformity' to describe the appearance of a Colles' fracture?
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Nick Napper replied to Moutaz Zakkar
@MoutazZakkar I think we'd agree with your first suggestion.
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@janepearson The videos all appear to be working. Can I suggest you contact Support via the pink tab on the bottom right of this page. they should be able to suggest a diagnostic check.
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@MoutazZakkar I'm not sure one can draw a line from an educational viewpoint - aside from a requirement for enduring materials to be accredited, they have the potential to be equally passive, depending on the personal approach of the learner.
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@janepearson Is this the video at the start of this step?
I've checked and it appears to be working - can you try again, and if you receive the same message report it to Support via the pink tab at the bottom right of this page. -
@CynthiaUdensi You make a valid point. We would suggest there are some variables; compare an attendee who networks with colleagues between conference sessions, has a demanding 2 hr drive home afterwards, and their evening is taken up with children's bedtime, etc.
While another attendee may not know many people at the conference. they sit and reflect between... -
@janepearson We would agree - in this context the primary function of technology (and AI for that matter) is to help the learner and their learning.
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@MoutazZakkar Agreed. One of the authors we recommend (Julie Dirksen) has recently published a new book which addresses this: 'Talk to the Elephant: Design Learning for Behaviour Change'.
It's an area too often missed (or perhaps we should say sidestepped?) in teaching. -
@MoutazZakkar In Week 4 we give the example of Martin Luther King's 'Dream' speech in which he employed figurative language to create many different mental images.
For a metaphors, similes, etc. to be effective they should ideally be fresh. Although its not always easy to come up with something original, it's noteworthy how often students remember the ones... -
@CynthiaUdensi Bear in mind that the visual channel is also employed when a trainer tells a patient story, uses a fresh metaphor, and so on.
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@MatthewWade Good point - we’ll rewrite this para to be clearer. What we should have said is that they sometimes miss chunks in provided summary notes so that learners are obliged to make their own at the time. It’s an approach perhaps best used with lectures that contain a large proportion of visual material, such as video case studies. We would agree that a...
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@MaryChapman Good point - I'm writing a piece on how to teach a complex topic and was going to use Kreb's cycle as the example - any thoughts on a more transferable alternative?
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@janepearson What you've outlined should be astonishing, but is sadly not uncommon. Even if the creators of such material had received zero training in how to teach, they presumably experienced 10+ years of education at school from which to form opinions on what works. One of the abilities that distinguishes us from lower order primates is that of conceiving...
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@MaryChapman Quite - rather like PowerPoint, the ease with which MCQs can be created belies the educational knowledge required to make them functional.
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@CynthiaUdensi Agreed. We enjoy opportunities to network during conference breaks, yet it's productive to spend 10 minutes after each session quietly thinking through key points and making additional notes.
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@OliviaGamble Unfortunately so, it's why we work so hard to promote evidence-based education. A counter argument is sometimes heard to the effect that, 'you can't carry out an RCT in a classroom'. While this may literally be true, it's a straw man argument and does not justify the promulgation of myths and psychobabble (however well intended).
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Agreed. The physicist Ernest Rutherford is quoted as saying, 'If you truly understand something, you can explain it to the person who serves you a glass of beer'. (I've modernised that quote a little...)
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@WahhajQayyum Re writing what you have learned, this method can be particularly powerful if used in the context of delayed recall.
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@AndrewJuniorSunday Thank you - now fixed
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@OritsesheyigbemiOrugbo Re praise and thanks and associated evidence, this is a difficult question to answer because of its subjective nature. It's interesting to note that while the great majority of comments on this course have been in favour of a 'praise sandwich', a small number of participants have commented that they prefer a 'horrible sandwich'...
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@OritsesheyigbemiOrugbo Visualisation can help maintain knowledge and skills memory, although in the absence of any opportunity to practise, refresher training as with ALS is a reliable approach.
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@arafaAdamAbdAllahBakr True. However uncertainty remains regarding its efficacy compared with (literally and figuratively) face to face learning. See for example, 'Separable processes for live “in-person” and live “zoom-like” faces' Zhao et al 2023 https://direct.mit.edu/imag/article/doi/10.1162/imag_a_00027/117875
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@DeepamDash We have checked Question 4 and the answers remain correct.
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@QaziWaleed Participants are allowed 3 opportunities for each question. Did you take advantage of this?
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@DeepamDash What is it about the 4th question that you believe to be incorrect?
Note: We have checked Question 4 and the answer is correct. If you have an issue with it, please outline here in Comments. -
@EmmaDonaldson Although not if you take 'one' literally; which to our surprise, it appears some do!
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@StanleyEmekaNwabuoku Re 'the ease with which they can be administered'; how would you feel about using measures which might require more effort to administer, but which provide a more accurate (and sometimes quite different) view of the degree to which outcomes have been achieved?
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@TatyanaSarnecki There is one, it's at the start of Week 3 (to allow some time to pass before retrieval)
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Nick Napper replied to Eleanor Harvey
@EleanorHarvey Absolutely. It's an example of the 'picture superiority effect' albeit with an irrelevant picture.
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@TatyanaSarnecki I think their point was that as far as storytelling is concerned, although many possess cameras they remain visually illiterate (in the context of creating meaningful stories on video). While we are taught how to write stories from a young age, few are taught how to do so visually. While tips may be helpful to someone with a given skill level,...
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@AvrilBeesley Re time to create, this is a perennial problem in teaching where sufficient time is rarely (if ever) allowed for lesson preparation. It's the reason many schoolteachers hate Sundays.
Good teachers, trainers and lecturers frequently prepare lessons/lectures in their own time, but as we've mentioned elsewhere, this is often not recognised -... -
@MeganNorris As you suggest the answer is yes regarding skills. Even for those which in time may become relatively automatic, retention is strengthened by delayed recall during the initial learning phase. For fine motor skills (which we haven't the capacity to address on this course) spacing is also valuable for the myelination which needs to take place.
With... -
@SusanHilton We often say that becoming aware of the wide variety of evidence-based education practices is like coming out of a cave and seeing the world in daylight for the first time (ref Plato's allegory of the cave).
However, this bright world also contains hills... and most expert trainers (and good school teachers for that matter) devote significantly... -
@AvrilBeesley Agreed, situations such as these present a challenge. For some, the 'sunk cost fallacy' can exert a strong influence. A considered application of the approach we suggest in Week 5, Step 5.5 may help.
Nonetheless, if an opinion has been held for a long time, attempts to change an established mental model do not always succeed. In the context of... -
@SamuelDavis The evidence regarding learning style hasn't convinced you?
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@ElisabethDaniels Inevitably - although the amount of mental activity applied each time would be an a key factor in how much reinforcement takes place.
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Nick Napper replied to ZAIN UL ABIDIN
@ZAINULABIDIN As mentioned above, we are unable to access the assessment part of the course. The only route available to learners is to explain to FutureLearn Support.
