Nurse Marguerite Underwood shows medical students show to navigate an ultrasound probe on a man's chest.

By David Hungate


Marguerite Underwood (second from left), a member of Carilion Clinic's Cardiology Services, teaches portable ultrasound technology to members of the Virginia Tech Carilion School of Medicine's Class of 2015. The patient stand-in is medical student Scott Dart.

The neurobiology of learning: lessons for medical education

How can insights from the neurobiology of learning improve the way medicine is taught? That was the central question in a plenary address that Michael Friedlander, executive director of the Virginia Tech Carilion Research Institute, delivered at the annual International Association of Medical Science Educators meeting, held in Portland, Oregon, in June.

During his plenary, Friedlander surveyed the current wisdom of cognitive neuroscience and the neurobiology of learning and memory to inform educational programs for medical professionals. He presented findings from a range of studies that have provided evidence for several principles central to learning among health care providers.

One example Friedlander cited was a Virginia Tech Carilion Research Institute study that used functional magnetic resonance imaging (fMRI) to look at the brain activity of experienced physicians as they made decisions. The researchers found that those who paid attention to failures as well as successes became more adept at selecting the correct treatment. In that study, the most experienced doctors tended to be the poorest learners.

Friedlander also offered tips for learning, consolidating, and retaining the tremendous amount of information that a mastery of medicine requires.

“We know from fMRI studies that when you combine learning with doing it’s more effective,” he said. “We also know that mental rehearsal can activate higher regions of the brain. You can do surgery in your mind. You can do diagnostic differentials in your mind.”

Friedlander also noted that active recall plays an important role in storing memories, yet that recall should be interspersed with breaks. “Spaced learning enhances subsequent recognition by reducing repetition suppression of the brain,” he said. “That is, repeating something is good, but if you keep repeating it and you don’t allow gaps for consolidation, it’s not as successful.”

Friedlander’s lessons were based on a review of decades of research, which he and colleagues summarized in an April 2011 article in Academic Medicine. In that article, the authors identified 10 key aspects of learning that can improve a medical curriculum: appropriate reward and reinforcement, repetition with appropriate spacing, visualization and imagery, active engagement, a judicious application of stress, the opportunity to encode and consolidate memories through rest, multitasking only when the tasks are integrated, a recognition of individual learning styles, learning through doing, and the use of multimedia for revisiting information and concepts.

Friedlander’s presentation—along with one by Steven Kanter, vice dean of the University of Pittsburgh School of Medicine editor-in-chief of Academic Medicine, on the learner-teacher relationship—kicked off the three-day International Association of Medical Science Educators meeting and set the major themes of the conference. More than 500 attendees from 23 countries attended the interactive workshops that followed, with the goal of identifying effective approaches to improving medical education that are based on strong scientific evidence.