Pattern Making is an essential requirement of long term memory. When children stop counting on their fingers and start remembering something called addition, they are experiencing pattern making. Patterns can also be experienced as physical memories; bike riding is an example. Patterns are a key element in retrieving information from long term memory and experienced physicians have 100s of thousands of medical patterns. Patterns are what help you to know what is wrong with a patient when they walk in the room. Patterns let you perform procedures automatically without thinking about the steps. The down side of this automaticity is that you forget how you developed the pattern and, therefore, it can be difficult to explain the steps to novices because you no longer think about the steps, you just do them..
Many medical students don’t start medical school with good pattern making skills. Like other critical thinking skills, pattern making can be taught and isn’t innate.
Here are some ideas for helping students create their own patterns.
Teaching Input Interrogation
As students are reading articles, viewing videos or listening to lectures, asking the right questions will help students understand the relationships between what they are reading and what they have previously learned. Questions should focus attention on key elements. Novices don’t know what questions to ask and need guidance from you, so here are some suggestions for questions you can include in your teaching. In flipped classrooms, providing questions with pre-class assignments that will be discussed in class will increase compliance and better prepare students for application activities.
- Use 5 WH – Who, What, When, Where, Why and How to dig out key elements
- Use specific pattern questions such as
• What do you need to learn from this?
• What are the key takeaways?
• How does this content form patterns with what you learned last week?
• What is this evidence of?
• What questions do I still have?
Opportunities to encourage reflection occur during simulation and case debriefing, critical incident discussions and feedback sessions. Here are 5 key questions to encourage reflection:
- What do you think about …?
- Why do you think this (data used for decisions and cognitive error identification)?
- How do you know this (appropriateness of evidence)?
- Can you tell me more?
- What questions do you still have?
Create Problem Solving Opportunities
Complex case based and clinical thinking teaching are all based on problem models that encourage recall of knowledge and critical thinking about interconnections.
Demonstrate Your Thinking Process
Novices need to see how different disciplines and different people create patterns. Radiology has different patterns from surgery and novices need to understand those differences. Sharing how you think through problems, either by explaining or drawing on a white board, will help novices realize the value in creating their own approach.
Each individual organizes information to meet their unique needs. Look at the examples used to illustrate this article; some people like to use text, others images, others talk through their process. (The images are links to more information). Once the pattern is created the physical representation is no longer needed, but until that time physical interpretations can be revisited over and over.
Each time a student brings a pattern into working memory, they are improving the links to that pattern in long term memory. Clickers questions and cases are easy ways to do this in medical classrooms; referencing previous experiences and supervised practice can be used in clinical settings.