Learning & The Transfer Problem

There’s a classic quote that gets attributed to a whole bunch of people, and it goes like this:

“In theory, there is no difference between theory and practice. But in practice, there is.”

This is the transfer problem, and it’s a real thorn for how we learn (and especially how we learn to perform in high-stakes roles like medicine).

When a medical student says, “I know all the information and can explain it but I just don’t do well on the multiple-choice test,” this is the transfer problem at work.

When someone else can do well on the multiple-choice test but can’t apply their knowledge to actually helping patients, that’s the transfer problem too.

The more different the learning methods are from the evaluation, the harder it can be to succeed. The more different the learning and evaluation methods are from the real-life goal, the less useful they are.

Here are some passages from Ultralearning: Master Hard Skills, Outsmart the Competition, and Accelerate Your Career:

Given a century of research showing the difficulties of transfer along with proposed solutions that have failed to provide lasting results, any student must take seriously the notion that transferring what has been learned between very different contexts and situations will be treacherous.

The answer is that learning directly is hard. It is often more frustrating, challenging, and intense than reading a book or sitting through a lecture. But this very difficulty creates a potent source of competitive advantage.

The best way to prepare for taking a high-stakes multiple-choice exam is to do lots of multiple-choice questions (e.g. How to Study for Step 1). The best to learn to do a procedure (other than actually doing the procedure) is to do a good simulation of said procedure.

If you can judge yourself only on how much you improve at the overall task, it can lead to a situation in which your improvement slows down because you will be getting worse at the overall task while becoming better at a specific component of it.

This is the treacherous problem of stagnant or decreasing qbank performance during dedicated review for some students. More time to trying to memorize low-yield minutia or shore up knowledge gaps doesn’t always yield upfront measurable gains. But, that doesn’t mean that when once again incorporated into a broader approach and after refreshing your core knowledge against the forgetting curve that it won’t ultimately yield results.

This practice of starting too hard and learning prerequisites as they are needed can be frustrating, but it saves a lot of time

Sometimes it’s best to just dive in because you’ll rapidly figure out exactly what you need to know.

I agree with this, and it argues for the early incorporation of question-based learning. This is actually how I learned pathology, by slogging through the question book and largely ignoring the larger text.

Human beings don’t have the ability to know with certainty how well they’ve learned something. Instead, we need to rely on clues from our experience of studying to give us a feeling about how well we’re doing. These so-called judgments of learning (JOLs) are based, in part, on how fluently we can process something. If the learning task feels easy and smooth, we are more likely to believe we’ve learned it. If the task feels like a struggle, we’ll feel we haven’t learned it yet.

No pain, no gain.

Imaging is the great equalizer

Imaging is the great equalizer. When we look deep into ourselves from the vantage of this fundamental level, with exterior barriers and labels removed, we just might just see ourselves, other people, and our lives in a whole new light.

From Dr. Cullen Ruff’s Looking Within: Understanding Ourselves through Human Imaging, currently an Amazon Black Friday deal for a whopping $0.99 on Kindle.

When I see patients these days, it’s usually because I’m about to put a needle somewhere, but Ruff is old enough that he has decades of stories from an era where radiologists got (relatively speaking) a lot more patient facetime.

And yet, what a strange job we have, bypassing everything externally visible to study people’s insides.

To be home is to be known

If anyone was looking for a summary of a core problem in American society, from former Surgeon General Dr. Vivek H. Murthy’s lovely book, Together: The Healing Power of Human Connection in a Sometimes Lonely World:

While loneliness engenders despair and ever more isolation, togetherness raises optimism and creativity. When people feel they belong to one another, their lives are stronger, richer, and more joyful.

And yet, the values that dominate modern culture instead elevate the narrative of the rugged individualist and the pursuit of self-determination.

To be at home is to be known. It is to be loved for who you are. It is to share a sense of common ground, common interests, pursuits, and values with others who truly care about you.

In community after community, I met lonely people who felt homeless even though they had a roof over their heads.

And, when people are desperate for community, the ones most emotionally convenient or accepting may not be ones that provide meaningful uplift.

Communities that focus on us vs. them distinctions, scapegoating, and villainization aren’t about bringing people together. They’re about frustration and fear.

Tomorrow is a new day

Finish every day and be done with it. You have done what you could; some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day; you shall begin it well and serenely, and with too high a spirit to be cumbered with your old nonsense.

—Ralph Waldo Emerson, in an 1854 letter to his daughter.

It’s my birthday today, and this is something I think about when considering my relentlessly increasing age.

The best day for a new positive change is always today. But we’re very fallible human beings and I’ve been stress eating for about six months, so barring that, let’s not discount tomorrow either.