Neuroplasticity in Innovative Teaching and Learning Methods

I. Introduction to the Topic and Speakers

• Host and Event:

  • The session is hosted by Sumit Tech.

  • It is a Continuous Medical Education (CME) talk at Believers Church Medical College Hospital (BCMCH) Thiruvalla.

  • This marks the third time Dr. Sarida Shenoi has been invited to BCMCH for a CME talk.

• Topic of Presentation:

  • The central theme is "educating the ever changing brain: innovative teaching learning methods rooted in neuroplasticity".

  • The presenter, Dr. Sarida Shenoi, aims to connect physiology with medical education.

• Presenter: Dr. Sarida Shenoi

  • Education:

    • Completed MBBS at Trandam Medical College (1993 batch).

    • Completed her PG at Cai Medical College (2004-2007).

  • Academic Acclaim:

    • Showed exceptional academic performance during her PG days, which she continues to maintain.

    • Previously took physiology classes for a long time at Cortumini PG classes.

  • Professional Persona:

    • Described as "a pinch of salt which add flavor in all programs at Kai Medical College and CME all over Kerala".

    • A gifted spokesperson and mentor of MBBS students.

    • Was a speaker at the BCMC 2024 osteophysicon CME.

  • Task for the Session: Expressed gratitude to Dr. Vijaya for challenging her to discuss newer teaching-learning methods in connection with neuroplasticity.

• Moderator: Dr. Vijayamma

  • Current Role: Vice Principal and Professor of Anatomy at BCMC.

  • Professional Relationship: A long-time friend and colleague of the introducer, having worked together at both Came and BCMC.

  • Education and Career:

    • Joined MBBS in 1970 (78 batch) at CM MCK.

    • Worked in the Anatomy Department at CM for an extended period.

    • Also worked at various other medical colleges.

    • Joined BCM Medical College after retiring from CM.

  • Capabilities: Excels in both academic and administrative roles.

  • Student Support: Known as a "real compassionate mentor to students".

  • Role in Meeting: Serves as the moderator of the Zoom meeting.

II. Foundational Concepts: Brain Structure and Dynamic Processes

A. Initial Brain State and Neuronal Development

• At birth, humans are considered "born rich" in terms of brain neurons, possessing approximately 86 billion neurons.

• While the maximum number of neurons is present at birth, this number gradually reduces as a part of aging.

• The process of neurogenesis (formation of new neurons) and neuronal connections is significant, particularly in the hippocampus, which reportedly has the ability to produce more neurons and connections. It has been documented that by the age of 60, one-third of the neurons in the hippocampus are new.

B. Synaptogenesis: Formation of Connections

• Synaptogenesis, the development of synapses, largely occurs later in life.

• The first synapse develops as early as 20 weeks of gestation.

• Before birth, more synapses are observed in the spinal cord and brain stem, serving the development of basic reflexes.

• After birth, a massive overproduction of synapses occurs, particularly in the sensory system (like the visual occipital cortex and auditory cortex) and the prefrontal lobe.

• By 2 to 3 years of age, the brain reaches its peak synaptic density, containing around thousand trillion connections. The development of these synapses is directly influenced by the number of inputs received by the brain.

C. Synaptic Pruning: Refinement of Connections

• Following the peak of synaptogenesis at 2-3 years, the number of synapses begins to decrease as a person moves into adulthood.

• This reduction is known as synaptic pruning. It operates on the principle of "use it or lose it," meaning only frequently used synapses are retained, while unused ones are eliminated from the brain.

• Maximum pruning generally occurs between 2 to 10 years of age.

• However, pruning in the prefrontal lobe, which is crucial for social behavior, continues into adolescence. This ongoing pruning means that adolescents' brains are still in the process of refinement based on their life experiences.

• Early pruning is influenced by genetic factors, while later pruning is shaped by epigenetic influences, which are environmental experiences.

D. Microglia and the Pruning Mechanism

• Synaptic pruning is primarily carried out by microglia, a type of neuroglial cell often referred to as the "scavenger cell" or "brain culture".

• Microglia utilize "find me and eat me pathways," mediated by specific chemokines (e.g., CX3 CL1) and the complement system, to identify and degenerate unused synapses.

• This process is continuous and influenced by both genetic and environmental factors.

• Disruptions to microglial activity due to environmental or genetic factors (e.g., pollution, stress, infections, dietary irregularities) can lead to developmental disorders such as autism spectrum disorder and schizophrenia, and various psychiatric disorders like psychosis, OCD, anxiety, depression, and dementia later in life. Proper functioning of this process is crucial for normal mental function.

E. Neuroplasticity: The Brain's Capacity for Change

• The brain is an "incredible organ" with the ability to continuously reorganize itself and form new neuronal connections.

• This ongoing molding and change in the brain, where frequently used connections remain and unused ones degenerate, is the fundamental concept behind synaptic plasticity.

• Neuroplasticity is important not only for enhancing learning and memory but also for the brain to regain activity after injuries like concussions.

• It is observed across the entire lifespan, from adolescence onwards.

F. Learning and Memory: Cellular Mechanisms

1. Hebbian Postulate:
   
   

   • Proposed by Donald Hebb, this postulate states: "Neurons that fire together wire together".

   • This means that when pre- and post-synaptic neurons repeatedly engage in coincident activity, it leads to a persistent change in synaptic efficacy.

   • Repeated firing of neurons establishes and strengthens neural circuits, making them dominant, while non-utilized circuits become non-dominant. This is the foundation of synaptic plasticity and the cellular mechanism underlying learning and memory storage.

2. Long-Term Potentiation (LTP):
   
   

   • LTP is the primary synaptic event responsible for encoding, storage, and associative learning in long-term memory.

   • It occurs when a synapse is persistently stimulated with high-frequency stimulation.

   • These changes primarily take place in the hippocampus, specifically in the pyramidal cells of CA3 and CA1.

   • The net effect of LTP is increased neurotransmitter release and increased receptor sensitivity at the synapse.

   • Early LTP: Occurs within seconds of stimulation and lasts for a few minutes.

     • Mechanism involves glutamate release from the presynaptic neuron.

     • Glutamate binds to both AMPA and NMDA receptors on the postsynaptic membrane.

     • The NMDA receptor, a calcium channel, is initially blocked by magnesium.

     • Glutamate binding to the AMPA receptor causes an influx of sodium and potassium, leading to a partial depolarization of the postsynaptic membrane.

     • This partial depolarization removes the magnesium block, allowing calcium to enter through the NMDA receptor.

     • Calcium acts as a second messenger, activating protein kinases (calcium-calmodulin kinase, protein kinase C).

     • These protein kinases phosphorylate and upregulate the number of AMPA receptors on the postsynaptic membrane and generate a retrograde signal (hypothesized as nitric oxide) that travels to the presynaptic neuron, causing enhanced neurotransmitter release. This overall increases synaptic activity.

   • Late LTP (Memory Consolidation): Occurs over hours, days, or even weeks, leading to more permanent changes that facilitate easier memory retrieval.

     • Calcium further activates adenylyl cyclase, leading to increased cyclic AMP (cAMP) and protein kinase A (PKA).

     • PKA activates the MAP kinase pathway, generating transcription factors (e.g., CREB - cyclic AMP response element binding proteins).

     • These transcription factors drive increased protein synthesis (e.g., more AMPA receptors, structural proteins, brain-derived neurotrophic factors (BDNF)).

     • This protein synthesis results in the growth of new dendritic spines, enlargement of existing spines, and the formation of new synapses, which are crucial for the formation of memory traces or engrams.

     • Memory formation is a complex process requiring significant protein synthesis, energy (ATP), and various chemical factors.

3. Long-Term Depression (LTD):
   
   

   • LTD is the process by which synapses are weakened by low-frequency stimulation. It's crucial for understanding "why we forget".

   • It involves a lower calcium influx and activation of protein phosphatases, leading to dephosphorylation and downregulation/internalization of AMPA receptors.

   • LTD is as important as LTP because it helps to clear irrelevant memories, refine neural circuits, enable new learning, and prevent the saturation of long-term potentiation.

   • Forgetting is a natural and necessary process for the brain to remain refined and clear, retaining only essential information.

4. Learning vs. Memory:
   
   

   • Learning is the acquisition of new experiences and the neural mechanism by which an individual changes behavior based on past experiences.

   • Memory is the storage and retrieval of this acquired information.

   • There is no memory without learning. However, learning can occur without being transformed into permanent memory if proper encoding, consolidation, and storage do not happen, meaning the learned information cannot be retrieved.

   • Repetitions and revisions are essential to convert short-term memory (early LTP changes) into long-term memory.

G. Factors Influencing Neuroplasticity and Brain Health

• Neuroplasticity is a continuous process throughout life but can be modified by various stimuli.

• Factors that can enhance brain health, memory, and learning through their influence on neuroplasticity include:

  • Repeated learning.

  • Engaging in activities like solving puzzles.

  • Exercise, which significantly increases the production of brain-derived neurotrophic factors (BDNF).

  • Adequate sleep, also linked to BDNF production.

  • Sun exposure (sunbath).

  • Healthy food habits.

  • Learning new skills.

  • Socializing.

  • Maintaining organization and setting clear goals.

• Neurogenesis has been specifically noted in the hippocampus and olfactory mucus memory. Research into factors that favor neurogenesis in these areas could have significant implications for neuronal regeneration, potentially in areas like the spinal cord following injury.

III. Memory Processing and the Cellular Basis of Learning

A. Memory Processing Blueprint

• Memory processing begins when the brain receives various stimuli.

• The first critical step is encoding, where stimuli are transformed into neuronal signals in the brain.

• The effectiveness of encoding is crucial, as it dictates the success of subsequent stages: consolidation, storage, and retrieval.

• Motivation and concentration during the encoding stage significantly improve the clarity and quality of later memory processing steps. If encoding is not proper, consolidation, storage, and recall will also be compromised.

• Proper encoding requires synaptic pruning and the plasticity of synapses.

B. Cellular Mechanisms of Learning and Memory

1. Hebbian Postulate:

   • This fundamental concept, proposed by Donald Hebb, states: "Neurons that fire together wire together".

   • It implies that repeated, coincident activity between pre- and post-synaptic neurons leads to a persistent change in synaptic efficacy.

   • When neurons repeatedly fire together, they establish and strengthen neural circuits, making them dominant. Conversely, non-utilized circuits become non-dominant.

   • This postulate forms the foundation of synaptic plasticity and is the cellular mechanism underlying learning and memory storage.

2. Long-Term Potentiation (LTP):

   • LTP is the primary synaptic event responsible for encoding, storage, and associative learning in long-term memory.

   • It occurs when a synapse is persistently stimulated with high-frequency stimulation.

   • These changes predominantly occur in the hippocampus, specifically in the pyramidal cells of CA3 and CA1.

   • The net effect of LTP is increased neurotransmitter release and increased receptor sensitivity at the synapse.

   • Stages of LTP:

     • Early LTP:

       • Occurs within seconds of stimulation and lasts for a few minutes.

       • Mechanism:

         • Glutamate, the neurotransmitter, is released from the presynaptic neuron.

         • Glutamate binds to both AMPA receptors and NMDA receptors on the postsynaptic membrane.

         • The NMDA receptor, a calcium channel, is initially blocked by a magnesium ion.

         • Glutamate binding to AMPA receptors causes an influx of sodium and potassium, leading to a partial depolarization of the postsynaptic membrane.

         • This partial depolarization removes the magnesium block from the NMDA receptor, allowing calcium to enter the postsynaptic neuron.

         • Calcium acts as a second messenger, activating protein kinases (e.g., calcium-calmodulin kinase, protein kinase C, tyrosine kinase).

         • These protein kinases phosphorylate and upregulate the number of AMPA receptors on the postsynaptic membrane, leading to more receptors and increased sensitivity.

         • They also generate a retrograde signal (hypothesized as nitric oxide) that travels back to the presynaptic neuron, causing enhanced neurotransmitter release.

         • In short, early LTP leads to an increase in synaptic activity.

     • Late LTP (Memory Consolidation):

       • Occurs over hours, days, or even weeks, leading to more permanent changes that facilitate easier memory retrieval.

       • Mechanism:

         • The calcium influx from early LTP further activates adenylyl cyclase, which increases cyclic AMP (cAMP) and subsequently protein kinase A (PKA).

         • PKA activates the MAP kinase pathway, generating transcription factors (e.g., CREB – cyclic AMP response element binding proteins).

         • These transcription factors drive increased protein synthesis.

         • The newly synthesized proteins include more AMPA receptors, structural proteins, and Brain-Derived Neurotrophic Factors (BDNF).

         • This protein synthesis results in the growth of new dendritic spines, enlargement of existing spines, and the formation of new synapses. These structural changes are crucial for the formation of memory traces or engrams.

         • Memory formation is a complex process requiring significant protein synthesis, energy (ATP), and various chemical factors. Any problem in these steps can destroy memory.

3. Long-Term Depression (LTD):

   • LTD is the process by which synapses are weakened by low-frequency stimulation. It is crucial for understanding "why we forget".

   • Mechanism: It involves a lower calcium influx compared to LTP and the activation of protein phosphatases. This leads to dephosphorylation and downregulation/internalization of AMPA receptors, thereby decreasing the number of receptors on the postsynaptic membrane.

   • Significance: LTD is as important as LTP because it helps to:

     • Clear irrelevant memories or memory traces.

     • Refine neural circuits.

     • Enable new learning.

     • Prevent the saturation of long-term potentiation.

   • Forgetting is a natural and necessary process for the brain to remain refined and clear, retaining only essential information.

C. Learning vs. Memory

• Learning is defined as the acquisition of new experiences and the neural mechanism by which an individual changes behaviour based on past experiences.

• Memory is the storage and retrieval of this acquired information.

• There is no memory without learning. However, learning can occur without being transformed into permanent memory if proper encoding, consolidation, and storage do not take place, making retrieval impossible.

• Repetitions and revisions are essential for converting short-term memory (which corresponds to early LTP changes that are easily destroyed) into long-term memory.

D. Factors Influencing Neuroplasticity and Brain Health for Learning

• 
  

• Neuroplasticity is a continuous process throughout life and can be modified by various stimuli.

• Factors that can enhance brain health, memory, and learning by positively influencing neuroplasticity include:

  • Repeated learning.

  • Engaging in mental activities like solving puzzles.

  • Exercise, which significantly increases the production of brain-derived neurotrophic factors (BDNF).

  • Adequate sleep, also linked to BDNF production.

  • Sun exposure (sunbath).

  • Healthy food habits.

  • Learning new skills.

  • Socializing.

  • Maintaining organization and setting clear goals.

• Neurogenesis (the formation of new neurons) is documented in specific areas like the hippocampus and olfactory mucus memory, with research exploring factors that favour it, potentially for neuronal regeneration in cases like spinal cord injuries. It's noted that by the age of 60, one-third of the neurons in the hippocampus can be new.

IV. Understanding Learning and Memory

A. Defining Learning and Memory

• Learning is defined as the acquisition of new experiences. It is the neural mechanism by which an individual changes their behaviour based on past experiences.

• Memory is the storage and retrieval of this acquired information.

• Fundamental Relationship:

  • There is no memory without learning.

  • However, learning can occur without being transformed into permanent memory if proper encoding, consolidation, and storage do not take place, making retrieval impossible.

  • For example, students may complain they "studied very nicely for the exam but could not remember anything" because their learning was not converted into long-term memory.

B. Short-Term vs. Long-Term Memory and Consolidation

• Early LTP (Long-Term Potentiation) corresponds to short-term memory changes that occur within seconds to minutes. These changes are easily destroyed.

• Late LTP represents the more permanent changes that lead to memory consolidation, occurring over hours, days, or even weeks. This stage is crucial for easier memory retrieval.

• Memory Consolidation:

  • The formation of memory traces or engrams in the brain is the synaptic event occurring as part of Late LTP.

  • This process involves significant protein synthesis, including more AMPA receptors, structural proteins, and Brain-Derived Neurotrophic Factors (BDNF).

  • Structural changes such as the growth of new dendritic spines, enlargement of existing spines, and the formation of new synapses occur.

  • Memory formation is a complex process requiring significant protein synthesis, energy (ATP), and various chemical factors. Any problem in these steps can destroy memory.

• Converting Short-Term to Long-Term Memory:

  • Repetitions and revisions are essential for converting short-term memory (Early LTP) into long-term memory (Late LTP). Without effort and repeated learning, not every learning process will be converted into consolidated memory.

C. Neuroplasticity and Brain Health for Learning & Memory

• Neuroplasticity is the brain's incredible ability to reorganize itself and form new neuronal connections. It is a continuous process throughout life.

• While the number of neurons is generally stable, the hippocampus has an ability to produce more neurons and connections, with it being documented that one-third of neurons in the hippocampus can be new by the age of 60. Neurogenesis also occurs in the olfactory mucus memory.

• Neuroplasticity is modified by various stimuli. Factors that enhance brain health, memory, and learning include:

  • Repeated learning.

  • Engaging in mental activities like solving puzzles.

  • Exercise: Significantly increases the production of brain-derived neurotrophic factors (BDNF).

  • Adequate sleep: Also linked to BDNF production.

  • Sun exposure (sunbath).

  • Healthy food habits.

  • Learning new skills.

  • Socializing.

  • Maintaining organization and setting clear goals.

• Neuroplasticity is also important for regaining brain activity after injury or concussion. Neuronal recovery is based on factors like growth factors, neurotropics, and BDNF. There is potential for regeneration in certain parts of the hippocampus.

D. The Teacher's Role in Facilitating Learning and Memory

• Understanding Student Development: As teachers, especially for First MBBS students (around 19-20 years old), it's important to understand that they are still in a phase where synaptic pruning is occurring. Their prefrontal lobe, concerned with social behaviour, is still undergoing pruning during late adolescence. This means their brain is still being refined, and their responses might sometimes reflect this ongoing process.

• Motivation is Key:

  • The encoding process, the first critical step in memory, is significantly influenced by motivation and concentration. If a student is not motivated, encoding will not be proper, and subsequent memory processing stages will be compromised.

  • Teachers need to plan and create conditions favourable for learning and motivate students.

  • However, nothing can replace the self-effort of the learner; if the learner is not motivated, even a highly knowledgeable teacher will fail to impart knowledge.

• Effective vs. Efficient Teaching: Teachers should strive to be effective teachers rather than just efficient ones. This means ensuring that what is taught produces a real change in students' knowledge, skills, or attitude, not just completing the allotted portion. This aligns with competency-based medical education (CBME) which emphasizes student-oriented, active learning, and problem-solving methods.

• Addressing Attention Span: The attention span of learners has progressively decreased (from 45 minutes to 20 minutes, and in the "reels and shorts" generation, even less). To maintain attention, student activities or interactions must be planned within lectures to break monotony.

• Innovative Teaching Methods for Memory Consolidation: Various methods can enhance encoding and memory consolidation:

  • Brainstorming: For general idea generation, where pre-preparation is not needed, and diverse solutions are sought from a large group.

  • Snowballing (or Think-Pair-Share): Students first think individually, then discuss in pairs, and potentially form larger groups to arrive at a consensus. Think-Pair-Share is easier to implement in large groups.

  • Bus Groups: Small groups within a large class discuss a specific point.

  • Fishbowl Technique: An inner circle of students discusses a concept while an outer circle observes and learns passively, with roles able to be reversed.

  • Team-Based Learning (TBL): Involves pre-class preparation, individual and team readiness assurance tests, followed by clarification and problem-solving activities. It fosters higher-level cognitive domains like analysis and problem-solving.

  • Case-Based Learning (CBL): Discussing a topic by presenting a relevant case, typically completed in one session to increase student interest.

  • Problem-Based Learning (PBL): Students are given parts of a clinical history and must research, collaborate, and gradually arrive at a diagnosis over multiple sessions. It requires significant learner effort and is not easily completed in one session.

  • Peer-Assisted Learning: High-scoring students teach low-scoring peers, especially useful in large groups.

  • Concept Mapping/Mind Mapping: Visual mapping of basic concepts, connecting main ideas, which can be given as assignments.

  • Game-Based Learning: Utilizing games, puzzles, or treasure hunts for learning (currently more in educational research).

  • Narrative Writing: Students write case histories as stories for effective domain learning and generating interest.

  • Reflective Writing: Students document what happened, what they learned ("so what"), and how it will change their future behaviour ("so what next") to develop the effective domain.

  • Self-Directed Learning (SDL): The learner takes full ownership of their learning, including goals, materials, and assessment.

  • Self-Learning Packages: Teachers design and make a package available (e.g., via a portal), and students access it at their convenience, with assessment often mandatory.

  • One-Minute Preceptor: A technique for intellectual skills in bedside clinics, involving commitment, probing, teaching, reinforcing, and correcting in a short summary.

  • DOA (Demonstrate, Observe, Assist, without Assistance): For psychomotor skills, where the teacher demonstrates, observes the student, assists, and finally allows the student to perform independently.

  • Pattent Four-Step Approach: A detailed method for teaching psychomotor skills involving teacher demonstration (with and without commentary), and trainee commentary while performing.

  • Cine-Education: Using film clips to impart effective domain skills, especially communication skills.

E. Challenges in the Learning Environment

• Time Constraints: Implementing many of these interactive methods requires significant time, which can be challenging given the limited time available in the curriculum (e.g., eight months).

• Student Motivation and Effort: Students often prefer easier methods, like downloading materials from YouTube or online sources, rather than actively engaging with notes or seminars.

• Reliance on AI: A new challenge is the increasing reliance on tools like ChatGPT or AI for assignments and reflective writing, which may bypass genuine learning. Teachers need to find ways to disconnect AI from student activities, perhaps by having preparation and presentation done in class under supervision.

• Balancing Activity Quantity with Effectiveness: While many activities can be planned, the number of activities that can be effectively supervised by a teacher in a large group setting is limited. The focus should be on making whatever is done effective.

V. The Evolving Role of the Teacher

A. Defining the Teacher's Purpose in a Changing Educational Landscape

• Teaching as a Catalyst for Behavioral Change: Teaching is defined as a process by which an expected change in the students' behavior is anticipated. This goes beyond mere information transfer.

• Shift from "Efficient" to "Effective" Teaching:

  • A teacher should strive to be an "effective teacher" rather than just an "efficient teacher".

  • An "efficient teacher" focuses on completing the allotted portions of the curriculum.

  • An "effective teacher," however, ensures that "what we have taught has really produced a change in the students' knowledge, students' skill or students' attitude". This aligns with the principles of Competency-Based Medical Education (CBME), which emphasizes student-oriented, active learning, and problem-solving methods.

B. Understanding the Learner's Evolving Brain

• Synaptic Pruning in Adolescence: Teachers, particularly for First MBBS students (around 19-20 years old), are catering to a group whose brains are still undergoing significant development. Synaptic pruning – the elimination of less-used synapses – is an ongoing process, especially in the prefrontal lobe (concerned with social behavior), which continues through late adolescence.

• Teacher's Role in Guiding Brain Development: It is the teacher's responsibility to "give them the right kind of information to provide them the right kind of stimulation so that the pruning occurs in the most efficient and most appropriate and most adequate manner". Teachers should understand this ongoing process and not blame students for "inexperienced responses," attributing it instead to the continued synaptic pruning and synaptogenesis in their brains.

C. Core Responsibilities and Qualities of the Modern Teacher

• Facilitator and Motivator:

  • The teacher's role should be more of a "facilitator" than a traditional teacher.

  • Motivation is a key factor for proper encoding of information in the brain. If a student is not motivated, encoding will be compromised, affecting subsequent memory processing stages like consolidation, storage, and retrieval.

  • Teachers play a main role in "planning and creating a condition which is favorable for learning and... motivate our students".

  • However, it's crucial to acknowledge that "nothing can replace the knowledge of the teacher and the self effort of the learner unless the learner is motivated however knowledgeable the teacher is will fail to impart the knowledge to the students". The learner's self-effort is paramount.

• Comprehensive Roles (Harden and Crosby): Educationalists Harden and Crosby have described 12 defined roles of a teacher, which go beyond just imparting knowledge. Teachers are not only information providers but also act as:

  • Role models.

  • Facilitators.

  • Assessors.

  • Involved in planning curriculum and developing resources.

• Adapting Teaching Methods:

  • No single teaching method is considered best; the suitable method must be adopted based on the audience, objective, competency, situation, and available resources.

  • Methods should be aligned with competencies and objectives, motivating, feasible, and suit the teacher's personality. If a method isn't comfortable for one teacher, it's better to delegate it to someone else who is.

• Addressing Decreasing Attention Span: The attention span of learners has significantly decreased (from 45 minutes to 20 minutes, and even less in the current "reels and shorts" generation). To maintain attention throughout a lecture, student activities or interactions must be planned within the lecture to break monotony.

D. Challenges in the Modern Teaching Environment

• Time Constraints: Implementing many interactive and innovative teaching methods is challenging due to limited time in the curriculum (e.g., an eight-month course).

• Student Motivation and Preference for Convenience: Students often seek "easier" learning methods, preferring online materials from YouTube or other sources over actively taking notes or participating in class. They may also download presentations for seminars rather than preparing them thoroughly.

• The AI Dilemma: A new challenge is the increasing reliance on Artificial Intelligence (AI) tools like ChatGPT for assignments and reflective writing, which may bypass genuine learning.

E. Strategies for Effective Teaching in Addressing Challenges

• In-Class Activities and Supervised Work: To counter the use of AI for assignments and seminars, it is suggested that teachers "do it in like class itself". This involves giving students a short topic and some time for preparation within the classroom, followed by their presentation in the same session. While this may reduce the number of activities, it ensures that whatever is done is effective and genuinely performed by the students.

• Emphasis on Student-Centered, Active Learning: CBME specifically advises a move towards learner-oriented teaching processes, promoting student-oriented, active learning, problem-solving methods, and incorporating skilled teaching. This approach aligns with the understanding that active engagement enhances neuroplasticity and memory consolidation.

• Advising on Brain Health for Learning: Teachers can advise students on factors that enhance neuroplasticity, learning, and memory, such as:

  • Repeated learning.

  • Engaging in mental activities like solving puzzles.

  • Exercise (increases Brain-Derived Neurotrophic Factors - BDNF).

  • Adequate sleep (also linked to BDNF production).

  • Sun exposure.

  • Healthy food habits.

  • Learning new skills.

  • Socializing.

  • Maintaining organization and setting clear goals.

VI. Innovative Teaching-Learning Methods (TLMs)

The modern educational landscape, particularly under Competency-Based Medical Education (CBME), emphasizes a shift towards learner-oriented teaching processes, promoting student-oriented, active learning, problem-solving methods, and skilled teaching. This approach is crucial due to the decreasing attention span of learners, which has reportedly come down from 45 minutes to 20 minutes, and even less in the current "reels and shorts" generation. To maintain attention throughout a lecture, student activities or interactions must be planned within the lecture to break monotony.

A. General Concepts for Adopting Innovative TLMs

• No single method is considered best.

• The suitable method must be adopted based on several factors:

  • The audience (e.g., large group, small group, individual).

  • The objective or competency to be achieved.

  • The situation and available resources.

• Methods should be:

  • Aligned to competency and objective.

  • Suitable for the learner.

  • Motivating.

  • Feasible to implement for the teacher.

  • Suit the teacher's personality; if a teacher is not comfortable with a method, it is better to delegate it to someone who is.

B. Innovative Teaching-Learning Methods

These methods aim to make classes more interactive and motivate learners, moving beyond traditional teacher-oriented approaches. They cater to various learning domains: cognitive, psychomotor, and affective.

1. Large Group Methods (Breaking Monotony in Lectures) These methods can be planned as short activities (e.g., 5 minutes) within a lecture to maintain student engagement.

• Brainstorming:

  • Purpose: To generate diverse ideas or solutions from a large group for a general concept or problem.

  • How it works: A question or concept is posed to the large group, and students are asked to come up with answers or ideas. For example, given a scenario (e.g., a 20-year-old female with pallor), students suggest differential diagnoses.

  • Key Features:

    1. No pre-preparation needed from students.

    2. No predefined solution; the goal is variety of solutions.

    3. Requires teacher control to manage discussion and ensure all generated points are noted.

• Snowballing:

  • Purpose: To progressively refine ideas through collaborative discussion, moving from individual thought to whole-class consensus.

  • How it works:

    1. Solo Brainstorming: Each student individually thinks about an answer to a question.

    2. Pair Discussion: Two students pair up and discuss their individual answers to come up with a single, agreed-upon answer.

    3. Group Expansion: These pairs then join with other pairs, gradually increasing the group size, with discussions continuing until the whole class reaches a single answer.

  • Note: This is more complicated and tedious to implement in a typical setup compared to brainstorming.

• Think-Pair-Share:

  • Purpose: A simpler, more easily implemented version of snowballing, suitable for large groups, promoting individual thought followed by peer discussion.

  • How it works: Students are given a question, asked to think separately, then pair with a peer to discuss their answers, and finally share their combined answer with the larger group or teacher.

• Bus Groups:

  • Purpose: Similar to Think-Pair-Share, involving small group discussions within a large class.

  • How it works: Students form small groups to discuss a particular point or question, and then present their findings. This can be a short (e.g., 5-minute) activity planned into a lecture.

2. Small Group / Learner-Centered Methods

• Fishbowl:

  • Purpose: To promote active discussion among a small group while allowing a larger group to learn by observation.

  • How it works: A small group of students forms an inner circle and discusses a concept or topic, acting as the primary learners and discussion participants. A larger group forms an outer circle and passively observes the inner circle's activity.

  • Key Feature: The inner circle students are actively learning and leading the discussion, while the outer circle students learn by observation without active participation. Roles can be reversed later.

3. Specific Learning Paradigms These methods are distinct and involve different levels of student preparation and teacher guidance.

• Case-Based Learning (CBL):

  • Purpose: To apply theoretical knowledge to real-life clinical scenarios, enhancing student interest and understanding.

  • How it works: Teachers discuss a specific topic (e.g., hypothyroidism) and then use a relevant clinical case to illustrate and discuss the concepts.

  • Key Feature: Typically completed within one session. It's widely used and easier to implement.

• Problem-Based Learning (PBL):

  • Purpose: To develop problem-solving skills and self-directed learning by having students work through an incomplete clinical problem to arrive at a diagnosis.

  • How it works:

    1. Session 1: Students are given only a partial clinical history and asked to research and come up with various differential diagnoses.

    2. Session 2: Students present their differential diagnoses. More information (e.g., complete history, general investigations) is provided, allowing them to narrow down the possibilities.

    3. Session 3: The definitive clinical diagnosis is revealed, leading students from a problem to a diagnosis.

  • Key Feature: Requires multiple sessions, significant time, effort, and research from the learner's side. It's not easy to implement in all setups.

• Team-Based Learning (TBL):

  • Purpose: To promote collaborative learning and engage higher levels of cognitive domains like analysis and problem-solving.

  • How it works:

    1. Pre-Class Preparation: Teachers provide materials and resources, and students prepare before class.

    2. Individual Readiness Assurance Test (I-RAT): Students take an individual test (e.g., MCQs) in class.

    3. Team Readiness Assurance Test (T-RAT): Students are then divided into small teams and take the same test collaboratively, typically achieving higher scores due to group discussion.

    4. Clarification and Discussion: The teacher clarifies doubts and facilitates discussion on the concepts. This aligns with a "flipped classroom" approach where learning happens before class, and class time is for discussion and feedback.

    5. Application Activities: Students are given tasks or problem-solving activities to solidify their understanding.

  • Key Feature: Heavily student-centered, focusing on interactive and collaborative learning to develop higher-order cognitive skills.

4. Other Innovative Methods

• Peer-Assisted Learning (PAL):

  • Purpose: To provide individualized attention and support to students, especially in large groups, by leveraging high-achieving peers.

  • How it works: Higher-scoring students are recruited to teach lower-scoring peers, either during or outside academic hours.

  • Key Feature: Promoted to address the challenge of providing individual attention in large classes.

• Concept Mapping / Visual Mapping / Mind Mapping:

  • Purpose: To help students visualize and connect key concepts of a difficult topic, suitable for visual learners.

  • How it works: Students are asked to prepare a concept map as an assignment, connecting the main concepts of a topic into a cohesive diagram. This can concisely summarize a whole concept on a single sheet.

  • Note: Can be utilized for museum or library projects under CBME.

• Game-Based Learning (GBL):

  • Purpose: To make learning engaging and fun, promoting interest in the subject.

  • How it works: Involves using games like puzzles, jigsaw groupings, or treasure hunts for learning.

  • Note: Currently more prevalent in educational research programs rather than routine curriculum implementation in colleges.

• Narrative Writing:

  • Purpose: To encourage students to capture patient stories and clinical events chronologically, fostering a more holistic understanding.

  • How it works: Instead of strictly following a format, students can be encouraged to write case histories or patient encounters as a story, detailing actual events in chronological order.

• Reflective Writing:

  • Purpose: To develop the affective domain in students by prompting self-reflection on learning experiences.

  • How it works: Students write about a learning scenario under specific headings: "What happened?" (describing the learning activity), "So what?" (analyzing the change it produced in them), and "What next?" (outlining future behavioral changes).

  • Key Feature: A very effective method for teaching the affective domain if done properly.

  • Challenge: Students often rely on ChatGPT or AI for reflective writing, bypassing genuine learning. A suggested countermeasure is to conduct such activities in-class under teacher control.

• Self-Directed Learning (SDL):

  • Purpose: To foster independent learning driven by student interest and initiative.

  • How it works: The student identifies their learning needs, sets goals, selects resource materials, and chooses assessment methods. The teacher's role is to provide direction.

  • Example: Students preparing for PG entrance exams who choose their own study materials and assessment exams.

• Self-Learning Packages (SLP):

  • Purpose: To provide structured learning content that students can access at their convenience, with teacher-designed material and assessment.

  • How it works: Teachers design a complete learning package (e.g., for research methodology), which is then uploaded to a platform (like Google Classroom or Moodle portal). Students access and study the package at their comfortable time, concluding with a mandatory exam.

  • Key Feature: The content and assessment are designed by the teacher, but teacher presence during learning is minimal.

5. Methods for Psychomotor/Skill Training These methods focus on developing practical skills.

• One Minute Preceptor (OMP):

  • Purpose: To efficiently provide feedback and instruction for intellectual skills, particularly in bedside clinics.

  • How it works: At the end of a bedside clinic, one minute is dedicated to:

    1. Getting a commitment from the student.

    2. Probing the student for evidence supporting their commitment.

    3. Teaching general rules.

    4. Reinforcing what the student did correctly.

    5. Correcting mistakes.

    6. In short, it's a one-minute summary of the clinical discussion.

• DOA (Demonstrate, Observe, Assist):

  • Purpose: To ensure effective learning of psychomotor skills through guided practice.

  • How it works:

    1. Demonstrate: The teacher shows the student how to perform the skill (e.g., examining radial pulse).

    2. Observe: The teacher observes the student performing the skill.

    3. Assist: The teacher assists the student when they make mistakes and corrects them.

    4. Finally, the student should be capable of performing the skill without assistance.

• Pattent Four-Step Approach:

  • Purpose: Another method for teaching psychomotor skills with a structured, progressive approach.

  • How it works:

    1. The teacher demonstrates the skill without any commentary.

    2. The teacher performs the skill again, this time spelling out each step or providing step-by-step commentary.

    3. The trainee spells out the commentary (describes the steps) while the teacher performs the skill.

    4. The trainee performs the skill without any assistance or commentary from the teacher.

  • Note: These psychomotor skill training methods are time-consuming and often require one-on-one teacher-student interaction.

6. Method for Affective Domain/Communication Skills

• Cine Education:

  • Purpose: To effectively teach attitudes and communication skills.

  • How it works: Utilizing film clips (not full movies) relevant to the learning objectives.

  • Note: Considered one of the most effective ways, alongside direct demonstration and role plays, to teach communication and attitudes.

C. Challenges and Considerations in Implementing TLMs

• Time Constraints: Implementing many interactive and innovative methods is challenging due to limited time in the curriculum (e.g., an eight-month course).

• Student Motivation and Preference for Convenience: Students often seek "easier" learning methods, preferring online materials (e.g., YouTube) over active class participation or note-taking. They may download presentations for seminars rather than preparing them thoroughly.

• The AI Dilemma: The increasing reliance on Artificial Intelligence (AI) tools like ChatGPT for assignments and reflective writing is a new challenge, as it may bypass genuine learning.

  • Suggested Solution: To counter AI use, it's proposed to conduct activities like assignments or seminar preparations in the class itself, allowing students short preparation time using textbooks and then presenting in the same session. While this reduces the number of activities, it ensures whatever is done is effective and genuinely performed by students.

D. Conclusion

Understanding the physiology of learning, including synaptogenesis, synaptic pruning, and memory processing (like LTP and LTD), is crucial for teachers. The students, especially those in late adolescence (e.g., First MBBS students around 19-20 years old), are in an evolving brain process where synaptic pruning is still active. Therefore, the teacher's role is to provide the right kind of information and stimulation to ensure pruning occurs efficiently and appropriately.

Ultimately, teachers must move beyond merely being "efficient" (completing portions) to being "effective" teachers, ensuring that what is taught genuinely produces a change in students' knowledge, skills, or attitudes. This requires motivating students, as motivation is a key factor for proper information encoding in the brain. While innovative methods are promoted, their adoption must be careful, considering suitability to the teacher, learner, teacher's personality, available resources, and the learning environment.

VII. Conclusion and Future Directions

The presentation provided a comprehensive overview of the physiological basis of learning and memory, emphasizing the brain's dynamic nature and its implications for medical education. It concluded with a discussion on various innovative teaching-learning methods.

Conclusion of the Session:

• The Ever-Changing Brain and Neuroplasticity: The session began by highlighting that humans are "born rich" in neurons (approximately 86 billion), but that synapses develop and refine later in life. Synaptogenesis peaks by 2-3 years, but critically, synaptic pruning occurs, particularly between 2-10 years and continuing into adolescence for the prefrontal lobe. This "use it or lose it" principle means that frequently used synapses are retained, while unused ones are eliminated, leading to a more refined and efficient brain. This continuous molding and changing of the brain is what is referred to as synaptic plasticity.

• Physiology of Learning and Memory:

  • Encoding is the critical first step in memory processing, converting stimuli into neuronal signals. Motivation and concentration at this stage are vital for better consolidation, storage, and retrieval.

  • The cellular mechanism behind learning and memory storage is based on the Hebbian postulate: "Neurons that fire together wire together".

  • Long-Term Potentiation (LTP) is the primary synaptic event for encoding, storage, and associative learning in long-term memory. It involves persistent stimulation leading to changes like increased neurotransmitter release (e.g., glutamate) and increased receptor sensitivity (e.g., AMPA and NMDA receptors, with calcium influx being key to activating protein kinases that enhance synaptic activity and lead to new protein synthesis for memory traces/engrams). This process takes minutes to hours (early LTP) or hours to days/weeks (late LTP for consolidation).

  • Long-Term Depression (LTD) is equally important, representing the weakening of synapses with low-frequency stimulation. This process is crucial for clearing irrelevant memories, refining neural circuits, and enabling new learning by preventing the saturation of LTP. Forgetting is a natural and necessary process.

  • Learning vs. Memory: Learning is the acquisition of new experiences, changing behavior based on past experiences, while memory is the storage and retrieval of this information. Not all learning becomes memory; repeated revisions are essential to convert short-term memory (early LTP) into long-term memory.

• The Teacher's Role in Medical Education:

  • Teachers must act as facilitators and effective teachers rather than just efficient ones, ensuring that what is taught produces a change in students' knowledge, skills, or attitudes.

  • Motivation is a key factor for proper encoding and memory processing. Teachers need to plan and create conditions favorable for learning and student motivation.

  • The "12 defined roles of a teacher" extend beyond information provision to include roles like role model, facilitator, assessor, curriculum planner, and resource developer.

• Innovative Teaching-Learning Methods (ITLMs):

  • No single method is universally best; methods should be aligned with competencies, objectives, learner suitability, and available resources.

  • The decreasing student attention span (now less than a minute for the "newer generation") necessitates incorporating activities to break monotony and maintain engagement.

  • ITLMs aim for learner-oriented, active learning, problem-solving, and skilled teaching. Discussed methods include:

    • Brainstorming: Generating ideas from a large group, time-limited and teacher-controlled.

    • Snowballing/Think Pair Share: Individual thinking, then pairing for discussion, then potentially expanding to larger groups to arrive at a single answer. "Think Pair Share" is an easier adaptation for large groups.

    • Bus Groups: Small group discussions within a large class, similar to Think Pair Share.

    • Fishbowl Technique: An inner circle of students discusses a topic while an outer circle observes and learns passively, with roles reversible.

    • Team-Based Learning (TBL): Involves pre-class preparation, individual readiness assurance tests (IRAT), team readiness assurance tests (TRAT), and in-class problem-solving, promoting collaborative learning and higher-order cognitive skills.

    • Case-Based Learning (CBL): Discussing a topic through a clinical case, typically completed in one session.

    • Problem-Based Learning (PBL): Students are given parts of a clinical problem over multiple sessions, requiring research and differential diagnosis to arrive at a definitive diagnosis.

    • Peer Assisted Learning (PAL): Higher-scoring students teach lower-scoring peers, especially useful for large groups.

    • Concept Mapping/Visual Mapping: Students create visual representations of concepts, consolidating information on a single sheet, useful for difficult topics.

    • Game-Based Learning: Utilizing puzzles, jigsaw grouping, treasure hunts for learning purposes (currently more in educational research).

    • Narrative Writing: Students write case histories as stories for affective domain.

    • Reflective Writing: Students reflect on learning experiences using headings like "what happened, so what, what next" for effective domain development.

    • Self-Directed Learning (SDL): Student-driven learning (needs, goals, materials, assessment).

    • Self-Learning Packages: Teacher-designed packages (e.g., on a portal) accessed by students at their convenience, with assessment often mandatory.

    • One Minute Preceptor: A bedside clinical teaching method focusing on commitment, probing, general rules, reinforcement, and correction within one minute.

    • DO A: For psychomotor skills – Demonstrate, Observe, Assist, and leave (student does without assistance).

    • Peyton's Four-Step Approach: For psychomotor skills – Teacher demonstrates without commentary; Teacher demonstrates with commentary; Trainee spells out steps while teacher demonstrates; Trainee performs without assistance or commentary.

    • Cine Education: Using film clips to teach effective domain or communication skills.

Future Directions:

Based on the discussion and challenges highlighted, several future directions emerge:

1. Research into Neurogenesis Factors: There is a strong suggestion to conduct research on factors that favor neonurogenesis (new neuron growth) in the hippocampus and olfactory mucus memory. The potential application of these findings to help in the regeneration of spinal cord neurons following injury, without harm, is a significant area for future investigation.

2. Addressing AI Integration in Learning: The increasing reliance of students on AI tools like ChatGPT for assignments and reflective writing poses a challenge. Future efforts need to focus on strategies to effectively "disconnect this AI from our students" during in-class activities, or conversely, to innovatively integrate AI in a controlled manner that genuinely enhances learning rather than substituting it. The suggestion to make students prepare and present within class time for assignments is one such immediate solution.

3. Optimizing Implementation of Innovative Methods: While many ITLMs were discussed, practical challenges like time constraints within the tight medical curriculum remain. Future efforts should focus on developing feasible and effective strategies for integrating these methods into daily teaching, ensuring they lead to actual learning outcomes and address student motivation issues. This might involve prioritizing which methods are most impactful for specific learning objectives and designing efficient ways to use them.

4. Continuous Teacher Training and Adaptation: As new concepts and teaching methodologies emerge, there's a need for teachers to continuously train themselves to effectively impart knowledge and adapt to the changing learning landscape, including understanding the underlying neuroscience.

5. Holistic Approach to Student Learning and Well-being: The discussion briefly touched upon the importance of daily habits like repeated learning, solving puzzles, exercise, adequate sleep, sun exposure, healthy food, learning new skills, socializing, and setting goals for improving memory and learning. Future directions could involve formally integrating these aspects into student support and guidance programs to enhance overall learning effectiveness, recognizing their physiological basis.

6. Broader Implementation of Game-Based Learning: Currently more of an educational research program, further exploration and wider implementation of game-based learning could be a future direction to increase student engagement and motivation, especially given the decreasing attention spans.

7. Sustaining Student Motivation: The observed decline in student motivation post-entrance exams is a critical area. Future strategies must delve deeper into understanding the root causes of this demotivation and developing innovative, long-term approaches to sustain student engagement and enthusiasm for learning throughout their medical education.