A Doctor's Journal
Learning to Learn
By MILES HOWARD WHEN 11 ..was swotting through a lot of rather dull textbooks, after the war, to prepare for higher degree exams, I was obliged to go over the same passage not once or twice, but a dozen times, before it was 'recorded.' Each reading was duller than the last, and. I was sus- tained only by the belief that repetition was essential to learning. To memorise material that had little reality value for me was very much harder than in the old days at school, when it was no trouble at all. I put the difference down to 1.-c, !e. and relied on repetition to ram the stuff home.
Looking back now on that tedious exercise, I can see that I misjudged the. memory-function : it is less machine-like, more subtle and more in- fluenced by states of feeling than we commonly suppose. Also, many of our ideas about it have turned out to be wrong. Irvin Rock, in the Scientific American, has described some experi- Ments,which seem to show that simple repetition does not help us to learn. Where there is too much material to 'record' at one trial, it eaters into learning only in the sense that it provides a chance to see again what has not been learned in an earlier .trial. The real villain in memorising is interference. Cut down interference, and learn- ing speeds up. If we have to learn a long list of items by heart, we do best to concentrate on making one or two connections on the first trials; if we try to memorise everything, we may learn nothing at all. Many observers have pointed to the im- portance of insight—the sudden flash of under- standing, often called the `Aha' experience. Sudden insight may be related to the sudden for- mation of associative links between items the student is trying to memorise. This is but one factor in the complex process of recording and recall which is the basis of our intellectual opera- tions. The student must know how to learn in order to pass his exams and practise his pro- fession, but everyone is learning (or should be) throughout life.
How strange, then, that so little effort and money is expended on research into the learning process in all its aspects! Education, in every field, has been far too much preoccupied with teaching and the content of curricula and far too little with the conditions of learning. At the recent conference on experiment in medical edu- cation at the Royal College of Physicians, it was refreshing to hear Nicolas Malleson speak on this theme: in an address of quite outstanding fluency and wit he called for more operational research on study problems in the student. I hope his comments were recorded in the brains of his distinguished audience and will issue in action. It was good to see so many teachers of medicine gathered together for the exchange of ideas. An especially bold and extensive experiment--the re- planning of the entire medical course at Western Reserve University in America—was described by one of its main architects, Dr. Hale Ham. Not long ago I met one of his students, on a visit to England, and was impressed by the en- thusiasm, even fervour, which she quite plainly felt for her chosen task in life. In some of our schools it seems to be not quite 1.1' to display fervour about medical work—about cricket, of course, but not study. I wonder why? The English distrust passionate feelings, I suppose, about everything except games.
As Maurice Backett said in his recent broad- cast talk, the tale of road accidents is now so large as to constitute an epidemic: the volume of injury and death resulting from accidents which might have been avoidable is a challenge to our society—but, as with a number of other kindred challenges, no one seems disposed to take it seriously. In the meantime, anything that can be done to reduce the death roll from these injuries is worth doing.
Two neurosurgeons from Newcastle, with their assistants, have now described new techniques of treatment for the patient with'severe head in- jury. After one of. these injuries the ;temperature sometimes rises to 104' and over and the, body becomes rigid; when these signs occur, the mor- tality is as high as 77 per cent. The surgical team has been able to bring this startling figure down to 38 per cent. by means of tracheotomy (to clear the airway) and cooling of the body by ice packs, air circulation and a 'lytic cocktail' made up of various drugs which protect against shock and relax muscle spasm. The impairment of breath- ing begins from the moment of •injury,. and the authors believe that if it is dealt with at once, and techniques of handling the patient are still further improved, the mortality of severe head injury could be brought down to 20 per cent. Under this regime, most of the patients who recovered will be fit to return to productive work and will not remain a burden to their families or the community.
This is indeed a remarkable advance in sur- gical skill for which we must be grateful. The main task, however—prevention of accidents— still remains : the problem of ,injuries on the road is a grisly skeleton in the cupboard, and there can be no effective way of tackling it until the cupboard door is opened and the problem is squarely faced.
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