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Feb 11, 2020

[A quick introduction to the motivation for this post: my passion for physical therapy is paralleled by an interest in teaching and education and part of this intrigue with learning science is due to being exposed to learning principles at a young age. I am fortunate enough to be the daughter of Dr. Mark McDaniel, the prominent educational psychologist and co-author of Make it Stick: The Science of Successful Learning. I have been researching and using these principles in my work in clinic but also as a teaching assistant for various DPT courses at Ohio University and now at Emory University. The tips below are derived from a combination of research-supported learning methods from “Make it Stick” and studies on learning science as well as my own experience and adaptation of these principles as I strive to become a more effective learner and educator.]  




To enhance learning and memory, there are five main points that I want to make. In order for you to remember these, here is an easy acronym: 


To optimize learning, you want to go for GAINS!


  1.     “G”: Generate Connections
  2.     “A”: Active Retrieval Practice
  3.     “I”: Interleaving Practice 
  4.     “N”: New-Monics & Memory Tricks 
  5.     “S”: Spacing Practice 


Let me explain…


“G”: Generate Connections

One of the most difficult challenges in learning novel information is developing an understanding of where it fits within a “framework” of knowledge. The more you can link new information with prior knowledge, the better it will “stick”. However, this is challenging when you are learning new systems or frameworks because you don’t have as much prior knowledge. As a mentor, providing a rationale for WHY newly acquired information is important can make a world of difference in how effectively that information is utilized and remembered. 


For example, specific to physical therapy, when teaching special tests for a diagnosis it can be helpful to include the rationale for those tests instead of just giving instructions on how to perform each test. 


Another way to deepen understanding is to have students “teach forward” or “teach back”. The “teach back” method involves having a learner “teach back” newly learned information to an instructor with the idea that this process helps memory consolidation and remembering. This has been shown to be an effective way to enhance retention for certain healthcare information. One study in particular showed improved retention of ER discharge instructions when patients were asked to “teach back” to the provider the instructions given1.  


The “teach forward” method is when a learner is instructed to retain information with the expectation that they will be required to teach this information to someone in the future. For example, if a student is taught a specific exercise with the expectation that they will need to teach this exercise to a future patient, this could be thought of as “teaching forward”. Research has shown that when one is instructed to learn information with the expectation that they will have to teach it to another person, memory for that information is enhanced2. 



“A”: Active Retrieval Practice

The ideal practice conditions for memory retention involve some form of recall practice that is also called “Active Retrieval”. This can take the form of flash cards, quizzing with programs like “quizzlet” or merely practicing explaining concepts to mentors, patients, or even family and friends. This is in contrast to re-reading, during which you repeatedly read, you see the information, it looks “familiar” and you think that means that you KNOW IT! But, this is very different from being forced to recall information with minimal cueing or out of a familiar context.The more you practice actively remembering or retrieving information, the more likely you are to remember it in the future3


A few other ways that active retrieval can be promoted:

  • Giving low-stakes quizzes or assignments that force active retrieval of information
  • Write questions for yourself as you study and then in the future, take these self-made practice quizzes (also useful in group study settings)
  • As a mentor, utilize “Ask before telling: initiate conversations with mentees/students by asking questions instead of just dropping knowledge bombs. 



“I”: Interleaving Practice

Interleaving refers to study methods in which different types of content are studied in succession instead of “blocking” study of one type of information before moving on to the next subject. Again, it may feel intuitive to study one section of content at a time, but learning is often shown to be better if you mix a variety of content within study session 4,5. It is worth noting the benefits of “interleaving”, especially if you are structuring more formal practice sessions for students or mentees, you will want to keep this principle in mind. 



“N”: New-Monics & Memory Tricks 

Mnemonics are any techniques or methods that enhance memory. These can include acronyms, multi-sensory recall (e.g., imagery or “the method of loci”), or methods such as “chunking” (memorizing like information in groups or “chunks”). Mnemonics such as acronyms can enhance memory for information by providing retrieval cues. I often use mnemonics in my teaching of anatomy, for example using the acronyms as well as chunking to remember groups of muscles that work together such as the rotator cuff.



“S”: Spacing Practice 

Having time or “rest” in between practice sessions has been shown enhance learning as well, as it forces the learner to recall previous information and apply it from memory (likely in a different setting/environment)3.  In one study with surgical residents, spacing of practice sessions (4 practice sessions, 1x/week) drastically reduced “failed surgery” outcomes when residents were tested on a simulated surgical model (performed vascular surgery on a rat) compared with massed practice (4 practice sessions in one day)5.



Though many of you reading this are in or have been through a DPT program, these strategies (and more that are discussed in Make it Stick) can potentially be helpful in any type of learning environment and for diverse content types. That is pretty cool! 


If you are interested in learning more, definitely check out the references below and let us know what you think!


Thank you for reading!


Leda McDaniel PT, DPT




1. Slater BA, Huang Y, Dalawari P. The Impact of Teach-Back Method on Retention of Key Domains of Emergency Department Discharge Instructions. The Journal of Emergency Medicine. 2017;53(5):e59-e65.

2. Nestojko JF, Bui DC, Kornell N, Bjork EL. Expecting to teach enhances learning and organization of knowledge in free recall of text passages. Mem Cogn. 2014;42(7):1038-1048. 

3. Brown, PC, Roediger, HL, McDaniel, MA. Make It Stick: The Science of Successful Learning. Cambridge, Massachusetts: The Belknap Press of Harvard University Press, 2014.

4. Rohrer D, Taylor K The shuffling of mathematics problems improves learning. Instr Sci. 2007;35(6):481-498. 

5. Moulton C-AE, Dubrowski A, MacRae H, Graham B, Grober E, Reznick R. Teaching Surgical Skills: What Kind of Practice Makes Perfect?: A Randomized, Controlled Trial. Transactions of the . Meeting of the American Surgical Association. 2006;124:66-75. 




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