the role of emotion in the learning and transfer of ... · pdf filemoods on knowledge transfer...

The Role of Emotion in the Learning and Transfer of

Clinical Skills and Knowledge

Meghan McConnell, PhD Kevin Eva, PhD

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Emotion and Learning

Knowledge Transfer

• The act of applying conceptual knowledge in one context to solve a problem in a new or unfamiliar context

Purpose of Review

• Representative summary of literature on emotion and related cognitive processes

• Emphasis on learning and knowledge transfer in health professional training

Structure of Review

• Perception and Information Processing

• Interpreting Information

• Acting on Information

Structure of Review

• Perception and Information Processing – Attentional Scope



Attention

• Likened to “spotlight” or “zoom lens”

• Attention expands → focus on global features

• Attention narrows → focus on local details

Global vs. Local Attention

• Examined impact of emotions on visual attention • Mood induction => students viewed 1 of 5 film

clips – 2 positive moods (amusement & serenity) – 2 negative moods (anger & anxiety) – Control

• Then perform global-local visual processing task

Global-Local Processing Task • Which of the two

comparisons items is most like the target item?

• Answer can be based on either global or local features

Comparison item 1 Comparison item 2

Target item

Fredrickson & Branigan (2003)





Target item


Global Features





Target item


Local Features

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Amusement Serenity Control Anger Anxiety

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• Examined effects of positive and negative moods on knowledge transfer

• Learning Phase – Solve 3 and 4 disk Tower

of Hanoi puzzles • Induce positive and negative moods

• Transfer Phase => solve 3 tasks – Similar surface features

• 5 disk Tower of Hanoi

– Dissimilar in surface features • Missionary-Cannibal Problem • Katona Card Problem

Positive Negative

Example: Pimping (in Medicine)

“[Pimping] increases retention of key points by being provocative. Most students recall these sessions very well…Finding the right balance between humiliating the student who gives incorrect answers and boring the audience by simply providing the answers is a real skill” (Detsky, 2009)

The Art of Pimping (in Medicine)

Pimping • Are pimping events more memorable and if so,

why? – Indirect effects?

• More likely to replay pimping events? • More likely to look up information?

– Direct effects? • Induces local processing style, increase memory for details

• Does pimping promote or impede the transfer

– Indirect effects? • More likely to replay pimping events? • More likely to look up information?

– Direct effects? • Induces local processing style, increase

attention to details

• Does pimping promote or impede the transfer?

Perception & Information Processing: Summary

• Positive moods – Global processing – ↑ knowledge transfer

• Negative moods – Local processing – ↓ knowledge transfer

• Dangers of pimping?

Structure of Review


• Interpreting Information – Cognitive Flexibility


Flexible Thinking • Being capable of or

responsive to change • Allows for discovery of

new strategies and solutions to problems

Cognitive Flexibility & Emotion

• Examined whether mood influences the ability to think beyond old, established strategies

• Induce positive or negative mood states - Write about “happy and positive” or “sad

and negative” life events

Cognitive Flexibility

• Participants then complete a problem solving task • Identify words from a string of letters

without rearranging the letters

GZOQAXT

Cognitive Flexibility

• Participants then complete a problem solving task • Identify words from a string of letters

without rearranging the letters

GZOQAXT GOAT

GZOQAXT GOAT Part I → Establish specific strategy

FYROOMG

Part II → Can use either established strategy OR more obvious strategy


FYROOMG FROG



FYROOMG ROOM FROG




Part III → “Set breaking trial” to disrupt strategy

FYROOMG ROOM FROG

GXEVERZOE




FYROOMG ROOM FROG

GXEVERZOE GEEZE




FYROOMG ROOM FROG

GXEVERZOE EVER GEEZE




Part IV → Solved using either strategy

FYROOMG ROOM FROG

GXEVERZOE EVER GEEZE

FYROOMG ROOM FROG

Gasper, 2003

Results

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1st half of Experiment 2nd half of Experiment

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d Positive Mood

Negative Mood

Clinical Errors

• Could emotions impact diagnostic accuracy? – e.g., premature

closure (acceptance of diagnosis before it has been verified)

Premature Closure: An Example

A 55 year old heavy smoker with poorly controlled diabetes presents with protracted vomiting. His clinician, suspecting diabetic gastroparesis, requests abdominal radiography, which shows a large gastric air bubble. Considering the diagnosis confirmed, he fails to consider neurological causes of vomiting and misses findings of bilateral papilloedema and central ataxia. Subsequent computed tomography of the head shows multiple enhancing lesions in the posterior fossa (Scott, 2009)

• Examined effects of positive mood on “anchoring” – Tendency to fixate on first impressions

• Control vs positive mood manipulation • Diagnose written case

– “45-year old female who presented with a 6-month history of arthralgias, fatigue, dark urine, and ‘red spots’ on both legs.”

• Use “think aloud” protocol

ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES Vol. 72, No. 1, October, pp. 117–135, 1997 Positive Affect Facilitates Integration of Information and

Carlos A. Estrada, Alice M. Isen, and Mark J. Young Decreases Anchoring in Reasoning among Physicians






Decreases Anchoring in Reasoning among Physicians Carlos A. Estrada, Alice M. Isen, and Mark J. Young









A 45-year old female presents with a 6-month history of arthralgias, fatigue, dark urine, and “red spots” on both legs. She was seen at another hospital and was told she could have lupus




Decreases Anchoring in Reasoning among Physicians Carlos A. Estrada, Alice M. Isen, and Mark J. Young • Degree of anchoring

– “Hypothesis was maintained in spite of non-supportive or disconfirming evidence”

– Raters made global assessment of anchoring




Decreases Anchoring in Reasoning among Physicians Carlos A. Estrada, Alice M. Isen, and Mark J. Young • Degree of anchoring

– “Hypothesis was maintained in spite of non-supportive or disconfirming evidence, by distortion or ignoring disconfirming evidence”


Example of high anchoring: Physician continues to consider hemolytic anemia after discovering the patient had jaundice, spider angiomata, and elevated liver function tests





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Positive Mood

Control



Interpreting Information: Summary

• Sad → more likely to get locked into a single decision strategy

• Happy → more likely to alter strategy on their own accord – Reduction in anchoring bias?

Structure of Review



• Acting on Information – Feedback

Feedback

• Important pedagogical tool • Both positive and negative feedback can have

similar influences on motivation and performance

• Why?

• Promotion Focus – Sensitive to advancement opportunities, rewards,

and accomplishments

• Prevention Focus – Sensitive to security, punishment, and avoiding

negative outcomes Higgins, 1998

→ Sensitive to positive feedback

→ Sensitive to negative feedback

Feedback

• “Imagine you are working at a job that…” – You have always desired (promotion focus) – You had to keep (prevention focus)

• Then told you either failed or excelled on a task • How much effort do you intend to invest in future

performance?

Results

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Promotion Focus Prevention Focus

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Positive Feedback Negative Feedback

Results

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Positive Mood, High Arousal

e.g., excitement, happiness

Positive Mood, Low Arousal e.g., relief, relaxation

Negative Mood, Low Arousal e.g., apathy,

discouragement

Negative Mood, High Arousal e.g., tension,

anxiety

Results

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Positive Mood, Low Arousal e.g., relief, relaxation

Negative Mood, High Arousal

e.g., tension, anxiety

Positive Mood, High Arousal

e.g., excitement, happiness

Negative Mood, Low Arousal e.g., apathy,

discouragement

Acting on Feedback “In task situations, arousal cues can be experienced as task-relevant feedback concerning the urgency or importance of current thoughts and inclinations. High arousal cues intensify tendencies to act in line with current thoughts and inclinations, whereas low arousal cues do not.” – Storbeck & Clore, 2008

Acting on Information: Summary

• Promotion focus → greater motivation with positive feedback (success)

• Prevention focus → greater motivation with negative feedback (failure)

• Role of arousal?

Emotion, Learning & Knowledge Transfer

Concluding Remarks

The Power of Affective States

• Mood inductions used in cognitive psychology experiments are minimal – Brief film clips – Candy – Recalling emotional event

• Emotional experiences in medical training and care are much more extreme

Source of Emotional Experiences?

• Emotions brought into the learning environment by trainees (internal source)

vs • Emotions specific to learning events (external

source)

• High prevalence of both in medical settings

Controlling the Influence of Emotions?

• Individuals can modulate the effects of mood on performance – When are irrelevant to

task (Berkowitz et al., 2000; Gasper, 2004)

– Differences in “emotional differentiation” (Barrett et al., 2001; Seo & Barrett, 2007)


• Individuals can modulate the effects of mood on performance – When irrelevant to task

(Berkowitz et al., 2000; Gasper, 2004)


Developing Emotional Awareness in Physicians

• Can we train physicians to be aware of how emotions bias perceptions, interpretations, and actions? – Simulated situations?

Developing Emotional Awareness in Physicians

• Can we train physicians to be aware of how emotions bias perceptions, interpretations, and actions? – Simulated situations? – Self-reflective checklists/self-audits?

• “How am I feeling right now?”

“Emotions have profound effects on learning. As such, administrators, educators, and designers of learning environments should pay attention to the emotions experienced by learners” (Pekrun, 2011)

“It’s okay, this is a teaching hospital. Some people just have to learn the hard way.”

Conclusions

Thank you for your attention!

[email protected]

Pure Grumpiness

Caffeine Jolt-O-Rama

Early Morning Stupefaction

Splitting Headache #1

Momentary Panic Attack

Caffeine Overdose

Pure Discontent

Waves of Nausea

Resentment of Others

Early After-noon Catatonia

Splitting Headache #2

Sudden Awareness of Incompetency


• Individuals can modulate the effects of mood on performance – When irrelevant to task

(Berkowitz et al., 2000; Gasper, 2004)


Preference for Prevention?

Self-Reflective Checklists

Meier, Back & Morrison, 2001

Dependent Variables 1. Generation of liver domain hypothesis 2. Hypothesis verification 3. Degree of anchoring






42 “…so, ah, here, I think we can now, at this point, narrow it down to a problem with the liver, it doesn’t necessarily have a liver involvement, I, it sort of narrows my differential diagnosis is to two major groups, liver disease and hemolysis ummm….again…her father…her father had a stroke at age 80…she traveled to Toronto…what else is there?

43 44 45 46 47




42 “…so, ah, here, I think we can now, at this point, narrow it down to a problem with the liver, it doesn’t necessarily have a liver involvement, I, it sort of narrows my differential diagnosis is to two major groups, liver disease and hemolysis ummm….again…her father…her father had a stroke at age 80…she traveled to Toronto…what else is there?

43 44 45 46 47

This transcript contained 174 lines → (43/174) * 100 = 24.7%.




156 “…Umm, lets’ review, jaundice, petechiae, spider angiomata, six months . So she has, definitely had chronic liver disease… hemolysis, Um, out of the question, Um Lupus, no, . . Liver disease, Um . . . But from what? . . . one option is that something is damaging the liver . . . alcohol?”

157 158 159 160




Transcript contained 259 lines → (157/259) * 100 = 60.6%. 156 “…Umm, lets’ review, jaundice, petechiae, spider angiomata,

six months . So she has, definitely had chronic liver disease… hemolysis, Um, out of the question, Um Lupus, no, . . Liver disease, Um . . . But from what? . . . one option is that something is damaging the liver . . . alcohol?”

157 158 159 160


– “Occurred when a hypothesis was maintained in spite of non-supportive or disconfirming evidence, by distortion or ignoring disconfirming evidence”



Decreases Anchoring in Reasoning among Physicians Carlos A. Estrada, Alice M. Isen, and Mark J. Young Dependent Variables 1. Generation of liver domain hypothesis 2. Hypothesis verification 3. Degree of anchoring


– “Occurred when a hypothesis was maintained in spite of non-supportive or disconfirming evidence, by distortion or ignoring disconfirming evidence”



Decreases Anchoring in Reasoning among Physicians Carlos A. Estrada, Alice M. Isen, and Mark J. Young Dependent Variables 1. Generation of liver domain hypothesis 2. Hypothesis verification 3. Degree of anchoring

Example of high anchoring: Physician continues to consider hemolytic anemia after discovering the patient had jaundice, spider angiomata, and elevated liver function tests



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Control

What We’ve Learned So Far… • Perception and Information Processing

– Negative emotions → focus on details – Positive emotions → focus on big picture, increase transfer

• Interpreting Information – Negative emotions → adhere to specific strategy – Positive Emotions → alter strategy on their own accord

• Acting on Information – Prevention Focus → motivated by negative feedback – Promotion Focus → motivated by positive feedback

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