Implicit visual learning: How the task set modulates learning by determining the stimulus–response binding

Gamification, Serious Games, and Simulation in Health Professions Education

Health care educators may enhance learning with thoughtful incorporation of game elements. Gamification has shown success across various fields in medical education. It has demonstrated deeper engagement by leveraging both intrinsic and extrinsic motivational factors. While beneficial, gamification requires thoughtful implementation to increase active learning and avoid potential negative effects, such as unhealthy competition. Serious games integrate learning objectives directly within their framework, making the educational experience an intrinsic part of gameplay. These games are specifically designed to enhance knowledge and skills while promoting decision making, teamwork, and communication. The immersive nature of serious games requires players to actively engage and apply their knowledge to solve complex problems. Serious games and simulation represent transformative educational approaches that not only enhance learning and retention but also develop essential competencies crucial for health care professionals. These strategies, when combined with effective debriefing, provide a robust framework to enrich education and training in health care. [Pediatr Ann. 2024;53(11):e401-e407.].

Across-task binding: The development of a representation in learning a continuous movement sequence

Across-task binding is defined as the stimulus/response of one task being linked to the response of another task. The purpose of the present experiment was to determine across-task binding in a continuous movement sequence task with an auditory task of high and low pitch tones and the development of a movement sequence representation. According to the two systems theory of sequence learning, we expected that the developed representation in the across-task binding context relies on the multi-dimensional system rather than on the unidimensional system which is restricted to a set of modules where each module processed information along one task/dimension. An inter-manual transfer design was used to disentangle the sequence representations. The mirror transfer test required the same pattern of muscle activation and joint angles (motor coordinates) in the contralateral limb as experienced during the acquisition phase, while in the non-mirror transfer test, the visual-spatial locations (spatial coordinates) of the target waveform were reinstated. The main finding was that consistently combining visual-spatial positions in a sequence and auditory dimensions such as the tone pitch does not rely on a multidimensional system as predicted by the two-systems theory.

Concurrent visual sequence learning

Many researchers in the field of implicit statistical learning agree that there does not exist one general implicit learning mechanism, but rather, that implicit learning takes place in highly specialized encapsulated modules. However, the exact representational content of these modules is still under debate. While there is ample evidence for a distinction between modalities (e.g., visual, auditory perception), the representational content of the modules might even be distinguished by features within the same modalities (e.g., location, color, and shape within the visual modality). In implicit sequence learning, there is evidence for the latter hypothesis, as a stimulus-color sequence can be learned concurrently with a stimulus-location sequence. Our aim was to test whether this also holds true for non-spatial features within the visual modality. This has been shown in artificial grammar learning, but not yet in implicit sequence learning. Hence, in Experiment 1, we replicated an artificial grammar learning experiment of Conway and Christiansen (2006) in which participants were supposed to learn color and shape grammars concurrently. In Experiment 2, we investigated concurrent learning of sequences with an implicit sequence learning paradigm: the serial reaction time task. Here, we found evidence for concurrent learning of two sequences, a color and shape sequence. Overall, the findings converge to the assumption that implicit learning might be based on features.

Enriched environments enhance the development of explicit memory in an incidental learning task

Learning, rendered in an implicit (unconscious) or explicit (conscious) way, is a crucial part of our daily life. Different factors, like attention or motivation, influence the transformation from implicit to explicit memory. Via virtual reality a lively and engaging surrounding can be created, whereby motivational processes are assumed to be a vital part of the transition from implicit to explicit memory. In the present study, we tested the impact of an enriched virtual reality compared to two conventional, non-enriched 2D-computer-screen based tasks on implicit to explicit memory transformation, using an audio-visual sequential association task. We hypothesized, that the immersive nature of the VR surrounding enhances the transfer from implicit to explicit memory. Notably, the overall amount of learned sequence pairs were not significantly different between experimental groups, but the degree of awareness was affected by the different settings. However, we observed an increased level of explicitly remembered pairs within the VR group compared to two screen-based groups. This finding clearly demonstrates that a near-natural experimental setting affects the transformation process from implicit to explicit memory.

What triggers explicit awareness in implicit sequence learning? Implications from theories of consciousness

This article aims to continue the debate on how explicit, conscious knowledge can arise in an implicit learning situation. We review hitherto existing theoretical views and evaluate their compatibility with two current, successful scientific concepts of consciousness: The Global Workspace Theory and Higher-Order Thought Theories. In this context, we introduce the Unexpected Event Hypothesis (Frensch et al., Attention and implicit learning, John Benjamins Publishing Company, 2003) in an elaborated form and discuss its advantage in explaining the emergence of conscious knowledge in an implicit learning situation.

The Role of IQ and Social Skills in Coping With Uncertainty in 7- to 11-Year-Old Children

Abstract. Most feedback we receive or give is correct (deterministic feedback), though a small fraction can be wrong for various reasons. Children need to cope with receiving some portion of wrong feedback (stochastic feedback). It is still unknown if better social functioning and communication skills or outstanding intelligence (IQ) or chronological age support children in the coping process. We tested a sample of 7-‍, 9-‍, and 11-year-old children ( N = 60) who deduced a sequence of four left and right button presses from a red and green stochastic feedback signal that was wrong in 15 % of the trials. Children performed worse with stochastic than with deterministic feedback but improved in the repeated trials, especially after receiving positive feedback about whether true or false. Controlling for IQ improved and confirmed these effects, while social and communicative competence explained little or no variance.

Task-separation in dual-tasking: How action effects support the separation of the task streams

Dual-task costs might reflect a direct consequence of confusions on the task-set level as both tasks are integrated into a single task-set, instead of two separate task-sets. In order to prevent this integration-driven interference, the two task streams have to be separated. Under three experimental conditions we investigated whether in a dual-task setting such separated task processing can be elicited by providing separated action effects for both tasks. Building on the finding that implicit sequence learning is hampered under dual-tasking conditions, we used it as an indicator for successfully separated task processing. To this end, we compared the implicit sequence learning effect under a single-task condition (baseline condition) to that under a dual-task condition either with separated action effects (action-effect condition) or with conjoined error feedback at the end of each trial (feedback condition): Learning should be unaffected under the former and reduced under the latter experimental condition. In all three conditions, the participants performed a visual-manual and an auditory-manual discrimination task which were always presented concurrently. The results show that, compared to the single-task condition, under dual-task conditions implicit sequence learning is hampered when only a conjoined error feedback is given, but is largely unaffected by dual-tasking when separated action effects are presented. Overall this suggests that whenever two tasks in a dual-task situation appear concurrently, they seem to get integrated into a single task-set by default. Yet, manipulations like the presentation of separated action effects could help to elicit a separated task processing, thus strengthening the representation as two separate task-sets.

No reduction of between-task interference in a dual-task with a repeating sequence of SOAs

A frequent observation in dual-tasking is that spatially or conceptually (in)compatible Task 2 response features can interfere with responses in Task 1 (backward crosstalk effect; BCE). Such between-task interference is, at least to some degree, under strategic control. It has been shown that the size of the BCE can be modulated by instructions, contextual regularities, recent experience of conflict, and motivational factors. Especially large temporal task overlap (i.e., short stimulus onset asynchrony, SOA) represents a condition of potentially high levels of between-task interference. Accordingly, Fischer and Dreisbach (2015) showed that specific stimuli, associated with mostly short SOAs, were able to reduce the size of the BCE. In the present study, we investigated whether a regular sequence of SOAs can also be used for contextual regulation of the BCE. In a dual-task with spatially (in)compatible hand- and foot-responses, we implemented a repeating sequence of three SOAs. If participants learned this sequence and used it for task shielding, the BCE should decrease over time in the sequence blocks, but should increase in a subsequent random block. However, this prediction was not supported in two experiments (N = 32 each). Instead, the size of the BCE was constant across all blocks (BFs₁₀ < 1 for the respective interactions). This is an important result, as it points at the necessity to discover the appropriate conditions allowing implicit SOA sequence learning and to further investigate whether or how the resulting implicit sequence knowledge can serve shielding against between-task interference.

Comparison of whole-body sensorimotor skill learning between strength athletes, endurance athletes and healthy sedentary adults

Motor sequences represent an integral part of human motor ability. Apart from simple movement sequences, complex coordinated movement sequences are the building blocks for peak athletic performance. Accordingly, optimized temporal and spatial coordination of muscle action across multiple limbs may be a distinguishing feature between athletes and non-athletes in many sports. In the present study, we aimed to assess differences between strength and endurance athletes and non-athletes during learning of a complex whole-body serial reaction time task (CWB-SRTT). For this purpose, 26 nonathletes (NAG) and 25 athletes (AG) learned the CWB-SRTT over 2 days separated by 7 days. Mean response times of participants were recorded and statistically analyzed for sequence-specific and non-sequence-specific improvements, as well as differences in learning rates and retention. Furthermore, AG was subdivided into strength (SG) and endurance (EG) athletes, and all analysis steps were repeated. Our results show a better mean response time of AG compared to NAG. However, we could not detect differences in sequence-specific or non-sequence-specific learning, as well as different retention rates between NAG and AG or SG and EG. We assume here that a potential lack of motor transfer between general athletic abilities and the specific complex motor sequence mainly accounts for our findings.

Examining implicit procedural learning in tetraplegia using an oculomotor serial reaction time task

Background and objective

Clinical observations indicate that implicit procedural learning, a central component of physical and psychosocial rehabilitation, is impeded following spinal cord injury. In accordance, previous research has revealed a specific deficit in implicit sequence learning among individuals with paraplegia using a standard, manual version of the serial reaction time task. To extend these findings and shed light on the underlying sources of potential spinal cord injury-related deficits in sequence learning, we used an ocular activated serial reaction time task to compare sequence learning performance between individuals with tetraplegia and healthy controls.

Participants and measures

Twelve participants with spinal cord injury in C5-T1 were compared to 12 matched control participants on measures derived from an ocular activated serial reaction time task. Depression and additional cognitive measures were assessed to explore the source and specificity of potential sequence learning deficits.

Results

Like controls, and in contrast with previous findings in paraplegia, the spinal cord injury group showed intact implicit sequence learning, evidenced by declining reaction times and improved anticipation over the first six blocks of the serial reaction time task, and an advantage for the initial learning sequence over a novel interference sequence.

Conclusions

The ocular activated serial reaction time task elicited a performance pattern similar to standard motor versions, such that participants with tetraplegia demonstrated unimpaired sequence learning. This suggests that previously reported implicit sequence learning deficits in spinal cord injury directly involved motor functioning rather than cognitive aspects of the task, and that the ocular activated sequence learning task could be a valid alternative for assessing implicit sequence learning in populations that cannot perform spinal-cord dependent motor tasks. Implications for post-spinal cord injury rehabilitation and adjustment are discussed.

Implicit perceptual learning of visual-auditory modality sequences

We examined perceptual modality sequence learning by presenting number words either visually (V) or auditorily (A). Manual responses were assigned to number identity, which was random, but the stimulus modalities followed a predictable 6-element sequence (e.g., VVAAVA). In two experiments, we assessed sequence-specific learning as the performance difference between the predictable sequence and a random transfer sequence. We expected learning benefits, but for visual trials we did not find any clear predictability benefits, and, surprisingly, for auditory trials we even found a general processing disadvantage (i.e., a predictability cost) for auditory trials (Experiment 1) or a cost-benefit pattern (Experiment 2, with equated shift rates in predictable and random sequences), with costs for auditory repetition trials and benefits for shifting to auditory processing. Hence, overall there was a general learning "cost" (Experiment 1) or a null net benefit of predictability for performance (Experiment 2). Together, the findings reveal a modality-specific sensitivity towards variations in shift frequency and modality predictability only for auditory trials, but there was no overall benefit of modality-specific sequence learning.

Sequence Knowledge on When and What Supports Dual-Tasking

The constraints in overlapping response selection have been established in dual-tasking studies with random sequence of stimuli and responses as well as random stimulus onset asynchrony (SOA). While this approach makes it possible to control for advance activation of upcoming stimuli or responses, it leaves open whether such preparatory processing can indeed influence dual-task performance. We investigated whether and how the sequence of stimuli and responses and the sequence of SOAs can be learned and used under dual-tasking. In each trial, participants (N = 28 in Experiment 1 and N = 30 in Experiment 2) were first presented with a random two-choice task followed by a four-choice Serial Reaction Time Task (SRTT), presented in a sequence of length four (position sequence). The SOA (timing) sequence also had length four. In test phases, one or both of the sequences were randomized. Results showed that both position and timing sequences were learned and supported dual-task performance, suggesting that predictive processing with respect to timing and identity of stimuli and responses can help to circumvent the response selection bottleneck constraints. Furthermore, in contrast to previous work on acquisition of interval sequences in single tasking, we found that the sequence of what (i.e. stimulus) and the sequence of when (i.e. interval between two tasks) contributed independently to performance.

Response-effects trigger the development of explicit knowledge

In implicit learning, task-redundant response-effects can enhance the development of explicit knowledge. Here, we investigated whether learning a fixed sequence of effects (stimuli occurring immediately after the participant's keypress, but are not mapped to the identity of the respective response) influence the development of explicit rather than implicit knowledge when these effects are afterwards mapped to the identity of the responses. We tested first, whether participants would learn a fixed sequence of effects in a serial reaction time task when these effects were not mapped to the identity of the responses. Next, we tested whether learning this effect sequence in advance would facilitate the development of explicit knowledge about a contingently mapped sequence of responses. The results showed that participants acquired implicit knowledge when confronted with only the effect sequence. Moreover, the further findings suggest that learning the effect sequence in advance led to the development of primarily explicit knowledge about a subsequently added response-location sequence. We interpret these results in light of the Unexpected-Event hypothesis: A sudden feeling of sense of agency is unexpected and triggers inference processes. PsycINFO classification codes: 2340, 2343.

Translating visual information into action predictions: Statistical learning in action and nonaction contexts

Humans are sensitive to the statistical regularities in action sequences carried out by others. In the present eyetracking study, we investigated whether this sensitivity can support the prediction of upcoming actions when observing unfamiliar action sequences. In two between-subjects conditions, we examined whether observers would be more sensitive to statistical regularities in sequences performed by a human agent versus self-propelled 'ghost' events. Secondly, we investigated whether regularities are learned better when they are associated with contingent effects. Both implicit and explicit measures of learning were compared between agent and ghost conditions. Implicit learning was measured via predictive eye movements to upcoming actions or events, and explicit learning was measured via both uninstructed reproduction of the action sequences and verbal reports of the regularities. The findings revealed that participants, regardless of condition, readily learned the regularities and made correct predictive eye movements to upcoming events during online observation. However, different patterns of explicit-learning outcomes emerged following observation: Participants were most likely to re-create the sequence regularities and to verbally report them when they had observed an actor create a contingent effect. These results suggest that the shift from implicit predictions to explicit knowledge of what has been learned is facilitated when observers perceive another agent's actions and when these actions cause effects. These findings are discussed with respect to the potential role of the motor system in modulating how statistical regularities are learned and used to modify behavior.

Implicit acoustic sequence learning recruits the hippocampus

The exclusive role of the medial temporal lobe in explicit memory has been questioned by several studies reporting medial temporal lobe involvement during implicit learning. Prior studies have demonstrated that hippocampal engagement is present during the implicit learning of perceptual associations, however, it is absent during learning response-related associations. Therefore, it was hypothesized that the function of the medial temporal lobe during implicit learning is related to the extraction of perceptual associations in general. While in most implicit learning tasks visual stimuli were used, the aim of the current functional magnetic resonance imaging (fMRI) study was to detect whether activations within medial temporal lobe structures are also found during implicit learning of auditory associations. In a modified version of the classical serial reaction time task, participants reacted to the presentation of five different tones. Unbeknownst to the participants, the tones were presented with an underlying sequential regularity that could be learned. To avoid an influence of response learning on acoustic associative learning, response buttons were remapped in every trial. After learning, two different tests were used to measure participants' conscious knowledge about the underlying sequence in order to assess the amount of implicit memory and to exclude participants with explicit knowledge acquired during learning. fMRI results revealed hippocampal activations for implicit learning of the acoustic sequence. When detecting a relation between implicit learning of acoustic associations and hippocampal activations, this study indicated a relation between hippocampal activations and memory formation of perceptual-based relational representation regardless of explicit knowledge. Thus, present findings suggest a general functional role for the formation of sequenced perceptual associations independent of the involvement of awareness.

What You Feel Is What You See: A Binding Perspective on Evaluative Conditioning

In this paper, we outline the predominant theoretical perspectives on evaluative conditioning (EC)—the changes in liking that are due to the pairing of stimuli—identify their weaknesses, and propose a new framework, the binding perspective on EC, which might help to overcome at least some of these issues. Based on feature integration theory (Treisman &amp; Gelade, 1980, https://doi.org/10.1016/0010-0285(80)90005-5) and the theory of event coding (TEC; Hommel, Müsseler, Aschersleben, &amp; Prinz, 2001, https://doi.org/10.1017/S0140525X01000103), we assume that EC depends on a selective integration mechanism that binds relevant CS, US, and action features into an event-file, while simultaneously inhibiting features irrelevant for current goals. This perspective examines hitherto unspecified processes relevant to the encoding of CS-US pairs and their consequences for behavior, which we hope will stimulate further theoretical development. We also present some preliminary evidence for binding in EC and discuss the scope and limitations of this perspective.

Improving Abnormality Detection on Chest Radiography Using Game-Like Reinforcement Mechanics

RATIONALE AND OBJECTIVES

Despite their increasing prevalence, online textbooks, question banks, and digital references focus primarily on explicit knowledge. Implicit skills such as abnormality detection require repeated practice on clinical service and have few digital substitutes. Using mechanics traditionally deployed in video games such as clearly defined goals, rapid-fire levels, and narrow time constraints may be an effective way to teach implicit skills.

MATERIALS AND METHODS

We created a freely available, online module to evaluate the ability of individuals to differentiate between normal and abnormal chest radiographs by implementing mechanics, including instantaneous feedback, rapid-fire cases, and 15-second timers. Volunteer subjects completed the modules and were separated based on formal experience with chest radiography. Performance between training and testing sets were measured for each group, and a survey was administered after each session.

RESULTS

The module contained 74 cases and took approximately 20 minutes to complete. Thirty-two cases were normal radiographs and 56 cases were abnormal. Of the 60 volunteers recruited, 25 were "never trained" and 35 were "previously trained." "Never trained" users scored 21.9 out of 37 during training and 24.0 out of 37 during testing (59.1% vs 64.9%, P value <.001). "Previously trained" users scored 28.0 out of 37 during training and 28.3 out of 37 during testing phases (75.6% vs 76.4%, P value = .56). Survey results showed that 87% of all subjects agreed the module is an efficient way of learning, and 83% agreed the rapid-fire module is valuable for medical students.

CONCLUSIONS

A gamified online module may improve the abnormality detection rates of novice interpreters of chest radiography, although experienced interpreters are less likely to derive similar benefits. Users reviewed the educational module favorably.

Action-effects enhance explicit sequential learning

Different studies have shown that action-effect associations seem to enhance implicit learning of motor sequences. In a recent study (Haider et al., Conscious Cognit 26:145-161, 2014), we found indications that action-effect learning might play a special role in acquiring explicit knowledge within an implicit learning situation. The current study aims at directly manipulating the action-effect contingencies in a Serial Reaction Time Task and examining its impact on explicit sequence knowledge. For this purpose, we created a situation in which the participants' responses led to a melodic tone sequence. For one group, these effect tones were contingently bound to the sequential responses and immediately followed the key press; for the second group, the tones were delayed by 400 ms. For a third group, the tones also followed the response immediately and resulted in the same melody but were not contingently bound to the responses. A fourth control group received no effect tones at all. Only the group that experienced contingent effect tones that directly followed the response showed an increase in explicit sequence knowledge. The results are discussed in terms of the multi-modal structure of action-effect associations and the ideomotor principle of action control.

The Emergence of Explicit Knowledge in a Serial Reaction Time Task: The Role of Experienced Fluency and Strength of Representation

The Serial Reaction Time Task (SRTT) is an important paradigm to study the properties of unconscious learning processes. One specifically interesting and still controversially discussed topic are the conditions under which unconsciously acquired knowledge becomes conscious knowledge. The different assumptions about the underlying mechanisms can contrastively be separated into two accounts: single system views in which the strengthening of associative weights throughout training gradually turns implicit knowledge into explicit knowledge, and dual system views in which implicit knowledge itself does not become conscious. Rather, it requires a second process which detects changes in performance and is able to acquire conscious knowledge. In a series of three experiments, we manipulated the arrangement of sequential and deviant trials. In an SRTT training, participants either received mini-blocks of sequential trials followed by mini-blocks of deviant trials (22 trials each) or they received sequential and deviant trials mixed randomly. Importantly the number of correct and deviant transitions was the same for both conditions. Experiment 1 showed that both conditions acquired a comparable amount of implicit knowledge, expressed in different test tasks. Experiment 2 further demonstrated that both conditions differed in their subjectively experienced fluency of the task, with more fluency experienced when trained with mini-blocks. Lastly, Experiment 3 revealed that the participants trained with longer mini-blocks of sequential and deviant material developed more explicit knowledge. Results are discussed regarding their compatibility with different assumptions about the emergence of explicit knowledge in an implicit learning situation, especially with respect to the role of metacognitive judgements and more specifically the Unexpected-Event Hypothesis.