The generation effect: activating broad neural circuits during memory encoding

Effectiveness of Child-rearing Information Booklet among Adolescent Mothers: A Quasi-experimental Non-equivalent Pre-test-Post-test Control Group Study

Background

Child-rearing is challenging for adolescent mothers at risk of providing limited care to their children because of the challenges and demands of simultaneously being an adolescent and a mother. Children aged 0-2 years depend on caregivers like their young mothers to promote their physical, emotional, social, and cognitive growth and development.

Objective

The study aimed to determine the effectiveness of the Child-rearing Information Booklet (CRIB) among adolescent mothers with children aged 0-2 years on the three dimensions of knowledge, attitude, and practices.

Methods

The study utilized the quasi-experimental non-equivalent pre-test-post-test control group design to investigate 30 intervention and 30 comparison adolescent mothers with children aged 0-2 years who met the study criteria in Baguio City from January 2019 to January 2021. The fishbowl sampling technique was used in selecting the population and the specific barangays. A validated self-made questionnaire (I-CVI of 0.95 with Cronbach's α of 0.96) determined both groups' knowledge, attitude, and practices (KAP). The study used the weighted mean for adolescent mothers' KAP while an independent sample t-test analyzed the significant change in the scores of both groups and to answer the significant difference in the pre- and post-test scores between the two groups.

Results

The results revealed that both groups are knowledgeable about child-rearing skills. Both groups have a favorable attitude when caring for their children and have a very satisfactory practice in childcare. The study also yielded a significant difference in the change of scores in the pre- and post-test scores of the two groups, specifically in knowledge and practice, while no significant difference in their attitude. It also presented a significant difference in the post-test scores between the two groups along with their knowledge (large effect size), attitude (medium effect size), and practices (large effect size).

Conclusions

Adolescent mothers have pre-existing KAP in child-rearing. The CRIB effectively enhances adolescent mothers' child-rearing knowledge and practice. Also, the increase of scores in KAP in child-rearing during the post-test may not be solely caused by the CRIB but also influenced by their age, level of education, living environment, experience in child-rearing, and age of their child. The CRIB has a high practical significance in improving the knowledge and practices among adolescent mothers but not in their attitude.

Assessing the Effectiveness of Student-generated Scenario-based Questions as a Tool for Active Learning

Background

Active learning is not new as an educational philosophy and its benefits over passive learning modes are well known. In a competency-based framework, active learning is one of the key thrust areas. However, across the globe studies have shown that its implementation is wrought with challenges and limitations. The present study explored the implementation and effectiveness of an innovative technique of active learning where students in small groups of 5-6 construct structured scenario-based questions (SBQs) and learn in the process of making questions.

Objectives

The study was done with the objective of assessing the effectiveness and feedback of student-generated SBQs as a method of active learning among medical students.

Materials and Methods

Sensitization about the project was done followed by deciding the topics which could be covered with this method. The method was implemented in Physiology for Phase 1 MBBS students. During implementation, two small groups (25 students each) were randomly assigned into a "study group" and two into a "control group." The students were given trigger topics, learning resources and then asked to make SBQs in sub-groups of 5-6. The questions were then opened to discussion, comments and answering by the peers. Knowledge obtained was compared by a pre-post analysis within-group using paired t-test. Between-group analysis was done using independent sample t-test. Feedback was collected both from faculty and students on a Likert Scale.

Results

The study group recorded a statistically significant higher score (11.92 ± 2.2) after the activity as compared to control group (8.04 ± 2.24). Feedback received from participants and faculty was positive with a mean score of more than 4 on a 5-point Likert Scale for all items, except feasibility in which the faculty feedback score was 3.67. Out of 49 participating students, 31 students commented on qualitative feedback that it was engaging. More than half (26) students mentioned they "want more such sessions."

Conclusion

The present study showed that this activity can be implemented in small group teaching hours of the timetable. It retains the benefits of active learning both in terms of learning outcomes and experientially. It can also be used as a means to implement problem-based learning and early clinical exposure.

Training the New Radiologists: Approaches for Education

The field of Radiology is continually changing, requiring corresponding evolution in both medical student and resident training to adequately prepare the next generation of radiologists. With advancements in adult education theory and a deeper understanding of perception in imaging interpretation, expert educators are reshaping the training landscape by introducing innovative teaching methods to align with increased workload demands and emerging technologies. These include the use of peer and interdisciplinary teaching, gamification, case repositories, flipped-classroom models, social media, and drawing and comics. This publication aims to investigate these novel approaches and offer persuasive evidence supporting their incorporation into the updated Radiology curriculum.

Neural representation of a one-week delay in remembering information after production and self-generated elaboration encoding strategy

Many studies have confirmed the memory enhancement effect of production, generation and elaboration which can be effective after only one encoding. It is also known that greater memory enhancement effects can be obtained by combining multiple memory strategies during encoding. This study aimed to investigate whether the combination of production and self-generated elaboration enhances memory performance compared with production or generation alone. A total of 23 undergraduate and graduate students participated in this study. In the functional magnetic resonance imaging analysis, we explored the neural representation of remembering information after production and self-generated elaboration strategy. We set four encoding strategy conditions: (1) Read Silent (read without production), (2) Read Aloud (only production), (3) Add Silent (self-generated elaboration without production), (4) Add Aloud (production and self-generated elaboration). The retrieval performance and brain activity while retrieving the learned sentences after a one-week delay were examined. The behavioral results showed that the highest memory performance was for sentences encoded in Add Aloud. The interaction between production and self-generated elaboration was statistically significant. These results suggest that the memory enhancement effect of combining production and self-generated elaboration is not a simple addition nor synergistic facilitation effect. The imaging results showed that the following areas were related to the retrieval of the target encoded in the add aloud condition: the area related to integration of internal and external information (precuneus), area related to information rich stimuli (lateral occipital lobe), area related to self-involvement and inference of others' feelings (MPFC), area related to seen imagery (retrosplenial region) and area related to adjustment of movement (cerebellum). These results suggest that with an encoding strategy that combines production and self-generated elaboration, integrated auditory input of vocalizations and generated images, visual images of the scene, self-relevance, inference of other's feeling, movement by moving mouth are stored with the target and enhanced memory performance of AA.

Using the Lessons of Learning Science to Improve Medical Education in Otolaryngology

OBJECTIVE

This review synthesizes information from original research in the field of learning theory and the psychology of learning in order to provide evidence-based study methods to adult learners in the field of medicine.

METHODS

A literature review was conducted and results were synthesized in a narrative fashion.

RESULTS

Deeper levels of analysis produce longer lasting memory; therefore, the concept of creating a "desirable level of difficulty" when it comes to study material and methods has been shown to promote learning. When the learner uses a higher subjective level of effort in processing information, they can maximize the efficacy of their studying efforts. This review describes how memory encoding can be enhanced by applying several theories of learning psychology including the generation effect and the interleaving effect. The use of mnemonics, the "memory palace," and hand-written notes have also proven useful to enhance information recall. Methods that promote long-term learning including the spacing effect and delayed repetition are reviewed. Learning theory shows that the most effective learners use self-testing and forced recall to retain more information with limited study time.

CONCLUSIONS

The application of these learning methods may help to improve information retention and productiveness among adult learners.

Functional underpinnings of feedback-enhanced test-potentiated encoding

The testing effect describes the finding that retrieval practice enhances memory performance compared to restudy practice. Prior evidence demonstrates that this effect can be boosted by providing feedback after retrieval attempts (i.e. test-potentiated encoding [TPE]). The present fMRI study investigated the neural processes during successful memory retrieval underlying this beneficial effect of correct answer feedback compared with restudy and whether additional performance feedback leads to further benefits. Twenty-seven participants learned cue-target pairs by (i) restudying, (ii) standard TPE including a restudy opportunity, or (iii) TPE including a restudy opportunity immediately after a positive or negative performance feedback. One day later, a cued retrieval recognition test was performed inside the MRI scanner. Behavioral results confirmed the testing effect and that adding explicit performance feedback-enhanced memory relative to restudy and standard TPE. Stronger functional engagement while retrieving items previously restudied was found in lateral prefrontal cortex and superior parietal lobe. By contrast, lateral temporo-parietal areas were more strongly recruited while retrieving items previously tested. Performance feedback increased the hippocampal activation and resulted in stronger functional coupling between hippocampus, supramarginal gyrus, and ventral striatum with lateral temporo-parietal cortex. Our results unveil the main functional dynamics and connectivity nodes underlying memory benefits from additional performance feedback.

Kessler Foundation Strategy-Based Training to Enhance Memory (KF-STEM™): Study protocol for a single site double-blind randomized, clinical trial in Multiple Sclerosis

New learning and memory impairments are common in Multiple Sclerosis (MS) and negatively impact everyday life, including occupational and social functioning. Despite the demand for learning and memory treatments, few cognitive rehabilitation protocols are supported by Class I research evidence, limiting the degree to which effective treatments may be utilized with persons with MS. The present double-blind, placebo controlled randomized clinical trial (RCT) examines the efficacy of an 8-session cognitive rehabilitation protocol encompassing training in the application of three strategies with the strongest empirical evidence (self-generation, spaced learning and retrieval practice) to treat impaired learning and memory in persons with MS, Kessler Foundation Strategy-based Training to Enhance Memory (KF-STEM™). A sample of 120 participants with clinically definite MS who have impairments in new learning and memory will be enrolled. Outcomes will be assessed via three mechanisms, an Assessment of Global Functioning, which examines everyday functioning and quality of life, a Neuropsychological Evaluation to examine objective cognitive performance, and functional Magnetic Resonance Imaging to examine the impact of treatment on patterns of cerebral activation. We will additionally evaluate the longer-term efficacy of KF-STEM™ on everyday functioning and neuropsychological assessment through a 6-month follow-up evaluation and evaluate the impact of booster sessions in maintaining the treatment effect over time. The methodologically rigorous design of the current study will provide Class I evidence for the KF-STEM™ treatment protocol for persons with MS.

Production can enhance semantic encoding: Evidence from forced-choice recognition with homophone versus synonym lures

The production effect-better memory for words read aloud rather than silently-has been attributed to responses at test being guided by memory for the act of production. In Experiment 1, we evaluated this distinctiveness account by comparing production effects in forced-choice recognition when lures were either homophones of the targets (toad or towed?) or unrelated words (toad or seam?). If the production effect at test was driven solely by memory for the productive act (e.g., articulation, auditory processing), then the effect should be reduced with homophone lures. Contrary to that prediction, the production effect did not differ credibly between homophone-lure and unrelated-lure groups. Experiment 1 led us to hypothesize that production may also boost semantic encoding, and that participants use memory of semantic encoding to guide their forced-choice responses. Consistent with these hypotheses, using synonym lures to interfere with semantic-based decisions (poison or venom?) reduced the production effect relative to using unrelated lures (poison or ethics?) in Experiment 2. Our findings suggest that enhanced conceptual encoding may be another useful product of production.

Scalable Science Education via Online Cooperative Questioning

A critical goal for science education is to design and implement learning activities that develop a deep conceptual understanding, are engaging for students, and are scalable for large classes or those with few resources. Approaches based on peer learning and online technologies show promise for scalability but often lack a grounding in cognitive learning principles relating to conceptual understanding. Here, we present a novel design for combining these elements in a principled way. The design centers on having students author multiple-choice questions for their peers using the online platform PeerWise, where beneficial forms of cognitive engagement are encouraged via a series of supporting activities. We evaluated an implementation of this design within a cohort of 632 students in an undergraduate biochemistry course. Our results show a robust relationship between the quality of question authoring and relevant learning outcomes, even after controlling for the confounding influence of prior grades. We conclude by discussing practical and theoretical implications.

Sex Differences in the Blood Oxygen Level-Dependent Signal to Placebo Analgesia and Nocebo Hyperalgesia in Experimental Pain: A Functional MRI Study

Objective

Placebo as well as nocebo responses are widely found in scientific research and clinical practice. Growing evidence suggests sex differences in placebo as well as nocebo responses. However, data concerning this question are still insufficient. This study examined whether the BOLD signals of two responses, as measured with functional MRI (fMRI), differ by sex under conditions of equivalent experimental pain perception.

Method

Thirty-one healthy volunteers (14 female) underwent two fMRI scans, once during a placebo intervention and once during a nocebo intervention, pseudorandomly ordered, in an acute lower back pain (ALBP) model. We collected visual analog scale (VAS) data after each scanning. fMRI data from different sex groups were subjected to functional connectivity (FC) analysis and behavioral correlation analysis (BCA).

Results

The results showed statistical differences in VAS scores between male and female participants, in both placebo and nocebo responses. Both groups also showed reduced FC in the pain-associated network of the placebo response and elevated FC in the pain-related network of the nocebo response. However, in the placebo condition, male participants displayed increased FC in the ventromedial prefrontal cortex, parahippocampal gyrus (PHP), and posterior cingulate cortex (PCC), while female participants showed increased FC in the dorsolateral prefrontal cortex, hippocampal gyrus (HP), and insular cortex (IC). In the nocebo condition, male participants showed decreased FC in the PCC and HP, while female participants displayed decreased FC in the mid-cingulate cortex, thalamus (THS), and HP. The BCA results of the two groups were also different.

Conclusion

We found that the endogenous opioid system and reward circuit play a key role in sex differences of placebo response and that anxiety and its secondary reactions may cause the sex differences of nocebo response.

Theories of the generation effect and the impact of generation constraint: A meta-analytic review

The generation effect is the memory benefit for self-generated compared with read or experimenter-provided information. In recent decades, numerous theories have been proposed to explain the memory mechanism(s) and boundary conditions of the generation effect. In this meta-analysis and theoretical review, we analyzed 126 articles (310 experiments, 1,653 estimates) to assess 7 prominent theories to determine which theories are supported by the existing literature. Because some theories focus on item memory (memory for the generated target) and others focus on context memory (memory for details associated with the generated target), we examined memory effects for both types of details (item, context) in this meta-analysis. Further, we assessed the influence of generation constraint (how constrained participants are to generate a certain response), which recent work has shown affects the magnitude of the generation effect. Overall, the results of this meta-analysis support some theoretical accounts, but not others, as explanatory mechanisms of the generation effect. Results further showed that generation constraint significantly moderates the magnitude of the generation effect, suggesting that this factor should be rigorously investigated in future work. Overall, this meta-analysis provides a review and examination of generation effect theories, and reveals important areas of future research.

Comparing factual recall of tapped vs. handwritten text

As a result of the rushed transition to remote teaching because of the COVID-19 pandemic, teachers have suddenly been forced to design mobile-assisted language learning (MALL; m-learning) activities, mostly for the first time in their careers. However, it is imperative that instructors realize that the challenge is greater than simply converting paper-based assignments into a digital format. There has been very little research done examining the cognitive effects of writing on a smartphone, compared to writing on paper. The current study therefore sought to examine how recollection of content differed depending on the medium used for notetaking. A population of 138 Japanese university students of English-as-a-Foreign-Language (EFL) were asked to transcribe a short text, either by paper or by smartphone, and then quizzed on the content immediately afterwards. Students who wrote the text by hand were found to have significantly greater recollection of the content compared to those who had 'tapped' on smartphones. These results follow precursor research which indicated that Japanese students compose significantly slower on their phones in English (Lee, 2020b), and wrote significantly less in writing tasks (Lee, 2019, 2020a) than handwriting counterparts.

Exploring why we learn from productive failure: insights from the cognitive and learning sciences

Advances in Health Sciences Education (AHSE) has been at the forefront of the cognitive wave in health professions education for the past 25 years. One example is research on productive failure, a teaching strategy that asks learners to attempt to generate solutions to difficult problems before receiving instruction. This study compared the effectiveness of productive failure with indirect failure to further characterize the underpinning cognitive mechanisms of productive failure. Year one pharmacy students (N = 42) were randomly assigned to a productive failure or an indirect failure learning condition. The problem of estimating renal function based on serum creatinine was described to participants in the productive failure learning condition, who were then asked to generate a solution. Participants in the indirect failure condition learned about the same problem and were given incorrect solutions that other students had created, as well as the Cockcroft-Gault formula, and asked to compare and contrast the equations. Immediately thereafter all participants completed a series of tests designed to assess acquisition, application, and preparation for future learning (PFL). The tests were repeated after a 1-week delay. Participants in the productive failure condition outperformed those in the indirect failure condition, both on the immediate PFL assessment, and after a 1-week delay. These results emphasize the crucial role of generation in learning. When preparing novice students to learn new knowledge in the future, generating solutions to problems prior to instruction may be more effective than simply learning about someone else's mistakes. Struggle and failure are most productive when experienced personally by a learner because it requires the learner to engage in generation, which deepens conceptual understanding.

Sex, Age, and Handedness Modulate the Neural Correlates of Active Learning

BACKGROUND

Self-generation of material compared to passive learning results in mproved memory performance; this may be related to recruitment of a fronto-temporal encoding network. Using a verbal paired-associate learning fMRI task, we examined the effects of sex, age, and handedness on the neural correlates of self-generation.

METHODS

Data from 174 healthy English-speaking participants (78M, 56 atypically handed; ages 19-76) were preprocessed using AFNI and FSL. Independent component analysis was conducted using GIFT (Group ICA fMRI Toolbox). Forty-one independent components were temporally sorted by task time series. Retaining correlations (r > 0.25) resulted in three task-positive ("generate") and three task-negative ("read") components. Using participants' back-projected components, we evaluated the effects of sex, handedness, and aging on activation lateralization and localization in task-relevant networks with two-sample t-tests. Further, we examined the linear relationship between sex and neuroimaging data with multiple regression, covarying for scanner, age, and handedness.

RESULTS

Task-positive components identified using ICA revealed a fronto-parietal network involved with self-generation, while task-negative components reflecting passive reading showed temporo-occipital involvement. Compared to older adults, younger adults exhibited greater task-positive involvement of the left inferior frontal gyrus and insula, whereas older adults exhibited reduced prefrontal lateralization. Greater involvement of the left angular gyrus in task-positive encoding networks among right-handed individuals suggests the reliance on left dominant semantic processing areas may be modulated by handedness. Sex effects on task-related encoding networks while controlling for age and handedness suggest increased right hemisphere recruitment among males compared to females, specifically in the paracentral lobe during self-generation and the suparmarginal gyrus during passive reading.

IMPLICATIONS

Identified neuroimaging differences suggest that sex, age, and handedness are factors in the differential recruitment of encoding network regions for both passive and active learning.

Associative Recognition Memory Awareness Improved by Theta-Burst Stimulation of Frontopolar Cortex

Neuroimaging and lesion studies have implicated specific prefrontal cortex locations in subjective memory awareness. Based on this evidence, a rostrocaudal organization has been proposed whereby increasingly anterior prefrontal regions are increasingly involved in memory awareness. We used theta-burst transcranial magnetic stimulation (TBS) to temporarily modulate dorsolateral versus frontopolar prefrontal cortex to test for distinct causal roles in memory awareness. In three sessions, participants received TBS bilaterally to frontopolar cortex, dorsolateral prefrontal cortex, or a control location prior to performing an associative-recognition task involving judgments of memory awareness. Objective memory performance (i.e., accuracy) did not differ based on stimulation location. In contrast, frontopolar stimulation significantly influenced several measures of memory awareness. During study, judgments of learning were more accurate such that lower ratings were given to items that were subsequently forgotten selectively following frontopolar TBS. Confidence ratings during test were also higher for correct trials following frontopolar TBS. Finally, trial-by-trial correspondence between overt performance and subjective awareness during study demonstrated a linear increase across control, dorsolateral, and frontopolar TBS locations, supporting a rostrocaudal hierarchy of prefrontal contributions to memory awareness. These findings indicate that frontopolar cortex contributes causally to memory awareness, which was improved selectively by anatomically targeted TBS.

Age related-changes in the neural basis of self-generation in verbal paired associate learning

Verbal information is better retained when it is self-generated rather than when it is received passively. The application of self-generation procedures has been found to improve memory in healthy elderly and in individuals with impaired cognition. Overall, the available studies support the notion that active participation in verbal encoding engages memory mechanisms that supplement those used during passive observation. Thus, the objective of this study was to investigate the age-related changes in the neural mechanisms involved in the encoding of paired-associates using a self-generation method that has been shown to improve memory performance across the lifespan. Subjects were 113 healthy right-handed adults (Edinburgh Handedness Inventory >50; 67 females) ages 18–76, native speakers of English with no history of neurological or psychiatric disorders. Subjects underwent fMRI at 3 T while performing didactic learning (“read”) or self-generation learning (“generate”) of 30 word pairs per condition. After fMRI, recognition memory for the second word in each pair was evaluated outside of the scanner. On the post-fMRI testing more “generate” words were correctly recognized than “read” words (p < 0.001) with older adults recognizing the “generated” words less accurately (p < 0.05). Independent component analysis of fMRI data identified task-related brain networks. Several components were positively correlated with the task reflecting multiple cognitive processes involved in self-generated encoding; other components correlated negatively with the task, including components of the default-mode network. Overall, memory performance on generated words decreased with age, but the benefit from self-generation remained consistently significant across ages. Independent component analysis of the neuroimaging data revealed an extensive set of components engaged in self-generation learning compared with didactic learning, and identified areas that were associated with age-related changes independent of performance.

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Verbal information is better retained when self-generated vs. received passively.

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Application of self-generation is associated with better retention across ages.

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Generated words were retained better than read words.

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Several components of network for word generation were identified.

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Age-associated changes within the network are discussed.

Dynamic changes in parietal activation during encoding: implications for human learning and memory

The ventral posterior parietal cortex (vPPC) monitors successful memory retrieval, yet its role during learning remains unclear. Indeed, increased vPPC activation during stimulus encoding is often negatively correlated with subsequent memory performance, suggesting that this region is suppressed during learning. Alternatively, the vPPC may engage in learning-related processes immediately after stimulus encoding thus facilitating retrieval at a later time. To investigate this possibility, we assessed vPPC activity during item presentation and immediately following its offset when a cue to remember was presented. We observed a dynamic change in vPPC response such that activity was negatively correlated with subsequent memory during stimulus presentation but positively correlated immediately following the stimulus during the cue phase. Furthermore, regional differences in this effect suggest a degree of functional heterogeneity within the vPPC. These findings demonstrate that the vPPC is engaged during learning and acts to facilitate post-encoding memory processes that establish long-term cortical representations.