Internal Medicine

Deep Surface Learning

Deep Surface LearningSurface Learning

At the risk of oversimplification, the surface learner views learning as:

1. A quantitative increase in knowledge: acquiring information or “knowing a lot”.

2. Memorising: in other words, storing information that can be reproduced.

3. Acquiring facts, skills and methods that can be retained and used as necessary.

Surface learners tend to be motivated primarily by fear of failing an exam, rather than by any desire to master the subject. Sadly, the fear is not that of becoming a poor doctor, only that of failing an exam. As such the drive to learn is predominantly external. The emphasis is on rote learning, which is difficult: hence learning may be experienced as an uphill struggle, characterised by fighting against boredom and feelings of inadequacy.

Note that surface learning is a maladaptive learning style, not a personality disorder! Many of the surface learners we encounter are very hard workers who continually disappoint themselves. Unfortunately, in the South African context, issues of previous schooling are probably very powerful in determining this. We must not conflate the compulsive surface learners with that group of poorly motivated, lazy students who try to scrape by with as little work as possible.

Problematic Surface Learners in the Medical Class

Students vary in the balance they strike between deep and surface learning. There is no doubt however that that small group which relies almost entirely on a surface approach present us, as clinical teachers, with most of our problem students. Here are common behavioural characteristics of the student most wedded to surface learning, which are deeply worrying to concerned staff and ultimately fail to benefit the student in any meaningful way:

1. They flounder as soon as they are asked to explain, justify or reason their way through a case or a scenario. In terms of Blooms’ taxonomy, they have not moved of the first level.

2. They under-perform repeatedly in public activities such as bedside tutorials and group discussions, since they cannot match the other students as soon as any conceptual thinking, comprehension, analysis or evaluation is required. After a while this repeated failure becomes embarrassing to all participants, and tutors begin to avoid asking such students questions, so as to spare them the humiliation of once again being unable to answer.

3. Learning may be strategic: concentrate on this to scrape enough to pass, ignore that.

4. They place extreme importance on protected “swottting time” just before examinations. This is because the mind set is that the more one can cram in, the better one will perform in the exam.

5. They are driven to “write off” their subjects as soon as possible. This is because: (a) They do not understand that there is no point at all in cramming in knowledge in the absence of long-term retention: it is all “use, forget and move on”. (b) They are under no illusions as to the transience of their memories; since the memorisation is not grounded in schema-type thinking, it has a very short half-life; (c) They do not grasp the concept that they might well perform better at a later stage, when there has been more time for further learning, reflection, experience and reiteration to strengthen their developing schemata. This is, sadly, understandable since these activities are not part of their learning repertoire.

6. They tend to blame failure on extraneous factors such as unfair exams, inconsistent marking, examiners who don’t stick to the rules and negative marking in MCQs. The student who manages to squeeze 2 extra marks out of his or her 48% script, reaching the magic pass mark, feels entirely vindicated. There may be no concept that as doctors of the future they ought to be as deeply worried about a 50% as they should about a 48%.

7. They tend not to blame their own inadequacy for failure. Indeed, it is uncommon for such students to admit to being weak. This is probably not just pride or stubbornness: it may well be a reflection of the fact that, lacking insight into what true, deep learning is and why it is necessary for their future professional competence, they genuinely do fail to understand their own shortcomings.

8. They equate the chance of success with how hard they have worked: not how effectively they have learnt. They are genuinely aggrieved when they fail after a period of intense studying, even when shown just how poor their performance has been. This is seen as “unfair”, the unstated assumption being that effort, not competence, ought to be rewarded by marks, .

9. They fail repeatedly. Extra time makes very little difference. Consider a high-flying student. If his or her time in Medicine is doubled (for instance, by spending a student elective in the ward), performance increases exponentially, from being a good student to operating at a level that puts most house officers and some registrars to shame. In contrast, the failing student who has his or her time in Medicine extended from 9 to 18 weeks after failing, is lucky if his or her mark shifts from 48% to 55%. Not infrequently, it fails to rise at all. This is because the surface learner fails to switch his or her goals from rote memorisation to the higher order ones, such as the ability to understand, apply, analyse, evaluate, or synthesise. In effect they continue to apply a failed learning technique to their problem, without understanding that if it has failed repeatedly in the past, it is likely to continue doing so now.

10. They fail to recognise the importance of additional time in compensating for their severe deficiencies. Instead of asking for a further 9 weeks, students who fail will try to negotiate a supplementary exam for the following week.

11. They appear to evince no worry about the significance of their academic weakness for their future performance – the possibility that they may go through life as a very poorly competent doctor. Instead, all their anxiety is focused on the possibility of failing the next exam.

Deep Learning

In contrast, the deep learner views learning as:

1. Making sense or abstracting meaning: relating parts of the subject matter to each other and to the real world.

2. Comprehending the world by re-interpreting knowledge.

In simple language, the deep learner likes to take things apart and put them together again, preferably in different ways. They understand the importance of schema theory, even though they have never actually heard the term or thought about it explicitly. They know instinctively that knowledge and competence go beyond memorisation. They reap a double reward denied to the surface learner: not only are they able to perform in the application, analysis, evaluation and synthetic domain – which makes them competent clinicians – but they even remember the basic facts – that most fundamental of Blooms’s levels – a whole lot better than the surface learner who spends day and night attempting to memorise those same facts. This seems fundamentally unfair, but is a direct consequence of the fact that active learning is more successful in promoting commitment to memory than is passive learning.

Deep learning is experienced as exciting and a gratifying challenge. The motivation is largely intrinsic: students are driven and to learn effectively because they have a desire to understand the subject well and to be able to demonstrate their mastery of the subject and apply their knowledge to real-life problems. In the clinical years, this equates directly with wishing to perform as a competent clinician.

The interplay between the deep or superficial learning style and the success or otherwise of the laying down of the type of complex cognitive structures discussed under schema theory and the SOLO and Bloom’s taxonomies is self-evident.

The following table contrasts some key attributes of deep and surface learners.


           Relate all new knowledge to previous knowledge, thus strengthening their schemata. 
 Surface     Lay down new knowledge haphazardly, with nor relation or relevance to previous knowledge.

   Develop webs of relationships between different areas of a subject,and between subjects, as seen in  the SOLO taxonomy.
 Surface    Merely memorise information for the next examination.
 Deep    Relate theoretical concepts and basic principles to actual experience.
 Surface    Regard facts and concepts as something to be memorised, and kept apart from actual experience.
 Deep    Can distinguish a principle from an example of the principle, can distinguish evidence and argument.
 Surface    Cannot distinguish a principle from examples.
 Deep    Are comfortable with abstract thought.
 Surface    Default to concrete thought and examples.
 Deep    Organise and structure their knowledge into a coherent whole – essentially into schemata.

   Treat learning as dealing with an externally imposed body of factual knowledge, with no attempt to  reorder or reinterpret it.

   Are motivated from internal sources, principally the desire to master the subject, and to become  competent.

   Are motivated externally, principally by fear of failing an examination – and, more specifically, the next  examination.

Adapted from: Atherton JS (2005) Learning and Teaching: Deep and Surface learning [On-line] UK: Available: Accessed: 5 February 2009

© R J Hift