End of Classes and Bookends
Whew! Classes are over, summer is beginning, the students are off on a well-deserved vacation, and so are you!
It’s time to relax, kick back,have an umbrella drink, perhaps mow the lawn occasionally, right?
What I’d like to suggest that now is the time to plan your next course.That’s right—while the course is fresh in your mind, and the foibles, and successes are shining bright, it’s time to plan.
And I have an idea about your planning. It comes from Dr. Maryellen Weimer in her blog Faculty Focus.
Let’s use Bookends.
Book-ending as a pedagogical and course design strategy is relatively simple. Add structure and “tie things together” to your course by building a thread throughout. You introduce the thread in the first class, continue it as much (or as little) in your course as you like, and then bring it to closure with an activity similar to the first class, at the end of the course in the last class.
Bookends are a common technique in writing professions, such as screenwriting, storytelling, and even essay writing and I think it has particular relevance for us in health sciences education. Think of the cases we use, especially in medical education, to ask students to apply their foundational knowledge to the “stories” of patients. Those cases have a thread, and are bookended, aren’t they?
Let’s see how it could work in your course…
Activity 1: First and Last Day Worksheet:
From MaryEllen Weimer: On the first day of class, give students a worksheet that they fill out (either in class or online). In MEdTech, you could use an online quiz to do this. Use prompts like these: “What do you know about INSERT YOUR COURSE TITLE? Or “What do you know about…INSERT KEY CONCEPT? What reasons justify making this a required class? Are there skills that will you be needing as a professional that you hope to develop in this course?”
Pass out the same sheet on the last day, give students time to complete it, and then return the one they filled out the first day. Have a brief discussion about the differences and similarities of the two sheets. We did something similar in the former Professional Foundations Course at Queen’s where Dr. Ruth Wilson introduced students to the Intrinsic Roles of a physician, and then asked them to look back a year later to see what they’d learned, as part of their Portfolio assignment on what they’d learned about the intrinsic roles.
Activity 2: First and Last Day Problem:
Also from Dr. Weimer: Pass out a problem set on the first day. Give bonus points for answers and for work that shows the student spent some time searching for the solution. Calm students’ fears by indicating that they’ll see these problems throughout the course. Pass out the same problem set on the last day and watch for smiles.
Activity 3: Meet Mr. Ms. Lavigne…
…or Mr. Gonzales or…. whoever you’d like to “star in your bookend case. Ms. Lavigne is a patient whose case is introduced in the first class. Checking in with Ms. Lavigne happens throughout the course. It could be that, after a lecture on infection or infection control, or hospital acquired infections, Ms. Lavigne has had this complication in her case. Or after a learning event about safe opioid prescription, and opioid addiction, Ms. Lavigne has to be treated. We don’t want to overload Ms. Lavigne G with every condition in the book—it becomes a bit of a joke, if she’s not treated with respect, relevance and as someone encountering real-life issues. But Ms. Lavigne’s case can also be the wrap up of the course in order to ask the students, “What have you learned?”. You can follow Dr. Sue Moffatt’s example at Queen’s with the case of Mr. McCade, and have an integrated case that bookends three different body systems such as Cardiovascular, Respiratory and Renal across a whole term.
Activity 5: Graphic Representations:
Create an algorithm or some other graphic representation of your course. Fill in the first few blanks. Leave the others blank and ask students to track their learning by filling it in through your the course. Reviewing these in small groups makes for interesting learning in itself, especially when compared to your own vision of the course. Or you can ask students to create a “concept map” of what they learned, based on the outline you provided on the first day.
Activity 6: What is working? What is not?
Introduce your students to informal evaluation of the course on the first day. Ask them to record (on an electronic survey, on a recipe card, or giving feedback to a class representative) what they have learned this week, what is confusing them (muddiest point), whatever questions you have for them. Start this early, and do it periodically as check-in’s throughout the course, and wrap up with final evaluations. In between, show students how you are responding to their concerns, especially muddiest points. (In our school, where faculty don’t always have a chance to come back to the class, they can email, or use our MEdTech Discussion Board).
So, what do you think of bookends?
Can you make them work for your course? You can always check in with our Educational Development Team to run ideas by us.
And of course, you can now get back to that well-deserved break!
Have a wonderful summer, and many thanks to all the wonderful teachers and students who made the academic year of 2015/16 at Queen’s UGME such a success!
Resources: Two of the ideas are from Dr. Maryellen Weimer’s blog article, The last class session: How to make it count, April 13, 2016. http://www.facultyfocus.com/articles/teaching-professor-blog/the-last-class-session-how-to-make-it-count/
Canada’s Medical Schools collaboratively engaging the issue of Student Wellness.
For this week’s article, I’ve asked Renee Fitzpatrick, Director of Student Affairs, to write to us about a topic of critical importance. Indeed, the issue of student wellness and risk should be a major concern of both individuals and institutions engage in the education and development of young people. As she points out, our efforts in this regard need to be ongoing, and she introduces a recent initiative taken up jointly by the Canadian Undergraduate Deans and Student Affairs leaders to consolidate and strengthen our approach to this problem.
In April 2016, Laura Taylor, a third year medical student at UBC, died just days before her 34th birthday. Her parents, devastated by the loss of their kind, loving, brilliant, athletic daughter shared that the bipolar disorder that she had struggled with for more than half of her life, became too much. She had worked tirelessly to reduce the stigma of mental illness.
Her photograph shows a girl with a full smile, the kind that would inspire confidence in any patient, a smile that is referred to repeatedly in her book of condolence, a hockey helmet, reflecting her passion for hockey and a stethoscope, the signature of the medical profession.
The tributes speak to her energy, her athletic ability, her generosity in volunteering, her openness about her mental illness, her academic brilliance, her wit, her courage and her humility.
Any medical school in the country would have been proud to have Laura as a student, and UBC was particularly proud of her. She had all the attributes that we have identified as important to sustain a career in medicine. She also had a serious mental illness, one that she had prior to medical school, which she actively tried to manage.
Just days before Laura’s death, at this year’s CCME, the Canadian Federation of Medical Students, presented results of a mental health survey of medical students across Canada, results that challenged us to take action. The report described increased rates of anxiety, depression, suicidal ideation and burnout, compared to the general population, replicating results from other countries. The Undergraduate Deans committed to a review of suicide risk factors in medical students in an attempt to understand what factors are associated with the conversion of suicidal ideation, a sign of distress to suicide.
Over the last few decades there has been increasing emphasis on the need to identify and treat mental illness in medical students, residents and physicians. Accreditation requirements include a need to demonstrate that there is access to help for mental health issues. However, there is still stigma about seeking help, with concerns ranging from impact on license to fear of judgment. The ACGME Council of Review Committee Residents made suggestions to identify ways to improve resident wellness and resiliency following the death by suicide of 2 resident physicians in New York in August 2014. These were. (1) increasing awareness of the risk of depression during training and destigmatizing it; (2) building systems to confidentially identify and treat depression in trainees; (3) establishing a more formal system of peer and faculty mentoring; (4) promoting a supportive culture during training; and (5) fostering efforts to learn more about resident wellness.
We had made some strides in the last few years to increase wellness initiatives, promote resilience and reduce burnout. The CFMS survey indicates that we have no reason to be complacent. It is crucial to identify the risk factors that convert ideation to suicide. We must reflect on the degree of perfectionism that we require to achieve one of the coveted spots in our medical schools. We must ask how students survive our scrutiny as we demand competent collaborators, communicators, managers, experts, leaders and advocates. Is the perfection that we demand reasonable? Is the environment conducive to negotiating the developmental tasks of early adulthood in addition to training as physicians?
I do not suggest for one moment that we reduce our standards or dilute the fact that medicine is demanding and that we need to be able to tolerate uncertainty, failures, distress and pain. I believe that this is achievable in an environment that promotes and facilitates the growth of healthy physicians. The leadership and support of the Undergraduate Deans is crucial in enhancing the health and resilience of the next generation of physicians, who have taken a courageous step in identifying the issues.
Our Undergraduate Deans have made a commitment that deserves all of our support and challenges us also to become healthy physicians.
Reducing the Burden of Concussions Through Education
By Chris Griffiths
The Concussion Education, Safety and Awareness Program (CESAP) seeks to reach a broad audience on the prevention, identification and management of concussion injuries. According to the Centre for Disease Control, 65% of all concussions occur in those aged 5-18, and concussions make up 13.2% of high school sports injuries (CDC, 2015). As high school populations are at increased risk of injury, it is important that they are properly educated on the risks they incur by participating in sport, and how to best minimize these dangers. However, a study in Florida examining high school football players, a sport at the highest risk of injury, found that only 1 in 4 received proper concussion education (Cournoyer & Tripp, 2014). As 20% of those injured eventually develop long-term sequelae of concussion, such as depression and anxiety disorders, it is important that schools develop supportive environments for those injured (Hudak et al., 2011). Increased awareness has been demonstrated to increase the likelihood students will adhere to management and prevention strategies, and increase the level of compassion received from their peers (Taylor & Sanner, 2016).
This past fall, a group of medical and graduate students teamed up to work on reducing the burden of concussion in our community. Two second year medical students, Logan Seaman and Chris Griffiths, began working with MSc Neurosciences candidate, Allen Champagne, to develop a free education program for high school students and athletes. With the advice of physicians at Queen’s University, namely Dr Mike O’Connor, Dr Fraser Saunders and Dr Andrea Winthrop, and endless support from the Centre of Neurosciences Studies, CESAP developed a classroom session focused on the biomechanics, symptoms, and management of concussions. With help from students at the School of Rehabilitation Therapy and their faculty, we have put emphasis on the many healthcare professionals who can help in injury rehabilitation around Kingston.
What we believe sets CESAP apart, however, is our behaviour modification and prevention arm. CESAP runs clinics for youth football teams with classroom sessions followed by on field drills led by Queen’s football players to teach proper tackling technique. The drills were developed based on research at the University of New Hampshire, showing that equipmentless drills that focus on fundamentals, or “heads up tackling”, reduced the number of head impacts by 4.4 per game in collegiate athletes (Swartz et al, 2016). CESAP has committed to expanding these principles to other sports, with drills developed for soccer and hockey.
CESAP’s classroom sessions are modified specially for each target audience. While some sections are shortened for particular groups, the structure of each talk is the same. We begin by introducing basic neuroanatomy, localizing different areas of the brain to their function. For senior high school classes, we go into greater depth into axonal structure, and show different imaging modalities such as MRI and Diffusion Tensor Imaging. Emphasizing that concussion is a functional injury, we explain how injury can occur and the symptoms that are caused. The goal is that students can identify unusual behaviour in themselves or their teammates, and encourage them to make a safe choice by removing themselves from play if necessary. We outline red flags or concerning symptomatic developments, and equip students with questions to ask their peers if they suspect injury.
Unfortunately, the reality is that injury does happen. With help from physicians, occupational therapists and physiotherapists in the field, we have compiled the best resources for management plans in concussion rehabilitation. Parents are provided with information on all of the health care professionals in the area who they can consult, and youth are educated on what to expect in their recovery. Perhaps the most powerful part of our program, however, are the testimonies offered by concussed athletes on our team, such as former Queen’s Football player Jesse Topley. The stories our athletes give make the effects of concussion a reality, as we hope to foster supportive environments around concussions in the community. By outlining the difficulties that follow injury, we hope that athletes understand they have the power to prevent severe sequelae by playing it safe in their recovery. We hope that athletes and youth are able to identify the injury in themselves and take it seriously, and reverse the “warrior culture” that exists in sports that encourages young athletes to play through any injury.
Since the middle of January at program launch, CESAP has presented to over 1,100 students, athletes, parents and coaches in Kingston, Sherbrooke, Quebec City, and across the GTA. Our program hopes to continue to expand into the Limestone District School Board, with regular classes in grade 9 PHE and senior biology classes. In athletics, we are advocating for more education of coaches, referees and trainers in leagues in the Kingston area.
With help from our colleagues at the Centre for Neurosciences, and in partnership with students in the School of Rehabilitation Therapy, we hope that CESAP can continue to grow across Canada. Our dream is to make CESAP, and programs like it, standard education for high school students and athletes. Through increased education, we believe that youth, parents and coaches can make safer decisions regarding head injury and reduce the burden of concussion and its chronic effects on society at large.
If you are interested in booking CESAP for an education session, please contact us at firstname.lastname@example.org. We will accept any audience and are happy to tailor a presentation to your needs! Please follow us on Twitter @cesap100 to learn more about our sessions and concussions in the news.
Centres for Disease Control and Prevention. “Online Concussion Training for Health Care Providers.” Centers for Disease Control and Prevention. N.p., 4 May 2015. Web. 31 Mar. 2016.
Cournoyer, Janie, and Brady L. Tripp. “Concussion knowledge in high school football players.”Journal of athletic training 5 (2014): 654-658
Hudak, A., Warner, M., Marquez de la Plata, C., Moore, C., Harper, C., & Diaz-Arrastia, R. Brain morphometry changes and depressive symptoms after traumatic brain injury. Psychiatry Research, 191(3), 160–165 (2011).
Swartz, E. E., Broglio, S. P., Cook, S. B., Cantu, R. C., Ferrara, M. S., Guskiewicz, K. M., & Myers, J. L. (2015). Early Results of a Helmetless-Tackling Intervention to Decrease Head Impacts in Football Players. Journal of Athletic Training, 50(12), 1219–1222. http://doi.org/10.4085/1062-6050-51.1.06
Taylor, M. E., & Sanner, J. E. (2015). “The Relationship Between Concussion Knowledge and the High School Athlete’s Intention to Report Traumatic Brain Injury Symptoms: A Systematic Review of the Literature.”The Journal of school nursing : the official publication of the National Association of School Nurses. PubMed. Web.
Teachers and Learners “Spring” Forward for Each Other
By Jonathan Krett, Aesculapian Society President, Meds’18
Recently I attended the Canadian Federation of Medical Students Spring General Meeting in Montreal, QC. Sitting around a table with medical student society presidents from across the country discussing a variety of issues really drove home that at Queen’s School of Medicine, we students have it pretty good.
One of our strengths is certainly the huge part that learners play in driving the student experience. The peer-peer support at our medical school is a true standout and I believe it fosters a strong sense of community. Another one of our notable strengths is without a doubt, the engagement and responsiveness of the faculty that come into the classroom to teach us each day.
Twice a year, the Aesculapian Society (AS) Council hosts general assemblies in which we have an opportunity to recognize both faculty and student contributions to our life as learners at the Queen’s School of Medicine.
It’s on these rare occasions where I have the opportunity to reflect on, and be proud of, the above-and-beyond efforts of a handful of very special people. I wanted to take this chance to celebrate peers and faculty who fuel the very essence of our wonderful community at Queen’s.
Without further adieu…
First-year President and AS President-Elect, Gray Moonen presented two AS lectureship awards on behalf of the Class of 2019.
Dr. Filip Gilic (Family Medicine), applied his direct and practical teaching style, helping to render common presentations in Family Practice accessible to medical students in their very first term of school.
Dr. David Lee (Hematology), engaged students in the classroom with a life-sized red blood cell piñata to demonstrate hemolysis. His careful and thoughtful approach to lecturing went a long way towards enabling material to percolate into the heads of his students.
Second-year President, Monica Mullin, presented four AS lectureship awards on behalf of the Class of 2018.
Dr. David Holland (Renal Course), won over students with his simplified framework for approaching renal disease. Leaving us with the wise words, “Teach Once, Learn Twice,” Dr. Holland thanked his students for the lessons they have taught him along the way.
Dr. Robyn Houlden (Endocrinology Course), was recognized for her organized course framework and emphasis on key concepts for practice in endocrinology. Her sense of humour in the classroom brought a certain levity to otherwise intimidating, complex material.
Dr. Alex Menard (Radiology), made several appearances before the second-year class and de-mystified diagnostic imaging using an interactive teaching method. He left us with pragmatic approaches to common clinical scenarios.
Finally, Dr. Heather Murray (Extended CARL, 2nd-year Course Director), was applauded for her extensive contributions to the well designed second-year curriculum. This year she incorporated a brand new initiative called “Case of the Month.” This series runs longitudinally through second-year, helping students to consolidate approaches to several core clinical presentations and get comfortable with applying our non-medical expert physician competencies.
In addition, non-academic awards were distributed to non-graduating students. (Note that students in fourth year receive their awards at graduation, and will not be specifically mentioned here.)
Wei Sim, AS VP Internal Affairs, presented the A. A. Travill Award to Graham Skelhorne-Gross. Graham was congratulated for his immense work and sacrifice on behalf of the entire student body at Queen’s in his role as our VP External. He spent countless weekends out of town representing us on provincial committees, such as the Ontario Medical Students Association (OMSA).
The AS Awards of Merit were presented to several students who excelled in their efforts to promote student life and learning in a variety of areas.
Adam Mosa (Meds’18), was applauded for his work as Queen’s Medical Review Co-Editor-in-Chief and as one of the Class of 2018’s Clerkship Curricular Representatives.
Peter Wang (Meds’18), was heavily involved in enhancing extra-curricular learning for his peers (SSTEP, Emergency Medicine Interest Group), along with his work in the community teaching first-aid to youths with Junior Medics.
Henry Ajzenberg (Meds’18), provided a great deal of leadership on the advocacy scene this year. He co-chaired the successful Health Policy Interest Group (HPIG) and acted as Chief Outreach Officer for the Ontario Political Advocacy Committee (OPAC).
Wei Sim (Meds’18), also received an award for heading up the popular acapella group, Hippochromatic Notes, and his many behind-the-scenes efforts on student council.
When all was said and done, I had to stop and think once again, at Queen’s we have things pretty good.
Please don’t hesitate to contact me at email@example.com with any questions or comments.
A list of past faculty winners can be found here.
Celebrating Student LEADership
This week, I’ve invited one of our soon-to- be-graduating students, Elizabeth Clement (Meds 2016), to report on the LEAD (LEadership Enhancement and Development) program, an initiative she and a group of her colleagues have conceived and completed over the past year. When Liz, Alia Busuttil and Graydon Simmons first came to me with this idea, I must admit to thinking it was overly ambitious, particularly given they were just beginning their clerkship. Once again, I underestimated the commitment and tenacity of our students when they are pursuing a deeply held and worthy cause. I attended the presentations of the Service Learning projects that Liz describes below, and was greatly impressed at the ingenuity and commitment to community service that went into them. Inspiring, indeed. The LEAD program is being passed along to other students, who will work with myself and other faculty to ensure this great work continues.
I’m often asked what keeps our Queen’s faculty so engaged and energized about medical education. For a glimpse into the explanation, read on.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Mind the Gap by Elizabeth Clement
There’s always a natural tension between student and teacher. While there is a clear common goal, which in medicine is that of graduating a competent doctor, it is easily muddied by the varied opinions on how to achieve such a goal. Students have many competing interests – that extracurricular activity, research project, or family commitment. Faculty, too, are juggling their many hats – hospital service, clinics days, conferences and their home life. Over time, many, if not all, show up to the classroom with slightly less enthusiasm, and as teaching begins to deviate further from one’s preconceived notion, it’s easy to see how that unity of working toward a shared goal begins to erode.
If you’ve ever been on the subway in London, England, I find this reminiscent of the vaguely haunting mind the gap. As the train pulls up to the platform, the two bodies never perfectly line up, leaving a small space between the two: a gap. The overhead voice reminds you to mind the gap: don’t fall in. Because of the nature of the subway’s short stops, you’re either on one side of the gap or the other. You’re either on the train or off the train. You’re either a student or a teacher. Mind the gap.
In my first year at Queen’s, I remember being floored by the openness and candidness of our faculty. Town halls and curricular feedback and personal email exchanges. Even more surprising was that changes were made within courses reflecting this feedback. Often this would happen in real time; courses would morph not after, but as we advanced through them.
It was not surprising to me, therefore, that when a dialogue began about students’ interest in leadership training, the idea of a student-run leadership course received faculty support. The first of many conversations about this project happened more than two years ago, and was the seed for the Leadership Enhancement and Development (LEAD) course. Now, at the conclusion of its first iteration, 12 preclerkship students have wowed us.
In the first of those two years, members of the Class of 2016 (Graydon Simmons, Alia Busuttil and myself) worked together to create a curriculum structure: one part seminar, one part self-reflection, and one part project. In the second year, the team grew as three members of the Class of 2017 (Rajini Retnasothie, Laura Bosco and Lauren Kielstra) joined us to help plan, administer and facilitate the course. Then, in November of this past year, 12 preclerkship students joined the course and we met for the first time as a large group. Amidst explanation of the structure of the course, we were clear about one thing: you will get out what you put in, and what you put in is completely up to you.
During the course, we heard from Queen’s School of Business’ Borden Professor of Leadership Julian Barling, who taught us about motivating with responsibility, and the importance of showing gratitude. We heard from our very own Dr. Sanfilippo about the pillars of leadership; optimism is imperative. We broke into groups of three to discuss our thoughts and reflections while working through the CMA’s “Leadership begins with self-awareness” modules. Meanwhile, outside of the course, students were independently working on “service learning projects,” which required community consultation, strategic design and a significant time commitment. The final seminar, held in mid-April, was a platform for the students taking the course to give short presentations on their service learning projects.
This was inspiring:
- Reza Tabanfar’s Telemedicine to Improve Access-to-Care and Treatment of Ear Disease in Remote Ontario Communities: We hope to use digital otoscopy and existing telemedicine infrastructure to leverage ENT’s expertise in diagnosing ear disease, facilitating much quicker review and prioritization of patients presenting with ear complaints in remote Ontario communities.
- Zain Siddiqui’s Jumu’ah Prayer Service at the Kingston General Hospital (KGH): The project’s aim is to have Jumu’ah, the weekly Islamic congregational prayer, in the KGH chapel so that that KGH staff and visitors can attend.
- Sejal Doshi and Elisabeth Merner’s Street Soccer Kingston: This project is an opportunity to build routine and social supports for Kingston’s homeless/transition housing community all while promoting the importance of physical health.
- Mahvash Shere’s Global Health Simulations – Queen’s Chapter: This project will allow students to engage in hands-on negotiation and problem-solving, by putting them in the middle of a humanitarian crisis and asking them to engage with different stakeholders attempting to resolve the crisis. Post-simulation debriefs will give students the opportunity to reflect on the complexity of problem-solving and power dynamics in these situations.
- Stephanie Pipe’s Revamping Altitude’s Mentee Recruitment Process: This project involves implementing new recruitment strategies, such as more advertisement of the program at the high school level and working with other groups and resources on Queen’s campus, to better reach our target population and hopefully increase the representation of our target population in the program.
- Katherine Rabicki’s Women and HIV/AIDS Situational Analysis: We are collecting data on the experiences of women living with, or at heightened risk of contracting, HIV/AIDS, with the goal of adapting Kingston’s community-based services to better suit the self-identified needs of this population.
- Connor Well’s Inspiring Future Medical Students Through High School Community Outreach: this project will determine the feasibility of encouraging high school students, especially from underrepresented backgrounds, to consider medicine as a career through knowledge translation of the medical school application process at high school career fairs.
- Akshay Rajaram’s Quality Improvement Practical Experience Program (QIPEP): QIPEP offers Queen’s students a chance to develop quality improvement and patient safety through participation in real quality improvement and patient safety initiatives that impact patient care.
As I walked around the room hearing students talk about Jumu’ah, global health simulations, and street soccer, (I’m a little embarrassed to admit it, but) I was getting euphoric. Maybe it was these students’ optimism or show of hard work. Maybe it was their passionate pursuits in the absence of obligation. At the end of the day, I think it was quite simply that I was learning about topics that, without these students, I would know nothing about. THEY were teaching and I was learning; not the original design of our course!
I had not occurred to me until then that perhaps faculty who teach are motivated because they, too, want to learn. When we consider life-long learning as a part of our professional responsibility, most of us consider that to mean staying up-to-date with medical practice changes, but there’s a lot more to be learned that can impact the practice of medicine. When faculty solicit student feedback, it’s in an effort to connect with students and better appreciate how learning is changing. Perhaps like a student’s satisfaction when performing well on an exam or rotation, faculty find satisfaction when making improvements to curricula; both demonstrate knowledge gain. And beyond this, I wonder if there is a deeper satisfaction borne from the notion that better learners will make better teachers.
In any case, a cyclic theme emerges: those who are committed to teaching are those who are committed to learning.
At Queen’s, it is clear that the doors are open to peer-teaching; the anatomy and Being a Medical Student professionalism curricula are two of many examples. But I think we can do more. Students are a resource; our diverse walks of life foster perspectives that can help reinvigorate content and delivery – this has particular relevance with the non-medical expert competencies.
Under no circumstance am I trying to suggest that Queen’s does not involve its students; in fact, I know the opposite to be the truth. Instead, I’m suggesting that a deeper involvement may serve both faculty and student in a novel way – by helping us appreciate the complexities of one another’s roles. Not only would the end product have curricular value, but the process would help us all to collectively mind the gap.
3 Key Teaching and Learning Principles: Revisiting RIA in UGME
This weekend, I was digging around in my hard drive, and pulling files, as I’m working with Dr. Lindsay Davidson on the concept of integrated threads in our curriculum. (Stay tuned for a future blog.) All of a sudden, out popped a document called “3 key teaching principles,” which Dr. Elaine Van Melle and I worked on in 2008. It eventually became part of the Teaching and Learning Policy for UGME.
I took a look and it’s one of those ageless documents that I think we can still learn a lot from and perhaps refresh in the light of 2016. Do any of you recall “RIA“? Come take a journey back and forward with me around the 3 Key Principles of Relevance, Integration and Active learning.
All learning experiences should be . . .
“to have significant and demonstrable bearing on the needs of the learner.”
A student says, Why should I care about this?
A teacher says, Why is this important for a student to know?
- Creating relevance fosters interest, motivation and engagement. It is a key step in facilitating retention and transfer of information.
How can I make teaching/learning relevant?
- Illustrate clinical applicability in the primary management of patients
- Ask these key questions about foundational concepts: “What does every physician need to know about this concept?” and “What does a learner entering my sub-specialty need to know?”
- Link the material to the Medical Council of Canada’s (MCC) objectives as the MCC objectives document forms the basis for the licensing exam.
- Begin with a clear statement of essential learning objectives reasonable for the time allotted.
- Explicitly state the relationship between the learning experience and the assessment process
Back to 2016, consider this checklist for relevance in your teaching:
- Do I use case studies both of my own, and as activities to let students apply learning to “real life”? Do I use lots of examples to clarify concepts?
- Have I reviewed the MCC’s for my learning event and made sure that my teaching is aligned to them?
- Have I got 2-3 clear statements of learning objectives at the level the learners per 1 hour learning event?
- Can I state a key idea or “core message” for this one hour of teaching
- Do I describe why this is important for students to know?
Learning is enhanced when it is relevant, particularly to the solution and understanding of real-life problems and practice. (Kaufman and Mann, 2007)
“to be connected and interrelated”
A student says, Where does this fit?
A teacher says, How can I connect this with other teaching and learning?
- Connecting to the knowledge of the learner facilitates retention & transfer of information from one context to another
- You’re not the only person in the curriculum teaching about this topic.
How do I integrate?
- Ensure learning is appropriate to the level of the learner and relates to the learner’s previous experiences.
- Structure information in a way that demonstrates the relationship between key ideas.
- Link to other sessions to allow for progressive reinforcement of fundamental concepts.
- Connect with other teachers to minimize unnecessary redundancy.
- Create horizontal integration by explicitly connecting to sessions that have come before and those that will follow a particular learning experience.
- Create vertical integration by linking to other types of learning experiences that may be going on at the same time e.g. problem-based learning, clinical skills, basic science teaching, etc.)
Back in 2016, try this checklist for integrated learning:
- Have I vetted the level of learning in my teaching with other faculty, my course director and/or an Educational Developer?
- Have I checked where else in the curriculum the topics of this learning event are taught? (Tip: Year Director and Educational Developers can help. So can MEdTech: Curriculum: Curriculum Search. TLIC is working on Integrated Threads.)
- Is my learning event “integrated” and well-organized in itself with sub-topics, links back to the introduction and a summary? Do I provide an outline and refer back to it during the learning event to orient the students?
- Do I know where my material fits in with in Clinical Skills, FSGL, and other parts of this course as well as others?
- If I’m teaching in C2, or a clerkship seminar, does this topic build on and become more complex than the foundational concepts taught in years 1 or 2 and C1? (Have I looked back at those? Looked forward to C3? Thought about how this applies in clinical clerkship rotations?)
In the hands of the most effective instructors, [this] then becomes a way to clarify and simplify complex material while engaging important and challenging questions…(Bain, 2004)
“ Students engage with and take responsibility for learning”
A student says, How will I learn this?
A teacher says, How will I engage the students?
Why use active learning?
- Facilitates retention and transfer through the construction of new ideas and/or ways of thinking.
- Learning is a process that results in some modification, relatively permanent, of the learner’s way of thinking, feeling or doing.
- Requires the active construction of new ideas or ways of thinking on the part of the learner.
How do I use active learning strategies?
- Students are encouraged to take responsibility to achieve new levels of understanding and/or skill development
- Create learning environments that foster rich interactions among students, between the instructor and students, and between the student and the learning materials.
- Students learn well by doing, and participating in “real-world” experiences.
Here’s the 2016 checklist for active learning:
- How will I change the students’ ways of thinking, feeling or doing with this learning event
- As a way to engage, have I tried using video clips? Illustrations? Demonstrations? Real (live) patients? A poll to take the “temperature” of the class? My own experiences in the clinic or workplace?
- How can I get the students to “construct” new ideas? Have I tried asking probing questions in key places in the learning event, or providing a worksheet or algorithm for the session? Have I tried to present an intriguing question, problem or case study and use different points in my lecture to solve the problem? Can I use “real world” artifacts to engage the students?
- How can I get the students interacting with each other, or with me and other faculty or residents in the room? Have I tried partner work, or small group work? Have I thought about Group RATs? Have I tried, Think, Pair, Share?
- Do I pause at key points and “change up” what is happening in the room?
- Have I integrated student activity in the learning event, or partnered with an expanded clinical skills or clinical skills learning event?
- Do I give the students a chance to demonstrate what they are learning?
Learning is not a spectator sport. Students… must talk about what they are learning , write about it, relate it to past experiences, apply it to their daily lives.” (Chickering and Gamson, 1987)
I hope you’re finding the results of my filing cabinet diving helpful. Do the checklists make sense now in 2016? Is there anything here you can use? Please check in and let me know. Or contact one of us in Educational Development at UGME.
CARMS Match Day: 2016
What our students are experiencing, and how to help them get through it
For medical students in Canada, there are three days in the course of their career that stand out above all others: the day they receive their letter of acceptance to medical school; convocation (when they officially become graduate physicians); and Match Day. The most emotionally charged by far, is Match Day. For those of you not familiar, Match Day is when all fourth year students learn which postgraduate program they will be entering. The match is the final step in a long process of contemplation, exploration and application. The match and the day itself are full of drama, with all results being released simultaneously at noon.
This year, Match Day is March 2. By approximately 12:00:05 that day, all students will know their fate. As you can imagine, there will be much anxiety leading up to the release. For most (hopefully all), the day will be one of relief and celebration. For a very few (and hopefully none), there may be disappointment and confusion. Many schools release their fourth year clinical clerks from clinical duties on Match Day. At Queen’s we have taken the position that our students take on professional obligations during their training and their personal celebrations should not supervene those obligations. Having said that, I’d like to remind any faculty supervising our fourth year students on March 2nd of the following:
- Anticipate that your student will be distracted that morning
- Please ensure your student is able to review their results at noon.
- Check on your student. If he or she is disappointed, please be advised that the student counselors and myself are standing by that day to help any student deal with their situation and develop a plan.
- Be advised that the students will almost certainly be holding some type of celebratory event that evening. Although your students are not excused for personal purposes, I would ask that you give them every reasonable consideration.
Fortunately, we have an excellent Student Affairs team, headed by Renee Fitzpatrick, who are available and very willing to answer any questions you may have and respond to concerns regarding our students. They can be accessed through Jacqueline Findlay at firstname.lastname@example.org, or 613-533-2542. The faculty counselors can also be contacted directly at the following:
Dr. Renee Fitzpatrick, MD, MRC Psych, FRCPC
Dr. Kelly Howse, BSc (Hon), MD, CCFP
Dr. Susan Haley, MD, FRCPC
Dr. Joshua Lakoff, MD, FRCPC
Thanks for your consideration, and please feel free to get in touch with myself or any of the Student Affairs Team if you have any questions or concerns about Match Day or beyond.
Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean, Undergraduate Medical Education
Smashing Stereotypes Using YouTube™ in Teaching – a Geriatric Medicine Perspective
By Michelle Gibson
Why Use Videos in Geriatric Medicine Teaching?
I teach first year medical students about the awesome world of geriatric medicine. I am a family medicine-Care of the Elderly trained doctor who loves her work, and although I am dutifully teaching about all the sacred geriatric syndromes (falls, confusion, frailty, etc.), my main motivation is to help (very) young medical students start to see why I fundamentally love my patients – because they are truly wonderful human beings.
Many students, most of whom are under 25, have little or no experience with seniors, particularly in health care settings, and some have unfortunately had negative experiences. Regardless of their experience, they, like all of us, are often bombarded by negative portrayals of older adults in the media.
To make matters worse, I am (ahem) “competing” with the following courses:
Pediatrics (cute babies and kids – unfair advantage), Genetics (the future of medicine according to everyone, with cool, high-tech tricks), and Musculoskeletal (broken bones! surgery! trauma!). I know my patients can take any of these competing patient populations in terms of general coolness, but my students don’t always realize this.
I have often invited my patients to come to class to discuss their experiences in the interdisciplinary outpatient program in which I am based, but due to their general frailty, this often doesn’t work out, and even when it does, there are many logistics barriers that must be overcome (such as a lack of accessible parking, but I digress).
My solution? I use carefully selected YouTube videos in class. I show these videos mostly at the beginning of class, so it also takes care of the (super-rare … or not) incidents of students arriving late for an 8:30 a.m. class, and missing my carefully constructed, brilliant opening teaching gambit.
Below, I have included a selection of the videos I use, including some information about how I found them, and why I use them.
This is one of the first videos I used, and it remains a fan favourite. Dancing Nana is 88 years young, and her grand-daughter takes her out for lunch every week. On this week, her grand-daughter played one of her grand-mother’s favourite songs, and you can see what happens next.
This video also illustrates one of the challenges of YouTube videos. The original video has had the audio blocked due to a copyright complaint. So far, as of today (February 2016), the music is intact here.
Why do I love it? Because Dancing Nana is real. She’s just like many of my patients. She has a great outfit, complete with her personal alarm system in place, and she puts her purse down to dance down the stairs. She is aging (she’s 88!) and but she loves life, and her granddaughter takes her out to lunch every week. It’s perfect.
It’s also a good length to show in class – 2.5 minutes long. How did I find Dancing Nana? I searched “old person dancing” on YouTube back in 2013. Complex search strategy, n’est-ce-pas?
I show this video before I teach about prescribing exercise to the elderly. I can’t think of a better introduction.
Pearls of Wisdom
This is a video I can use before any of my teaching sessions.
This is a lovely little video full of humour and poignancy. Older adults in a care home in the UK provide “Pearls of Wisdom” – which reflect lifetimes of experience.
This video makes me smile, and (sometimes) can make me tear up. The folks are eloquent, witty, and have obviously thought about what they are going to say – and each Pearl reflects their individual personality, which then shines through. The stars of the video really demonstrate the great spirits contained in older bodies, which are often frail. It really helps us appreciate the person and not the disease, age, or condition. I choose it because it demonstrates that one’s humanity does not depart upon admission to a care home.
Hal Lasko: Painting with technology
Hal Lasko is an amazing 97 year old man, who was losing his vision, and his grandson introduced him to a software program that allowed him to continue to “paint”. The video is in fact produced by a huge company (you’ll see if you watch the movie) but it’s really all about the amazing art that Hal can make using technology.
I think this video truly “smashes stereotypes”. Hal’s cognition appears very much intact, at the age of 97. He has embraced technology, and he makes art that most of us could never hope to make. He has a passion, and he pursues it, despite his disability.
How did I find Hal? I was searching for another video, since taken down, about “Old man painting”, and Hal popped up.
I do address explicitly in class that I have no financial affiliation with the company in question, nor have I ever used the product. I wish it wasn’t a commercial, but it is, so I just discuss it explicitly. I have decided not to use other videos that were produced by pharmaceutical companies, as I am not comfortable with the implied endorsement.
Mark Ronson ft. Bruno Mars – Uptown Funk “Oldtown Cover” ft. Alex Boye’, & The Dancing Grannies
Some videos are just plain fun, and need to be shown.
This one was posted by a friend of mine on Facebook (sometimes these videos just fall in my lap), but also by a number of first year students after I started to show the videos in the geriatrics unit. It’s a great resource. It’s impossible for students to ignore at the beginning of class and it works better than coffee to wake up in the morning. It’s got great seniors being, well, funky. It’s very clever.
I often point out that many of the seniors are “too young” for me, in terms of the patient population I see, but it’s important to me to show healthy aging at all ages.
As Alex Boyé says in the notes on YouTube:
“All the grandmas and Grandpas in this video did their own stunts 🙂
They range in age from 65-92! Between them, they have raised 500 children, 1,200 grandchildren, and 250 great grandchildren!!!”
(And not, I do not show videos to make me seem cool. That ship sailed eons ago. I don’t even pretend to try anymore. You get what you see- quirky, middle-aged, me.)
100 Year Old Drivers (I saved the best for last)
This is my all-time favourite teaching video. It’s actually much too long to show in class in its entirety, but it is so well done, that showing 3-5 minutes worth hooks many of my students. I give you, the BBC’s 100 Year Old Drivers. I encourage you to watch the first 5 minutes, but I should probably warn you not to do this unless you’re ready to devote 46 minutes to frequent, uncontrollable bursts of laughter.
This was another accidental find. I was searching YouTube for videos of centenarians and found this gem. Harry, Ken, Basil, and friends are spectacular. They’re amazing examples of healthy aging, with perfectly intact senses of humour. I dare you not to laugh WITH these amazing folks. Basil is my especial favourite – with his exercise program, his patents, and his tennis. (Intrigued yet?)
This video is actually a perfect teaching video for those of you who might have to teach about determining medical fitness to drive. If you do, you’re likely like me, and you dread it. Or rather, I used to dread it, until I found this video.
Now, I love teaching about driving. I use clips from this video to illustrate many features of aging and how they may (or may not!) affect driving safety. In addition, it leads to a great discussion about differences in regulations in different countries.
In this case, I embed the YouTube link into my slides (insert hyperlink works well), and I note when to start and stop the video right on the slide, and I post the link to the full video for my students.
I’ve received very positive feedback from students about my use of videos. It’s great to see students smiling as they watch these great folk, all of whom remind me of my own patients. Instead of seeing one patient in class, they see many over the course of my unit.
(For those who wonder, I do use lots of clinical videos in teaching- they are great for demonstrating movement disorders, gait analysis, etc, and they’re great resources for students. )
All the videos are of “regular” seniors- not famous folk, by design. I will only show videos where seniors are treated like adults, with respect. (This means there are many news interviews I won’t use, sadly, because they often have a patronizing “yes dear” tone to them that I can’t stand.)
Although some of the videos are more professionally produced than others, so long as the sound is clear, and the image is reasonably clear, I will consider using them. I try to match something to my teaching session, but even if I can’t, I still start with a video.
I have elected not to show videos that are negative in tone or portrayal of seniors, and I’m explicit with my students about this. They will see enough of ageist attitudes, and people treating seniors like children/problems/not worthy of care over and over and over again in their health care training, sadly. I aim to challenge stereotypes, have my students question their assumptions, and, ultimately, to have them think of their first year geriatrics unit with a smile.
In fact, every year, students themselves send me videos to use in class – which I view as a major victory in my efforts to engage students with the awesomeness of my patients!
Contact Information – Feel free to ask questions
Keeping things fresh: Routine doesn’t have to be boring
It’s February, and despite the recent Family Day holiday, we’re still stuck in the depths of winter. Things are just a little harder to get excited about when it’s bleak, cold and snowy. Add in the task of teaching something that’s become routine, and the doldrums can be nearly certain to set in.
It can be a challenge for experts to teach introductory content. This can be further exacerbated by the cycle of teaching: each year brings another round of the same—or very similar—material. When the old adage of reminding yourself that while this is the hundredth time you’ve taught this, it’s the first time for these learners just isn’t enough, how can you get excited about teaching for the 101st time?
Here are five suggestions to ramp up your enthusiasm:
- Back to basics: What do you want your learners to know or be able to do when you’re done? Sometimes when teaching becomes routine, we’ve actually lost focus on the goal. Make a quick list of your key take-away points. If you’re not sure, take some time to reflect and make revisions to your teaching plan.
- Get some feedback: Add in some formative assessment either partway through your learning event, or partway through your sessions if you are teaching multiple times. This gives you—and them—feedback partway through to make sure things are clear. Formative assessment can be individual or team-based and doesn’t necessarily have marks attached. It can be as simple as an online poll to gauge understanding of a key concept.
- Refresh the page: Since the underlying concepts haven’t changed, it’s easy to slip into a rut of repeating yourself. Even if it’s new to this group of learners, you’ll be more engaged if you freshen your cases, or revise the background materials you assign. Is there something in the news that’s timely and on-point?
- Toss in technology: It may strike you as gimmicky, but using technology can freshen “old” material. Consider incorporating PollEverywhere’s polling (which you can use for #2 above) or incorporating a short video for discussion.
- Ask for input: Bounce ideas around with colleagues, brainstorm with others teaching in your course. Ask your course director for feedback. If you’re the course director, that conversation can work both ways: ask for input from your team.
Keeping things fresh for yourself can help your learners. Your excitement and enthusiasm contributes to a climate of learning. If you’re looking for more ways to shake things up but you’d like some customized advice, get in touch with the Education Team. We’re here to help.
7th Annual QHIP Speaker Series underway
The 7th Annual Queen’s Health Interprofessionals (QHIP) Speaker Series launched last week, but there’s still time for students to register for the remaining workshops.
Each workshop takes place on Mondays from 6:30 – 8 p.m in Room 132 at the Medical Building. The series is free, but you need to register to attend. (Here’s the form: http://goo.gl/forms/xgH2k2ao2U). Those who attend at least four workshops are eligible to receive and Interprofessional Education Certificate.
While some of these topics are covered in uni-professional classrooms, this is an opportunity to address these complex issues as an interprofessional group of students.
For more information on QHIP, check out their page on Facebook: https://www.facebook.com/QHIPSociety/