Discover, Examine, Commit: A New Way of Looking at Group Work

I’m back with another perspective on collaborative learning.  This time, I’m indebted to Jim Sibley at UBC for giving me permission to use Framework for TBL Application Activity Reporting Facilitation by Loretta Whitehorne, Larry Michaelsen, and Jim Sibley, reproduced here:

Our own Dr. Lindsay Davidson brought this home from the Team Based Learning (TBL) Collaborative’s Meeting this year.

or click on this:

framework for reporting

This framework is designed to help us facilitate reporting on activities in our TBLs (SGL’s for Queen’s)…The 3 stages of an activity’s progression, Discovery, Examination and Commitment are great terms for ways of looking at key steps in any activity—in other words:  get information, look carefully at the information and do stuff with it, and create a product. Specific tasks within each stage are extremely helpful advice for students and faculty to give reports on how they are doing in an activity.  They’re also very helpful prompts for actual tasks!

(Actually, for the physicians and medical students out there, you can also see the 3 stages of arriving at a diagnosis:  Gather information, Examine the information carefully and relate to experience, patterns, etc. and finally Commit to a diagnosis.)

However, these days I am focused on collaborative learning, and trying to go beyond the Norming, Storming, Reforming approach which many have often been taught.  I often hear from students, “I’m not sure what to do in the group, except report back.”

The framework that Whitehorne, Michaelsen, Sibley have developed immediately gave me ideas about roles a student could take on in a group.  In looking at the framework, I’ve grouped the 5 main roles and given them an attribute.  So following are several behaviours that students can adopt;  ideally the same person could adopt all 5 roles in one activity, depending on the group’s need.  In fact, if a person remains in one role too long, it may make the group less productive.  The idea is to recognize what is needed and move into that role to help move the group task along:

1. Sensor (Listens, shares, looks for consensus, is aware of others’ ideas)

2. Converger or Focuser (Focuses on specifics, probes, builds on others’ ideas, examines in depth)

3. Generalizer (Takes specifics to generalizations, expands, relates to frameworks or theory)

4. Summarizer and Synthesizer: (Puts it all together, supports and asks, “What if?”)

5. Maverick: (Looks for the different, the alternative, the unconventional, etc. Dare’s to differ instead of follow the crowd if it’s going “down the rabbit hole.”) Checks on things.

If you look at the Framework’s matrix, you’ll see that the Sensor’s role stays quite true throughout the different stages of an activity, as does the Summarizer-Synthesizer, etc..

Then there are great descriptions of behaviours a group member can adopt to move the group work forward based on the framework.

For example, looking at the framework, under the Discovery stage,

a Sensor can respect and listen actively to all contributions.  H/she can also be a person who moderates or facilitates so everyone gets their turn.  A Sensor can also unpack or explain in detail how a team arrived at a decision.

A person who is the Generalizer might restate the aggregated ideas of previous speakers, or link or combine, or put ideas together. S/he may articulate links between ideas or incorporate multiple sources into a single idea.

If your activity has progressed to Examining stage, the Sensor might compare or contrast by examining rationales to articulate similarities and differences.  The Maverick might redirect or park by gently guiding conversation away from non-productive directions, and refocusing to direct attention to other thematic elements.

Under the Commitment stage (and I like this term, because it symbolizes positive and concrete final steps), the person who is a Converger-Focuser may generate specific examples by applying concepts and incorporating personal experience.  The Generalizer may create general rules by drawing out the general principles and developing tentative “rules of thumb”.  The SummarizerSynthesizer may make predictions by considering what might happen as a result of particular idea in particular scenario.  What is the role of a Maverick at this late stage? Even as the group pulls together a product or a choice, or an answer, the Maverick considers to what degree the choice or answer fits into the context or the applicability.

All in all, I got very excited when I saw this framework—not only because it focuses on ways to extend tasks and activities for group work but because it adds to my thoughts on collaborative learning.  I also have to compliment the artist behind the figures in this framework (Angela Cunningham?)—they are extremely helpful when you work at grasping what the behaviours are!

So happy collaborative learning with a few more tips and strategies for our students working in groups and teams.

 

P.S. I’m also writing this on July 1…and so want to celebrate our country’s 150th with you by wishing you a Happy Canada Day!

Canada Day South Huron 2017

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Sorry to interrupt but I just had this great idea: How learning about and adapting communication styles can help move group learning forward

When I last wrote to you in March, I asked if you were a constructive or destructive problem-solver in groups.  We do a lot of small group (and larger group) learning in Queen’s UGME and I hoped to give a great framework to help prevent groups from imploding before or while constructive work could be done.

We looked at identifying the types of problem-solving that might occur in a group and some strategies that could help prevent destructive problem-solving.  The ideas came from Team writing:  A guide to working in groups by Joanna Wolfe.  For this article, I wanted to share another set of ideas she has put forward in the same book, about Conversation Styles, and why they’re important to successful group functioning.

Why am I writing about challenges that small group learners can face?  In the research project that was the foundation for Wolfe’s book, she noted that nearly half the teams [she] observed experienced major breakdowns and that instructors responsible for teams were rarely aware of the problems students were facing, mainly because students almost never notified instructors of the problems and instructors had no independent information that could help them anticipate and head off trouble. (Preface, p. v)

I’d like to offer another of Wolfe’s frameworks to help anticipate and head off trouble and prevent implosion in constructive group work.

This framework concerns assumptions we make about communication styles including how we should talk to one another, what constitutes productive behavior and rude behavior.  Wolfe posits we need to understand others’ assumptions about “normal communication” behaviours and preferences in order to modify our own, and adapt to others’.

She provides a sampling of common communication norms (that are mostly extreme ends of a spectrum) and challenges us to self-assess, and also assess others in assumptions of appropriate and effective communication and teamwork.  While Wolfe discusses 3 types of communication styles (Discussion Styles, Presentation Styles and Problem-Solving Styles), I’ll focus on Discussion Style here.

We start with self-assessment and recognition.

In a self-assessment tool about discussion style,  Wolfe asks us to rate how well our behaviour is described in statements such as “When I get a good idea during a team meeting, I say it as soon as possible, even if I have to interrupt to do so.” Or “My teammates accuse me of not listening.” Or When a teammate expresses a new idea my first instinct is to point out the flaws” or “I think it is rude when my teammates never stop to ask me for my opinion,” or “If I need to express criticism, I am always careful to avoid hurting my teammates feelings.” (p. 84)

The outcome of the self-assessment is to place oneself on a spectrum of “norms”.  For example, the “Competitive Norm” is defined as “conversation [which] is a miniature battle over ideas. Speakers tend to be passionate in supporting their ideas and interruptions are frequent.”

 

The “Highly Considerate Norm” features “speakers who acknowledge and support one another’s contributions, and disagreements are often indirect.  Interruptions are rare and the conversation often pauses to allow new people to speak.” (p. 87)

There are pros and cons to each norm:  in the former while this style leads to fast-paced conversation and the often exciting challenge of publicly defending ideas in the face of competition, the most aggressive speaker rather than the best idea often wins out and speakers are more concerned with defending their own ideas than carefully listening to their teammates. In the latter, while there is concern for others, a polite tone and equitable conversations, the conversations may be perceived as slow-moving and even unimportant, and this norm sometimes privileges feelings and emotions over constructive criticism of ideas. (p. 87)

The idea is to recognize that there are values and assumptions to each style first and in this recognition understand the others in the group.  Then you have to learn to work with the others in the group.

So…if you identify yourself more with the “Competitive Norm”, what can you do to adopt a more considerate style? (Note, some of these strategies are from beyond Wolfe’s book.)

  1. Repeat back or restate ideas before disagreeing with them.
  2. Repair interruptions and other competitive behaviours with an apology (“Sorry, I didn’t mean to interrupt” or “I’m sorry—you were saying?”)
  3. Check in with the quieter speakers—often a job for a manager or chair of a group, but a person on the competitive norm spectrum could surprise everyone by doing this, asking, “Do you have any thoughts?”
  4. Pay attention to body language…pay attention to others.
  5. Listen.  (LISTEN!)  Write down good ideas.  Affirm non-verbally. 
  6. Write down questions or ideas you have, to save them for after the speaker has finished.
  7. Engage in uncritical brainstorming (all brainstorming is supposed to be non-judgemental but often people jump in with criticisms. Give a limited period for any ideas to be put forward with no judgement (say 10 minutes).  Members can build on another’s ideas and ask questions but do no fault finding.

And if you identify with the “Considerate Norm, how can you adjust to a competitive conversation?

  1. Prevent or forestall interruptions by saying, “I’m not finished yet,” or “One minute please.”
  2. Speak within the first 5 minutes of a meeting, so people don’t ignore you or think you’re peripheral.
  3. Find gentle ways to interrupt in a competitive conversation. Humour, such as waving a hand wildly, or timing interruptions so they don’t seem rude may help. Say (when someone pauses for breath) “May I contribute here?” “Is now a good time to hear from others?”
  4. Ask the chair to institute a round robin (everyone goes around the circle and contributes a set amount of time) or raising of hands or perhaps using the Indigenous strategy of a Talking Stick.
  5. I like these respectful but firm reminders to someone who is holding the floor too long from Sharing the Floor: Some Strategies for Effective Group Facilitation https://www.uua.org/re/adults/group-facilitation
  • “Excuse me, Francois, but I’m concerned about the time.”
  • “I’m going to stop you there, Laila, because I’m concerned that we are moving off our focus.”
  • “Francois, can you summarize your point in 25 words or less, because we need to move on.”
  • “Laila, is this an issue we can put on the Unfinished Business list? We can’t address it now.”

I would like to propose some steps from Wolfe’s discussion, to adapt our communication styles to the needs of a group and a group task:

  1. Self Assess: and be honest about your style
  2. Analyze: What’s positive about your style? How might your style be perceived negatively?
  3. Resolve: Decide what you can do to ameliorate some of the less constructive aspects of your style, while still retaining some of the positives.
  4. Enact: Practice in a group setting. Practice until it becomes habit.
  5. Seek feedback: Ask others:  Am I helping the group along?  Am I listening more? Am I contributing more?

Well! Speaking of communication styles, I apologize. I’ve talked for too long:  It’s your turn now 🙂

Do you think that this discussion about communication styles may be helpful to students? Perhaps helpful to your meetings (communication styles feature heavily in business literature about meetings)?
Let me know if you decide to use these strategies and steps.  I’d really like to see them in action and there are more wonderful ideas in Wolfe’s book!

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Are you a constructive problem-solver or a destructive problem-solver? Some strategies for working in groups

Here at Queen’s UGME, we use small group learning a great deal—from our prosections to PBL-based Facilitated Small Group Learning, to our TBL-based Small Group Learning.

SGL: Hard at work (Credit: T. Suart)

One very important aspect of group learning is preparing students to work successfully in teams. We do this in our first sessions in Orientation Week and in our new course, Introduction to Physician Roles.

In my quest to support our faculty in promoting successful group learning, I recently came across a jewel and I thought I’d share it with you.

The jewel is actually a whole book:  Team writing: A guide to working in groups by Joanna Wolfe (2010,  Bedford/St. Martin’s).  I started with my usual dipping into sections and found myself reading cover to cover because of the concise, sensible and evocative ideas.

The concept I wanted to talk to you about today is what Wolfe terms Constructive and Destructive Conflicts.

Our students have lots of experience negotiating in groups (Think of all those high school groups!  And case work in Commerce and projects in Engineering!  And Lab partners!) and in making sure their groups work well. But research tells us that conflict in groups is a very challenging part of arriving at a successful outcome.  Teams that deal with conflict by competing or trying to avoid the conflict are likely to suffer.  One main aspect of conflict is not to prematurely close a discussion because of conflict but to make sure it’s healthy.

I think Joanna Wolfe’s ideas would further help students solve problems themselves, by deciding if they are constructive or destructive in a conflict situation.

The term constructive conflict was coined to stress the productive role that healthy conflict can play in problem-solving.  Constructive conflict occurs when two people share the same goal but hold different ideas about how to achieve that goal.  (Wolfe p. 52)

This type of conflict is good especially when there is productive debate of merits and drawbacks of ideas in pursuit of the best solution to a problems. But not all conflict aids learning.  Destructive conflict occurs when there is intransigence, mockery or ridicule, personal affronts, and emotional defensiveness. (Wolfe, p. 53)

Here are the differences between Constructive Conflict and Destructive Conflict as recorded by Wolfe.  Can you see aspects of yourself in the Destructive Conflict? in Constructive Conflict?

Wolfe, p. 54

If you find you are in destructive conflict mode, here are some strategies Wolfe recommends (italics mine):

  • Clarify roles and responsibilities up front in a task schedule.
  • Lay ground rules for conversation
    • Set aside time for uncritical brainstorming
    • Get input from everyone in the group including the introverts who may need more time
    • Restate ideas (to help with listening)
    • Don’t interrupt or if you do, apologize, write down your idea, listen, and wait
    • Set time limits for discussion of certain items before moving to an action proposal
  • Establish team priorities in a project plan or team charter

I found a few other helpful ideas from GOE, a group which has worked with NASA on simulation of small groups for space missions.

  • When a team members offers a dissenting point of view, thank her/him for speaking up (to encourage others to speak up).
  • Easiest way to kill psychological safety? Punish someone for voicing a dissenting opinion.
  • When two team members have an interpersonal conflict, it should typically be handled in private perhaps with a neutral mediator.
  • Conflicts sometimes emerge because small concerns go unchecked. Talk with your team to bring irritants to the surface before they become bigger problems.
  • Be constructive when you disagree with a team member (to model how to disagree effectively).
  • Admit your own concerns or mistakes (so other team members become comfortable voicing theirs).

And here’s one I use:  Think of a role model who handles conflict well, and channel their behaviour or even their words.

I haven’t even touched on the communication styles Wolfe identifies (Competitive vs Highly Considerate, Self-promotional vs Self-deprecating, and Action-Oriented vs. Holistic problem-solving styles) in Chapter 7.  But this will give you a good taste of self-analysis and strategies to assist in moving the team forward.

Stay tuned in a later blog article for Jewel 2 for small group learning:  What are good roles a small group learner can adopt?  A small group facilitator can adopt?

In the meantime, what do you feel can aid in preventing destructive conflict in a group?  And enhance constructive conflict?

 

 

 

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Tips to help with Teaching Dossiers in your upcoming reports:

Here’s a riddle for you:riddle

It may not be the type of writing you’re used to, and it requires thinking and reflection about an aspect of your work that you may not think as much about.  It has an intimidating word in the title and is the first hurdle in preparing an outline of your work.  What is it?

Answer: A Teaching Philosophy Statement

 What is a teaching philosophy statement?

A Teaching Philosophy Statement is a reflective statement of your beliefs about of vision of teaching, your educational goals, and preferred educational practices/approach(es). Included are reasons for your teaching approaches. Critical self-reflection is a key component here. Your Teaching Philosophy can inform all of the subsequent materials in your dossier—acting as the spine of your dossier.  It should also discuss how you put your beliefs into practice by including concrete examples of what you do or anticipate doing in the classroom.

 Introduction:

Often medical faculty are required to prepare a teaching dossier or portfolio.  These are often requirements for awards, for competitions or for promotion.

The actual dossier may be a familiar piece of writing for many of you:  Describe what I do, prove what I do, summarize what I do.

But most dossiers start off requiring you to write a Teaching Philosophy Statement.

businessman-thinking1

And this is where you may come up against a form of writing that is somewhat unfamiliar, unless you specialize in narratives or reflection.

Annual reports are coming up, and awards are being bruited about.  So I thought it was timely for some ideas, tips and definitions for you, some from a much longer piece I’ve written on the Teaching Dossier for OHSE, and others from readings that have struck me.

(If you’ve done all your thinking and just want some writing tips, skip to TIP 4.)

Tip 1: Don’t do it…first

First of all, I suggest leaving your teaching philosophy alone until you’ve prepared some of the other parts of your dossier. So my tip is: Get your materials, your explanations, proof and evidence of your teaching together. Then…

Look through all your data.  What similarities do you see?  Any patterns?

What does this say about you as a teacher?  What have your students said about you over the years? (or year, if you just started).  What have your colleagues or your Course Director or Dept. Head said about your teaching?

These are all other parts of the dossier, necessary, and helpful to reflection.

Tip 2:  Reflect

Yes, there’s that word again…Reflect.  Or, if you don’t like to reflect, try: Analysing or recalling.  You can also  mull, ponder or ruminate.

I find it helps me reflect if I have prompts or hooks to anchor my thoughts.  Try these 3 questions first, and just jot ideas down as they come to you. (You can “word splash”–just what the phrase says.)

Make your teaching philosophy personal to you

1) Why do I teach?
2) What do I want my students to leave my class with?
3) What do I believe my role is in the classroom?
Now try this:  What in your experience and/or in your study of education has lead you to believe this?  Describe your preferred approach, practices, and methods.

Need more help with your reflection? 

Try these prompts to make your writing soar: (but don’t use all of them to write your statement or it will be a book, not a statement!)prompts-make-your-writing-fly

 

  1. Put students first: In many courses on pedagogy, teachers are advised to place the students as learners at the centre or forefront of their teaching. If you begin with knowing how your students learn, how does that impact on you? What would be some of the first steps you would take in your classes?
  2. Learning: What is your definition of learning?  How do you facilitate this in the classroom? How have your experiences influenced your view of learning?
  3. Teaching: What is your definition of an effective teacher? What are the roles and activities of an effective teacher? How do you challenge or engage learners? How do you teach? This should be a reflective statement describing your preferred approach, practices, and methods.
  4. Your teaching experiences: Think of times when you have been an effective teacher. What were you doing? Why and how? Times when you were ineffective? What were you doing? How can you improve that?
  5. Your teaching strengths:  What are your strengths as a teacher? How will you capitalize on this? What are your weaknesses? How will you improve this?

And lastly, try these prompts:
Educational Goals:

  • What are the chief goals you have for your students?
  • What content knowledge and process skills, including career and lifelong goals, need your students achieve?
  • How do you help your students achieve their goals?

NOTE:  Please don’t try to answer all of these questions in one Teaching Philosophy Statement. Select a few that will guide you personally as they relate to you.  See Tip 10 below in #4.

So what we’ve done so far is Collect, Select, and Reflect*.  (*Sheila’s patented approach to dossiers and portfolios.)

TIP 3:  Use and outline or a graphic organizer

Some people are gifted enough to have full statements spring full blown from their minds.  I on the other hand, need an outline.  Now, my outline is usually just a mass of words that I start organizing into themes.  Thematic organization is actually just pattern recognition.  However, you may find some helpers such as word clouds or concept maps useful.  Here are some I found on the web as examples:

cloud-teaching-philosophy

http://eportfoliorobbins.weebly.com/traditional-teaching-philosophy.html

Image result for concept map teaching philosophy

https://computingteacher.wordpress.com/my-philosophy/

If we’re still using my approach, now we’ve done: Collect, select, reflect, connect.

TIP 4:  10 TIPS for crafting your writing:

i.         Write in the first person with “I”, “my” etc.

ii.         Some people use a metaphor to guide tyeats1heir statement. (teacher as coach, fitness trainer, gardener, strike a spark, not filling a pail but lighting a fire, tour guide, 911 dispatcher… Teaching is like….)

iii.         Use the teaching philosophy statement as a guide to link with your responsibilities, strategies and effectiveness sections to form a cohesive dossier by drawing connections this statement.

iv.         Buff or polish it to ideally 3-4 paragraphs—max. full page for physician educators’ teaching dossiers. (Some requirements are for 2 pages.  That violates writing tip # 10.)

v.         Provide specific supportive evidence, either from personal teaching experience or relevant teaching literature (See prompts above).  Treat this like evidence in a study, if that expository kind of writing is more familiar.

vi.         Use language appropriate to the audience.

vii.         Work with another person as an editor and/or brainstormer.  And view others’ statements as exemplars.

viii.       Ensure that you can refer back to the key points of your philosophy in later components.

ix.         If you can, make it a narrative, engaging and rhetorically effective text.  Whoever is reading this might as well enjoy the experience.

x.          Be brief and concise.

OK, I’m pushing it, but we’ve done all these steps:  Collect, select, reflect, connect and now we’re beginning to “perfect” or “confect”.

I hope these are helpful tips and strategies for you. Please let me know if they are helpful and also if you have tips and strategies as well!  Happy writing!

 

References

 

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Reflections on reflection on reflection

elbow lake reflection2

Hi all:  I’m back from a few weeks at our family cottage near Sudbury. Now for those of you from north of Parry Sound, you know that it’s not a cottage, it’s a camp, but I’m translating for all the Southerners here at the UGME blog.

I find that there’s nothing like total exhaustion from installing a new water pump, sanding and staining a deck, staining 6 new Muskoka chairs, and bringing water by hand, up a steep hill, to the garden which one has foolishly planted up that hill.  I find total exhaustion quite conducive to reflection.  I simply sit and stare at the water.  After awhile, my brain starts to work again, and after solving basic issues like food and water (shades of Mazlow), I can even start to get creative.  I think about what’s gone wrong, or what needs to be better and I plan.  I can plan a brand new cottage (hah!), a new way to pump water (hah!), and even a new garden location.  I can plan things to say to my husband when he says, “These Muskoka chairs are so cheap—we couldn’t build them for this money.  Let’s get 6.”  And then, furtively, because UG at Queen’s is never far from my thoughts, I can even start to reflect on things at UG, and plan to make things even better.

Now this urge to action based on reflection is my favourite perspective on reflection. Unfortunately, I’ve never been one to meditate, or think about the moment, or think about nothing, or “relax”.  (However, I did take Dr. John Smythe’s 6 week course on mindfulness and just to show you how good he and the course are, by week 6, I found I actually could be mindful, focus on an object and poof!  Gone for 15 minutes! I highly recommend it, and I try very hard to put his precepts into practice!)

But generally, I’m a Kolb-ian.  I like Kolb’s model of experiential learning—it speaks to me as a call to action.  He advises, in essence, to act, reflect on the action, take it to other reference points and then make an action plan.  I think I’ve shown you this before, but just in case…:)

kolb_cycle

 

So, on what did I reflect, in my moments of recovery from projects at the cottage?  (Did I mention my perennial and consistent devotion to ridding the cottage of mice droppings as part of my activities?  I abstractly conceptualize that as draining the ocean with a teaspoon. (See Stage 3 above.)

Well, one thing I did was bring a book that I promised I’d give you some feedback on, up to the cottage.  It’s entitled English and Reflective Writing Skills in Medicine by Clive Handler, Charlotte Handler and Deborah Gill (CRC Press).  I took some great things from this, to share with you.  They are reflections and pieces of reflections, morphed into this article, which is something I strongly advice with reflection.  Reflections are private.  An action or a blog article, for example, is something that can be crafted from reflections into a public piece of writing.

One thing that really spoke to me was the list of areas and experiences that can generate good critical reflection especially for learners in medical education.  I think, too, that even for experienced practitioners these questions can trigger reflection.

About a patient:

  • A patient happy or unhappy with their treatment by you or others
  • A question of confidentiality, consent or inappropriate risk
  • Doing something for the first time
  • Communicating with older or frail people
  • Consultations involving more than one person (for example, a relative)
  • Sudden death or deterioration

About you:

  • An aspect of a patient encounter that revealed gaps in your knowledge or skills
  • An even that caused you anxiety or enjoyment
  • An aspect of care that left you surprised, puzzled or confused
  • A patient that challenged our assumptions or whose actions are at odds with your personal beliefs and values

About the team

  • When you feel an aspect of the treatment or management is wrong
  • A dysfunctional team that affects patient outcomes or experiences
  • The actions of a team under pressure

Good medical practice

  • Times you have exhibited good medical practice or found yourself in a situation that may be at odds with good medical practice
  • Times when you have seen medical practice or behavior that may be at odds with medical practice. (pp. 6-7)

What do you think?

Now the authors also tackle the dicey area of marking and giving feedback on reflective writing.  Medical students are often extremely concerned about who will see their reflective writing, and whether that will impact on the faculty member’s opinion of the student.  This seems to me to be quite understandable, and it’s why I mentioned above, that taking a reflection and crafting it into a set of goals or more concretely, an action plan, with some work already done, is often a very positive spin to put onto a problem area that a student has identified.  I used to tell my education students, “It’s not a question of whether any of us will make a mistake or not. It’s a question of how we recover, and deal with the mistake that makes the good teacher.”  I think that is also true of the good doctor.

So…in order to create an action plan the authors advise using the Kolb cycle but changing it slightly to:

  1. Identify and describe a professional scenario
  2. What are the perceived consequences of these behaviours?
  3. What are the implications for professional practice? [Sheila’s note: at this point I would challenge students to walk the walk and provide some evidence from medical and medical education literature to demonstrate the implications and help provide solutions for 4.]
  4. What evidence can you provide to show how you have used this experience to develop your practice and inform your behavior in professional scenarios? [Sheila’s note again: OR What is your plan of action to change the behavior?] (p. 12)

At this point the book delves into how to assess the writing skills of the students and it’s full of good advice about grammar and tons of examples of reflective essays.

Speaking of assessment, I’ve been hearing that some students don’t feel that receiving feedback on the lack of clarity and the amount of spelling and grammar errors in their med ed writing is within the realm of medical education.   Well, it is one of our Curricular Objectives (CM 1.3a: Provide accurate information… in a clear, non-judgmental and understandable manner.) And I can only imagine what you readers are saying to yourselves right now, about the importance of clear writing in transitions of care, etc.

What I do have for you is a row for a rubric I created for clarity of expression.  So should you ever be assessing student writing, and want to use it, feel free.

10 prompts write reflections

Lastly, here are some ways to write about reflections that give a format or form to the thoughts.  Students may find these more enjoyable, or at least more guided.  What do you think?  Do you have others?

  1. So What? Journal:  Identify the main idea of the lesson or incident. Why is it important? Why is it important to others?
  2. Analogy (or Simile):  Explain the main idea using an analogy. (Has the benefit of making everyone look up “analogy”.) OR could be explain this idea as a simile:  It’s as if, or it’s like… Then, folow the thread of the anaology or simile.
  3. Question Stems
    • I believe that ________ because _______.
    • I was most confused by _______.
    • What surprised me was _______
    • A patient (a nurse, a physiotherapist, etc.) would see this incident as _____________.
    • When I read up on this, here was one interesting solution____________
  4. Muddy Moment:  What frustrates and confuses you about this incident?  What will you do about it?
  1. PAS_Double-Entry-JournalDouble Entry Journal: Jot down main points, questions, etc. in left hand column.  In right hand column write about these, including actions for the future
  2. Twitter Post: encapsulate in under 140 characters.
  3. Praise from your Mother (or Father or other person who loves you):  “My son’s (daughter’s etc.) done this_______” (In other words, have someone else brag about you if you won’t.)
  4. Top Ten List:  What are the most important takeaways, written with humor?
  5. Quickwrite:  Without stopping, write what most confuses you.  Use a concept map or other format to try sorting it out.
  6. If I were writing a blog about this ____(opinion, incident, topic), I would write__________________.
(Adapted from “Dipsticks: Efficient Ways to Check Understanding; http://www.edutopia.org/blog/dipsticks-to-check-for-understanding-todd-finley)

Well, those are some reflections on reflections from my time up North.  I’ve also partially solved the mouse dropping problem (all the dishes are now in bins when we leave!)  And I’ve figured out what to say to my husband when he advises buying 6 chairs we have to build and stain:  “You are right, dear!”  (because he was right, and  they look awesome!).  muskoka 1

I’ve also once again realized how rejuvenating short physical projects can be (they have an end! 🙂 and how much I love to sit by a lake and think.  I just have to figure out how to keep this reflective spirit going all year long!  As for the water pump…well, maybe part of the reflection is that some things you just have to live with!

Any reflection on reflections to share?  Feel free to write in!

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Queen’s UGME Curriculum Committee Retreat Updates

Hello all!  I’m writing this on behalf of Dr. John Drover, Chair, UGME Curriculum Committee and Candace Miller, Administrative Support, UGME Curriculum Committee as part of the UGME Curriculum Committee’s commitment to outreach.

May 31, 2016 saw an action-packed morning as the UGME Curriculum Committee held its annual retreat from 9:00 a.m. to 1:00 p.m.  One purpose of the annual retreat is to consider for approval recommendations made by the Curricular Change Working Group.  The Working Group had met previously to collate, synthesize and review requests for changes to the Curricular Framework and changes to course assignments of MCC’s and objectives.  small change goldfishThese had been submitted by Competency Leads, the Educational Development Team, Year and Course Directors and required a review from the whole curriculum perspective.

Another purpose for the retreat is to hear reports from the sub-committees that report to the Curriculum Committee as well as from the Competency Leads.  In the policies and procedures of the Curriculum Committee, a report through the UGME Blog is required about the retreat and its outcomes.

As a result of this retreat, and the subsequent Curriculum Committee Meetings June 23 and July 21, faculty and students at Queen’s UGME will see a new edition “Red Book” or Curricular Framework coming out at the end of August.  Screen Shot 2016-07-22 at 1.43.57 PMMany of the changes in wording to our Curricular Objectives were made to align with new Entrustable Professional Acts (EPAs) which were adopted at the July 18 meeting.  Please stay tuned to a later blog for information about these EPA’s.

A few new objectives have been added under Medical Expert, and some objectives were consolidated, deleted, or combined, especially at the request of the Competency Leads.  Medical Expert, Communicator, Advocate, Scholar and Professional roles and competencies each saw some changes.

Course and Year Directors had requested changes to assigned course MCCs and Objectives for courses based on a review of the teaching/learning and assessment in their courses.  Those which were approved will be made in MEdTech for each of our courses as submitted, by the end of August, ready for the new academic year.  That will automatically change the dropdown menus for each learning event for easier access.  There will be a system that maps the old objectives to the new, and this will be done automatically.  However, faculty will see a NEW as well as OLD set of objectives, while we transition.  Make sure you focus on the NEW set.NEW

Course Directors will be notified about the changes pertinent to their courses from their respective Year Director by the end of August.

The Advocate, Professional, Collaborator and Scholar Competency Leads (Drs. Carpenter, Allard, Davidson, and Murray respectively) reported on work in the intrinsic roles.  The template requires them to report on:  a follow up to last year’s report, operational aspects, student progress, and curriculum.  CanMEDSAs well each report gives a status report and a discussion of future plans.

Please note: If you are faculty with access to Queen’s MEdTech, you can view all the agendas and the minutes from the Curriculum Committee Meetings, the Curricular Working Group notes and the Curriculum Committee Retreat, online at https://meds.queensu.ca/central/community/facultyresources:curriculum_committee.

 

 

 

 

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From Bookends to Bookcases: On Finding Some Great Summer Reading

Oh hello! Still in that hammock from our last blog?

hammock

Well don’t worry—this time I’m not here to get you up to plan next year’s courses. 🙂  I do have more to say about bookends, but that can wait until closer to September, when you start planning your classes.

For now, I’m here to help with your summer reading list to fill up your bookcase. I’ve asked a few colleagues for ideas, and (as always) I have some ideas of my own.

bookcase

Dr. Lindsay Davidson contributed: Getting started with TBL by Jim Sibley http://learntbl.ca/book/ as an excellent way to introduce yourself to teaching with small groups as we do in Queen’s UGME.

Dr. Sue Fostaty-Young contributed one of her go-to books on teaching: Therese Huston’s Teaching What You Don’t Know. Sue says, Intended as a book for new and junior faculty members who frequently have to teach large service classes that may be far removed from their areas of interest or expertise, the book is simply one of the best all round books on teaching that I’ve come across.

Paola Durando, librarian at Bracken suggests: How to Teach: A Handbook for Clinicians (Success in Medicine) 1st Edition by Shirley Dobson, Michael Dobson, and Lesley Bromley. (Now in Bracken Library!)

Sandra Halliday, and Suzanne Maranda, also librarians at Bracken, remind us about the reading guides for medical education: http://guides.library.queensu.ca/healthed A quick skim of this really great resource turns up some intriguing titles: Medical education : a dictionary of quotations by Kieran Walsh, Medical Education: theory and practice with Tim Dornan, Karen V. Mann, Albert Scherpbier and John A. Spencer (Editors) (I think I’ve mentioned this one before—it’s another what I call a great “Dipping” book and anything by Karen Mann has my vote),

Dr. Richard Van Wylick contributes these 4 books. He says,

  1. This one got me off to a good start:  Guidebook for Clerkship Directors:
  1. I have not read it yet, but was recommended and I certainly need help personally with this these days!: Make it Stick by Peter Brown:  (Sheila’s note:  I’ve read this and it’s really helpful, practical and interesting for teachers as well as learners—turns traditional teaching “beliefs” on their head. Here’s what Amazon says, Many common study habits and practice routines turn out to be counterproductive. Underlining and highlighting, rereading, cramming, and single-minded repetition of new skills create the illusion of mastery, but gains fade quickly. More complex and durable learning come from

And now you’ll have to read it! SP)                   stick

  1. This is a light read,with funny short anecdotes and stories: The Surprising Lives of Small Town Doctors:
  2. And well, because I have two of them: The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults by Frances Jensen with Amy Ellis Nutt: https://www.amazon.com/Teenage-Brain-Neuroscientists-Survival-Adolescents/dp/0062067842

Sheila’s completely idiosyncratic picks:

  1.  As for me, I’ve finished dipping into The Question of Competence: Reconsidering Medical Education in the Twenty-First Century, with Brian Hodges as editor. With Competency-Based Education so critical, question it’s a great book to get at some of the implications of CBE and it truly is dippable—you don’t need to read it cover to cover in one setting, but can dip into chapters as interest guides you. I call these my “Dipping” books.

2.  Someone recently gave me Gratitude by Oliver Sacks (Thanks SM!) which has motivated me to pick up his Musicophilia: Tales of Music and the Brain. I find him an inspiring writer so I’m looking forward to reading this. And Gratitude is certainly worth picking up for its three lovely reflections.

3.  Recently, one of our faculty heard that it wasn’t her job to comment on students’ spelling, grammar and syntax as a medical educator. That’s actually not correct (it’s in our Red Book objectives) but to bolster the case, I found this book by Clive E. Handler that looks interesting: English and Reflective Writing Skills in Medicine: A Guide for Medical Students and Doctors. I’m ordering it to read over the summer so I can let you know. But anything that has writing skills and reflection in the same title is a hook for me!

4.  Because I’m fascinated by the odd reputation that reflection has in medical education, (I’ve seen medical students blanch and strong doctors flinch at the term :), I’ve been dipping into A Teacher’s Reflection Book, Exercise, Stories, Invitations by Jean Koh Peters, and Queen’s own Mark Weisberg. I’ve just finished Chapter 5, The Teacher and Vocation (I have a bad habit of reading chapters out of sync—I read Margaret Atwood’s Alias Grace, from the end backward—turned out to be a great book!). While the word vocation might make some shy nervously, I’m really liking the exercises. It starts off by asking “What if you had nothing to prove?” What a great question!

Since I’m reflecting on writing about reflecting for a later blog, I’ll save the full review for later, but try this one exercise: Write your personal mission statement or your “call” as a bumper sticker. And here’s a teaser. There is a paradigm shift in viewing your teaching as a vocation rather than a career. Here’s one example: Career = Who am I? What’s in it for me? Vocation = Whose am I? Who am I in teaching for? (James Fowler).

I’ve just started reading When Breath Becomes Air by Paul Kalanithi.   airIsn’t it a wonderful book? I also have a bad habit of reading 3 books at the same time, but this one is maintaining first place in my reading triad easily! When Breath Becomes Air is a memoir chronicling Paul Kalanithi’s life as he studies at Stanford University, and then at Yale University’s medical school. Kalanithi is close to finishing his training as a neurosurgeon when he is diagnosed with stage IV lung cancer. This is a haunting book for me and one that is inspiring me as well.

And last but not least, because summer and especially vacations are a great time to exercise your right brain, and because she’s a favourite author of mine, may I recommend: The Virginia Woolf Writers’ Workshop: Seven Lessons to Inspire Great Writing by Danell Jones? WolfeThis is another great dipping book, and I’ve tried each of the exercises—so much fun!

What about you?  What great books are you heading for this summer?  Feel free to write in with your suggestions!  And thanks to my colleagues for their suggestions!

Hope these give you some ideas so you can climb back into that hammock and bury yourself in many good books this summer! Have a peaceful, restful, reading-ful summer and I look forward to seeing you come the fall.hammock

 

 

 

 

 

 

 

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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?hammock

Wrong!

What I’d like to suggest that now is the time to plan your next course.whatThat’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. 

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. cases 2Checking 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.  Pulmonary Hypertension.cmap

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.   checklist-on-a-paper-with-a-pencil_318-64499In 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?

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!

hammock

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/

 

 

 

 

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3 Key Teaching and Learning Principles: Revisiting RIA in UGME

filing cabinet
Sheila digging around in her filing cabinet

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 . . .

RELEVANT

“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?

Why relevance?

  • 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, calendar consider this checklist for relevance in your teaching:

  1. Do I use case studies both of my own, and as activities to let students apply learning to “real life”? relevant 1Do I use lots of examples to clarify concepts?
  2. Have I reviewed the MCC’s for my learning event and made sure that my teaching is aligned to them?
  3. Have I got 2-3 clear statements of learning objectives at the level the learners per 1 hour learning event?
  4. Can I state a key idea or “core message” for this one hour of teaching
  5. 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)

INTEGRATED

“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?

Why integrate?

  • 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 integrate 4of 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, calendar try this checklist for integrated learning:

  1. Have I vetted the level of learning in my teaching with other faculty, my course director and/or an Educational Developer?
  2. 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.)integrated 2
  3. 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?
  4. Do I know where my material fits in with in Clinical Skills, FSGL, and other parts of this course as well as others?
  5. 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)

ACTIVE

“ 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.  active 5
  • Students learn well by doing, and participating in “real-world” experiences.

 

Here’s the 2016 checklist calendarfor active learning:

  1. How will I change the students’ ways of thinking, feeling or doing with this learning event
  2. 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?
  3. 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?active3.jpg
  4. 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?
  5. Do I pause at key points and “change up” what is happening in the room?
  6. Have I integrated student activity in the learning event, or partnered with an expanded clinical skills or clinical skills learning event?
  7. 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.

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“When the patient fainted, her eyes rolled around the room”: How to make medical charting clear and accurate.

Recently Dr. Maurice Bernstein from The Keck School of Medicine, at University of Southern California, wrote into the listserve DR ED with this intriguing question:

I find many first and second year medical students present their patient write-ups for their instructor’s review with errors both typographical but also errors in presentation that makes statements seriously ambiguous.  I tell my students to read what they have written and then re-read again as an individual who knows nothing about the patient.  In addition, I have presented them with a list of “comic” but presumably also realistic medical charting errors. 

Is there something more I can do to teach the students to be more attentive particularly later when what they write for the record has greater clinical significance for the patient than a first or second year student?

MEDICAL CHARTING ERRORS 

  • By the time he was admitted, his rapid heart had stopped, and he was feeling better.
  • Patient has chest pain if she lies on her left side for over a year.
  • On the second day the knee was better and on the third day it had completely disappeared.
  • She has had no rigors or shaking chills, but her husband said she was very hot in bed last night.
  • The patient has been depressed ever since she began seeing me in 1986.
  • Patient was released to outpatient department without dressing.I have suggested that he loosen his pants before standing, and then when he stands with the help of his wife, they should fall to the floor.
  • The patient is tearful and crying constantly. She also appears to be depressed.
  • Discharge status: Alive but without permission.
  • The patient will need disposition, and therefore we will get Dr. Shapiro to dispose of him.
  • Healthy appearing decrepit 67 year old male, mentally alert, but forgetful.
  • The patient refused an autopsy.
  • The patient has no past history of suicides.
  • The patient expired on the floor uneventfully.
  • Patient has left his white blood cells at another hospital.
  • The patient’s past medical history has been remarkably insignificant with only a 45 pound weight gain in the past three days.help pile of records
  • She slipped on the ice and apparently her legs went in separate directions in early January.
  • The patient experienced sudden onset of severe shortness of breath with a picture of acute pulmonary edema at home while having sex which gradually deteriorated in the emergency room.
  • The patient had waffles for breakfast and anorexia for lunch.
  • Between you and me, we ought to be able to get this lady pregnant.
  • The patient was in his usual state of good health until his airplane ran out of gas and crashed.
  • She is numb from her toes down.
  • While in the ER, she was examined, X-rated and sent home.
  • The skin was moist and dry.
  • Occasional, constant, infrequent headaches.
  • Coming from New York, this man has no children.
  • Patient was alert and unresponsive.
  • When she fainted, her eyes rolled around the room.

After I finished giggling, I started to think…this is a problem with an educational and literacy component. What does educational pedagogy teach us to assist with this issue?

So here are a few ideas from my experience as an educator —these could be potential teaching strategies.   BTW, don’t do all of these…:)  1-3 should make some impact.

  1.  Work with this list: Give students the charting errors list above—it will be a good teaching moment for them and help them see how awful some of their errors could be.  You could ask them in partners (to share the fun) to correct the errors as best they can, reading between the lines, or to create a set of questions that would help clarify some of them. In other words, put them in the role of the teacher.
  1. Think of busy times: Ask students to list the times they may be most busy in a clinical setting.  This list should be posted for them to remind them that these are the times they need to slow down and focus most, ironically, on their writing.

    Busy? Slow down.
    Busy? Slow down.
  1.  Writing and recall for purpose:
think of the patient
Think of the patient.

a. Ask students to generate a list of purposes for charting; writing for purpose is a strong strategy for improving writing. I’m hopeful some of the purposes will be:  pay respect to the patient’s illness and the patient (patient-centred care), safe care for handover and for others reading the chart, legal documents for liability, etc.

b. Then, ask students to keep these in mind as they chart.  Mindful exercises could include using a symbol to associate with each purpose—drawing it, literally, or drawing it clearly in their minds, using a key word to help them recall, or if they tend to associate sounds, or colours with concepts, they could do that.

handover
Here’s my image for handover, for example. Don’t drop the baton.

Ask students pause for exactly 3 seconds prior to charting to collect their mind, to steady their writing and to recall these purposes.  Actually 3 seconds is like taking a deep breath.

NOTE:  thinking about the target audience, as in “Who potentially is going to read this?” can also achieve a impact.

  1.  Simulated chart exercise: Give students a simulated case and a chart exercise and a very stringent time limit.  Ask them to work in pairs and edit each other’s notes after the exercise.  OR, use “Pass It On” strategy, where students affix a nickname, or number to their work (to preserve anonymity and dignity :)) and pass the chart along to the left, so that at least 4 people get to weigh in on it with feedback.  NOTE:  this is also a good exercise in how to give feedback—warn them against being sarcastic, or harsh—their time will come! Ask students to practice good feedback techniques:  being specific, offering suggestions, avoiding judgements of the person, focusing on the writing, etc.
  1. Read the chart entry aloud.  Ask students to practice this.  This takes approximately 6 seconds at most (depending on the chart).  Reading a piece of writing aloud is another recommended editing strategy practiced by writers.

    each-word
    Read it out loud.
  1. Be careful with the use of abbreviations and acronyms which are not commonly used or can be ambiguous in interpretation. For their patient write ups, except for absolutely classic clinical acronyms such as C for “centigrade” or BP for “blood pressure”, the words should be written out such as “myocardial infarction” and NOT “MI” since MI could also represent “mitral insufficiency”. You could teach students that if any obscure acronym is to be used later on in the text, in its first use, the full expression should be written then followed in parentheses with the acronym noted.  Unfortunately, also, many acronyms or abbreviations in medical use are not written in a standardized manner between one institution and another and this can also lead to errors if not recognized. Bottom line: avoid or be really careful. (Thanks to Dr. Maurice Bernstein for this tip.)
  1. Avoid General statements: I got this feedback to a student from a nursing blog article by Katie Morales called 17 Tips to Improve Your Nursing Documentation.

Teacher: For example, you wrote “Dr. Smith called.” Did you mean: you called and are waiting for a return phone call; physician called nurse; or nurse called and spoke to physician?”  A better option is “MD

EmergencyResidencyStudents
Work with a partner and correct.

paged, assessment findings discussed, and no additional orders at this time.” 

 

Similar to strategy 1, I would give the students general statements where they can figure out what’s going on, similar to Ms. Morales’ example.  I’d work through one or two on the screen with the students first.

 

  1.  Checklist of common charting errors:  Making a checklist of these for students is helpful and having it handy when they are charting is also helpful (make it pocket-sized).  Checklists are a helpful literacy tool—no reason they shouldn’t work with charting literacy:  Here are errors from a good module RN.com has: Professional Documentation:  Safe Effective Legal.  (Students could make it into an alpha list or an acronym list). Most of these would be applicable for physicians as well as nurses. (You might want to make them positive: e.g. “Record Pertinent Health or Drug Information.”)

3d small person makes a tick in cell. 3d image. White background.

Common charting mistakes to avoid include the following:

  1. Failing to record pertinent health or drug information
  2. Failing to record nursing actions
  3. Failing to record that medications have been given
  4. Recording in the wrong patient’s medical record
  5. Failing to document a discontinued medication
  6. Failing to record drug reactions or changes in the patient’s condition
  7. Transcribing orders improperly or transcribing improper orders
  8. Writing illegible or incomplete records
from:  Nurses Service Organization, 2008, pp. 4 – 5

From a medical standpoint: Take a look at: Top 10 documentation error pitfalls: from Wisconsin Medical Society: 2008.

  1.  Teach with examples.  Show students excellent examples of charting to give them the necessary language for their work.  Give them criteria that facilitate effective charting.  Look back at the RN.com for some great criteria! As well CMA (Canadian Medical Association) has a good module called Medical Records Management with 31 (!) criteria for effective charting.

NOTE:  I’ve never met anyone who can keep to a 31 point checklist, but the criteria cited are all really important, so…perhaps students can check off the ones they think they do well already, and star the ones they need to work on.  A sampling of their work in clerkship (observation and feedback—still necessary) will demonstrate their self-assessment skills as well as how well they record.

10.  For senior clerks and residents: The  nursing module, RN.com: Professional Documentation:  Safe Effective Legal, has a list of situations that are classified as high stakes documentation.  This would be critical information for senior clerks and residents. (You’ll see that I’m citing nursing education here a lot: Nurse Researchers and Nurse Educators do excellent work on health and education.)

charts patient safety handover
For Residents and Senior Clerks

In Ratnapalan et al, Charting Errors in a Teaching Hospital, these suggestions for residency are included:

  • Many training programs recognize that residents in their first month may have charting errors and have put in place orientation programs, increased supervision from senior residents and staff, and a more thorough review of the notes that are written by new residents.
  • The ED at the Hospital for Sick Children is the only dedicated pediatric emergency department in the city of Toronto, and 380 to 400 trainees rotate through the department annually. Currently, there are orientation packages, orientation sessions, and a Web-based orientation available for trainees to teach accurate charting of emergency records.
  • The orientation package is a large binder with complete instructions on goals and expectations, codes of conduct, medical record keeping, handling of specimens, procedures, and academic activities.

Glad to get feedback on these strategies, and add to the list! What do you suggest?

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