We’re thankful for our students!

We’re thankful for our students!

thanksgiving-2011

It’s Thanksgiving again, and an opportunity for us to express gratitude. This year, we have had the gift of several groups of students working with us in Undergraduate Medical Education and we’d like to showcase their efforts and publicly thank them for their help in making our program even better!

Making DIL work! Beginning with work from last summer, and continuing into this fall, Marie Leung (Meds 2015) has helped us better understand and plan for improvement of the Directed Independent Learning events incorporated in many pre-clerkship courses. Marie performed a review of 247 hours of DIL learning events, providing the Educational Team with a detailed breakdown of the range of structure in these sessions. She followed up with a student focus group, identifying ‘best practices’ from the point of view of our learners. We have recently collated this material and delivered two faculty development sessions to spread the word to course directors. In the next few months the Teaching and Learning Committee will draft guidelines to help teachers and course directors structure this type of mandatory independent learning to ensure quality across the board.

 

Physiology “Bootcamp”: This summer a group of dedicated students worked with Dr. Chris Ward, Lynel Jackson and myself to create a series of Physiology “bootcamp” modules for those who’d like more of a background in physiology. Kelly Harper (Meds 2017), Lauren Kielstra (Meds 2016) , Amro Qaddoura (Meds 2017), Rajini Retnosothie (Meds 2017) and Peter Vo (Meds 2017) developed online modules, with text, images and animation on these topics: Endocrine Physiology, Respiratory Physiology, The Autonomic Nervous System, Gastrointestinal Physiology and The Renal System and the Heart. The students also worked with Sarah Wickett, Informatics Librarian at Bracken Health Sciences Library to ensure that all images and animation met copyright guidelines. Dr. Ward’ theory is that students would have the best sense of what basic foundational information would be helpful to upcoming classes. Stay tuned for publication of these modules through the work of Lynel Jackson at MEdTech.

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Procedural Skills Modules: Dr. Lindsey Patterson is grateful for her students and her Resident! Dr. Curtis Nickel, Meds 2013, and a Resident in Anesthesiology, has been overseeing the work of  Sarah-Taïssir Bencharif, Lauren Welsh‎ and Richard Di Lena, all of Meds 2016, as they developed online modules on procedural skills. Beginning with the skill of intubation, Dr. Nickel and Dr. Patterson were working with the students to incorporate video, text, images and step-by-step instructions. The goal of these modules is to provide a consistent method and set of skills to students and faculty alike, accessible anywhere and at any time.

 

QBank and Test Anxiety: Two of our Meds 2017 students, Adam Chruscicki and Natasha (Natalia) Ovtcharenko as student curricular representatives noticed a high demand for practice questions to help diffuse some of the anxiety around first term mid-term examinations. To answer this demand they decided to start a student-generated question repository, that will serve as a resource for self-testing and hopefully help students prepare for all the different exams through the years. To show the effectiveness of generating questions and self-testing, the students designed a study to look at exam-anxiety (which is negatively correlated with academic outcomes) and the use of QBank as a means to reduce exam anxiety. The study is looking at two separate ways of reducing anxiety: i) self-testing and ii) generating questions. The student investigators are using the STAI (State-Trait Anxiety Inventory), as a measure of success. They anticipate that users who access QBank the most will show the largest decrease in anxiety/lowest levels of anxiety around exams.

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Adam writes, “We are looking to expand QBank into all four years of undergraduate medicine, we want QBank to become a ubiquitously-used study resource by all QMeds, and eventually become a tool that can be used to study for out LMCC, and we hope to expand the functionalities of the website and the bank, eventually linking all the questions to the MCC objectives. Most of all we hope that QBank will make our classmates fell more at ease with testing…and turn it from a stressful experience into what it is meant to be–an educational tool. “

Stay tuned because the team anticipates results prior to the winter holiday!

Online Module Audit: Seven students worked on a special project for the Teaching, Learning and Innovation Committee (TLIC) this summer to review eLearning modules in the UGME data base. Corey Bricks (Meds 2015), David Carlone (Meds 2017), Elizabeth Clement (Meds 2016), Kelly Harper (Meds 2017), Alicia Nickel-Lingenfelter (Meds 2016), Laurent St-Martin (Meds 2017) and Rebecca Wang (Meds 2016) reviewed 131 modules to determine if the modules should be revised or archived. Working with Theresa Suart of the UGME Ed Team, and Dr. Lindsay Davidson, through the audit process, the students noted whether revisions involved content, format, resources or assessment tools. With a huge bank of online modules, some of which are out of date, have been superseded or have other issues, the work of the students is so useful! As a result of their work, TLIC will draft best practices for online module development including review and archive protocols. The students’ work is a first step to enable the TLIC and MEdTech to offer an up to date bank of useful modules.

 

First Patient Project Impact on Career Choices: This summer and fall, First Patient Project Student Rep, Jason Kwok developed a study to determine if and how the First Patient Project affects students’ career choices.

This study is significant because making informed career choices is a key milestone for medical students within the Leader role of the CanMEDS 2015 Series III draft Framework. Jason created an online survey which was by Queen’s medical students who have participated in the FPP for at least 6 months. Statistical and thematic analyses have been conducted to pinpoint and record patterns within responses. 23% of medical students indicated that the participation in the FPP has a direct impact on their career direction. Thematic analysis of narrative responses indicated that FPP had motivational and inspirational impact on students while responses provided curriculum renewal feedback for the Program Directors and Coordinators

.fpp

Nursing Home Module: One of alternative projects in the First Patient Project this year was to help peers understand about nursing home care, and the roles of physicians and nurse practitioners in nursing home. After giving an oral presentation with her partner Brandon Maser, Chelsie Warshafsky(Meds 2016) put together a learning module for other students to let them know important facts about nursing home care and about nursing homes as a future career path. It will be available through MEdTech soon.

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 Student Handbook and Roles, Responsibilities and Safety Modules:  Tyson Savage (Meds 2017) has had a busy summer!  He has developed the new Student Handbook with Alice Rush-Rhodes and built it into an i-book.  A one-stop-shop for students to find information, it was released this fall.  As well, Tyson developed much needed one-stop-shop modules for preclerkship and clerkship students on their roles and responsibilities in clinical situations as well as important safety information both on campus and in any of the hospitals in which they may have clinical placements.  Tyson even built the quizzes that allow students to demonstrate they’ve read the modules and know where this information is housed.  All students from 2016-2018 have been introduced to these modules.

 

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Student Monitors: There is a group of students who must remain unsung but are integral not only to the workings of the curriculum, but to our accreditation standards. These students are our learning event monitors, 2 from each year, who record any inconsistencies in the types of learning events recorded. The students maintain anonymity so as not to be influenced by any personal bias. Their work helps UGME remain true to its Teaching and Learning Policy standard, whereby every course must have under 50% lecture as a teaching methodology. The work of the students confirms  self-identification and helps us to maintain a balanced “constellation” of teaching strategies.

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Aesculapian Society Student Representatives: We are so fortunate to have student representation on all of our committees in the UGME program! Our students are not passive on these committees—they have voices, voting rights, and are called upon to represent the perspectives of their year, or of larger groups of students. As well, there are student representatives for Competencies, for the First Patient Project and new this year, for the Portfolio. These student representatives help plan events, connect with the students about innovations, help with revisions and other tasks. We can’t forget the technology reps who podcast so politely and who are often called upon by harassed faculty when technology fails. (We do have technology assistance, tho’ and we are ensuring we are respectful of our tech reps’ learning time.) Another group of invaluable students are the student academic reps who meet with their Course and Year Directors faithfully through the year to give feedback to faculty and to bring responses back to their peers. I’m grateful personally for last year’s AS Vice President Internal, Graydon Simmons (Meds 2016), who not only helped pilot the student peer mentorship in orientation week’s confidentiality session, but came up with a great communication system which his successor Mike Baxter is continuing. Through VP Internal, I’ve connected with the Year “Pres” group who so diligently pass along messages about opportunities for students.

The UGME Ed Team is always most grateful to the students who help us out with focus groups, provide feedback and who thoughtfully contribute to reviewing and improving our projects.

And then, of course, there are all our students…the ones who come up to thank faculty for their efforts, who pay attention and ask insightful questions, who look for opportunities to “do more” and who greet faculty and staff with smiles and flashes of neon (and more subdued hues of) backpacks. It’s fun to come into work each day knowing our students are there, and we’re grateful.

thankyou

Do you know about a student or group of students for whom you are grateful? Please write into the blog to tell us of students who have helped the UGME program.

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How to make “DIL” work for you

Best Practices in DIL: Directed Independent Learning

Thanks to Dr. Lindsay Davidson, Director of UG Teaching, Learning and Innovation for writing this blog article.

Have you ever wondered about the mysterious learning event type used in the undergraduate MD program known as a DIL?

You may even have your name associated with such an event but be unsure what you’re supposed to do with it? If so, this blog posting is for you. We’ll tell you about how to create “blue ribbon” DILs.  DIL is short form for “Directed Independent Learning” (although some students have nicknamed the sessions “Do It Later”).

blue ribbon DIL

First some background. Previously, our curriculum was almost entirely taught using large class lectures. Over the past decade, prompted by educational research, best practices and accreditation standards, we have shifted towards more active forms of classroom case-based learning. These sessions are preceded by required student preparation. Initial attempts to ‘protect’ curricular time to allow these independent study activities were foiled by the introduction of new curricular learning events. This led to the strategy of formally protecting curricular time for student preparation – and the “directed independent learning” (or DIL) learning event was born.

Originally intended as simple ‘placeholders’, directed independent learning events are now formally defined as scheduled curricular sessions associated with a course, with the goal of allowing specific student preparation prior to a companion classroom learning event. Put another way, DIL sessions are one component of a flipped classroom blended learning model.  In fact, they are literally another “teaching opportunity” for you.  These sessions are different than the 8 hours of freeform independent learning time built into the student week – this is intended for student-directed inquiry around personal learning goals, observerships, research or community based-projects.

Directed independent learning sessions, in their ideal form, are an excellent format to help students scaffold learning. The concept of scaffolding is very evocative – implying the application of a supportive structure to facilitate learning with the understanding that over time the scaffolding can be withdrawn. Scaffolding can involve a variety of instructional techniques such as providing a reading guide, fill-in-the-blank worksheet or graphic organizer to complete. When done well, scaffolding helps students reach higher levels of comprehension and skill acquisition than they would without help.

Some examples of scaffolding appropriate for a DIL include:

·      Develop a table or algorithm to compare different conditions from the same presentation

·      Check for understanding with quiz questions

·      Provide a reading guide to help students perceive the critical pieces of a longer reading, and direct them to key understandings and concepts

Marie Leung, a student in MEDS 2015, conducted an audit of DIL sessions in 2013. She determined that these comprise 13% of all structured pre-clerkship curricular time.  Of these, 39% included text-based readings, 25% online modules and 19% audio-visual instruction. She also noted that 5% of DIL sessions included no identified resources. Subsequent student focus groups identified six problems with certain DIL sessions:

1.     No details

2.     Lack of objectives

3.     No resources

4.     Too many resources

5.     No opportunity for self- assessment

6.     Stand-alone resource (i.e. not linked to subsequent session)

Additionally, students identified five best practices when designing a DIL. These include:

1.Be directed and purposeful – use learning objectives and provide focused, carefully selected readings

2.Give instructions and/or guides to reading or viewing.

3.Encourage students to produce a deliverable – worksheet, comparison tables, etc

4.Allow opportunities for students to assess their learning – self-administered quizzes

5.Connect directed independent learning sessions to in class sessions which are opportunity to debrief, clarify, apply, reinforce.

We encourage all teachers to strive to meet these guidelines. Please contact our educational development team if you require assistance constructing an effective DIL learning event – theresa.suart@queensu.ca or sheila.pinchin@queensu.ca.

 

 

 

 

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How will Curriculum Committee Decisions impact on your Queen’s UGME teaching? Read this post to find out!

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In 2013-2014 the Queen’s UGME Curriculum Committee made the following decisions of general interest.  Please read to see if this will impact on your UGME teaching.

(Note:  resource documents for the following are available in MEdTech Faculty Resources Community.)

Change from “QMCCs” to MCCs

In July 2013 the Curriculum Committee decided to adopt the list of MCC clinical presentations http://apps.mcc.ca/Objectives_Online/objectives.pl?loc=home&lang=english instead of the QMCCs (Queen’s MCCs) for the Medical Expert portion of the curriculum. The list of QMCC to MCC changes was approved in May 2014. The changes will take effect in September 2014. Course Directors will see the changes through the MEdTech objectives assigned to their courses. An email outlining the changes will also be sent to each Course Director.

Career Counselling

In August 2013 the Curriculum Committee voted to allow students in Term 2b to schedule one-on-one meetings at the Learner Wellness Centre with either Dr. Howse or Dr. O’Neill in order to assess progress in attaining career competencies as part of Professional Foundations 1.

Course Directors’ Role Description

The “Course Directors’ Role Description” document was approved by the Curriculum Committee in October 2013. Revisions were approved in August 2014.

New Course

In November 2013, the Curriculum Committee approved the creation of the new Population Health course as outlined in Dr. Carpenter’s detailed proposal.

Red Book Policy

In December 2013, the “Policy and Procedures for the Red Book” (the Undergraduate Medical Education Competency Framework) was approved by the Curriculum Committee. Revisions were approved in February 2014.

Adding items to the Curriculum Committee’s Agenda

In January 2014 the Curriculum Committee approved the document “How to request that items be added to the Curriculum Committee’s agenda”.

Accreditation “Hot Topics”

Learning events in MEdTech can now be coded with the accreditation “Hot Topics” from the ED-10 standard’s Hot Topic list http://www.lcme.org/connections/connections_2013-2014/ED-10_2013-2014.htm

Making changes to courses

The course change process outlined in “Making Changes to Courses – Role of the Course Director” was approved by the Curriculum Committee in January 2014.

Gaps and Redundancies Process

In May 2014 the Curriculum Committee took jurisdiction over the “Gaps and Redundancies Process”, which was formerly overseen by the Teaching, Learning and Innovation Committee.

First Patient SGL Pass

In May 2014, the First Patient SGL Pass was approved by the Curriculum Committee to facilitate students’ attendance at First Patient Program appointments.

Changes in Course Names

On June 13, 2013, the name of MEDS 113 Professional Foundations 1 course was changed to MEDS 113A Professional Foundations 1A. The course MEDS 113B Professional Foundations 1B was added to Term 2 and MEDS 123 Professional Foundations 2 was deleted from Term 2. The following courses were renumbered and/or re-named: MEDS 454 – Clerkship Preparation was changed to MEDS 351 – Clerkship Preparation (year 3 term 5 fall); MEDS455 – Complex Presentations and Competencies was changed to MEDS 481 – Complex Presentations (fall, year 4) and MEDS456 – Consolidation and Readiness for Residency was changed to MEDS 491 – Readiness for Residency (winter, year 4).

On April 23, 2014, the name of the course MEDS 242 – Ophthalmology and Otolaryngology was changed to MEDS- 242 Skin and Special Senses. Also, the course code for MEDS 234 was changed to MEDS 234 A and B (Clinical and Communication Skills 2A and Clinical and Communication Skills 2B). In addition, MEDS 233 A and B Professional Foundations was renamed to MEDS 233 A and B Professional Integrations.

Please see MEdTech Faculty Resources Community for more details.

Please stay tuned for more Curriculum Committee news from the July Retreat, later on in the fall.

 

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A great read: Faculty Focus Blog

As part of your summer reading list, may I encourage you to look at Faculty Focus, higher ed teaching strategies from Magna Publications. Whenever Maryellen Weimer writes, I sit up and pay attention, but actually the other contributers have great ideas, and provide evidence for them too.  This is not just for medical education, but for all educators in general.
http://www.facultyfocus.com/

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How to integrate science into clinical courses and vice versa

How hard is this?  Not too hard. 

Here are some ways to integrate science into the clinical courses (and vice versa)

integrate

Hi all:  I’m recycling a recent post, having drastically reduced it.  I hope to write more about examples of integration and integrators from our curriculum in the future.

You may think you don’t use basic science knowledge anymore.  Think about this case:

An adult patient comes into the outpatient office of
a doctor complaining of facial pain and nasal
obstruction for 2 days duration. Instantly, from these
2 signs, knowledge about acute facial pain pops into
the clinician’s mind, with sinusitis being especially
salient because of its frequency of occurrence in this
age group. This specific knowledge then orients the
questions asked and physical examinations administered.
A few minutes later, a new patient comes in
with vertigo signs. Instantly, knowledge about sinusitis
and facial pain is dismissed from active memory,
and knowledge of vertigo takes over. (Charlin, 2007).

Many physicians, encountering these patient presentations would react exactly as the physician above did.  We call the virtually unconscious use of basic science in this scenario “encapsulation.” (Schmidt, 2007) Alternatively,  a physician mobilizes organized knowledge in an “illness script.” (Charlin et al 2007, Schmidt, 2007) It’s not that you as a physician don’t use basic science–it’s just that experience, and practice has blended it seamlessly into your thinking.

But how can we get our students there? Of course, practice makes perfect and experience tells.  However, the  practice needs to be guided and scaffolded by good teaching and learning.  Here are some good teaching and learning interventions:

In pre-clerkship or clerkship, some key principles:

  1. Be explicit about the science that grounds the clinical case or knowledge.  Insert science slides into your lecture/seminar slides that speak to basic science concepts at work.
  2. Use various media (words,pictures,practical experiences, lab results, microscope slides, etc.) to link science concepts to the clinical picture.
  3. Link to assessment. Critically, the assessment of integrated learring should reflect students’ sophisticated understanding of how the basic science relates to clinical understanding–not their ability to recall facts.   (Mandin, 2000).

In clerkship:  Practical ideas:

Here are some ideas:ideas 1

Provide opportunities for students to explore, research and strengthen their knowledge base of basic science issues relevant to commonly encountered clinical problems. Context is critical…for example, Laplace’s law describes fluid flow in the lungs which you can relate to asthma.

  1. Try: Case of the week? Case of the day? In rounds, or in a seminar, or in  Case of the Week such as Internal Medicine undertakes, consider questions for students to investigate:  What are the basic science issues that underlie this case? What is the pathophysiology at work here? (See Questions and Cues below.)
  2. Complement the mini-scholar CEX with a “Mini-science CEX”: ask students to use the same case as for their mini-Scholar CEX and inquire into the underlying science principles. Provide a worksheet or table for them to fill in that allows them to capture what you’re looking for. (See Questions and Cues, below.)
  3. Use some of the online modules developed for pre-clerkship as refreshers for clerkship. Students do this already.  Why not make it a part of the learning?

Need some help finding the modules? Ask an Educational Developer –we’re working with students to update the list.

OR

Work with one of the scientists in terms 1 or 2 and build one that will be useful from years 1-4.

  1. Bedside teaching: Ask a question about the underlying science of the case, in order to activate that learning.
  2. Questions and Cues that activate learning:

 

Cues and Questions:questions you could ask

  • What organ system(s) draws your attention here?
  • How does this system normally work?
  • What normally happens?
  • What’s likely to have interrupted the process here?
  • What does that look like? What changes does that precipitate?
  • What are the basic processes used in reaching this state?
  • What changes occur when someone reaches this state?
  • What influences:  the quality, location, duration, precipitation, course of symptoms
  • What could be misleading you (confounding)?
  • What are limitations to your knowledge of this?
  • Use this blank schema/organizer to illustrate what is going wrong…(you’ll have to fill this one in!)

Now, you can see that your questions will be better than mine. Please write in with them!help from a doc

Basic Science Questions for Clerkship and Pre-Clerkship:

I found  some examples of questions in Bierer et al’s work, Methods to assess students’ acquisition, application and integration of basic science knowledge in an innovative competency-based curriculum in Medical Teacher. Their examples come from a first year course (!) that integrates science and clinical teaching. Please read about what they do in the article, but here are some of the questions:

  1. What are the urea and creatinine clearances in ml/min and L/day?
  2. If they are not the same as inulin, explain the difference.  Which substance provides the most accurate estimate of glomerular   flitration rate?
  3. How is it possible that the volume of urine is so high with such a low inulin clearance?
  4. In the above patient, assuming that the daily intake of sodium chloride is 5g, the plasma sodium concentration is 140mEq/L and the 24 h urine sodium excretion is 86mEq,

o   What percentage of filtered sodium is being excreted?  Reabsorbed?

o   Is the patient in sodium balance?

o   What does this information tell you about the kidney’s role in sodium homeostasis?

I like these Self-Assessment Questions too:

1. The renal clearance of inulin and creatinine are different. What explains this?

A.  Creatinine is not freely filtered through the glomerulus, whereas inulin is.

B.   Creatinine is only filtered while inulin is both filtered and secreted.

C.   Creatinine is both filtered and secreted while inulin is only filtered. *

D.   Creatinine is metabolized in the urine while inulin is not.

 2. Which of the following events is most likely to result in lower extremity edema?

A.   Low capillary hydrostatic pressure

B.   High plasma oncotic pressure

C.   Low plasma oncotic pressure *

D.   High tissue oncotic pressure

3. The majority of glomeruli are found within which region of the kidney?

A.  Calyces

B.   Cortex *

C.  Infundibula

D.  Medulla

E.   Papilla

 Pre-Clerkship Ideasideas 1

  1. Develop a weekly or monthly, undifferentiated case, where possible, “Case of the Week”, either in pre-clerkship or clerkship, to look at 20 main opportunities or “boluses” or “nodes”.   In clerkship these can be sent electronically, similar to “NEJM” Case, to create an online curriculum. Focus can be given to special populations. Course Directors would need to get together to do this to include the Course Directors from year 1. Year Directors can provide a focus.
  2. Build online resources that may be used in different ways by different faculty in the future into clerkship. E.g. Sodium/Acid Base. Consult the foundational science faculty for assistance, as they have a huge database of images for use.
  3. OR consult the library for existing modules that may be used similarly. There are several videos, and other media, such as Anatomy TV which may be used.
  4. Modify the Clinico-Pathologic Conference Approach used in the NEJM cases (examples at http://oac.med.jhmi.edu/cpc/links.cfm) where a case is presented to a clinician, who then demonstrates the process of reasoning that leads to his or her diagnosis. A pathologist then presents an anatomic diagnosis, based on the study of tissue removed at surgery or obtained in autopsy. Students work on the diagnosis, and discussion ensues.
  5. Who could be involved in preclerkship or clerkship? See how these faculty and concepts are located around a single node or bolus?

node

We have some places in pre-clerkship that are waiting for some basic science; and some great places that are waiting for some clinical applications.

  1. In FSGL, we have the opportunity to integrate pathology, anatomy, imaging, etc. into cases.
  2. In Expanded Clinical Skills, there exist spaces for this integration.
  3. Problem solving exercises in SGL require foundational science for solutions and diagnoses. See above re. cases for some examples.
  4. CAUTION: Don’t overload. Use these examples of integration judiciously. Perhaps imaging is all that Dr. Davidson will use in a case of a limping child. Or perhaps Dr. Murray will use knowledge of histology and pathology or drug therapies in a case of a female patient presenting with shortness of breath that could be a case of myocardial infarction.
  5. Looking for some places and people with which to integrate?
  • In term 1, we teach Normal Human Structure (anatomy/histology), Normal Human Function (Physiology) and Critical Appraisal, Research and Learning (Epidemiology, stats, methods of study).
  • In term 2 we teach Therapeutics (pharmacology) and Mechanisms of Disease (immunology, infection, pathology). We teach about neoplasia, etc. in Blood and Coagulation. Genetics is taught in Genetics and Pediatrics in Term 2.
  • In the C courses, many concepts are bundled together, often by faculty who taught in pre-clerkship.

I hope I’ve given you some insight into the how and the where of integration.  In later blog articles I hope to feature the “who”.

Let me know your thoughts on integration of science into clinical courses.

 

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How hard is it to integrate basic science and clinical learning?

How hard?  Not too hard…Ways to Integrate Science into the Clinical Courses (and vice versa)

integrate

For this blog, I need your help. And also I’ve tried something new.

First of all, I need help with some of the questions I’m positing. I’ve used questions used in activation of prior knowledge generally.  So please read them, and add your clinical know-how to them.

Secondly, I’m putting the theory last. I’m going to begin with practical ideas for integrating clinical and basic sciences in hopes you’ll agree that this is warranted.  I’ll put the reasons and the concepts behind integration later on at the end.

I’ll need your help with the practical too—what ideas do you have to integrate basic science and clinical concepts?

So… to get started:

You may think you don’t use basic science knowledge anymore.  Think about this case:

An adult patient comes into the outpatient office of
a doctor complaining of facial pain and nasal
obstruction for 2 days duration. Instantly, from these
2 signs, knowledge about acute facial pain pops into
the clinician’s mind, with sinusitis being especially
salient because of its frequency of occurrence in this
age group. This specific knowledge then orients the
questions asked and physical examinations administered.
A few minutes later, a new patient comes in
with vertigo signs. Instantly, knowledge about sinusitis
and facial pain is dismissed from active memory,
and knowledge of vertigo takes over. (Charlin, 2007).

Many physicians, encountering these patient presentations would react exactly as the physician above did.  We call the virtually unconscious use of basic science in this scenario “encapsulation.” (Schmidt, 2007) Alternatively,  a physician mobilizes organized knowledge in an “illness script.” (Charlin et al 2007, Schmidt, 2007) It’s not that you as a physician don’t use basic science–it’s just that experience, and practice has blended it seamlessly into your thinking.

But how can we get our students there? Of course, practice makes perfect and experience tells.  However, the  practice needs to be guided and scaffolded by good teaching and learning.  Here are some good teaching and learning interventions:

In pre-clerkship or clerkship:

  1. Be explicit about the science that grounds the clinical case or knowledge.  Insert science slides into your lecture/seminar slides that speak to basic science concepts at work.
  2. Use various media (words,pictures,practical experiences, lab results, microscope slides, etc.) to link science concepts to the clinical picture.
  3. Link to assessment. Critically, the assessment of integrated learring should reflect students’ sophisticated understanding of how the basic science relates to clinical understanding–not their ability to recall facts.   (Mandin, 2000).

In Clerkship:

Here are my ideas: What are yours?ideas 1

Provide opportunities for students to explore, research and strengthen their knowledge base of basic science issues relevant to commonly encountered clinical problems. Context is critical…for example, Laplace’s law describes fluid flow in the lungs which you can relate to asthma.

  1. Try: Case of the week? Case of the day? In rounds, or in a seminar, or in  Case of the Week such as Internal Medicine undertakes, consider questions for students to investigate:  What are the basic science issues that underlie this case? What is the pathophysiology at work here? (See Questions and Cues below.)
  2. Complement the mini-scholar CEX with a “Mini-science CEX”: ask students to use the same case as for their mini-Scholar CEX and inquire into the underlying science principles. Provide a worksheet or table for them to fill in that allows them to capture what you’re looking for. (See Questions and Cues, below.)
  3. Use some of the online modules developed for pre-clerkship as refreshers for clerkship. Students do this already.  Why not make it a part of the learning?

Need some help finding the modules? Ask an Educational Developer –we’re working with students to update the list.

OR

Work with one of the scientists in terms 1 or 2 and build one that will be useful from years 1-4.

  1. Bedside teaching: Ask a question about the underlying science of the case, in order to activate that learning.
  2. Questions and Cues that activate learning:

help from a docCan you help me provide some specific clinical applications?

 

Cues and Questions:questions you could ask

  • What organ system(s) draws your attention here?
  • How does this system normally work?
  • What normally happens?
  • What’s likely to have interrupted the process here?
  • What does that look like? What changes does that precipitate?
  • What are the basic processes used in reaching this state?
  • What changes occur when someone reaches this state?
  • What influences:  the quality, location, duration, precipitation, course of symptoms
  • What could be misleading you (confounding)?
  • What are limitations to your knowledge of this?
  • Use this blank schema/organizer to illustrate what is going wrong…(you’ll have to fill this one in!)

Now, you can see that your questions will be better than mine. Please write in with them!

Clerkship and Pre-Clerkship:

I found  some examples of questions in Bierer et al’s work, Methods to assess students’ acquisition, application and integration of basic science knowledge in an innovative competency-based curriculum in Medical Teacher. Their examples come from a first year course (!) that integrates science and clinical teaching. Please read about what they do in the article, but here are some of the questions:

  1. What are the urea and creatinine clearances in ml/min and L/day?
  2. If they are not the same as inulin, explain the difference.  Which substance provides the most accurate estimate of glomerular   flitration rate?
  3. How is it possible that the volume of urine is so high with such a low inulin clearance?
  4. In the above patient, assuming that the daily intake of sodium chloride is 5g, the plasma sodium concentration is 140mEq/L and the 24 h urine sodium excretion is 86mEq,

o   What percentage of filtered sodium is being excreted?  Reabsorbed?

o   Is the patient in sodium balance?

o   What does this information tell you about the kidney’s role in sodium homeostasis?

I like these Self-Assessment Questions too:

1. The renal clearance of inulin and creatinine are different. What explains this?

A.  Creatinine is not freely filtered through the glomerulus, whereas inulin is.

B.   Creatinine is only filtered while inulin is both filtered and secreted.

C.   Creatinine is both filtered and secreted while inulin is only filtered. *

D.   Creatinine is metabolized in the urine while inulin is not.

 2. Which of the following events is most likely to result in lower extremity edema?

A.   Low capillary hydrostatic pressure

B.   High plasma oncotic pressure

C.   Low plasma oncotic pressure *

D.   High tissue oncotic pressure

3. The majority of glomeruli are found within which region of the kidney?

A.  Calyces

B.   Cortex *

C.  Infundibula

D.  Medulla

E.   Papilla

 

Some Great Examples in Pre-Clerkship examples

We have some great examples of how to do this in our curriculum. The  key is the spiral curriculum where a student revisits a topic, theme, or subject several times, in deepening complexity (including science helps increase complexity), and a new learning relationship attached to old information. You’ve heard me talk about this before. See below for the theory and my conception.

Nowhere does this make sense more than in the clinical application of concepts from basic science.  For the first 2 years, here at Queen’s, there are some excellent examples of this.  Many of these came from a Curricular Leaders’ Retreat last year, with my thanks!

Have you clerkship examples?  Please send them here!

  1. Develop a weekly or monthly, undifferentiated case, where possible, “Case of the Week”, either in pre-clerkship or clerkship, to look at 20 main opportunities or “boluses” or “nodes”.   In clerkship these can be sent electronically, similar to “NEJM” Case, to create an online curriculum. Focus can be given to special populations. Course Directors would need to get together to do this to include the Course Directors from year 1. Year Directors can provide a focus.
  2. Dr. Romy Nitsch in Obs/Gyn has created an excellent introductory lab idea. Contact Dr. Nitsch for ideas.
  3. GI/Surgery and Neurology are trying a similar approach during the first week of the courses. Neurology is trying an online “diagnostic” test to assess student retention of anatomy and other scientific themes. Students who fall below a threshold will be required to participate in a tutorial. See Dr. Stuart Reid for ideas.
  4. Shared or Team Teaching: Dr. Sue Moffatt has worked with Dr. Conrad Reifel in his NHS course and Dr. Les MacKenzie has taught in Dr. Moffatt’s Respirology unit. See attached handout for ideas, or contact one of the participants.
  5. In Renal part of Endocrine/Renal, Dr. Jocelyn Garland and Dr. Iain Young work to show a “real time pathology consult” for each case. See Drs. Garland or Young for ideas.
  6. In therapeutics, it’s important for students to understand the visual process of how a drug works and the mechanism of the action. Students are provided with clinical cases from internal medicine to illustrate different mechanisms. In future, goals are to develop sessions/modules around classes of medicines for specific courses e.g. antibiotics and asthma meds for pediatrics/ beta-blockers for cardiology, etc. As well, the evidence base for use of these therapies is important.
  7. Bring clerks into pre-clerkship sessions you’re teaching. E.g. if you’re teaching about Acid Base in Renal/Endocrine, bring clerks from the service into the class to assist students with the learning and to show how it’s applicable to them in future. Can also occur in first year courses.
  8. Build online resources that may be used in different ways by different faculty in the future into clerkship. E.g. Sodium/Acid Base. Consult the foundational science faculty for assistance, as they have a huge database of images for use.
  9. OR consult the library for existing modules that may be used similarly. There are several videos, and other media, such as Anatomy TV which may be used.
  10. Use the Clinico-Pathologic Conference Approach used in the NEJM cases (examples at http://oac.med.jhmi.edu/cpc/links.cfm) where a case is presented to a clinician, who then demonstrates the process of reasoning that leads to his or her diagnosis. A pathologist then presents an anatomic diagnosis, based on the study of tissue removed at surgery or obtained in autopsy. Students work on the diagnosis, and discussion ensues.
  11. Who could be involved in preclerkship or clerkship? See how these faculty and concepts are located around a single node or bolus?

node

Great Places to Integrate

places for integration

We have some places in pre-clerkship that are waiting for some basic science; and some great places that are waiting for some clinical applications.

  1. In FSGL, we have the opportunity to integrate pathology, anatomy, imaging, etc. into cases.
  2. In Expanded Clinical Skills, there exist spaces for this integration.
  3. Problem solving exercises in SGL require foundational science for solutions and diagnoses. See above re. cases for some examples.
  4. CAUTION: Don’t overload. Use these examples of integration judiciously. Perhaps imaging is all that Dr. Davidson will use in a case of a limping child. Or perhaps Dr. Murray will use knowledge of histology and pathology or drug therapies in a case of a female patient presenting with shortness of breath that could be a case of myocardial infarction.
  5. Looking for some places and people with which to integrate?
  • In term 1, we teach Normal Human Structure (anatomy/histology), Normal Human Function (Physiology) and Critical Appraisal, Research and Learning (Epidemiology, stats, methods of study).
  • In term 2 we teach Therapeutics (pharmacology) and Mechanisms of Disease (immunology, infection, pathology). We teach about neoplasia, etc. in Blood and Coagulation. Genetics is taught in Genetics and Pediatrics in Term 2.
  • In the C courses, many concepts are bundled together, often by faculty who taught in pre-clerkship.

Some Theory:

As promised, here’s the theory (with a few practical applications to keep you reading)

theory 2

What is integration?   It refers to situations in which knowledge from different sources (basic science, clinical, factual, experiential, etc.) connect and interrelate (Regehr, 1996) in a way that fosters understanding and performance of the professional activities of medicine (diagnosis, management,etc.). (Kulasegaram, 2013).

  1. Integration of concepts is a two way street. We may bring aspects of clinical cases back to foundational Basic Science Courses. We may bring aspects of basic science and other concepts into clinical courses and clerkship.
  2. The key to this is communication, and knowledge of what each other is teaching.

See Integrating across years and courses: Lessons learned in NHS and Circ/Resp Handout attached. Educational Developers and Year Directors know what’s going on in the whole curriculum.

  1. Integration works in many ways from year 1 to year 2 and vice versa, and from year 1 to year 2 to clerkship and vice versa.
  2. Think of integration as “booster dose” to increase learning. Foundational courses provide the initial “vaccine” but students require booster doses to boost their learning.
  3. A “spiral curriculum” is a curricular model where students revisit specific aspects of previous learning but build on it to move forward. Integration is the key concept here. See below.

Integrated teaching offers many advantages (Harden, 2000)and may be a key factor in the delivery of an effective educational programme.

For the following, I am indebted to Kulasegaram, KM et al. (2013) in Cognition Before Curriculum: Rethinking the Integration of Basic Science and Clinical Learning.

Kulasegaram et al write, “Causal integration is not just an aid for memory and retention (Woods, 2007).  Rather, the cause and-effect relationship between the basic sciences (such as the physiology of upper motor neurons) and clinical features (such as the symptoms of stroke) creates a framework within learners’ minds that allowed them to organize the constellation of the features of a diagnosis. (Woods, 2007). This cognitive conceptual coherence is the advantage of integrated basic science teaching.” See this excellent article for more theory behind integration.

In a spiral curriculum, “a curriculum as it develops should revisit this basic ideas repeatedly, building upon them until the student has grasped the full formal apparatus that goes with them” (Bruner, 13).  Different terms are used to describe such an approach, including “distributed” and “spaced.” A spiral approach is often contrasted with “blocked” or “massed” approaches.

In a spiral curriculum,

  • The student revisits a topic, theme or subject several times throughout their school career.
  • The complexity of the topic or theme increases with each revisit.
  • New learning has a relationship with old learning and is put in context with the old information.

The benefits ascribed to the spiral curriculum by its advocates are:

  • The information is reinforced and solidified each time the student revisits the subject matter.
  • The spiral curriculum also allows a logical progression from simplistic ideas to complicated ideas.
  • Students are encouraged to apply the early knowledge to later course objectives.

Here’s how I envision our spiral curriculum at Queen’s. What do you think? Advice and feedback most welcome!

sheila arrow-2

References

These articles are either cited above, or were consulted in putting these arguments together.

Bierer, S. B.,  Dannefer, E .F., Taylor, C., Hall, P. (2008).  Methods to assess students’ acquisition, application and integration of basic science knowledge in an innovative competency-based curriculum. MedTeach.30.

Bruner, Jerome. (1960). The Process of Education. Cambridge, MA:  The President and Fellows of Harvard College.

Charlin, B. et al. (2007). Scripts and Clinical Reasoning.  Medical Education, 41(12).

Harden, R. (2000). The integration ladder: a tool for curriculum planning and evaluation.  Medical Education, 34(7).

Harden, R.M., Sowden, Susette, Dunn W.R. (1984). Some educational strategies in curriculum development: The SPICES model. Medical Education. 18 (4).

Kulasegaram, KM et a.(2013). Cognition before curriculum: Rethinking the integration of basic science and clinical learning. Academic Medicine, 88 (10).

Mandin, H. (2000). Evaluation: The engine that drives us forward—or back.  Clin Invest Med., 23 (1).

Regehr, G, Norman, GR. (1996). Issues in cognitive psychology: Implications for professional education. Acad Med., 71(9).

Schmidt, H. G. & Rikers, R. M. J. P.  (2007). How expertise develops in medicine: knowledge encapsulation and illness script formation. Medical Education, 41(12).

Woods, N. (2007). Science is fundamental: the role of biomedical knowledge in clinical reasoning. Medical Education, 41 (12).

Woods, N.N., Brooks, L.R., Norman, G.R. (2007). It all makes sense: Biomedical knowledge, causal connections and memory in the novice diagnostician. Adv Health Sci Educ Theory Pract., 12(4).

 

 

 

 

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Did you know? Faculty Evaluations are just a click away

An easy click to find your Faculty Evaluations

Undergraduate Meds has been working with MEdTech on enhancing the way faculty receive their faculty evaluations from students.

In MEdTech, go to “My Evaluations” at the top right hand side of the screen, and click.

 

MyEvaluations

All of your evaluations from the past years will be laid out for you there.

Tips for Processing Teaching Evaluations

Sometimes it’s challenging reading teaching evaluations.  Here are some tips for you to process this important information effectively:

1. Analyze.  Don’t get sidetracked by one outlier or a few negative comments.  To do that:

2.  Identify your key strengths. What are the questions that received the top three scores? Read the narrative comments that accompany these.

3.  Identify key areas to improve.  What questions received the lowest three scored?  Read the narrative comments that accompany these.

4.  How can you account for your strengths and weaknesses?  How are you teaching, or how are your learning events designed to give evidence for this?

5.  What will you ensure you keep doing in the future?

6.  What might you want to change in the future and how will you do this?

7.  Who can you consult with?  There are 3 categories of people who can assist you:

a.  Students:

  • Try to get earlier (formative) feedback in the future with a simple quiz that asks students how a session went.  Try questions like “Did this learning event meet the learning objectives?”  “Was the teaching clear?”  “Did I use enough steps, examples, figures and references to explain challenging concepts?”  “Was the session organized so that you could follow along?”
  • Use an “exit card” which asks students to put a statement of success on one side, and a challenge you can work on, on the other.
  • Or ask students “What is the muddiest point” in writing.  That will tell you what you have to clear up, and where your teaching may have met a challenge.  NOTE:  it’s important that you clear up the muddiest point, either through the Discussion Board on MEdTech, in another session, or through an email to the class academic reps.

b.  Peers or Course Director:  Peer coaching and getting advice from a colleague who has undoubtedly “been there” is a very useful way to get answers to questions and solutions to problems.

c.  The Educational Team:  This is what we are here for.  The Educational Developers work one-on-one with faculty to help them in all areas of their learning events.  Don’t hesitate to call.

Teaching is not easy, and for many, it’s not intuitive.  Focus on your strengths, and consult to build your skills.

Questions?  Write here, or write to sheila.pinchin@queensu.ca

 

 

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Medical Council of Canada (MCC) Clinical Presentations: How are they used in our curriculum?

Our UG curriculum has been built to accept the MCC clinical presentations as the core or spine for our Medical Expert role and competencies.

What are they?

MCC clinical presentations are part of the learning objectives for the MCC Exams, under the “Expert” section. They contain approximately 190 ways in which a patient with clinical issues may present to a clinician. The MCC clinical presentations are located at http://apps.mcc.ca/Objectives_Online/objectives.pl?loc=home&lang=english

The Medical Council of Canada changes and updates the presentations and keeps a record of this on its website. The website has a great search feature, under which you can search for disease entities, foundational science concepts, etc. http://apps.mcc.ca/Objectives_Online/objectives.pl?lang=english&loc=search

The website is newly updated with population health, and the intrinsic roles of a physician as well as a “Normal Values” section.

Queen’s Meds and the MCC’s

Previously we at Queen’s Undergraduate Medical Education (UGME) had modified the MCC presentations. However, the UGME Curriculum Committee has decided to use the full MCC presentations as they are represented on their website, and change annually to accord with the updates.

Important Note:  Soon, the UGME Educational Team will send out to Course Directors, on behalf of the UGME Curriculum Committee, a list of all the MCC presentations that have been assigned to each course. Course Directors are encouraged to review these as there may be some changes from previous assignments, due to MCC changes, and due to our conversion to the MCC presentations. With a new tracking report, Course Directors will also have access to data that shows where the MCC presentations have been tagged in their courses at the learning event level.

What if a Course contains other MCC’s than were assigned?

There may be MCC presentations that are taught in courses that have not been formally assigned by the UGME Curriculum Committee. A Course Director should bring this either to the Year Director for the Curriculum Committee or bring it directly to the Curriculum Committee.

The role of the committee is to ensure that all the MCC presentations are taught in the four years of medical school, and to ensure that there is a logical, spiral progression to the teaching. Thus, if two or more courses teach about the same presentations, there is usually no difficulty, but all concerned parties must be aware of who is teaching the presentation, how, and when. The Curriculum Committee will ensure that course directors are brought together to discuss this, usually through the Educational Team or the Teaching, Learning and Innovation Committee’s special projects.

What if a Course Director judges the teaching of a specific MCC to be a problem in a course?

If a Course Director feels that a specific MCC assigned to the course presents a problem, the process outlined above holds good here too…either bring the matter to the Year Director for Curriculum Committee or to the Curriculum Committee with an explanation. Again, the concern of the Committee is to ensure that the MCC presentation is taught in the appropriate place and manner within the four years of medical school.

How are the MCC presentations taught in our courses?

It’s important for us in UGME to consider how these MCC presentations may be taught in our classes. Our UGME curriculum is varied and integrated. In early pre-clinical years, MCC presentations may be a part of teaching such as:
1. Foundational science teaching and learning leading to clinical application
2. Links of a clinical presentation to systems and disease/conditions
3. Approaches to patient presentation
4. Collection and interpretation of information
5. Diagnosis
6. Intervention/Management
7. Complexities, multi-system integration, co-morbidities
8. A component of learning about “intrinsic” (non-medical expert) objectives

In clerkship, the MCC presentations are often integrated within all or many of the above.

But MCC clinical presentations often apply to more than one system or course…What then?

This is one of the reasons that the Curriculum Committee has adopted the MCC clinical presentations: because often a patient doesn’t come in knowing his/her disease or knowing which body system has been affected. In fact, it is important that our students learn undifferentiated diagnostic skills for “chest pain,” “cough,” “headache,” or “dyspnea.”It is one thing to know that dyspnea will be an indicator of a heart condition if the teaching is part of the Cardiovascular unit in the CV/Respiratory Course. It is a very different thing to encounter dyspnea in the Emergency Department, in Internal Medicine, or in Family Practice and trace it to a specific cause.

This is why we are building more undifferentiated diagnosis sessions into our preclinical years. As well, it’s why anatomists and physiologists in our first term of teaching in medical schools partner with clinicians to teach about the different aspects of a clinical presentation—considering anatomical/physiological changes and pathological insults that are of concern to the treatment and management of an illness or condition.

We are working on the spiral nature of our curriculum, building to an integrated approach to clinical presentations in the clerkship. That is, we’re revisiting topics from years 1-4, in greater complexity.  That’s why it’s important the different people teaching about the same presentation need to be in contact with each other and consider the best way to approach this shared teaching to create the spiral.

Do you have questions about this process of assignment of MCC Clinical Presentations in Queen’s UGME? If so, write here, or to sheila.pinchin@queensu.ca

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“Reluctant Congratulations” to Dr. Ted Ashbury on his retirement

We would like to extend reluctant congratulations to Dr. Ted Ashbury on his retirement, and acknowledge his contributions to our Undergraduate Medical Program. 

Screen Shot 2013-05-30 at 8.54.21 AM

Here are remarks from Dr. Sanfilippo on the occasion of Dr. Ashbury’s retirement party:

Ted Ashbury has been as important as any individual to our curricular renewal over the past 7 years.  He was conscripted, somewhat deviously, to an Advisory Group that was formed in 2007 to completely review and overhaul the MD program.  In that process, Ted became the voice and strong proponent of Professionalism within the curriculum.  He chaired a working group consisting of dedicated faculty and students that developed effective and innovative teaching methods.  He participated actively in that teaching, and became the “face” of professionalism by speaking to the first year class annually on the first day of their medical school orientation.  Whether in the pre-clerkship or clinical rotations, Ted’s sincerity and the passion of his commitment to the advancement of professionalism, and to medical education in general, has always been at least as powerful as his words.  The students immediately identify him as the “real deal”, as someone who “walks the walk”.  Quite simply, they listen and try to emulate his example.  He has had an incredibly powerful and positive influence on a generation of Queen’s medical graduates.

In addition to being the voice of professionalism, Ted has been the voice of reason.  I have been incredibly grateful for his thoughtful and always tactful commentary at meetings, and for his continuing support and advice over the years.  The only thing that really gets me about Ted is this unfathomable notion that he needs to retire, but here’s hoping he comes to his senses at some point soon.  In any case, I fully intend to call from time to time for advice, whether he’s on a porch or in a boat, and welcome unsolicited commentary at any time.

I’d like to add a personal note as well.  I joined the Advisory Committee when Ted did and I was a rookie medical educational developer.  He was a constant source of support, of inspiration, and of knowledge as we all negotiated our foray into competency-based education and the development of a curriculum framework.  Throughout the next 7 years (!), collegial, collaborative, articulate, learned and wise, he taught and worked as he practised, and the students and I and many faculty and staff are much the better for it.  It’s my fervent hope that Ted will soon tire of the peace of retirement, and yearn for the excitement and pressure of life in UG, and return to us.  In the meantime, Ted, I can see you on that dock, relaxed in the sunshine, eyes looking ahead to the future!  Congratulations!

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There’s gold in those Ottawa Hills: Nuggets from the CCME and Ottawa Conference

Last week, a number of us from Queen’s School of Medicine were privileged to attend the Canadian Conference on Medical Education combined this year with the Ottawa Conference on assessment and evaluation, in Ottawa.

It was a jam-packed schedule with great ideas from medical education, teaching, assessment, evaluation, interprofessional education, Undergraduate, Post-Graduate and Continuing Medical Education and much more.  There were attendees from all over the world, as the Ottawa Conference is an international conference with conference locations that alternate among North America, Europe and Australia.

I’ve asked people for nuggets from the conference to share with you.  From my point of view, the whole conference was a panful of gold!

gold-nuggets

Here are some thoughts:
Dr. Tony Sanfilippo writes that the number and quality of submissions from Queen’s faculty and students were very impressive and indicative of an active and involved educational program.

In fact, from Queen’s there were:

  • 43 presenters of 13 posters
  • 52 presenters of 18 oral presentations
  • 2 presenters presenting at 1 symposium (Drs. Jane Griffiths and Karen Schultz on their portfolio and EPA work)
  • 16 presenters giving 9 workshops
  • 8 presenters giving 3 pre-conference workshops

(Thanks to Lori Rand for collecting these from the program!)

gold nugget 1Noteworthy:

  • Dr. Michelle Gibson and Dr. Bob Connelly were awarded the CAME Certificate of Merit Awards for teaching. Congratulations to them!
  • Dr. Danielle Blouin was awarded The Award for Outstanding Contribution to Faculty Development in Canada from the Association of Faculties of Medicine Canada (AFMC).  Congratulations!
  • Dr. Leslie Flynn gave a terrific talk at the Dean’s Reception, outlining all we’ve done in the Faculty of Health Sciences over the year.
  • Many of our meds students presented, including James Simpson, Marie Leung, Graydon Simmons  and Eve Purdy.
  • Meds students Rebecca Wang and Andrew Dhawan won the CHEC-CESC Virtual Patient Challenge, ($1000.00 prize) for  their online module Tackling Diabetes Together, Dr. Robyn Houlden, Advisor.
  • Stefania Spano, Meds 2016, exhibited her artwork, entitled Talking to Myself (\/Dialogue avec moi-meme, featured in the White Coat, Warm Art exhibit, below.

ccme-blog

Eleni Katsoulas who is the UG Assessment and Evaluation Consultant offers this advice from a great workshop on Remediation:  Make remediation learner-centred by using these steps:

  • Step 1:Identify areas of deficits in terms of three domains: 1) Communication skills/Professionalism; 2) Knowledge/Clinical Reasoning; and 3) Efficiency/Time Mgt
  • Step 2: Identify his/her Readiness to Learn (using Stages of Change Model): Pre-Contemplation; Contemplation; Preparation.
  • Step 3: Formulate a learner-centred remediation plan; include remediation and monitoring
  • Step 4: Consider possible facilitators & barriers for learner-centred remediation

Theresa Suart our Educational Developer, adds to this from another workshop on remediation:

  • It’s important to have a remediation strategy, rather than responding reactively to individual situations. Learners still need individualized remediation plans, but having a strategy for how to address these needs will improve learning and administration for all circumstances.
  • We need to understand why a student is failing before applying a solution.
  • A coach model can be effective.
  • All schools are wrestling with these challenges

gold nugget 1Eleni also offers this great, succinct selection from a symposium Bridging the Gap: How Medical Education and Measurement Science can Better Collaborate to Meet the Growing and Broadening Assessment Needs:

  1. Dr. Kevin Eva noted the importance of distinguishing between performance orientation (performed well, satisfaction from grades and task avoidance) vs. mastery orientation (become proficient, deepen engagement and stronger motivation).
  2. Dr. Eric Holmboe spoke of the importance of a shared model of responsibility between students and faculty, (for example, where portfolio is a verb not a noun) and making assessment an active process with a lot of learner engagement.
  3. Professor Dame Lesley Southgate asked, “Has Assessment killed judgment?” “No, she concludes, “Measurement informs judgment through better design of assessment programmes.”

Dr. Laura McEwen who is the PG Assessment and Evaluation Consultant, offers this insight after 4 days of attending events on assessment:  assessment is hard, and competency based assessment is harder!  smile

Actually, what she really wanted to offer was a nugget to all of us managing and prioritizing our work from one of the speakers:

Laura heard about the importance of systematically aligning responsibilities with goals.  And so periodically (3-6 month intervals) it’s important to review what you are “Doing”, “Planning”, and “Dreaming” as a means of strategically managing competing professional responsibilities and informing prioritizing in relation to managing your academic career.

Theresa Suart attended a workshop on reflection, and found these nuggets:

  • Remind learners that not all experiences are transformative. Learners may, in writing a critical reflection, uncover a transformative experience, but they may also (equally importantly) write about a confirmation of learning.
  • Consider using a short narrative prompt or a poem to help learners with reflections
  • What are we assessing? Students’ abilities to reflect, or the learning they are reflecting about?  Can we/should we do both at the same time?
  • Theresa noted that “We seem to be facing the same challenges at medical schools around the world – the best ways to support learners and faculty with the resources (time, staff, funding) at hand.”

gold nugget 1

Dr. Peter O’Neill writes, “Queen’s success in the CaRMS match was shared across the country by sharing our careers curriculum and our student forms”

Dr. Michelle Gibson tweeted from Dr. Glen Regehr’s talk one of his many provocative slides:  (She actually took a photo of his slide and tweeted—an excellent way to collect, save and share from a presentation)

Everything we call cheating on high stakes exams we call good practice in the clinic:

  • Anticipating challenges and putting supports in place
  • Seeking collaboration and multiple perspectives on problems
  • Admitting we don’t know and looking it up instead of guessing
  • Double-checking rather than assuming you are right.

Working through pages and pages of notes, here’s what I found to share:

Adding to what we have learned about Entrustable Professional Activities (EPA), Dr. Ollie Ten Cate spoke about the “trust” part of entrustable and stressed the critical nature of observation in assessment and teaching.  Two resources I noted were:

  • Dr. Ten Cate spoke about the TED Talk, Should you trust your first impressions?  http://ed.ted.com/lessons/should-you-trust-your-first-impression-peter-mende-siedlecki#review
  • And he cited Dr. Cees van der Vleuten’s Utility Index, with Reliability• Validity• Educational impact• Cost efficiency• Acceptability as 6 components that should be balanced when creating an assessment tool.
  • He said we should observe rather than assume information about students’ knowledge and skill (competence), their truthfulness (honesty), their ability to discern limitations (show vulnerability) and how conscientious (reliable) they are. In this way, we can entrust them to carry out EPAs appropriate to their level of learning.
  • I have to warn you that a few of us attended a session on faculty development and making assessment learning enjoyable.  So stay tuned for some fun workshops around assessment!  🙂

gold nugget 1One thing we can certainly say:  We are all working hard on similar issues, ideas, and challenges across Canada and internationally.  It’s difficult to see what others are thinking and doing sometimes, and CCME gives us a venue to do this.  It’s a collaborative supportive space, with people really interested in sharing what they’ve done.  Next CCME is in Vancouver—come and join the learning!

What nuggets did you pick up at CCME/Ottawa Conference?  Write to the blog to add them!

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