Author: Theresa Suart
Balancing service and learning in service-learning
Formalizing opportunities for service-learning is increasingly important to schools of medicine, both for the inherent merits of service-learning itself (for both learners and communities), as well as for accreditation considerations.
The Future of Medical Education in Canada (FMEC) report places a strong emphasis on social accountability, and service-learning is integral to carrying out this mandate: “Central to these social accountability initiatives is the provision of a comprehensive education for physicians that will enable them to respond directly to the ever-changing health care needs of the communities they serve” (FMEC, p. 16).
Ways forward suggested in the FMEC document include:
- Provide greater support to medical students and faculty as they work in community advocacy and develop closer relationships with the communities they serve.
- Provide students with opportunities to learn in low-resource and marginalized communities as well as international settings. To emphasize student and patient safety in a socially and ethically accountable framework, students should experience adequate training and preparation prior to working in these communities and should have adequate support throughout. (p. 17).
As well, service-learning projects can provide students with opportunities to develop many aspects of the CanMEDS competencies in community settings, enhancing our existing classroom and hospital-based curriculum.
But what, exactly, is service-learning? There are many definitions of service-learning (one reference points to 147 definitions in the literature) and many interpretations of what service-learning may look like.
The LCME has defined service-learning as “a structured learning experience that combines community service with preparation and reflection. Medical students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens and professionals.”
It’s also helpful to consider this chart (from Marquette University in Milwaukee) which illustrates the differences among community service, service-learning, and internships.
Regardless of variations in definitions, service-learning is always a three-part process which incorporates preparation, service, and reflection.
The core components of service learning include:
- Formal, deliberate preparation, which includes consulting with the members of the community who will be served by a project and which may include classroom instruction or another form of mentorship/coaching. A plan, detailing both the intended service and learning outcomes is created.
- The “service” and “learning” are completed
- The learner reflects on the process, the service and the learning. (This may occur throughout the project or period of service). The learner provides evidence of learning. (This could be provided in different ways, for example, through written reflections or an interview with a preceptor).
Some things to consider when thinking about incorporating a service-learning project into an existing course or a student-developed learning plan:
- Time & Scope: Is this in addition to, or as a replacement for, an existing project or assignment? There may be ways to extend or expand existing assignments to allow for service-learning. How much time can students realistically devote to the project both to make it a success and in light of other academic and personal responsibilities?
- Goals: How does the project relate to curricular objectives and individual students’ learning goals? How does the project serve the community group or agency’s goals? An individual or group of students may have short-term goals that feed into an agency’s long-term planning: A particular cohort could complete a component of a larger service-learning endeavor with subsequent cohorts carrying on with other components of the same over-arching project.
- Mentoring & Accountability: How will students be guided and supervised during the project? Is this responsibility shared between an instructor and community member or does one person have the lead? How will students’ learning be assessed and documented?
Encouraging opportunities for service-learning should in no way suggest that other, equally-worthy, voluntary service is not valued by the School of Medicine, Queen’s or the wider Kingston community (and other communities in which our students find themselves). However, because of the integrated nature of service-learning, it has the potential to provide unique opportunities for our students and our communities. The Professional Foundations Committee is exploring ways to address service-learning formally in the UGME Curriculum.
If you’re interested in incorporating service-learning in your course, the Education Team is available to help with your planning. Please feel free to get in touch.
Brainstorming in the classroom
Have you ever used brainstorming in your teaching? If you want groups of students to come up with a variety of ideas quickly, brainstorming is one tried-and-true way to get creative juices flowing.
Since the concept was introduced in Alex Osborn’s 1953 Applied Imagination, brainstorming has caught on in business, education, volunteer organizations and elsewhere to generate ideas and solve problems.
Brainstorming, as set out by Osborn, is designed to produce a large quantity of ideas in a short space of time, in order to encourage creativity. He had four simple rules for brainstorming sessions:
- Don’t allow criticism
- Encourage wild ideas
- Go for quantity
- Combine and/or improve on others’ ideas
Last week I saw a post on Twitter that suggested “brainwriting” rather than brainstorming. I was intrigued and clicked-through, only to find a new name for a familiar best practice: brainstorming works best when it’s planned, not haphazard, and it starts with the individual, not the group.
As described by Patrick Allan (citing work of Leigh Thompson and Loran Nordgren) brainwriting avoids the brainstorming pitfall of anchoring: where an early idea streams all other suggestions in a particular direction. “Brainwriting” gives individual team members time to write down their own ideas free of others’ influences.
Osborn himself advocated this (although he didn’t use the term brainwriting), asserting that the best ideas come from a blend of individual and group work. Classroom brainstorming shouldn’t be unplanned: students should have prep and thinking time.
As Robert Sutton notes in “Eight Tips for Better Brainstorming”: “Skilled organizers tell participants what the topic will be before a brainstorm.”
Barbara Gross Davis also encourages individual preparation in Tools for Teaching. She suggests posing an opening question and having students spend five minutes writing a response. This “gives students time to think and enriches subsequent discussion.”
Here are some other ideas to encourage better brainstorming in your classes:
- Assign roles within the brainstorming group. Groups need a moderator (to guide discussion, keep the group on topic, and encourage wide participation), a scribe (or two) to capture the ideas (using either flip charts, Post-It notes, computers or consider audio recording), and members (to contribute and build ideas).
- If you’re going to use brainstorming, make sure your scribes have some tools. To Osborn’s original four rules for brainstorming, OpenIDEO adds be visual: “In live brainstorms we use coloured markers to write on Post-its that are put on a wall. Nothing gets an idea across faster than drawing it. Doesn’t matter how terrible of a sketcher you are! It’s all about the idea behind your sketch.”
- MindTools advises that the moderator can help keep the team on task and can help the team avoid narrowing its path too soon. “As the group facilitator, you should share ideas if you have them, but spend your time and energy supporting your team and guiding the discussion. Stick to one conversation at a time, and refocus the group if people become sidetracked.”
- Remember, the students who are the moderators and scribes aren’t actively brainstorming while they’re attending to their key roles. Encourage teams to share these tasks throughout a term, so it’s not always the same couple of people who end up taking notes rather than contributing their ideas.
And, what to do with all those ideas the groups generate? Sutton points out that brainstorming should “combine and extend ideas, not just harvest them,” so have a plan for what you want students to do next.
The next steps are sorting and follow-up. In Small Group and Team Communication, Harris and Sherblom recommend an “ACB Idea Sorting Method”:
- Assign an A to the best one-third of the ideas
- Assign a C to the least usable one-third
- The middle one-third automatically receive a B
- Go back to the B’s and separate them into the A or C category
- Store the C category ideas for later use
- Prioritize the A’s in terms of their importance, urgency, or applicability to the problem at hand.
The Education Team can help you with incorporating brainstorming and other techniques in your teaching. Contact us to arrange for one-on-one coaching or to facilitate a workshop for your team.
7 Tips on Better Brainstorming. (n.d.). OpenIDEO. Retrieved August 12, 2014, from https://openideo.com/blog/seven-tips-on-better-brainstorming
Allan, P. (n.d.). Use “Brainwriting” Instead of Brainstorming to Generate Ideas. Lifehacker. Retrieved August 12, 2014, from http://lifehacker.com/use-brainwriting-instead-of-brainstorming-to-generate-1615592703?rev=1407126541539&utm_campaign=socialflow_lifehacker_twitter&utm_source=lifehacker_twitter&utm_medium=socialflow
Brainstorming: Generating Many Radical, Creative Ideas. (n.d.). Brainstorming. Retrieved August 12, 2014, from http://www.mindtools.com/brainstm.html
Davis, B. G. (2009). Tools for teaching (2. ed.). San Francisco, Calif.: Jossey-Bass.
Harris, T. E., & Sherblom, J. (2011). Small group and team communication (5th ed.). Boston: Pearson/Allyn and Bacon.
Johnson, D. W., & Johnson, F. P. (2009). Joining together: group theory and group skills (10th ed.). Upper Saddle River, N.J.: Pearson/Merril.
Sutton, R. (2006, July 25). Eight Tips for Better Brainstorming. Bloomberg Business Week. Retrieved August 12, 2014, from http://www.businessweek.com/stories/2006-07-25/eight-tips-for-better-brainstorming
Incorporating technology into teaching should focus on providing high-quality learning experiences for students, not just adding the latest tech fad to your teaching toolbox.
That was one of the messages shared by Sidneyeve Matrix, PhD, keynote speaker at the 7th annual Celebration of Teaching, Learning and Scholarship in Health Sciences Education. Sponsored by the Office of Health Sciences Education, the theme of the one-day conference was “Learning Together: Relationships in Health Sciences Education.”
Matrix, a Queen’s National Scholar and Associate Professor with the Department of Film and Media, Faculty of Arts and Science, addressed the topic of High-Engagement and High-Tech Teaching and Learning Experiences, by Design.
Although most of today’s students have grown up with technology, they’re not all the tech experts some may expect. They have surface knowledge of technology they use, but not necessarily a broad range of skills. And while students may not have deep digital competencies, they expect faculty to have them, Matrix said.
The first step to enhancing teaching with technology is addressing the faculty tech-skills gap through faculty professional development, Matrix suggested. This, she acknowledged, may be easier said than done: the biggest barrier to tech adoption by both students and faculty is time.
So, why bother with educational technologies? The payoff in student learning has been studied: teaching with edtech and social media improves student outcomes by 10 percent. And what about the distraction factor? Another study Matrix cited revealed students with smartphones study 40 extra minutes per week versus those without them.
Matrix advised faculty interested in incorporating more technology in their teaching to seek out innovators within their own departments and schools: approach these people to find out what’s worked for them and what hasn’t. She said blended learning teams should include ITS consultants, instructional designers and faculty peer mentors. Key messages: don’t go it alone and don’t think you have to reinvent the wheel.
And, she emphasized, focusing on students’ learning experiences—not the technology—is the key to success. Like all good teaching, teaching with technology should focus on excellence and engagement, not just adding in a tech tool or two – or 20.
While there’s “choice abundance” in online tools for teaching—Matrix pointed out there are over 2000, producing “choice fatigue”—too much technology can turn a good course into a “Frankencourse”, producing frustration for all concerned and lower student learning outcomes.
Matrix also advocates incremental innovation, pointing to her own Film240 Media and Culture course: its first iteration in 2007 had 75 students; by 2009 it had 500 students and a social media component. In 2011 she added a new online section, mobile app and webinars and boosted enrolment to 1000. The 2013 class had 1400 students, e-flashcards, podcasts, eBook, self-quizzes and lectures available on demand. Her point: she didn’t do it all in one term, or even one year.
One technology-assisted assignment Matrix showcased in her presentation was infographic digital posters, used as an alternative to a research essay assignment. These are shared via the course Learning Management System (LMS) for peer-to-peer inspiration and feedback. Students can use Piktochart to create their assignment.
These aren’t just pretty posters, but well-researched assignments presented in a visually-appealing, accessible way. “It’s visual storytelling with research narratives,” she said.
* * *
What’s your favourite tech teaching tool? Let us know what it is and why it works for you by sharing in the comments.
If you’re interested in tech teaching training, let us know what topics are of interest to you. We’ll incorporate these requests in our future UGME faculty development planning.
Find the full slidedeck from Dr. Matrix’s presentation here. You can find more on trends in digital culture, communication and commerce, with emphasis on social, mobile, and educational technology at her Cyberpop! blog.
Tackling your summer “To Be Read” pile
Do you have an ever-growing “to-be-read” (TBR) pile of books and journals that you’ve told yourself all year you’ll get to “in the summer”? And now it’s summer and the pile is daunting and the beach is calling. What to do? Try these five steps to get started.
Weeding the list (or culling the pile): If it’s been a while since you organized your list or your pile, don’t be afraid to remove titles. Your needs and interests may have changed in the intervening months. Also, if you start a book and find it’s not living up to its promise, ditch it. Why waste your time? I give a book 40-50 pages to impress me; otherwise, I move on. (This works for non-fiction and fiction alike).
Book time (sorry for the pun): We schedule times for meetings, but reading – even to keep up with our professions – often drops to the “squeeze it in somewhere” category. Consider scheduling 30 minutes a day of dedicated reading time. Can’t manage one half-hour slot? If it’s something you plan for, you could break it into two 15-minute chunks. Stow the book in your briefcase or make sure it’s downloaded to your eReader. Experiment to see what works.
Balancing interests: Sheila Pinchin shares that she uses two categories for her TBR list: Feed the Program and Feed the Soul. “This helps my priority lists and helps me balance profession and personal or other interests.”
Choose your own adventure: Sure, there are some books that require a start-to-finish reading strategy, but sometimes reading a single chapter can give us the information or tools we’re looking for. Sheila’s using this strategy for Engaging Ideas: The Professor’s Guide to Integrating Writing, Critical Thinking, and Active Learning in the Classroom by John C. Bean. “It’s a wonderful but huge book,” she says. “I’m going to dip into the book at different parts, and just read a chapter or two as they strike my interest or need.” Make use of Introductions and Tables of Contents to find what’s relevant to you and just read that.
Let technology serve you: How can tools you already use help with your TBR list? I routinely use my iPhone to read journal articles in those “gap” times — when I’m early for an appointment or waiting to pick up one of my children from an activity. I also keep two folders on my computer desktop: “Journal Articles Unread” and “Journal Articles Read”. When I scan the e-versions of journals, I’ll save the PDFs to the Unread folder, then move them over when I’ve completed them. I use key subject words in my “Save as” file names.
Do you have a favourite way of managing your TBR pile? Is there an app or computer program or maybe a filing system that works for you? Please share!
Finally, here are (some of) the titles on the Education Team’s summer lists which might be of interest to you, too. (Sorry that this could add to your TBR pile!)
From Sheila Pinchin’s TBR Pile:
- See John C. Bean’s book, Engaging Ideas above. Two chapters that have caught my eye: Using small groups to coach thinking and teach disciplinary argument and Bringing more critical thinking into lectures and discussions.
- Our Queen’s Meds SGL is founded on Team-Based Learning. A great book with ideas for all of us is Team-Based Learning for Health Professions Education, edited by Larry K. Michaelsen, et al. The frontpiece says “A guide to using small groups for improving learning” and they certainly carry through on that promise.
- Medical Teacher’s newest edition has an article, “Developing questionnaires for educational research: AMEE guide no. 87” (2014, 36: 463-474). A lot of us are doing educational research and developing surveys. This article’s 7-step process looks very practicable.
- “Assume hope all you who enter here.” This is the first line of Getting to Maybe: How the World is Changed (2006) by Westley, Zimmerman and Patton. This book, “not for heroes or saints or perfectionists” helps us see how to harness the complex relationships to lead to change. Education is all about change…this is a wonderful read about “how to.”
From Eleni Katsoulas’ TBR List:
- Remediation in Medical Education by Adine Kalet and Calvin L. Chou. I have had this book for about a month now and only looked over the table of contents. My plan is to delve into it during my holidays next month but from what I can see it offers practical tips to remediation. Looking ahead: Dr. Michelle Gibson will give us some key points from this book in a later blog.
- Quiet by Susan Cain. This book comes highly recommended to me by a friend that works as a consultant for the school board. A must read that explores “the power of introverts in a world that cant stop talking”.
And from my own teetering stack:
- Creating Self-regulated Learners by Linda B. Nilson. This is one of the goals of our curriculum. I bought this book back in February and have neglected it. I’m interested in Nilson’s strategies and if they can be applied in the UGME setting.
- Where’s the Learning in Service-Learning by Janet Eyler and Dwight G. Giles, Jr. I’ve dipped into this one for work on a service-learning module for QuARMS, but I’m eager to delve into the whole thing. Formalizing service-learning in UGME curricula could become increasingly important.
- Life, Animated by Ron Suskind I read an excerpt of this book in the New York Times earlier this year. The author’s son, who has autism, used Disney movies to understand the world. It’s a story of resilience and innovation; of seeing the world through a different lens. Important lessons in whatever walk of life we find ourselves.
- Mindset by Carol Dweck Although this book is about seven years old, it’s new to me. Dweck’s research on motivation is intriguing and could have application to our goal of creating self-regulated learners.
Send some suggestions from your TBR pile and… Happy Reading!
Clinical Problem Solving: A student and a teacher talk about lessons learned from an online course
By Heather Murray, MD, and Eve Purdy, MD Candidate, 2015
For many medical students, the process involved in turning a presenting complaint into an appropriate and focused differential diagnosis seems like a big black box. For clinicians who do this many times every day, the process is unconscious, and it is hard to explain to medical student learners how to break it down. Both students and teachers sometimes struggle with how to transition early medical learners to competent diagnosticians.
So, when a clinician (Heather Murray) and a second year medical student (Eve Purdy) independently stumbled across the link to a Massive Open Online Course (MOOC) on Clinical Problem Solving offered through Coursera both of us jumped at the opportunity to learn more about diagnostic reasoning. Eve registered with the hope of shedding light on the type of problem solving that she might be faced with in clerkship, while Dr. Murray registered with the intention of improving her teaching around diagnostic reasoning for students.
Though it is difficult to summarize the six-week course in one blog post there were a few takeaways from the course that we will outline. These key points might help medical students improve clinical reasoning and the same tips might help teachers in clarifying the process for learners. Much of this approach to clinical reasoning comes from the NEJM article “Educational Strategies to Promote Clinical Reasoning” by Judith Bowen (2006).
1. Organize the way you learn about diseases using Disease Illness Scripts
If you have a structured approach to the way you learn about diseases, then you will be more efficient at recalling that information and comparing diseases effectively. One way to organize information is into “Disease Illness Scripts”. This requires organizing information about the conditions into four broad categories.
|-who gets the disease?-what are the risk factors?
-making a mental picture of who you would expect to see with the disease can help
|-over what time period does the condition present?
acute on chronic
-a good way to think about this is where you would expect to see the patient (ER, vs walk-in vs family doctor)
|-what are the symptoms?
*key features are signs and symptoms that are essential to the diagnosis
*differentiating signs and symptoms are those that make this disease different then diagnoses that present similarly
*excluding signs and symptoms are those that, if present, exclude the disease
|-describe and understand the underlying disease mechanism|
2. Organize the way you think about patients using Patient Illness Scripts
When thinking about patients try to frame their presentation using the same structure as the disease illness scripts.
|What important risk factors does the patient have-age
-relevant medical history
-presentation specific risk factors i.e. recent transcontinental air travel in a patient with shortness of breath
|How long has the patient had the symptoms, have they changed?||What symptoms and clinical signs does the patient have?
-try to group as many as possible to shorten the list (e.g. group febrile, tachycardic and hypotensive as septic)
3. Compare disease illness scripts and patient illness scripts to generate a tiered differential diagnosis
Generate a differential diagnosis based on the chief complaint. You can compare your understanding about each disease on your differential with your patient using the illness scripts easily. Pay close attention to key features, differentiating features and excluding features. The closer a disease illness script is to the patient illness script the higher it should end up on your differential. Your final differential has three tiers:
Tier 1: Diseases that are those most likely belong here. The epidemiology, time course and clinical presentation are concordant with the patient illness script.
- Tier 1e: Diseases on tier 1e are diagnoses that may be less likely than tier 1 but if missed will cause immediate and serious harm. These are dangerous diagnoses! The “e” in this tier stands for “emergency” and diseases on this list must be ruled out, even if they are less likely.
Tier 2: Diseases that have some similarities to the patient illness script but aren’t a perfect fit belong here. They are still possible but less likely than tier 1 diagnoses.
Tier 3: Diseases on your original list that do not fit the illness script. They may have excluding features or lack key features.
4. Use your tiered differential to determine what tests to order
The tier that a possible diagnosis falls into will help you decide what tests to order to determine the final diagnosis. Think of each tier as a pretest probability.
Tier 1 diagnoses have a “high” pretest probability
- No tests or few tests may be needed to convince you that a diagnosis in tier 1 is responsible for the patient’s presentation and similarly you would need very convincing information to take it off your list completely.
- These and Tier 1e diagnoses should drive your initial investigations
Tier 1e diagnoses may have varying pretest probability
- These diseases may or may not be likely but regardless tests with high sensitivity are needed to rule them out (remember “SnOUT”)
Tier 2 diagnoses have a “medium” pretest probability
- Diseases on this tier are tricky. You really have to evaluate the sensitivity, specificity and information given from each test. You may need a few good tests get from a “medium” pretest probability to final diagnosis.
Tier 3 diagnoses have a “low” pretest probability
- Even relatively good tests may not move diagnoses from Tier 3 up to tier 1. The positive result that you get might be due to chance. Investigating these diagnoses should be a last resort.
These four tips won’t magically turn a medical student into an expert at clinical reasoning but they might serve to expose the way that experts think. They offer concrete ways for medical students to approach clinical reasoning and a common language for experts to discuss their approach with their learners.
For more information about MOOCs and why explicit discussion of clinical reasoning is important, see these links.
- Many MOOCs are available at Coursera on everything from jazz improvisation, to biostatistics, to the principles of cardiopulmonary resuscitation and everything in between.
- “Teaching Clinical Reasoning” by Michelle Lin (@M_Lin) at Academic Life In Emergency Medicine
- “Teaching Clinical Reasoning” by Nadim Lalani (@ERMentor)
- “Thinking about teaching thinking” by Robert Centor (@medrants)
- Lauren Westafer’s (@LWestafer) great medical student thoughts on “Thinking About Thinking” and “Metacognition for the Pragmatist”
- For a review of the Course and thoughts about how it might be applied to Facilitated Group Learning at Queen’s see Eve’s blog posts here and here.
- MOOC’s as they relate to Free Open Access Medical Education, “What is a MOOC” by Chris Nickson (@precordialthump)
Updated Faculty Resources Community Available
The newly-updated Faculty Resources Community is now available in MEdTech Central. This online resource contains great teaching and assessment ideas, highlights of Curriculum Committee, notes and slides from the retreats, and more.
The resource material available includes refresher instructions on the audio-visual equipment in teaching theatres 132 and 032 (including a map of the numbered student microphones), e-learning resources and links to the small group learning community.
This Faculty Resource Community is open to all faculty at the School of Medicine. For more information, please contact Sheila Pinchin (firstname.lastname@example.org) or Theresa Suart (email@example.com).
Translating students’ comments on course evaluations
Navigating students’ comments could be one of the most challenging aspects of interpreting course evaluations. In an article in Innovative Higher Education, Linda Hodges and Katherine Stanton (2007) suggest using these comments as “windows into the process of student learning and intellectual development” rather than as reviews of “how they have been entertained” by an instructor.
Hodges is Director of the Harold W. McGraw, Jr. Center for Teaching and Learning at Princeton University; Stanton is the center’s assistant director. They point out that sometimes students’ comments stem from “students’ expectations of or prior experiences with college classes” that “entail teachers standing in front of the room ‘telling.’”
For example, is a comment like “I did not learn in this class because the teacher did not teach” evidence of a lack of effective teaching, or evidence that the style of teaching – including lots of team-based work – wasn’t what the student was expecting? Reframing student comments in this light can ultimately help improve teaching, Hodges and Stanton suggest.
“We may see our evaluations less as judgments of our performance and more as insight into our students’ intellectual growth—insight that may engage us in intellectual growth as teachers and scholars.”
Hodges, L.C., and Stanton, K. (2007). “Translating comments on student evaluations into the language of learning” in Innovative Higher Education 31:279-286.