New Features on MEdTech
At the fall Curricular Leaders’ Retreat, Lynel Jackson highlighted four new and improved MEdTech features that can assist faculty in presenting information for students and in planning learning events and courses.
Adding Resources to Learning Events
The EdTech team has completely redesigned the way resources (such as files, links, and quizzes) are added to the Learning Events and displayed to learners in Student View. This new view uses much of the information the EdTech team has collected for years during the upload process, like “Should this resource be considered optional or required?” and “When should this resource be used by the learner?” then displays it to learners in a clear and user-friendly timeline on the Learning Event page. The new format clearly shows what learners need to do to prepare for class, and also clearly marks what resources are required versus what is for information only.
In Development: In the future, these classifications will be used to provide learners with a checklist on their Dashboard, identifying all the activities they need to complete before classes for the week.
The EdTech team has enhanced MEdTech’s Curriculum Explorer tool which is now able to show not only where objectives (at any level) are mapped to Courses, and Learning Events, but also Gradebook Assessments. Faculty members and staff can use this tool to really explore the curriculum at all levels.
There are a number of new and enhanced reports – such as MCC Presentations by Course, Course Objectives by Events Tagged, and Learning Event Types by Course – that can assist in evaluating past course iterations as well as planning the next one. Curriculum coordinators can generate these reports for Course Directors, on request.
One of the most frequently requested features by faculty has been the ability to easily upload images or documents, and embed video into rich text areas throughout the MEdTech platform. With this Fall release, the team was pleased to announce this can now be done within any of the rich text areas.
To upload images or documents, click the “Browse Server” button from within the “Image” or “Link” icons. This will open your personal “My Files” storage area where you can upload images or documents from your local computer. Once you upload the image or document, clicking it will embed the image or document directly in the rich text area. You can also embed video from the Queen’s Streaming Server, YouTube, or Vimeo into any rich text area by clicking the “Embed Media” icon, and pasting in the “Embed Code”.
For questions on these updates and other aspects of MEdTech, reach the Education Technology team at email@example.com
Everything you need to know about exam questions types in our curriculum!
Are all exam questions created equal? Not really—different type of questions test different levels of understanding. In the UGME program, we use a variety of exam questions to assess student learning—broadly classified as multiple-choice questions (MCQs) and short-answer questions (SAQs). But within these broad categories are a range of types of questions designed to test different levels of cognition. We use these different types of questions at different points both within courses and within the program.
Based on Bloom’s Taxonomy
Bloom’s taxonomy is a classification system used to define and distinguish different levels of human cognition—thinking, learning, and understanding. The taxonomy was first developed in the 1950s by Benjamin Bloom and further revised by him in the 1990s. In his original version, there are six levels of cognitive behaviours that explain thinking skills and abilities of learners. The original six levels of cognition as described by Bloom are: knowledge, comprehension, application, analysis, synthesis and evaluation. Educators have used Bloom’s taxonomy to inform or guide the development of assessment, such as with the construction of MCQs. MCQs are widely used for measuring knowledge, comprehension and application of learning outcomes. Our curriculum uses MCQs in different assessment formats, for different purposes, and those are described below.
You may hear acronyms and terms about assessment in our UGME program: RATs, MCQs, SAQs, Key Features. Here is a brief description of each:
Readiness Assessment Tests (RATs)
RATs used in our curriculum often consist of 10-15 multiple-choice questions that are linked directly to the readings (and/or prior lectures). A RAT focuses on foundational concepts that will be important for following SGL activities. MCQs found on a RAT, test for knowledge (i.e., recall information) and less for application of knowledge. Examples of verbs used in the question stem that would test knowledge include: define, list, label, recall, select, name, outline, or match.
Multiple-choice questions (MCQs): on midterms and finals
There are three components to an MCQ: the stem, lead-in question, and options that consist of one correct answer and typically three distractors (wrong answers). The stem should be directly linked to a learning objective assigned to a course. MCQs that are used on midterms and final exams often test for comprehension and application of knowledge; this is beyond the recall information that is typically the case with MCQs on RATs. Some multiple-choice questions may assess simple recall, depending on the learning objectives of the course but should be kept to a minimum. Verbs used in the question stem to test comprehension include: predict, estimate, explain, indicate, distinguish, or give examples. Verbs that would test application include prompts such as: solve, compute, illustrate, interpret, demonstrate, or compare.
Short-answer Questions (SAQs)
SAQs typically are composed of a case scenario followed by a prompt that requires a written answer that varies in length from one or two words to several sentences. SAQs often test the higher cognitive skills in Bloom’s taxonomy. Final examinations in our curriculum are typically composed of a mix of MCQs and SAQs. To test analysis, verbs in the question stem include: explain, arrange, select, infer, calculate, or distinguish. Verbs such as develop, design, plan, devise, formulate, or generalize test for synthesis, whereas verbs in the question stem to test evaluation include: argue, assess, estimate, justify, predict, compare, conclude, or defend.
Key Features Questions
Key features problems are used by the Medical Council of Canada for the assessment of clinical decision-making skills in the MCCQE Part 1. Key features problems have a case scenario usually followed by two or three questions, each question testing one or more key features. A key feature is defined as a critical step in the resolution of a clinical problem, and key-feature problems consist of clinical case scenarios followed by questions that focus only on those critical steps. While knowledge is an important feature for effective problem solving, the challenge posed by key features problems is the application of knowledge to guide clinical decision-making. For each question, instructions may require selection of whatever number of responses is appropriate to the clinical tasks being assessed, and there may be more than one response in the answer key. The development of key features problems for clinical decision-making is being piloted in the Clerkship curriculum courses this year.
How do we administer our tests?
Queen’s Undergraduate Medical Education has moved to an electronic exam system called ExamSoft for the administration midterms and final exams in Preclinical and the Clerkship curricular courses. Medical students no longer write exams on paper; rather they do it all on laptops. This greatly facilitates marking of exams, and it means we are no longer managing huge volumes of paper and deciphering student handwriting.
- Page, G., Bordage, G. & Allen, T. (1995). Developing Key-feature proglems and examinations to assess clinical decision-making skills. Academic Medicine, 70 (3).
- Laura April McEwen, OHSE 2011, MCQ Checklist
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!
Can first year medical students carry out cardiac ultrasound examinations? Recent graduates publish results of recent trial.
Two former Queen’s medical students, Thomas R. Cawthorn, MD and Curtis Nickel, MD, of the recently graduated class of Meds 2013 conducted ultrasound education research during their time as students at Queen’s School of Medicine. They worked with Dr. Michael O’Reilly, Dr. Henry Kafka, and Dr. Amer M. Johri, of Queen’s and Dr. James W. Tam, of Winnipeg. Their results have been recently published in the Journal of the American Society of Echocardiography, in the article Development and Evaluation of Methodologies for Teaching Focused Cardiac Ultrasound Skills to Medical Students.
There are several noteworthy aspects about this: One is that our students embarked on this research during their time at Queen’s UGME, and worked on medical education in echocardiography as their field.
Secondly, the Journal of the American Society of Echocardiography published an article on medical education. It’s uplifting to see focus on education in medicine as well as continuing professional development and new issues in medicine in a scholarly medical journal.
Thirdly, the article outlines an excellent, innovative education program that the authors developed, using sound pedagogy to assist learning of a key skill in medical education.
And for me, their conclusion is most exciting:
Third-year medical students were able to acquire FCU image acquisition and interpretation skills after a novel training program. Self-directed electronic modules are effective for teaching introductory FCU interpretation skills, while expert-guided training is important for developing scanning technique. (Cawthorne, et al, 302)
The authors emphasize the importance and benefits of teaching/learning via self-directed electronic modules:
- reduction of overall resource costs
- provision of readily available resource easily accessed by students for future reference
- opportunity to learn at the pace and setting desired by the learner
- provision of standardized educational material to centres where specialists may not be found (Cawthorne, et al. 307)
They cite Ruiz et al. (2006) for literature about the benefits of this type of learning. Ruiz’ excellent article is worth a read as well. (See Sources below.)
The other telling aspect of their findings is the importance of “practical small-group instruction under the supervision of experienced sonographers and echocardiographers.” They recommend that supervised simulation training be combined with practical instruction sessions on volunteer patients (Cawthorne et al, 308).
The key to Drs. Cawthorne’s and Nickel’s recommendations is the combination of demonstration, practice, and feedback. And educational literature emphasizes that these are key aspects of learning skills as well. It’s also intuitive: just think back to learning to play a sport. These three facets of skills-based learning helped you learn that sport; without one of them, you would have found the learning challenging.
Educational literature calls this “deliberate practice” where the following are involved:
- repetitive performance of intended cognitive or psychomotor skills in a focused domain, coupled with
- rigorous skills assessment, that provides learners with
- specific, informative feedback, that results in increasingly
- better skills performance, in a controlled setting. (Issenberg et al, 2005)
What does that mean for teachers? It means that despite the savings and other benefits of online learning, it’s important to pair that type of learning with practice and feedback from experts, especially in skills-based learning. That has implications for us all–online, independent, self-regulated learning works best when there is an additional face-to-face demonstration, practice/feedback component, especially when new skills are being taught. (I’ve written before about the importance of feedback–without feedback, “it’s like learning archery in the dark.”)
So rather than saving wholly on faculty’s time by building online modules for student independent learning, what this suggests is that we use faculty in other ways. Not only do faculty lecture and facilitate group work, they are instrumental in providing feedback on skills, as happens in our Clinical and Communication Courses. In clerkship this emphasis on independent learning complemented by practice and feedback becomes crucial.
Congratulations to our students for their hard work and success, and that of their mentors and colleagues as well! Dr. Sanfilippo writes,
It’s rather remarkable for medical students to produce work that would be accepted for presentation at a national meeting, and then be published in the leading Canadian cardiovascular journal. It’s also rather unique to see a study that combines cardiac and educational components. This is quite a tribute to Tom and Curtis, and to Dr. Johri who mentored and guided them through the process.
Would you like to read the article (and accompanying editorial!) yourself? Here is the link:
Cawthorne, T.R., Nickel, C. O’Reilly, M., Kafka, H., Tam, J. W., Jackson, L., Sanfilippo, A. J., Johri, A.M. (2014). Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students. Journal of the American Society of Echocardiography, 27(3), 302-309.
Ruiz, et al. (2006). Impact of e-learning in medical education. Academic Medicine, 81, 207-212
Issenberg, B. et al. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review: BEME guide 4. Medical Teacher, 27(1), 10-28.
Educational Resources at your Fingertips: Faculty and Students
As teachers, you may want to find resources that assist you with teaching, or find out what the latest news from the Curriculum Committee is, or find out who to contact about what. As students you may want help about people, places, policies and other “p’s” in the Undergraduate Medical Education program.
We have published two resources recently:
The first is the new Faculty Resources Community: https://meds.queensu.ca/central/community/facultyresources
NOTE: first log into MEdTech via the dashboard URL, then simply click on the community, which would be among those listed on the left side of each user’s dashboard page. All faculty members including community preceptors are members of the Faculty Resources Community, but to “see” it you’ll need to log in first.
The Faculty Resources Community was created to provide faculty members, Course Directors, Year Directors and Committee Chairs with advance notice of topics to be discussed at Curriculum Committee meetings as well as easy access to Curriculum Committee Highlights, links to faculty development on teaching and assessment and materials distributed at Course Directors’ Retreats. Other resources posted in the new community include the Future of Medical Education in Canada reports and the latest LCME accreditation standards. We welcome suggestions for additional resources.
The second resource is for students! The Student Handbook, a brilliant idea from Associate Dean Sanfilippo, and edited by Alice Rush-Rhodes, is now published on MEdTech and is available in a printable pdf format thanks to Lynel Jackson from MEdTech.
To access the Student Handbook, please go to https://meds.queensu.ca/central/community/studenthandbook and to print a copy, scroll down to the bottom of the side menu. The Student Handbook contains information on people to assist students (including peer mentors), advice on careers, CaRMS and the Dean’s Letter, lockers, MEdTech, the Curriculum, and Special Programs to name a few components.
Is there anything we should add to the Student Handbook? Any other way you’d like to see faculty ideas? Just respond to the blog and let us know, or email Sheila Pinchin at firstname.lastname@example.org
Education Workshops for New Faculty (and those who’d like a refresher)
The Education Team is providing workshops for new faculty (and those who’d like a refresher) on a variety of topics.
What we’ll cover:
The 3.5 hour session will give you the basic tools you need, including:
• Foundations of the UGME curriculum
• Who’s Who in UGME & what they can help you with
• Introduction to Small Group Learning (SGL)
• Assessment 101 (MCQs and Beyond)
• MEdTech & You
• Classroom equipment
And, we’ll share with you information on other training that the Education Team can provide for you.
Three sessions to choose from:
Monday, August 26
9 a.m. – 12:30 p.m. (Then join us for lunch with the incoming first year class)
Monday, August 26
1 -4:30 p.m (But come at 12:30 for lunch with the incoming first year class)
Friday, September 20
8:30 – 4 p.m.
We are submitting this workshop for approval for CME credits for you.
To register, please email
Theresa Suart (email@example.com), indicating your preferred session.
(For the August 26 sessions, please register by August 21, so we can let the Orientation team know how many to expect for the lunch. For the September 20 session, please register by September 16).
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)
MedEdPortal: a great resource
MedEdPortal is a repository of online modules, and other tools that are vigourously peer-reviewed and suitable for medical and other health professions education. To find out more about this great resource, to to their short video: www.mededportal.org/about