A book that’s in my beach bag — Teaching What You Don’t Know

beach-bag-on-shore
You know how there are books that everyone says you should read, and you just can’t get to it? I finally got to sit down with Teaching What You Don’t Know by Therese Huston after hearing about it, well, since she published it in 2009.

The author wrote the book for those faculty in a university/college who are asked to teach on subjects far outside their research areas, and end up teaching by the skin of their teeth, staying a day or two ahead of their students.

This may not seem as relevant for our meds, nursing or rehab therapy teachers, at first glance, but as I read through the book there were so many messages that I thought our colleagues in Health Sciences Education would value.

So here’s a smattering…(I’m still dipping back into this book, and it’s going up to the cottage with me.)

First of all, why not volunteer to teach in an area that is not that familiar to you? For example, could a cardiologist teach in a respiratory course? Could a neurologist teach in an anatomy course? What would an obstetrician bring to a gastro course?

Teaching in an area you’re not as familiar with can be very beneficial:
You learn something new and interesting, you connect with faculty outside of your traditional area, and you broaden your own areas of research and interest. But most importantly (to me anyway), you may spend more time thinking about the topic, more time thinking about the students and their learning level, and you may end up learning along with the students, perhaps thinking a bit more like them than you usually do. When I’ve seen some of our clinical faculty instructing outside their own comfort zone, what impresses me most is that they’re breaking down material into very understandable chunks–really helpful to our students.

Teaching as telling breaks down when you’re more of a novice in an area. It’s actually “disastrous” especially if you’re anxious already. As Huston says, students don’t learn as well when we’re doing all the work for them, and falling back on default lecture mode isn’t helping them any. If we’re teaching outside our comfort zone (or frankly in it :)) we should avoid asking ourselves “What do I have to cover today?” Huston offers these questions to start the planning with instead:

What do students already know about this topic?
How can I connect this new material to their knowledge?
Which examples will be meaningful to them and how can I structure time in class so they’ll get the most from these examples

Huston gives a great summary that is an effective introduction to “planning backward” or “backward design” made popular by two those two innovators in the field, Wiggins and McTeague. In Chapter 4, she cites 3 mistakes that novices to a subject area can make: over-preparing, lecturing too much, and focusing on lists. I blush to say that it’s not only novices who can make this mistake (ahem:).

Some of the best tips are in Chapter 5, “Thinking in Class”, where Huston looks at some great strategies to get students active, whether in a lecture, or small group session. Two of my own personal favourite activities are listed here: Think Pair Share, where students think about a question, work with a partner on the answer and present a shared answer to the class and Category Building, where students work to create charts/tables/schema and generate categories from the work they’ve done OR where you give students a list of categories and ask them to put the work into the right spaces. (This works well with an algorithm).

I enjoyed learning about Sequence Reconstruction, where students reconstruct a list of items into a proper sequence. This got me started thinking on how students learn well from errors, a fact borne home to me in a recent conversation with our Meds students about Directed Independent Learning. Several said they like having quizzes where the wrong answers have explanations for why the answer is wrong–“I go through all the wrong answers, even if I’ve gotten it right, because I learn so much more then,” said one. This is a whole other conversation, Teaching from Errors!

There are other chapters with gold in them, in the book: “Teaching Students You Don’t Understand” and “Getting Better” (Huston says she was going to call the chapter “Getting Feedback” but she realized that if we’re being honest, many of us shy away from feedback, especially if we’re already anxious:). I think I’d like to try her “clarity grid” exercise with students–it will give me a great understanding of what students are getting and where they are getting lost. And there is a good advice for Course Directors, Department Heads, and Faculty Developers etc. in “Advice for Administrators.”

In her appendices, Huston give us some great stuff: Ten solid books on teaching strategies (2 of our blog’s favourites are in there), a great activity for a Syllabus Review, and a sample mid-term evaluation (which is a very useful time to get student feedback).

I hope I’ve convinced you that even if you’re not a novice teacher, and even if you’re teaching in an area in which you’re knowledgeable, this book has great value. And who knows? Maybe you’ll be inspired to teach a bit outside your comfort zone. Either way, this is a good book to take on your vacation.

Have a good one!

image from http://cruise-dude.com/

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Mentoring – a “win-win-win” proposition

What do practicing physicians remember about their medical school experience?  What do they feel had the greatest impact on their development?  What do they retain?  My guess, based on many reunions and even more conversations with graduates, is that it’s not the classes, labs or examinations, but rather the faculty they encountered along the way.  Of course we all remember the “characters” and the “larger than life” personalities that populate every medical school, but it’s those faculty with whom we were fortunate enough to develop a personal, one-on-one relationship that have the most enduring and significant impact on our development as physicians, and on our personal lives.  We call such folk “Mentors”.

mentorThe derivation of the word “mentor” is interesting.  The origin is Greek and is traced to Homer’s Odyssey.  Mentes was a wise and valued friend of Odysseus to whom he entrusted the education of his son Telemachus when he set out on his epic voyage.  The elements of wisdom and trust are therefore intertwined in the term, qualities obviously central to the role as we understand it today.

The value of mentorship is well known in all facets of professional education.  It’s this realization that leads many schools and departments to deliberately develop programs designed to promote these mentoring relationships.  At Queen’s, we have developed a program that assigns a mixture of students from all years in groups led by two faculty members.  Like all such programs, much depends on the specific and usually unpredictable “chemistry” that develops among the group.  When it works (and it usually does) the relationships that emerge are highly rewarding.  Below I provide testimonials from two students and one faculty member regarding their mentorship experience that may provide some insights.

Eve Purdy
Eve Purdy, MEDS 2015

In a 1973 article “Indoctrination of the Medical Student” Dr. Vilter pointed out that turning a new, eager medical student into a competent, caring physician takes more than just training in science, more even than just training in science and clinical skills. The mentorship program at Queen’s has been a special part of my indoctrination to the profession. Our group’s main goal is to have fun in a relaxed way but I am always surprised at the impact of these casual interactions. Whether it be a night of bowling, an intense night of trivia or a simple evening over shared drinks and food, I always leave more energized and excited about what’s to come. 

When a clerk in your mentorship group gives you a tip for the wards next year, you don’t forget. When the fourth year students graduate, you celebrate with them and picture yourself walking across the stage in a few years’ time. When a mentorship group leader encourages you to dream big, you might just. 

And a few more interesting links that I have come across about mentorship in medicine: 

Trivia…or is it? – this is a link to a post on my blog about trivia night earlier this year

Being a Mentor for Undergraduate medical Students Enhances Personal and Professional Development

Mentoring Programs for Medical Students- a review of the literature

Informal Mentoring Between Faculty and Medical Students

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Graydon Simmons, MEDS 2016

The Queen’s Medicine Mentorship Program has provided me the opportunity to have informal interaction and communication with Queen’s faculty and residents that I wouldn’t be able to experience anywhere else. In the hospital or after a lecture, it is hard to just walk up to a physician to inquire about what they enjoy about their profession or how they balance their personal lives with their work. Through the mentorship program, I have been able to build relationships with faculty and residents in a more relaxed atmosphere that is conducive to conversations about one’s future directions in medicine. Additionally, the mentorship program has also increased that sense of Queen’s community for me. As a pre-clerkship medical student, it can be intimidating to enter the hospital during your first clinical experiences. With something like the mentorship program in place, you begin to see the quality of physicians we have here at Queen’s and the encouraging, open teaching environment that they create. Ultimately, this interaction and positive community that the mentorship program has created for me has contributed to my learning and career exploration as a Queen’s medical student.

Dr. Peter O’Neill
Dr. Peter O’Neill

It is About Mentorship

Being a mentor in the mentorship program has been one of the most exciting aspects of being on faculty at Queen’s. At my mentorship group’s last meeting, we had breakfast. For our group, breakfast was a good time to get everyone together without the distractions that can happen with an evening out.

One of the first year students asked if we should have an agenda for the meeting, but the senior students just laughed. The agenda is always the same. I ask the senior students: “what is cool in what you are doing right now”? They answer, in the usual spectrum of experiences, and the junior students say: “wow, how do I get to do that”! That is mentorship in action.

While I enjoy checking in with all the students to see what is cool or if they are struggling, I think the students would rather hear from their near peers. I see our relationships not so much as a vertical structure, but a horizontal one. The clerk explains how to get an elective to the second year student. The second year student describes the observership program as a kind of “back stage pass” to the first year student.

Our group has enjoyed the group events and while I couldn’t make the “Great Mentorship Race & BBQ” in the park this spring, our group was well represented. Over the years we have had fun with Guitar Hero, and had pot luck suppers (which means that everyone has some food that they can surely eat without looking into all the dietary restrictions).

At the Convocation in May, I enjoyed meeting the family of one of my mentees. He said: “Dad, this is Dr. O’Neill, I beat him at guitar hero the second month of medical school.  You couldn’t believe it when I told you we were playing guitar hero in his basement. I smoked him at guitar hero. In spite of that, three years later he taught me how to deliver a baby.”

In the years to come, memories of delivering a baby might fade in this future internist, but I will bet he will remember beating me at guitar hero. He may never know that I let him win.

win-win-winAnd so it seems mentoring is truly a “win-win-win” proposition, benefiting both parties involved, as well as our school, which is becoming known for the value we place on faculty-student interactions at many levels.  We’re always looking for more faculty willing to become involved in this program.  If you’re interested, or simply wish to learn more about it, feel free to contact myself, Peter O’Neill or Erin Meyer in the UG office who coordinates the program.  Erin can be reached at ugmelwc@queensu.ca.

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Nourish your educational health and wellbeing

It’s summer time, and a good time to think of health and wellbeing. I heard of this concept from MaryEllen Weimer who writes in Faculty Focus when she wrote about taking care of our teaching vitality. She reminds us, “for too long we have assumed that by force of will we can make it through, semester after semester. Like someone out of shape climbing too fast, we gasp for air between semesters, over spring break, or that 2 week family vacation but it’s never enough.”

In our blog today, we’d like to challenge you to consider how you can nourish your educational wellness. What will you do for your educational self this year? What muscles can you stretch? What nourishing ideas can you take in?

Last week Theresa Suart featured several books that take medicine in different directions—novels, poetry…
(What’s on your summer reading list?)
It started me thinking of some other nourishing ideas for us all.

1. First is attending conferences. Many of you have attended or will attend conferences in your area of medical expertise. Don’t neglect conferences in education. Here are a few to think of:
a. CCME (Canadian Conference on Medical Education (CCME), Ottawa, April 26-30, 2014. http://www.mededconference.ca/ccme2013/
b. STLHE (Society for Teaching and Learning in Higher Education) (at Queen’s next!) http://www.queensu.ca/stlhe2014/stlhe2014 Kingston, June 17-20, 2014
c. ICRE (International Conference on Residency Education): http://www.royalcollege.ca/portal/page/portal/rc/events/icre Calgary, Sept. 26-28, 2013
d. The Ottawa Conference: Transforming Healthcare through Excellence in Assessment and Evaluation (not always in Ottawa but this coming year it is) April 25-29, 2014 http://www.ottawaconference.org/#!ottawa-2014/c16br

2. Other nourishment: great educational writers. Here’s what’s on my bookshelf for “dipping into”:
Bain, K. What the best college teachers do (great advice based on a huge study with lots of exemplars—very readable)
Kotter, J.P. Leading Change (anything by Kotter—a leader in the field of leading change—another definition of education?)
Holmboe, E.S. & Hawkins, R.E. Practical guide to the evaluation of clinical competence (Holmboe is intensely readable, intensely useful—and clinically oriented)
Marzano, R. et al. Classroom instruction that works: Research-based strategies for increasing student achievement (anything by Marzano et al is very useful!)
Angelo, T. & Cross, P. Classroom Assessment Techniques: A handbook for college teachers. (These two have a lot of practical ideas based on sound theory about assessment!)
Brookfield, Stephen & Preskill, Stephen. Discussion as a Way of Teaching (Brookfield has 2 new books out that I want to get my hands on: Teaching for Critical Thinking: Tools and Techniques to Help Students Question Their Assumptions (2011) and Powerful Techniques for Teaching Adults (2013))
Palmer, Parker. The courage to teach: exploring the inner landscape of a teacher’s life. (10th edition is now out. I think I have the third! One of the first teaching books I ever read)
Wiggins, G. and McTighe, J. The Understanding by Design Guide to Creating High-Quality Units (“Backward Design” is a great concept you’ll find so intuitive!)

3. Stretch those educational muscles: Follow a Blog or list:
There are a few I follow:
Faculty Focus, edited by MaryEllen Weimer, published by Magna http://www.facultyfocus.com/ I’ve quoted from MaryEllen before—she has a real gift and reads prolifically
Tomorrow’s Professor (actually it’s a list) from Stanford: http://cgi.stanford.edu/~dept-ctl/tomprof/postings.php
Medical Education Blog by Deirdre Bonnycastle (U. Sask) Lots of great ideas! Last one I read had a list of songs that match to different medical disciplines http://words.usask.ca/medicaleducation/
Team Based Learning Collaborative http://www.teambasedlearning.org/ (drink the TBL cool-aid—it’s very refreshing!:)

4. Consistent high quality nourishment is a good idea for the whole year. Subscribe (Try RSS feed) to Journals
Here are the top ranked medical education journals and one education journal I never skip. Our Bracken Library subscribes to all and the librarians can show you how to get an RSS feed so you get alerts and topics only! (Someday I’ll write about some general education journals—fascinating reading!:)
o Academic Medicine
o Medical Teacher
o Medical Education
o Advances in Health Sciences Education
o Medical Education Online
o Teaching and Learning in Medicine
o Medical Science Educator
o Basic Science Educator
o Journal of the International Association of Medical Science Educators

Do you have advice for nourishing our educational wellbeing? Please let us know through posting to the blog.

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Revised Policy: Immunization and Communicable Disease Policy

Immunization and Communicable Disease Screening Committee is requesting comments on revisions made to the  policy on Immunization and Communicable Disease Policy.  A summary of the changes are listed below. The full revised policy may be viewed by clicking here.   Please submit all comments no later than July 22, 2013 by using the “Discussion” Comments:  Communicable Disease Screening Policy

The changes to this policy are as follows:

  • Students are now required to submit evidence of their status, in accordance with the Ontario Hospital Association (OHA) Communicable Disease Surveillance Protocols.
  • Document review is now in conjunction with an Occupational Health, Safety and Infection Control consultant.

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What’s on your summer reading list?

Theresa Suart, our Educational Developer weighs in on how to nurture your educational self over the summer. We compiled a list of reading that may help stretch your medical/educational muscles over the summer. To make our list a book had to be recommended by a clinical faculty member as one that has changed or enhanced her/his perception of medicine or medical matters. Dr. Shayna Watson was very helpful in bringing to light some of the Medicine in Literature books. We’ve asked for your help in referring other books, so please jump in!

Remember days lazing at the beach, latest bestselling novel in hand? Or too-short summers with too-long required reading lists? Whatever your summer reading memories, longer days seem to go hand-in-hand with book list suggestions, so the Education Team decided to add its five-cents’ worth to the conversation.

Whether you’re getting away for a couple of weeks to the cottage, or still slogging away on the wards of KGH, summer can be a great time to expand perspectives, explore new ideas and nurture your soul with a good book.

So here’s our “Summer Ten” list (it’s not a “top 10” or a “10 must read”, it’s a “consider this” list… just to get you started). If you pull one of these from the shelves, please let us know what you think of it.

1. The Emperor of All Maladies: A biography of cancer by Siddhartha Mukherjee (available in the Stauffer Library)

2. The Curious Incident of the Dog in the Night-time by Mark Haddon (available in the Education Library)

3. Nocturne: On the life and death of my brother by Helen Humphreys (On order by Stauffer Library)

4. Care of the Soul in Medicine by Thomas Moore

5. Kitchen Table Wisdom by Rachel Naomi Remen (available in the Kingston Frontenac Public Library)

6. Intoxicated by My Illness by Anatole Broyard (available in the Kingston Frontenac Public Library)

7. Cutting for Stone by Abraham Verghese (available in the Kingston Frontenac Public Library)

8. Bloodletting and Miraculous Cures: Stories by Vincent Lam (available in the Stauffer Library)

9. The Checklist Manifesto: How to get things right by Atul Gawande (available in the Bracken Health Science Library)

10. Any of Atul Gawande’s essays from the New Yorker: http://www.newyorker.com/magazine/bios/atul_gawande/search?contributorName=atul%20gawande)

And a bonus #11 since any reading list needs some poetry (thank my Dad, the English teacher and poet, for instilling this in me):

In Whatever Houses We May Visit: Poems that have inspired physicians, edited by Michael A. LaCombe, and Thomas V. Hartman.
(Here’s a sample, from the previews on the acponline.org site, Pathology Report by Veneta Masson:
https://www.acponline.org/eBizATPRO/images/ProductImages/books/sample%20chapters/In%20Whatever%20Houses_%20Pathology%20Report.pdf

If you pull any of these from the shelves, please let us know what you think of it.

What’s on your list? Share your suggestions in the comments section below.

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Student Directed Learning ”Everything old is new again”

My undergraduate education was enlivened by a number of professors who were fond of taking rather unconventional points of view, many of which would be considered “politically incorrect” in today’s parlance.  They were even fonder of defending those perspectives with spirited and colourful debate.  Perhaps travillthe leading proponent of this approach was Dr. Tony Travill, professor of Anatomy, who would spend more of his curricular time discussing points of professional practice and social foibles than the assigned topics of embryology or anatomy.  On the rare occasion that one of us mustered the temerity to point this out, he would make the rather emphatic point that “universities aren’t centres of teaching, they’re centres of learning”.  The message was clear – it wasn’t his business to teach so much as it was our responsibility to learn.  Our goal should be to learn for the benefit of our future patients, not simply to satisfy curricular goals.  I recognize in retrospect that his not-to-subtle shift of emphasis helped us to transition from being passive consumers of information to what today’s educational theorists would term “active learners”, although we had no idea this was happening at the time.

Turing our attention to the present, one of our 2015 students, Eve Purdy, spoke eloquently at the recent Celebration of Teaching Day of how she addressed her interest in the process of clinical decision-making.  She searched the internet and came upon a free web-based seminar series from the University of California (San Francisco) that she accessed over several weeks and found quite useful.  She shared the information with others, both students and faculty who also made use of this resource.  As teaching faculty, we should take considerable comfort in the fact that our students are, on their own, seeking opportunities to advance their learning, often going beyond the baseline requirements of our curriculum.

In fact, our students make use of a wide variety of unstructured learning opportunities in addition to standard curricular offerings such as Courses, Integrated Learning Streams, various types of Small Group Learning, clinical rotations and assigned projects.

Last academic year, about 20 Student Interest Groups were active, each developing a series of at least 8 learning sessions outside standard curricular time that were devoted to a particular discipline or theme.  Although supported by faculty on a voluntary basis, students developed the themes and content of these sessions.  The following is a list of some of the groups that were active this past academic year:

hidden

In addition, our students informally access the world of information available to them through the internet and social media.  A world of information is studentsliterally at their fingertips, and they make use of this almost continuously, both to search information and to dialogue with each other, with faculty (sometime during lectures), and people farther afield.  The challenge is not access, but rather discernment of relative value.

Perhaps the most powerful non-curricular learning experience our students engage is what’s been termed the Hidden Curriculum.  This term refers to all of the unintentional but incredibly powerful messaging that occurs in the context of their environment and clinical experiences.  Observing a respectful and effective interaction between an attending physiciansphysician and nursing staff provides a much more effective and durable lesson than hours of formal teaching on the topic of professionalism.

The challenge for teaching faculty in the midst of all this is to keep pace what’s happening around us, and to shift our focus from delivering content to guiding the learning process.  To borrow an old adage – we can’t control the wind, we can only set our sails.  In this environment, it becomes more important to set the objectives and provide direction than to attempt to rigidly control the process.

And so, as the song says “Everything old is new again” when it comes to student directed learning in medical education, although technical advances and connectivity expand the potential (and our challenge) tremendously.  I like to think Dr. Travill would be amused.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

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