Facilitating Millennials’ Learning

Welcome to our class of Meds 2017! Dr. Sanfilippo talked about our incoming class of 2017 medical students in our last blog.

I thought those of you preparing to teach this class, and our other classes in undergraduate medicine might appreciate the great ideas from an article called Twelve tips for facilitating Millennials’ learning by David H. Roberts, Lori R. Newman and Richard M. Schwartzstein of the Harvard Medical School, published in “Medical Teacher”.

Now the discussion about Millennials is not new: Millennials refer to students who turned 18 in 2000 and entered college or the workforce as defined by Howe & Strauss in 2000. Since then there have been many articles, texts and videos that outline what the characteristics of a Millennial are.

And, while the characteristics of Millennials have some new traits, they share traits with all of those learners who have come before them. However, there are some key factors that distance them from their teachers, and therein lies the crux of this article and the really great advice the authors offer. Millennials are influenced by and influence technology so much more than their teachers who are usually Baby Boomers or those from Generation X. Millennials have not experienced global economic stability, have lived through “9/11” and other terrorist threats, have experienced what to their teachers are novel ways of communication (email, social media, cell phones) and the ubiquitous nature of online technology. The article has some very provocative characteristics of Millennials from several studies.

The authors have 12 key tips for teachers and they range from educating ourselves about the concept of generational differences to recognizing the environmental and cultural forces that affect the Millennial learner, from recognizing the importance of team dynamics and encouraging collaboration to identifying the limits of multi-tasking.

Here are a few of the strategies the authors use to help us as teachers bridge any gap with our students. These tips are useful, frankly, no matter who your learners are.

For example, with the overwhelming power of the Internet at their fingertips, for Tip 4, “Millennials need guidance and focus in their learning” , these strategies are offered:
1. Remind learners to focus on the “why, how, and in what context”
2. Avoid asking students to list or identify specifics (answers easily found with an Internet search), and encourage students to apply knowledge through problems that require critical thinking
3. Help learners prioritize and identify the context in their learning

To help learners form a connection to you and see the relevance of your teaching, for Tip 5, “Identify your teaching or life philosophy,” here is one of three suggestions: Always introduce yourself to your learners and provide details on your background and path to your current role.

For Tip 7, “Recognize that Millennials value (and expect) aesthetically appealing educational presentations,” one strategy is to ask colleagues or invite students to review your slides or curricular materials and provide feedback and suggestions as you learn to embed video, create interesting slides, etc.

For Tip 8, “Emphasize opportunities for additional help and support”, there are 4 strategies that I would advocate with any learner:
1. Post directions, reading assignments, and a list of available resources on a website that students can easily access
2. Establish “office hours” when a student can drop by to discuss a concern
3. Directly observe student performance and provide specific feedback
4. Provide structure to learning activities and set specific achievable targets for learners (e.g., “By the end of this 3-month internal medicine block, you will be able to perform a complete history and physical on 2 new patients per session.”)

For tip 12, “Identify the limits of multi-tasking,” I have to highlight this excellent strategy from the authors: Ask students to complete The New York Times online test “How Fast You Juggle Tasks” (Ophir & Nass 2010, to measure how fast they can switch between tasks and discuss their results and how multitasking may affect patient care.

As we begin our new academic year, and another group of “Millennials” are in front of us and beside us in learning, it’s good to think about the key question a good teacher always asks: “Who are my learners?” While you may not subscribe to the characterization of generations, it’s always best practice to get to know your learners, how they may be similar to and different from you, and to consider strategies to make the learning relevant to them.

I offer my best wishes for a very successful year to the teachers and the students both here at Queen’s and elsewhere, and, as always, look forward to hearing from you.

Featured Article:
Roberts, David. H., Newman, Lori R., Schwartzstein, Richard M. (2012). Twelve tips for facilitating Millennials’ learning. “Medical Teacher”, 34, 274-278.

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Facilitating Millennials’ Learning

Welcome to our class of Meds 2017! Dr. Sanfilippo talked about our incoming class of 2017 medical students in our last blog.

I thought those of you preparing to teach this class, and our other classes in undergraduate medicine might appreciate the great ideas from an article called Twelve tips for facilitating Millennials’ learning by David H. Roberts, Lori R. Newman and Richard M. Schwartzstein of the Harvard Medical School, published in “Medical Teacher”.

Now the discussion about Millennials is not new: Millennials refer to students who turned 18 in 2000 and entered college or the workforce as defined by Howe & Strauss in 2000. Since then there have been many articles, texts and videos that outline what the characteristics of a Millennial are.

And, while the characteristics of Millennials have some new traits, they share traits with all of those learners who have come before them. However, there are some key factors that distance them from their teachers, and therein lies the crux of this article and the really great advice the authors offer. Millennials are influenced by and influence technology so much more than their teachers who are usually Baby Boomers or those from Generation X. Millennials have not experienced global economic stability, have lived through “9/11” and other terrorist threats, have experienced what to their teachers are novel ways of communication (email, social media, cell phones) and the ubiquitous nature of online technology. The article has some very provocative characteristics of Millennials from several studies.

The authors have 12 key tips for teachers and they range from educating ourselves about the concept of generational differences to recognizing the environmental and cultural forces that affect the Millennial learner, from recognizing the importance of team dynamics and encouraging collaboration to identifying the limits of multi-tasking.

Here are a few of the strategies the authors use to help us as teachers bridge any gap with our students. These tips are useful, frankly, no matter who your learners are.

For example, with the overwhelming power of the Internet at their fingertips, for Tip 4, “Millennials need guidance and focus in their learning” , these strategies are offered:
1. Remind learners to focus on the “why, how, and in what context”
2. Avoid asking students to list or identify specifics (answers easily found with an Internet search), and encourage students to apply knowledge through problems that require critical thinking
3. Help learners prioritize and identify the context in their learning

To help learners form a connection to you and see the relevance of your teaching, for Tip 5, “Identify your teaching or life philosophy,” here is one of three suggestions: Always introduce yourself to your learners and provide details on your background and path to your current role.

For Tip 7, “Recognize that Millennials value (and expect) aesthetically appealing educational presentations,” one strategy is to ask colleagues or invite students to review your slides or curricular materials and provide feedback and suggestions as you learn to embed video, create interesting slides, etc.

For Tip 8, “Emphasize opportunities for additional help and support”, there are 4 strategies that I would advocate with any learner:
1. Post directions, reading assignments, and a list of available resources on a website that students can easily access
2. Establish “office hours” when a student can drop by to discuss a concern
3. Directly observe student performance and provide specific feedback
4. Provide structure to learning activities and set specific achievable targets for learners (e.g., “By the end of this 3-month internal medicine block, you will be able to perform a complete history and physical on 2 new patients per session.”)

For tip 12, “Identify the limits of multi-tasking,” I have to highlight this excellent strategy from the authors: Ask students to complete The New York Times online test “How Fast You Juggle Tasks” (Ophir & Nass 2010, to measure how fast they can switch between tasks and discuss their results and how multitasking may affect patient care.

As we begin our new academic year, and another group of “Millennials” are in front of us and beside us in learning, it’s good to think about the key question a good teacher always asks: “Who are my learners?” While you may not subscribe to the characterization of generations, it’s always best practice to get to know your learners, how they may be similar to and different from you, and to consider strategies to make the learning relevant to them.

I offer my best wishes for a very successful year to the teachers and the students both here at Queen’s and elsewhere, and, as always, look forward to hearing from you.

Featured Article:
Roberts, David. H., Newman, Lori R., Schwartzstein, Richard M. (2012). Twelve tips for facilitating Millennials’ learning. “Medical Teacher”, 34, 274-278.

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New and Revised Policies

Prior to a new or amended policy or regulation being submitted for MD PEC approval, it must be published for review and comment by faculty and/or students within the School of Medicine.  Feedback received will be directed to the Policy Sponsor.

In the event that major changes are made based on this feedback, a new draft will be posted for additional comments.

In keeping with this procedure the following policies are being posted for comment or feedback:

If you wish to comment on any of these documents, please add your feedback to the discussions or email saunderj@queensu.ca

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Introducing Queen’s Meds 2017

One of the special benefits of working in a university environment is the sense of renewal that comes each fall with the entry of new students.  This week we welcome members of Meds 2017, the 159th class to enter the study of Medicine at Queen’s since the school opened its doors in 1854.

meds 2017

A few facts about our new colleagues:

They were selected from the largest applicant pool in recent memory – 3818 highly qualified students submitted applications last spring.

Their average age is 23 with a range of 20 to 36 years.  Fifty-seven percent of the class are women.

They hail from no fewer than 49 communities across Canada, including Abbotsford, Ajax, Ancaster, Ariss, Barrie, Bedford, Brampton. Brockville, Burlington (3 students), Calgary (2), Coquitlam, Delta, Edmonton, Etobicoke, Hamilton, Inverary, Kamloops, Kingston (5), Kitchener, London (4), Maple, Markham (9), Mississauga (6), Montreal, North York (2), Ottawa (4), Owen Sound, Palgrave, Peterborough (2), Pickering, Puslinch, Richmond Hill (2), Scarborough, Stittsville, Thornhill (2), Tillsonburg, Toronto (19), Upper Island Cove, Shrewsbury, Vancouver (2), Vaughan, Waterloo, West Vancouver, Whitby (3), Windsor, Winnipeg, Woodbridge (2) and Yarmouth.

Ninety of our new students have completed an Undergraduate degree, and 27 have postgraduate degrees, including 4 PhDs.  The average grade point average achieved by these students in their pre-medical studies was 3.82.  Their undergraduate universities and degree programs are listed in the tables below:

Screen Shot 2013-08-27 at 8.08.35 AM

Undergraduate Degree Programs

Screen Shot 2013-08-27 at 8.09.14 AM

Postgraduate Degree Programs

Screen Shot 2013-08-27 at 8.09.27 AM

An eclectic and academically very qualified group, to be sure.  This week they will undertake a variety of orientation activities organized by both faculty and their upper year colleagues.  At their welcoming session they were called upon to demonstrate commitment to their studies, their profession and their patients.  They were assured that they will have a voice within our school and be treated with the same respect they are expected to provide each other, their faculty and all patients and volunteers they encounter through their medical school careers.  I invite you to join me in welcoming these new members of our school and medical community.

 

 

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Meds student Joe Gabriel completes his ride

On June 5, I wrote about Queen’s Meds 2015 student Joe Gabriel and his ride across Canada. Joe was riding across Canada to benefit a series of 10 small charities (one in each province).http://meds.queensu.ca/blog/undergraduate/?p=635

Well, Joe’s completed his ride. He’s in Halifax and has raised almost $3000.00 of the $10,000 he’d hoped for. http://www.cyclingforcanada.org/

joe gabriel 3

Joe is a great example of the physician as advocate in action. He has taken on some extremely worthwhile focused causes that all contribute to quality of life of people in each province. From Native housing to recycling bikes for those in need to a music program for at-risk youth to pay-what-you-can transportation services for medical visits, Joe has taken the concept of determinants of health and made them real. Here are descriptions of all 10 charities that Joe was riding for: http://www.cyclingforcanada.org/?page_id=15

We here at Queen’s Undergraduate Medical Education support Joe and are donating to his causes. Can Joe count on you too?

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Planning for the upcoming academic year? Here are some resources that you may find useful

The beginning of the academic year 2013/14 is drawing near. You may have already begun to plan for your course or sessions. If you’re in a planning mood over the next few weeks, here are some resources that may help you:

Curricular Coordinators:: Our UGME Curricular Coordinators assist with all operational aspects of your teaching: putting the timetable into MEdTech, assisting with your session page, helping to build quizzes and RATs, and a host of other activities. They are:
Zdenka Ko: Year 1: zk@queensu.ca, ext 77804
Tara Hartman: Year 2: tara.hartman@queensu.ca, ext. 79546
Candace Miller: Clerkship Core Academic Courses (“C Courses”): candace.trott@queensu.ca, ext. 74102
Jane Gordon: Clerkship Clinical Courses, ugme.clerkship@queensu.ca, ext. 75162

The Educational Development Team (Education Team) at Undergraduate Medical Education: We are:
Sheila Pinchin, Educational Developer, assisting with curriculum planning, clerkship teaching and learning, and teaching about physicians’ intrinsic roles through Professional Foundations
sheila.pinchin@queensu.ca, ext. 78757
Theresa Suart, Educational Developer, assisting with planning and observations for years 1 and 2 in medical school and for QuARMS (Early Entry Program) theresa.suart@queeensu.ca, ext.75485
Eleni Katsoulas, Assessment and Evaluation Consultant, assisting with assessment planning in all years, and planning and analysis for OSCEs eleni.katsoulas@queensu.ca ext. 78094

Here are some resources you may find helpful:

In MEdTech, we have placed many of our curriculum documents and ideas for you in our Faculty Resources Community:
https://meds.queensu.ca/central/community/facultyresources

Don’t feel you have to plan alone! Give one of us a call or email to help out.

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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:

Session 1
Monday, August 26
9 a.m. – 12:30 p.m. (Then join us for lunch with the incoming first year class)

Session 2
Monday, August 26
1 -4:30 p.m (But come at 12:30 for lunch with the incoming first year class)

Session 3
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 (theresa.suart@queensu.ca), 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).

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Remembering three great mentors and teachers

Over the past few months, our faculty and medical school have lost three people who made tremendous contributions over the course of their careers.  Peter Munt, Robert Hudson, and Ed Yendt were all master clinicians, leaders in our medical community and contributors to our understanding of illness and disease.  They were also gifted teachers and mentors who were always willing and eager to pass on their wisdom.  As we approach the beginning of another academic year and are about to welcome a new class of medical students, it seems appropriate to reflect on the lessons and legacies that they’ve so ably provided.

Dr. Peter Munt was recruited to Queen’s after postgraduate training in Respiratory Medicine to head the newlymunt formed Division of Respirology and Critical Care Medicine.  He went on to head the Department of Medicine through a time of tremendous transition, and then became Chief of Staff at KGH.  As his medical resident many years ago, I recall caring for a patient with a pulmonary infection eventually traced to a rather novel organism.  Not content to simply identify and treat the infection, he encouraged me to identify the source and explore for any patients who may have suffered from similar infections.  By doing so and documenting the results of our search, we were able to contribute to the care of many more patients, and raise awareness among other physicians of a little appreciated source of infection.  Moreover, he taught me and my fellow residents the importance of pursuing root causes and the value of documentation and publication in disseminating knowledge.  His career, both as a physician and administrator, was characterized by this quality of uncompromising attention to all facets of an issue, and unwillingness to accept the expedient solution.

hudsonDr. Bob Hudson was head of our Division of Endocrinology for many years.  In addition to his clinical responsibilities, he maintained a very active research career making important contributions to the understanding of androgen function.  I’ll remember him for his dedication to physical examination and bedside teaching.  His ward rounds were highly valued by housestaff.  Not content with mere identification and demonstration of physical findings, Dr. Hudson challenged us to understand the underlying cause and pathogenesis.  “So I agree this patient has exophthalmos” he would concede, but always follow with something like “but why do patients with thyroid disease develop this finding? What’s the mechanism?”  His great skill was to help the learner work his or her own way through the problem without intimidation or belittlement.  In fact, you emerged from these sessions not simply knowing something about a particular finding, but with a mechanism that could be applied to a variety of findings and conditions.

yendtDr. Ed Yendt had already developed a reputation as a leading specialist in calcium disorders by the time he was recruited to Queen’s to head the Department of Medicine.  He led that department through a period of rapid growth, and development of many of the subspecialty divisions.  He continued to do basic research through his career, becoming an internationally recognized expert in osteoporosis.  Always a dedicated clinician, he continued to see patients long after usual retirement age and long after financial considerations provided any motivation.  He was the embodiment of what we would today refer to as “translational” or “bench to bedside” research.  I had opportunity to talk to him on numerous occasions in recent years, and was continually impressed at his knowledge of recent literature and eagerness to apply new findings to his patients.  He was intrigued by patients with unusual presentations or responses to therapy, and continually used those experiences to learn more and apply that knowledge.  He never lost his excitement for discovery or dedication to patient care.

Three great teachers, three different styles, but all sharing an insatiable curiosity, dedication to advancing the science of medicine, and to applying that science to their first concern – the care of their patients.  Their families might find some solace in the knowledge that those lessons are not lost and that their examples and teaching will continue to inspire our students and those currently charged with their learning.

 

 

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2nd Annual Medical Student Research Showcase

Queen’s School of Medicine is proud to host the 2nd Annual Medical Student Research Showcase on September 26, 2013. This event has been designed to offer opportunities for medical students engaged in summer research activities to showcase their work in posters displayed in the School of Medicine Building, and to celebrate excellence in the form of an oral plenary session. This plenary session, moderated by Dean Reznick, will feature up to three outstanding submitted projects, each delivered in a ten minute oral presentation. The students selected for the oral plenary and the top student poster presenter, as adjudicated by a judging panel, will jointly receive the Albert Clark Award for Medical Student Research Excellence.

The conference organizers are pleased to announce the development of a **NEW** Medical Student Research Showcase Community accessible via MEdTech. Here you will find all important information regarding the research showcase. We have also implemented a new electronic system for all abstract submissions. We encourage you to visit the new community regularly to stay up to date on important information regarding the showcase. Abstract submissions open on August 12, 2013 (08:00am) and more information will be forthcoming in the coming weeks.

https://meds.queensu.ca/central/community/researchshowcase

We look forward to seeing you on September 26, 2013!!

Heather Murray & Melanie Walker

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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.

black boxSo, 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.

Epidemiology Timing Clinical Presentation Pathophysiology
-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? 

hyperacutely: hours

acutely: days

sub-acutely:    days-months

chronic: months-years

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? 

-physical signs?

*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.

Epidemiology Timing Clinical Presentation
What important risk factors does the patient have-age

-smoking

-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.

Gear box

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.

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