What’s the price of professional autonomy?Are we willing to pay it?

We all need people in our lives who are willing to tell us “how it is”. These are special folks, often spouses, relatives or lifelong friends, whose relationship with us is strong enough to allow candid, honest, unvarnished commentary about topics close to the heart.

I found myself in a conversation with one such person recently who had the temerity to point out that Doctors, they have observed, can become somewhat self-absorbed and consumed with their own “specialness”, to the extent that they develop a certain blindness to issues of public concern or, at the very least, impose their own interpretation on such issues. During a time when the profession and government are engaged in rather intense dialogue on many public concerns, it’s certainly not difficult to find examples.

At about the same time, another friend (a physician in this case), dropped an article on my desk with the notation “I thought of you when I read this”. The article was entitled “Ministerial Ethics: A matter of character, conduct or code?” and was written by Joe E. Trull, an Associate Professor of Christian Ethics at the New Orleans Baptist Theological Seminary. Not being at all familiar with either Mr. Trull or the ministerial ethics literature, I was rather intrigued as to why my friend would have identified a connection. In reading the article, it became clear that the issues being engaged by clergy as they undertake their professional roles are remarkably similar to those facing the medical profession and, by extension, many groups that we might characterize as “professions”.

Historically, the term “profession” was initially applied to Clergy, Medicine and Law, groups entrusted respectively with the spiritual welfare, physical health and personal rights of all citizens. Many other groups have emerged with responsibility for other areas of social concern, such as nursing, engineering, architecture, pharmacy, and dentistry, to name a few. All are similarly described as “professions”, a term that has come to identify groups of individuals whose role in society is primarily to provide a needed service or role, with a degree of commitment to that cause which goes beyond their personal, individual interests. People who engage such roles are said to be “professionals”, and the concept of “professionalism” is ingrained in the values and training of such groups. It can also be said that any person who engages an occupation in a manner that puts the interest of those served above personal interests is practicing in a “professional” manner. The person who comes in the middle of a cold winter night to fix your furnace or re-establish your power supply can be said to be doing so, at least in part, because of a recognition of your critical need, and therefore providing a “professional” service.

There are several practical features that characterize a profession:

  • Professions have a defined and broadly acknowledged base of knowledge and skills.
  • Professions control or strongly influence their educational processes.
  • That educational process always entails some period of practical training within the practice setting – a derivation of the traditional apprenticeship.
  • Professions control or strongly influence the selection processes for entry to training, and therefore to the profession itself.
  • Professions have societies or organizations that define and maintain standards of practice, define methods by which those standards can be demonstrated, and publicly identify individuals who have achieved them. Membership in those organizations is accepted by society as evidence of competence.

There are also a number of more personal attributes and values that have been identified with professions. Professions are often characterized as “vocations”. The term implies that those drawn to practice professions are somehow “called” to do so. It suggests that they perceive, for whatever reason, a sense of deep and personal purpose in the engagement of that work. It further implies that those engaging professions view their work as an important service to society, and perceive that service as their main purpose and source of fulfillment in life. People who “profess” to serve within a particular domain commit to do so whenever and however the opportunity to serve may arise. It’s significant that the very word “profession” has dual meanings: not only is it a “special occupation”, but also an “avowal, or promise”.

Professions are afforded a considerable degree of autonomy, which relates to a number of practical considerations. Established members of professions best understand their cognitive and skill based “turf”. They are therefore essential to teaching it to others. Their practice experience makes them best suited to define the standards of practice of the profession, and to identify the personal qualities that characterize those best suited to enter and practice the profession.

But above these practical considerations, the autonomy arises from a societal trust that those “called” to practice a profession are motivated solely by the desire to ensure that the quality of that service is maintained to all who require it. In the words of Eliot Freidson, author of Profession of Medicine: A study of the sociology of applied knowledge (University of Chicago Press, 1970), “the occupation sustains its special status by its persuasive profession of the extraordinary trustworthiness of its members”.

But this “extraordinary trustworthiness” comes with a price. There exists an understandable societal expectation of any autonomous professional group.

Responsible professionals:

  • Do not withhold their service from those in need.
  • Do not withhold their service for the purpose of personal gain.
  • Can be relied upon to provide the highest quality work and recognize when they have fallen short
  • Ensure their knowledge and skills are maintained
  • Commit to their responsibilities regardless of clock or calendar
  • Ensure continuity of their responsibilities when they themselves are no longer in a position to provide.

Of all the recognized professions, perhaps none has undergone greater change over the past century than Medicine. The tremendous expansion of knowledge and potential therapies, emergence of specialties, sub-specialties and increasingly focused practices, and need to navigate an increasingly demanding and complex health care system have increased the physician’s role without a commiserate increase in authority. These considerations result in greatly increased personal demands and make it more difficult to achieve the expectations listed above, particularly when combined with a very understandable desire on the part of physicians to protect their personal time and health.

In addition, many of these challenges have brought the profession into conflict with government, which, in our society, is ultimately responsible for ensuring the safety of its citizens and distribution of resources, and have a clear mandate to do so through our electoral processes. A delicate and mutually respectful balance between those who possess and safeguard the necessary skills, and those entrusted to ensure their safe and effective provision seems increasingly difficult to achieve.

So, it appears that the existence of an autonomous medical profession benefits society for all the reasons noted above. It seems equally clear that autonomy is a privilege that must be earned, and is based in trust. That trust, in turn, is rooted in the selfless provision of care, doled out through careers as a series of individual, thankless acts.

Are we willing?

convocation-s-archer
© Photo by Stephen Archer

This past week I participated in two events that are relevant to this issue. The first was the convocation ceremony for our 2015 graduating class. I’ve had the opportunity

to get to know these hundred new physicians quite well over the past four years and, as I watched them receive their degrees, I felt nothing but optimism for the future of an autonomous and vibrant profession, probably much better suited to meet the mounting challenges than was my generation.

belliveau_smallTwo nights later, I attended the retirement dinner of a Queen’s colleague, Dr. Paul Belliveau, who has been active in medical education both locally and nationally, all while maintaining a very active practice in colorectal surgery. The hall was full of faculty from various departments, nursing colleagues, therapists, residents, hospital and faculty leaders, who participated in a very sincere and touching recognition of Paul’s varied contributions. At one point during the evening, his longstanding administrative assistant read a long list of tributes from patients who Paul had treated over the years. All were grateful for the care he’d provided, but all emphasized the compassion and humanity of the man. It was clear that their trust has indeed been earned.

As I was participating in these two events and contemplating the content of this article, it became clear to me that my students and Paul Belliveau were providing the answer to my question. Yes, the profession has been, and will continue to earn that privilege of autonomy, not through edict or legislation, but one patient at a time.

 

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

Posted on

What’s the price of professional autonomy?
Are we willing to pay it?

We all need people in our lives who are willing to tell us “how it is”. These are special folks, often spouses, relatives or lifelong friends, whose relationship with us is strong enough to allow candid, honest, unvarnished commentary about topics close to the heart.

I found myself in a conversation with one such person recently who had the temerity to point out that Doctors, they have observed, can become somewhat self-absorbed and consumed with their own “specialness”, to the extent that they develop a certain blindness to issues of public concern or, at the very least, impose their own interpretation on such issues. During a time when the profession and government are engaged in rather intense dialogue on many public concerns, it’s certainly not difficult to find examples.

At about the same time, another friend (a physician in this case), dropped an article on my desk with the notation “I thought of you when I read this”. The article was entitled “Ministerial Ethics: A matter of character, conduct or code?” and was written by Joe E. Trull, an Associate Professor of Christian Ethics at the New Orleans Baptist Theological Seminary. Not being at all familiar with either Mr. Trull or the ministerial ethics literature, I was rather intrigued as to why my friend would have identified a connection. In reading the article, it became clear that the issues being engaged by clergy as they undertake their professional roles are remarkably similar to those facing the medical profession and, by extension, many groups that we might characterize as “professions”.

Historically, the term “profession” was initially applied to Clergy, Medicine and Law, groups entrusted respectively with the spiritual welfare, physical health and personal rights of all citizens. Many other groups have emerged with responsibility for other areas of social concern, such as nursing, engineering, architecture, pharmacy, and dentistry, to name a few. All are similarly described as “professions”, a term that has come to identify groups of individuals whose role in society is primarily to provide a needed service or role, with a degree of commitment to that cause which goes beyond their personal, individual interests. People who engage such roles are said to be “professionals”, and the concept of “professionalism” is ingrained in the values and training of such groups. It can also be said that any person who engages an occupation in a manner that puts the interest of those served above personal interests is practicing in a “professional” manner. The person who comes in the middle of a cold winter night to fix your furnace or re-establish your power supply can be said to be doing so, at least in part, because of a recognition of your critical need, and therefore providing a “professional” service.

There are several practical features that characterize a profession:

  • Professions have a defined and broadly acknowledged base of knowledge and skills.
  • Professions control or strongly influence their educational processes.
  • That educational process always entails some period of practical training within the practice setting – a derivation of the traditional apprenticeship.
  • Professions control or strongly influence the selection processes for entry to training, and therefore to the profession itself.
  • Professions have societies or organizations that define and maintain standards of practice, define methods by which those standards can be demonstrated, and publicly identify individuals who have achieved them. Membership in those organizations is accepted by society as evidence of competence.

There are also a number of more personal attributes and values that have been identified with professions. Professions are often characterized as “vocations”. The term implies that those drawn to practice professions are somehow “called” to do so. It suggests that they perceive, for whatever reason, a sense of deep and personal purpose in the engagement of that work. It further implies that those engaging professions view their work as an important service to society, and perceive that service as their main purpose and source of fulfillment in life. People who “profess” to serve within a particular domain commit to do so whenever and however the opportunity to serve may arise. It’s significant that the very word “profession” has dual meanings: not only is it a “special occupation”, but also an “avowal, or promise”.

Professions are afforded a considerable degree of autonomy, which relates to a number of practical considerations. Established members of professions best understand their cognitive and skill based “turf”. They are therefore essential to teaching it to others. Their practice experience makes them best suited to define the standards of practice of the profession, and to identify the personal qualities that characterize those best suited to enter and practice the profession.

But above these practical considerations, the autonomy arises from a societal trust that those “called” to practice a profession are motivated solely by the desire to ensure that the quality of that service is maintained to all who require it. In the words of Eliot Freidson, author of Profession of Medicine: A study of the sociology of applied knowledge (University of Chicago Press, 1970), “the occupation sustains its special status by its persuasive profession of the extraordinary trustworthiness of its members”.

But this “extraordinary trustworthiness” comes with a price. There exists an understandable societal expectation of any autonomous professional group.

Responsible professionals:

  • Do not withhold their service from those in need.
  • Do not withhold their service for the purpose of personal gain.
  • Can be relied upon to provide the highest quality work and recognize when they have fallen short
  • Ensure their knowledge and skills are maintained
  • Commit to their responsibilities regardless of clock or calendar
  • Ensure continuity of their responsibilities when they themselves are no longer in a position to provide.

Of all the recognized professions, perhaps none has undergone greater change over the past century than Medicine. The tremendous expansion of knowledge and potential therapies, emergence of specialties, sub-specialties and increasingly focused practices, and need to navigate an increasingly demanding and complex health care system have increased the physician’s role without a commiserate increase in authority. These considerations result in greatly increased personal demands and make it more difficult to achieve the expectations listed above, particularly when combined with a very understandable desire on the part of physicians to protect their personal time and health.

In addition, many of these challenges have brought the profession into conflict with government, which, in our society, is ultimately responsible for ensuring the safety of its citizens and distribution of resources, and have a clear mandate to do so through our electoral processes. A delicate and mutually respectful balance between those who possess and safeguard the necessary skills, and those entrusted to ensure their safe and effective provision seems increasingly difficult to achieve.

So, it appears that the existence of an autonomous medical profession benefits society for all the reasons noted above. It seems equally clear that autonomy is a privilege that must be earned, and is based in trust. That trust, in turn, is rooted in the selfless provision of care, doled out through careers as a series of individual, thankless acts.

Are we willing?

convocation-s-archer
© Photo by Stephen Archer

This past week I participated in two events that are relevant to this issue. The first was the convocation ceremony for our 2015 graduating class. I’ve had the opportunity

to get to know these hundred new physicians quite well over the past four years and, as I watched them receive their degrees, I felt nothing but optimism for the future of an autonomous and vibrant profession, probably much better suited to meet the mounting challenges than was my generation.

belliveau_smallTwo nights later, I attended the retirement dinner of a Queen’s colleague, Dr. Paul Belliveau, who has been active in medical education both locally and nationally, all while maintaining a very active practice in colorectal surgery. The hall was full of faculty from various departments, nursing colleagues, therapists, residents, hospital and faculty leaders, who participated in a very sincere and touching recognition of Paul’s varied contributions. At one point during the evening, his longstanding administrative assistant read a long list of tributes from patients who Paul had treated over the years. All were grateful for the care he’d provided, but all emphasized the compassion and humanity of the man. It was clear that their trust has indeed been earned.

As I was participating in these two events and contemplating the content of this article, it became clear to me that my students and Paul Belliveau were providing the answer to my question. Yes, the profession has been, and will continue to earn that privilege of autonomy, not through edict or legislation, but one patient at a time.

 

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

Posted on

When you are yourself, I’m free to be myself

“When you are yourself, I’m free to be myself”

The Reverend Bill Hendry spoke these words as a “first patient” at the First Patient Program’s 3rd annual Grand Finale on Wed. May 13. He was addressing the 100 students of the class of 2017 who had completed their 18 plus months of relationship with their first patient, whom they’d met in September, 2013. Since then, the students in partners have visited 50 first patient/teachers at their homes, during health care visits, at the ER, in support groups and even grocery shopping to learn about the health care journey through the eyes of the patients.

Photo by Wilfred Ip
Photo by Wilfred Ip

Wednesday was a day to focus on the doctor patient relationship for the students. Hosted by Dr. Tony Sanfilippo, the developer and director of the program, the afternoon began with Dr. Leslie Flynn speaking to the students about the trust that is necessary in a doctor patient relationship, and how extraordinary that trust is. She urged students to take the lessons of their first patient experience—the challenges as well as the good times– as they build that trust in their future relationships.

 

Reverend Bill Hendry, first patient and maple syrup maker extraordinaire, and his wife Lorna spoke to the students about the same relationship. Bill and Lorna have been involved in the program since its inception.

Lorna spoke about how when one partner has a chronic illness, both partners have that illness and experience its effects, and how important it is that physicians respond to this.  Bill HendryPhoto by Wilfred Ip

Bill said that his students were very much themselves when they met with the Hendry’s and how much that is appreciated by patients. Patients appreciate the honesty, the care, and the commitment—the trustworthiness of their physician.

Students afterward shared their experiences of their first patients with their teammates. With prompts such as “Challenges” and “Impact” students were able to tell their stories to their classmates. Using Poll Everywhere, students generated a word cloud, where words such as “humbling” “enlightening”, “perspective” and “eye-opening” came to the fore.

FPP_Humbling_WordArt

Then it was time to have a party! Erin Matthias, Kathy Bowes, Jason Kwok (Meds 2017) and Vincent Wu ( Meds 2018) organized a great party—with a wonderful buffet, balloons, music, and many volunteers from the first year class to escort patients to the 2nd floor. We also had a photographer–thanks to Wilfred Ip, Meds 2018 for his excellent photographs used here in this article!

Photo by Wilfred Ip
Photo by Wilfred Ip

About 30 patients, some with family members, several physicians, many of whom have been part of the program since its inception, Dr. Phil Wattam the incoming Director of the program, 100 students in 2nd year meds, 12 volunteers from first year meds, Kathy, Erin, and yours truly mingled in the Lantern Lounge, and several of the rooms on the 2nd floor.

Photo by Wilfred Ip
Photo by Wilfred Ip

I was musing on the doctor/patient relationship too…earlier that morning, Dr. Ingrid Harle had introduced a very provocative article  in the Health Sciences Education Journal Club, called Professionalism: A framework to guide medical education by Brody and Doukas, in Medical Education: 48: 980-987, 2014. The authors wrote, “The concept of the social contract reminds the student that trust involves a two-way relationship. Ideally, trust exists on the patient’s side and trustworthiness on the physician’s. A dedication to professionalism, viewed as character, establishes the conditions for trustworthiness.” And further…

Photo by Wilfred Ip
Photo by Wilfred Ip

“Students will best understand a virtue approach when they are reminded of how hard it is to keep one’s public promise to put the interests of patients first, as the maintenance of public trust requires. To do this not only on good days, but also on bad days when we are tired and irritable and no-one is watching, requires more than simple rules; it requires that we devote ourselves to becoming certain sorts of persons. If students engage in honest reflection, they will agree that little in their previous lives has taught them to be the sorts of persons who routinely put the interests of others first, even if to do so requires some significant sacrifice. If students see that professionalism, properly understood, requires them to grow into the sorts of persons who not only engage in that hard work, but who do so willingly and cheerfully, they then understand what character and virtue have to do with their education.”

Photo by Wilfred Ip
Photo by Wilfred Ip

In one quiet moment during the very successful if hectic afternoon, as I looked around the room, I was thinking of Bill Hendry’s words, of the theme of the professionalism article, and of our goals in UG as we had set out to design this program with our now graduating class of 2015 three years ago. I was looking around at the students helping their patients at the buffet, solicitously helping them to a chair, listening intently to their patients and laughing with them, at the end of a long day and scant days before exams, and I thought, “Whew! We’re ok then. This group of future physicians has got it. Compassion, trustworthiness, the sorts of persons who put the interests of others first–those characteristics are all here in our future physicians at Queen’s.”

Congratulations to the First Patient Program on another successful year…each year you make it better!

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Milestones: A tribute to our tenacious 2015 graduating class.

“One hundred and eighty-five”. That was the answer to my question.

The question, that I’d posed somewhat naively to our intrepid assessment coordinator, Amanda Consack, was “how many assessments have the 2015 class undertaken during medical school?”

“Do you mean everything?” she asked.

“Yes. Everything, I answered, not wanting to sound wimpy.

In her typical fashion, Amanda provided me not only with the precise answer, but also the following breakdown by type and curricular phase.

Screen Shot 2015-05-11 at 1.30.24 PM

Seems like a big number. Given that our curriculum spans a total of about 140 weeks, this means our graduates have been examined, in one form or another, an average of more than once per week during their four-year program. Closer examination reveals a somewhat less ominous picture. The 32 RATS (Readiness Assessment Tests) and 41 Quizzes are very low stakes methods used by our Course Directors to review course material. They’re therefore used as Formative assessments (to guide student learning), as are the 19 mid-terms utilized by most of our first and second year courses. The 37 “Assignments” and 7 mini-Scholar exercises, also have a largely formative role, and used primarily for teaching the Integrated Roles (non-Medical Expert Competencies). The major sources of Summative Assessment (for the purpose of ensuring students have achieved curricular objectives) are the end of course finals, OSCEs, NBME examinations and ITERs (In-Training evaluation reports) used in the Clerkship. Most of this apparently burdensome assessment load, therefore, is for the purpose of informing our students and curricular leaders as to the effectiveness of the learning process.

Nonetheless, 185 is a big number, and one might reasonably ask, “Why?” Is all this worth the considerable effort, expense (on our part), and stress (on the part of our students)? Do all these assessments make for a better-educated, more practice-ready graduate?

On one side of this issue is the “assessment drives learning” camp, which feels quite strongly that students must be led to the appropriate learning by their intrinsic desire/need/compulsion to succeed in examinations. This approach actually takes advantage of the drive for objective and external validation that allowed our students to succeed in the highly competitive medical school application process.

However, many feel that this approach promotes purpose-driven learning only and fails to establish the “deep learning” necessary for career success. It also falls short of embedding lifelong learning skills that are so important to ensuring ongoing physician competence. This camp, which has both strong faculty and student support, would much prefer a somewhat more Utopian educational environment where faculty directs learning and trust that students will enthusiastically undertake their studies because it’s fundamentally important to their own educational goals, personal interests, and future needs as physicians. They are, after all, adult learners selected from the most motivated and academically accomplished young people our society produces. These folks will go on to argue that postgraduate programs, the Medical Council of Canada and provincial regulatory bodies will, down the road, provide more than sufficient opportunities to ensure they are qualified to do fill the roles they choose to engage.

Unfortunately, this controversy can’t be resolved on the basis of the sort of objective, controlled evidence we all crave. There are no randomly controlled trials, and we would prefer not to assess only half our class and wait a generation to evaluate the fallout.

But that’s not to say we lack evidence of student success.

The Medical Council of Canada, National Board of Medical Examiners, and USMLE all provide external examinations that our students undertake and which allow comparison to other Canadian or North American schools, and show that our students do quite well in comparison to their peers. The Canadian Graduation Survey provides our school feedback from our graduates as to their satisfaction and sense of preparedness for residency, and shows that our students rank their educational experience at or above Canadian means. Perhaps most importantly, our students do very well in the increasingly competitive postgraduate matching process, with the 2015’s matching their 2014 predecessors in achieving a 100% match, with most achieving their first choices. The more informal feedback we receive regularly from preceptors who encounter our students and graduates in electives and postgraduate programs is very favourable and leaves our curricular leadership with the sense that “we must be doing something right”.

travelWith regard to my view on the assessment controversy described above, I’ve come to feel that the purpose rather than the number of assessments is the key issue. In doing so, I’ve been drawn to the image of the Inukshuk. These are the elaborate arrangements of stones that have come to symbolize Inuit culture and are featured on the flag of Nunavut. I’d always assumed these were simply a native art form. I came to learn a few years ago from a prominent educator who I admire greatly that these are, in fact, cairns, left along migration routes in order to guide travellers to their destinations. In bleak and featureless landscapes, they point to the next step along the way. They also mark places

where provisions might be stored for the journey. They are, therefore, sources of both direction and nourishment. Our examinations, small and large, should do the same. They should provide encouragement to sustain the journey, and direct further learning.

And so, our 2015 graduates have truly encountered a series of milestones set along the way by a faculty that’s gone ahead, knows the trail, and is now intent on ensuring that those who follow will safely reach their destination. To our graduating students I would say that you have earned the right to be confident – confident in your knowledge, confident in your abilities, confident that your judgment and personal qualities will equip you for the challenges ahead. You are capable of being excellent physicians and, more importantly, excellent contributors to our profession and to our society. On behalf of all your proud faculty at Queen’s, I bid you safe travels.

 

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

Posted on

Student attention in class: Whose responsibility?

I just received a posting from Faculty Focus with the engaging title:  Why can’t students just pay attention?  Dr. Chris Hakala, the author, gives a really good overview of the dilemma many of us face when teaching:  students are not engaged, are multi-tasking at best, and distracted at worst, and are not learning or retaining key concepts.  How much responsibility should teachers bear for this lack of attention, and if we assume responsibility, what can we do about it?  http://www.facultyfocus.com/articles/effective-teaching-strategies/why-cant-students-just-pay-attention/

distraction

Dr. Hakala defines attention, from the cognitive literature, as the idea that students have a finite amount of cognitive resources available at any given moment to devote to a particular stimuli from their sensory environment.  To that end students’ attention is constantly shuttling between what they are experiencing externally and internally…At any given moment, [they] select from a large number of potential stimuli and focus on a small number of them. If class is interesting and there is activity, students can focus on those activities and work to remember that information for later use. However, when class isn’t engaging, students will find other things to occupy their attention.

You may recall reading my thoughts and others’ on multitasking and how it’s not really effective tasking at all.  (http://meds.queensu.ca/blog/undergraduate/?p=822 and http://meds.queensu.ca/blog/undergraduate/?p=113

However, it’s a very challenging mind-set to change, as students appear convinced that they can multitask (they can) and learn well (a much more difficult proposition).

     multitasking 1

Dr. Hakala claims, as do many educators, that we as teachers should accept some of the responsibility for engaging students, and allowing them to focus on our teaching.  He suggests the following:

  1. Ask questions and require students to write responses. Then ask again and have them read their answers to the class (not all, obviously, but a sampling).
  2. Have students respond to questions about readings or a previous class activity and bring those answers to foster peer discussions.  in groups 2
  3. Craft mini-lectures to include time for student comment, feedback, and response.
  4. Focus learning on student perspectives.
  5. Create rapport with students and build a classroom climate where students feel comfortable sharing their ideas.

I would add,

  1. Use small group learning, especially when all groups report to the whole class (this can be done by having the group answer a challenging multiple choice question that is the focus of the group task)
  2. Ask students to answer a question or solve a problem and share the answer with a peer. (See Peer Instruction by Eric Mazur.)  Peer answers can be shared with the whole class. (Think, Pair, Share).
  3. Break up a lecture into 15 minute “chunks” punctuated by student activity.
  4. Create an outline, follow it, and demonstrate to students where in the activities of the outline you are.
  5. Use quizzes, or Readiness Assessment Tests to determine understanding

AND (and I’m going to be radical here) ask students to close their devices at certain points in the class when they’re not needed for taking notes, looking up references, etc.

It wouldn’t be one of my blog articles without a reference (in case you want to read more): look_it_up

Dr. Hakala states that there is evidence to support that deep processing, which happens when students are engaged (with only one task!), leads to better learning  and cites Brown, Roedigger & McDaniel, 2014; Benassi, Overson, & Hakala, 2013.  I highly recommend the Brown, Roedigger and McDaniel text: Make it stick: the science of successful learning. Cambridge, MA: Belknap Press. I’ve directed students and faculty to Prof. Roediggers’ writing before–he makes learning about learning accessible.

You can find a description of Benassi, Overson & Hakala’s book, Applying Science of Learning in Education: Infusing Psychological Science into the Curriculum (2014) at http://teachpsych.org/ebooks/asle2014/index.php.

Back to the blog article:

My stance is that teachers bear a some responsibility for student engagement…Yes, I know we all learned from 4 hour lectures; yes, we all had boring professors… and yes, look at how well we learned.  However, we understand a lot more about learning now, and we have a different group of learners now.  In the interests of good pedagogy as well as good role modelling and personal satisfaction, it’s important to set the stage so that learners will learn well.

What happens after that, however, is a student’s own responsibility.  Part of the challenge in medical school comes from students not always being able to distinguish what is important at early stages.  But as adult learners in medicine, and with patient safety, professionalism, and their future sound practice at stake, it’s important that we challenge students to take on part of the responsibility for learning, put the distractors away, and focus.  It’s a hard habit to break for some of our “wired generation” but I believe it is worthwhile.

What are your thoughts on student and teacher responsibilities for engagement?  And what ideas do you have to stimulate learning in class?

 

 

 

 

 

 

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