Author: Theresa Suart
Small connections matter
My Dad died last week in New Brunswick.
I write that not as an invitation to sympathy (but, thank you), but to share a few thoughts from the patient’s family perspective – not on death during a pandemic, although that intensified and complicated things, so much as death in general.
Dad had a stroke nearly four years ago and his memory wasn’t what it once was. I’ll leave parsing out what was effects of the stroke versus medication versus dementia to course case studies. When he fell two weeks ago and broke his hip, the cause of his cognitive difficulties didn’t matter so much as the fact that he was an old man who was scared who was in hospital with visitor restrictions. That is: no visitors at all, unless the patient had palliative status (and Dad didn’t until his last day). Dad didn’t really understand the pandemic, and sometimes forgot what was really going on with his care – doing such things as trying to pull out his IV and catheter, for example. He was scared and in pain and confused.
One bright part of these terrible days was the day his nurse was from Miramichi, his hometown. He was so delighted to talk with her and talk about the places of his boyhood with someone who knew where he was talking about. Who shared the same connection to the River, to the place, to home.
This reminded me of decades ago and my last visit with my maternal grandmother in a Moncton, NB hospital a week before she died. My grandmother was Acadian but lived most of her life in a predominately English community. Her children spoke English. Her grandchildren were truly assimilated with only classroom-based, mediocre French. One of my indelible memories from that last visit was that her conversations with the nurses were always in French. And she seemed so happy to be able to do that. That her first language mattered; that she mattered.
I don’t want to suggest that for meaningful connections healthcare professionals need to share hometowns and language with all of their patients. This is both unrealistic and absurd. These connections highlight just that: connections. Those two nurses, decades apart, connected with scared, dying patients by honoring their shared humanity. My father wasn’t a broken hip; my grandmother wasn’t a failed kidney.
When my mother-in-law was in palliative care in a Toronto hospital in 2010, one of the volunteers did music therapy with the patients. When I arrived for a visit one of the last afternoons, there was a Rachmaninov CD on the table with a Post-It note: “When she wakes up, play track 4 for Sylvia”. He hadn’t had one in his kit and she had spoken about it with him; she was sleeping when he came back with it. (We still have the CD, as he wanted us to keep it).
There isn’t always time in busy clinics and wards to make substantial connections with each and every patient – especially for students who are wrestling with mounds and mounds of material to learn, remember, apply. I’d argue that small connections are just as meaningful. Small moments matter – a shared favourite song, listening to reminiscing. Dignity and connections matter.
None of those things I mentioned were “medical care” for Dad, Nanny, or Sylvie, but it was medicine in the compassion, the care, and the connections. And it’s these connections which give comfort to those of us left behind.
If you want to read a bit about my Dad, check out this link: https://nble.lib.unb.ca/browse/n/michael-o-nowlan
Have you ever used brainstorming in your teaching? If you want groups of students to come up with a variety of ideas quickly, brainstorming is one tried-and-true way to get creative juices flowing.
Since the concept was introduced in Alex Osborn’s 1953 Applied Imagination, brainstorming has caught on in business, education, volunteer organizations and elsewhere to generate ideas and solve problems. Brainstorming, as set out by Osborn, is designed to produce a large quantity of ideas in a short space of time, in order to encourage creativity. He had four simple rules for brainstorming sessions:
- Don’t allow criticism
- Encourage wild ideas
- Go for quantity
- Combine and/or improve on others’ ideas
A few years ago, some writers recast “brainstorming” as “brainwriting”. This is a new name for a familiar best practice: brainstorming works best when it’s planned, not haphazard, and it starts with the individual, not the group.
As described by Patrick Allan (citing work of Leigh Thompson and Loran Nordgren) brainwriting avoids the brainstorming pitfall of anchoring: where an early idea streams all other suggestions in a particular direction. “Brainwriting” gives individual team members time to write down their own ideas free of others’ influences.
Osborn himself advocated this (although he didn’t use the term brainwriting), asserting that the best ideas come from a blend of individual and group work. Classroom brainstorming shouldn’t be unplanned: students should have prep and thinking time. As Robert Sutton notes in “Eight Tips for Better Brainstorming”: “Skilled organizers tell participants what the topic will be before a brainstorm.”
Barbara Gross Davis also encourages individual preparation in Tools for Teaching. She suggests posing an opening question and having students spend five minutes writing a response. This “gives students time to think and enriches subsequent discussion.”
Here are some other ideas to encourage better brainstorming in your classes:
- Assign roles within the brainstorming group. Groups need a moderator (to guide discussion, keep the group on topic, and encourage wide participation), a scribe (or two) to capture the ideas (using either flip charts, Post-It notes, computers or consider audio recording), and members (to contribute and build ideas).
- MindTools advises that the moderator can help keep the team on task and can help the team avoid narrowing its path too soon. “As the group facilitator, you should share ideas if you have them, but spend your time and energy supporting your team and guiding the discussion. Stick to one conversation at a time, and refocus the group if people become sidetracked.”
- Remember, the students who are the moderators and scribes aren’t actively brainstorming while they’re attending to their key roles. Encourage teams to share these tasks throughout a term, so it’s not always the same couple of people who end up taking notes rather than contributing their ideas.
And, yes, even with Zoom: with all the above, you may think this is a post-pandemic teaching tool. With a bit of planning and creativity (and the right tools), you can use brainstorming even in our online (synchronous or asynchronus environments. You can use online tools such as PollEverywhere’s “Q&A” function – once students provide initial ideas, classmates can vote up or vote down a suggestion. You can also use Zoom’s built-in white board as a brainstorming wall. (This takes a bit of set-up to get right, but could be worth it for the right topic).
And, what to do with all those ideas the groups generate? Sutton points out that brainstorming should “combine and extend ideas, not just harvest them,” so have a plan for what you want students to do next.
The next steps are sorting and follow-up. In Small Group and Team Communication, Harris and Sherblom recommend an “ACB Idea Sorting Method”:
- Assign an A to the best one-third of the ideas
- Assign a C to the least usable one-third
- The middle one-third automatically receive a B
- Go back to the B’s and separate them into the A or C category
- Store the C category ideas for later use
- Prioritize the A list in terms of item importance, urgency, or applicability to the problem at hand.
The Education Team can help you with incorporating brainstorming and other techniques in your teaching. Contact me to arrange for one-on-one coaching or to facilitate a workshop for your team.
7 Tips on Better Brainstorming. (n.d.). OpenIDEO. Retrieved August 12, 2014, from https://openideo.com/blog/seven-tips-on-better-brainstorming
Allan, P. (n.d.). Use “Brainwriting” Instead of Brainstorming to Generate Ideas. Lifehacker. Retrieved August 12, 2014, from http://lifehacker.com/use-brainwriting-instead-of-brainstorming-to-generate-1615592703?rev=1407126541539&utm_campaign=socialflow_lifehacker_twitter&utm_source=lifehacker_twitter&utm_medium=socialflow
Brainstorming: Generating Many Radical, Creative Ideas. (n.d.). Brainstorming. Retrieved August 12, 2014, from http://www.mindtools.com/brainstm.html
Davis, B. G. (2009). Tools for teaching (2. ed.). San Francisco, Calif.: Jossey-Bass.
Harris, T. E., & Sherblom, J. (2011). Small group and team communication (5th ed.). Boston: Pearson/Allyn and Bacon.
Johnson, D. W., & Johnson, F. P. (2009). Joining together: group theory and group skills (10th ed.). Upper Saddle River, N.J.: Pearson/Merril.
Sutton, R. (2006, July 25). Eight Tips for Better Brainstorming. Bloomberg Business Week. Retrieved August 12, 2014, from http://www.businessweek.com/stories/2006-07-25/eight-tips-for-better-brainstorming
An earlier version of this post was shared in August 2014
5 Tips: Coping with learning in COVID Times
I’m writing this from what I dubbed my “basement bunker” back on March 23 when we started our remote teaching and learning. At the time, it was a way of injecting some humor into a stressful, face-paced pivot to working from home and supporting teaching and learning online. Six months later, I’m still here, but conscious that a few quips won’t get us through the potential tedium and distractions of working and learning from home.
As we all settle in for a semester unlike any other (are you tired of “unprecedented times” yet?), the Education Team offers these 5 additional learning strategies to help during COVID-Times:
1. Carve out spaces: Staying home for most of the semester’s classes (except for your short “Red Zones” with small-cohorted face-to-face instruction) could make it difficult to focus and concentrate. One strategy to break up the day is to carve out more than one “school” space where you’re living: one for “class” and one for “homework”. Simply moving to the other side of the room can signal your brain that you’re switching activities. If you have a roommate and limited spaces (say, one desk and the kitchen table), maybe trade off your class and study spaces.
2. Get up and move: There’s a reason FitBit buzzes every hour when you wear one, and it’s not just marketing. Too much sitting is bad for everybody. At least once an hour, turn off your camera and walk around a bit, do some standing yoga stretches, or a few jumping jacks – you can still listen! Pro-tip: make sure this isn’t when you might need to turn on your mic. I was on the far side of my (admittedly small) basement bunker on a walking break during a meeting, when the chair said: “Theresa, what do you think?”
3. Pack your lunch: This one may seem silly, but I’m serious. You don’t have to go to the extreme of putting everything in a lunch bag, but think about prepping your lunch either the evening before, or while you’re making breakfast – just like you would if you had to take it to campus. Chances are, you’ll eat healthier that way. After a morning of zooming, and facing an afternoon of more, if you have nothing prepped, you may be tempted to gobble that leftover pizza, or half-finished bag of chips instead of the great lunch you (would have) packed.
4. Get outside: Whether it’s after class or during, make sure you get outside at least once a day. While the weather is still nice, if you have access to an outdoor space and your Wi-Fi extends that far, consider setting up outdoors for your afternoon classes. (I saw a few of our students on a couple of Zoom classes last week doing this). Keep social-distancing rules in mind, but get some fresh air to wake up your brain.
5. Do something social: Don’t get bogged down in “just” doing schoolwork – schedule something social. It’s good to connect with people outside your program. Again, keep social-distancing rules in mind, but book time for something fun. Schedule a Zoom story time with nieces and nephews, set up a walking phone visit with a pal, or sign up for a non-academic class or activity. Lots of organizations are getting creative about programming. My sister (a high school teacher in Toronto) and I signed up for the Kingston-based Cantabile Choirs “Virtual Voices” season of weekly online voice lessons. Not only do we each now have a scheduled “fun” activity, we’re doing it together while apart. Think outside the box for planned not-school-work! (If you like singing, there’s still time to check out Virtual Voices, which begins Wednesday evening: https://cantabilechoirs.ca/virtual-voices/)
Do you have a learning from home tip? Share your advice in the comments!
~ With thanks to my teammates Rachel Bauder and Eleni Katsoulas for their contributions to this post.
Including learners with “remote” patient encounters
We’ve been focusing on classroom-based teaching tips in recent blog posts, this week, we focus on some practical tips for clinical teaching for clinicians working with learners while using telephone and computers for patient appointments.
By Debra Hamer, MD FRCPC, and Theresa Suart, MEd
Since March and continuing for some patient populations, physicians have shifted to “remote” technologies to conduct patient encounters, which used to take place face-to-face. This has complicated how to readily include learners – clinical clerks and residents – in those encounters.
First – let’s just put this out there – we don’t like the word “virtual” to describe working with patients using telephone or computer interfaces. This is not simulated care, it’s actual care!
Whether you’re using telephone appointments or a computer-facilitated patient interface, it can be a challenge to incorporate learners. We’re providing some suggestions based on telephone and OTN (in this case); these can be modified for your own tech situations. (As always, feel free to reach out to the UG Education team for help brainstorming solutions.)
The tasks associated with each can be divided into three parts: before, during, and after. These are things you likely do automatically with in-clinic or in-hospital patient visits that include learners because you’ve been doing it for years. Working with “remote” technologies just requires a bit of deliberate thought to what that preparation, appointment, and debrief looks like.
Depending on what social distancing is in effect, you may be in the same room as your learner, or you, the learner, and the patient may be in three different locations. The suggestions below assume you are in three different locations. If you and the learner can be in the same room, this will be simplified.
(You may book your appointments yourself or have an administrative assistant who does so.)
Prior to Encounter:
- When the patient’s appointment is booked, ask if a learner can be involved with the appointment.
- If there’s a reminder call, include a reminder that a learner will be involved (if they said yes, of course!)
- Make sure you’re in a room by yourself with no intrusions or distractions. This might seem self-evident, but work-from-home situations can change day-by-day.
- Ensure your phone is set up to block your caller ID. On an iPhone, you need to deselect this under settings.
- Ten minutes before the patient call, call the learner and review the referral and any pertinent information from the chart, since students won’t have access to the chart if they are not physically in the clinic. At that point, you can answer any questions or concerns the learner has
- If you’re using a phone with “conference” capabilities (adding a participant) you can keep the learner on the phone while you initiate the call with the patient. (On iPhone, this is “add a call, put in the patient’s number, then press merge calls).
- Once the patient answers, check to ensure both the patient and learner are on the call. All three participants should be able to hear each other.
- In the greeting, you can remind the patient of the learner’s role on the call.
- Make sure the patient understands the potential privacy issues with cell phones and consents to continue, then outline what to expect during the appointment.
- Proceed with the patient interview/discussion/assessment as you would do ordinarily.
- Depending on the learner’s stage, at this point they may be listening in; if not, let the patient know you will mute yourself and unmute yourself near the end to join back in. (If the learner is going for too long or going off the rails, you don’t need to wait until the end, simply unmute yourself and redirect them, as you would in a face-to-face encounter).
- At the end of the appointment, if you haven’t already, you can unmute yourself, ask any questions and finish off.
- After ending the call with the patient, call the learner back and debrief the encounter.
- If it’s a senior learner, you may take the option to call the patient back – talk to the learner, find out a diagnosis and plan and then call back together with this. This will vary on the learner’s level. (Be sure the patient knows you are going to do this!)
- With a more senior learner, with the patient’s consent, you could use a three-step appointment: the learner initiates the call with patient, then ends that call to confer with you (by phone or other means), then the learner or you calls the patient back with the plan for going forward.
Pro-tip: If you use headphones, then there’s less reverberation and you can use your hands while you’re listening to the phone calls.
(Dr. Hamer uses OTN, you may use another platform. These instructions assume the patient has agreed to an internet-mediated appointment and has received the log-in instructions by email).
- Make sure your computer is set up with a neutral background with nothing to distract the patient.
- Also, make sure you’re in a room by yourself with no intrusions or distractions.
- Telephone the learner 10 minutes before the appointment time and review the case with them. End this call
- Launch the appointment with the patient. (In OTN, this is either “make a video call” or clicking on the link from your schedule). Use your program’s function to add the learner. (On OTN, it’s “add a guest”
- Ensure the patient still consents to continue with the appointment online, and outline how the appointment will go. Then mute yourself and block your video so it’s just a black box at the bottom of the screen. The learner and patient will just see each other. (This is less distracting)
- Re-enter as needed (similar to the telephone suggestions above).
- If there is time available on the appointment, ask the patient to stand by for a few minutes. You and the learner both mute and block your video and have a telephone discussion about the case.
- Come back to the call to see the patient. (Make sure the gap is no more than five minutes).
- Once the computer-mediated appointment has finished, call the learner back to talk about the case.
Do you have advice or suggestions for facilitating learning with these types of patient encounters? Share your advice in the comments.
Five non-pedagogical things to do to get ready to teach using Zoom
The UGME Education Team has prepared “how to” documents that outline the technical aspects (with such things as downloading the Zoom app, and things like checking that your microphone works). And we’ve previous written with tips about how to engage students in a virtual classroom which might seem rather unfriendly. This post is about other practical things – things we don’t need to think about, or just do automatically – when going to teach in a physical classroom with students there face-to-face.
Here’s our top-five non-pedagogical things to keep in mind before teaching live on Zoom:
1. Look behind you! Give a bit of thought to what’s behind you when your camera is on. Most things are fine, but consider if there’s a lamp that’s coming out of your head like an antennae or something equally distracting. Think about any privacy concerns, if you’re teaching from your home. My work-from-home space is in my basement all-purpose room. If I’m situated in one direction, you’ll see my husband’s degrees on the wall; another you’ll see a collection of elephant figurines (yes, there’s a story to that), and a third shows my Nancy Drew, Cherry Ames, and LM Montgomery books from my childhood. Most stuff is innocuous, but think about if you want to share those things with everyone.
Zoom virtual backgrounds are, of course, an option for an instant non-personal look. Keep in mind, however, that the green-screen technology isn’t perfect. If you move around or (like me) talk with your hands, you may have visual blips of hands or your head momentarily disappearing.
2. Turn off all things that beep, buzz, or whirr Just like in a movie theatre (remember those?!), it’s helpful if you can turn off sounds that are within your control – like your cellphone or email notifications. Also, any environmental noises you can control. My home workspace is adjacent to the laundry room. At the exact moment I was typing this sentence, the dryer buzzer went off (loudly!). It’s also helpful to remind housemates that you’ll be teaching so they can make good noise-related choices.
3. Refreshments, anyone? If you’re settling in for a two-hour session, that could be a lot of talking. It’s good to have a glass of water handy, or throat lozenges nearby. Or, if you’re teaching an 8:30 class: COFFEE. Also, tissues or paper towels perhaps – you likely don’t want to dig into a pocket while sitting down for a sneeze or spill of aforementioned coffee.
4. Office supplies, what office supplies? If you typically take notes of questions students have or keep track of which groups you’ve already called on, make sure you have pen and paper on your desk. Also, do you have any small props you want to show? Figure out where in your teaching space you can put these to keep them nearby, but out of the way of things like your refreshments (above) to avoid needing the tissues or paper towels.
5. Time, please. It’s easy to get caught up in teaching material and lose track of the time. Keep your eye on the clock on your computer, or set a timer (this sound we’ll allow) so you finish on time. There will likely be another instructor waiting to begin their session right after yours and you won’t have the usual visual cue of your colleague appearing at the back of 032 or 132.
Keep in mind, this is real life, real time teaching, not a Hollywood film. Things will happen and it will be fine – paging, for example, is unavoidable if you’re teaching in your hospital office. Also, you won’t be the first of our instructors (or students) who’ve had a child or pet wander into camera range. (I routinely warn of random “teen boy” appearances when I’m on Zoom calls. He wandered in while I was drafting this, too).
Are there things you would add to this list? Use the comments box below to share your tips.
For a different (more humorous, maybe more accurate?) take on preparing your environment for online teaching, check out this video by Dr. Andrew Ishak at Santa Clara University. https://vimeo.com/447645552?fbclid=IwAR3lKAaNY0zCPgVJWdPUjog-AD0g7FjsSNBtUL5HAEdcFlUgWaUHi–7JqU
Three ways to think about student engagement in remote curriculum delivery
While you’re preparing to deliver our UGME fall curriculum for Years 1, 2 and 3 predominantly via remote technologies (and some of that asynchronously), the challenge of keeping student engaged and involved may be top of mind. Three strategies (useful in any teaching, not just pandemic-restricted scenarios) are useful to keep in mind.
1. Set expectations early For many – students and teachers alike – remote teaching using a platform like Zoom is a new way to learn, so it helps to set the expectations when you start. In face-to-face teaching, this is sometimes done formally, but more often informally. A learner sitting alone in front of their computer can’t “read the room” to know what’s ok. If you’d prefer that students use the Zoom “raise hand” function to ask questions, let them know this at the start of class. If you’d rather they unmute their microphones to interrupt, set this as your norm. If you invite students to email you with questions after your session, set a reasonable time-frame for response. If you expect them to have downloaded a worksheet from Elentra ahead of time, make sure this is in your learning event’s “required preparation” section, since you can’t have a handout ready as back-up. Be clear, so no one gets frustrated.
2. Use tools effectively All the tools available in the classroom are also available in remote teaching – they just sometimes need a bit of tweaking to use effectively. For example, one really low-tech engagement tool is silence. In my early days teaching at the University of New Brunswick, I had a Post-It note on my lecture notes which said: “shut up, Theresa!” This was a succinct reminder to myself to give students time to hear and process questions before I went ahead and answered them myself. With remote teaching, we need to factor in time for student to click on their “raise hand” button or hit “unmute” along with that processing time. Silence can be uncomfortable for instructors as we think we should be filling every moment, however, using questioning and dialogue effectively remotely requires becoming comfortable with longer intervals waiting.
Most other tools you use routinely face-to-face can continue to be used via Zoom. For example, Poll Everywhere and videos were also used quite easily during the spring term. Do you sometimes use “show of hands” to get a response? Both the “raise hand” function and the “reactions” one can be used for this purpose. Some in-class tools might take a bit of strategic thinking and planning to rework for remote classes. If you have something in particular in mind, reach out for brainstorming and to capitalize on collective wisdom.
3. Assign roles Whether you’re in a Zoom class, or assigning asynchronous work, it can be helpful to proactively assign roles to individual students to keep everyone engaged and participating equitably. Whether it’s the randomizer app used by Dr. Gilic and Dr. Simpson in MEDS 115 to call on individual students for responses, or a “Someone from group X” call-out, these can all be tailored for Zoom.
If you’d like some Zoom-mediated face-to-face feedback, ask that one student from each SGL group be “on camera” during the class. Not everyone’s internet supports using video throughout, but teaching to a sea of names in black boxes makes it hard to gauge responses. Using a rotation within groups will share this responsibility. (And get more camera-shy students used to being “on” in a low-stakes way).
If you’d like a student to monitor the chat box for questions, create a roster of students who are willing to do it and share that task through the term.
If you’re using discussion boards for asynchronous teaching, break up the tasks needed to meet the learning outcomes of the discussion: have one or two students assigned to pose a discussion question based on the preparatory materials, another to moderate, someone else to write a one-paragraph summary of the discussion to share with the large group. You could also assign a student or two from each group to write multiple choice questions based on the assigned material. (If you’re interested in using discussion boards on Elentra, get in touch and we can set it up for you).
It’s true we’re in somewhat uncharted waters for teaching this way, but there are solutions to the teaching challenges. If you’re stumped or frustrated, please reach out – we can find some solutions together. Reach me best by email (firstname.lastname@example.org).
Planning your teaching in uncertain times
Summer is upon us and, with it, planning for fall semester teaching. There’s a lot of uncertainty in the world these days vis-à-vis the COVID-19 pandemic – which has contributed to some uncertainty in planning for curricular delivery. At the School of Medicine, we have permission to run some learning activities face-to-face (such as clinical skills) with new restrictions in place to maintain social-distancing, but our traditional classroom-based teaching will be impacted as well.
The Education Team is here to support Course Directors and all teaching faculty as we face these new challenges. While we don’t have all the answers yet about room assignments and scheduling, there are still many things we can do right now to help with your planning and preparation for both your synchronous (all students learning at an appointed time, either in a classroom or via Zoom) or asynchronous teaching (students provided with learning materials that need to be completed by a certain deadline, but otherwise, they can learn on their own schedule and own pace). If we don’t have solutions to your queries, we’ll help find them.
Things we can help you with now:
- Discovering options for asynchronous teaching
Course Directors have been asked to consider different avenues for asynchronous learning. While this already exists in many courses in the form of Directed Independent Learning electronic modules, there are other options, too. If you would like to increase the amount of asynchronous learning in your course – or just explore possibilities – we can help with this.
- Learning techniques for interactive teaching via Zoom
We learned a lot from our two-and-a-half months of remote teaching using Zoom from March – May. If you’re concerned about how to keep your teaching engaging and interactive while “talking to a box”, we can help with this – and provide some practice opportunities, too, so it’s not so intimidating. Tools you may already be using in the classroom, such as videos and polling, are easily leveraged on the Zoom platform.
- Exploring approaches to assessment
Your current assessment plan may be just fine, but there may be things you’d like to tweak given the logistics of remote delivery. We’ve sorted out quizzes, graded team assignments (GTAs), and proctored exams already, so we can address these and any other concerns you have and make any appropriate modifications.
- Guiding you to resources
We can point you towards Faculty of Health Sciences and campus-wide faculty development opportunities and services that are available and talk about which approaches already fit with the UG program, and navigate through other possibilities.
- Brainstorming and problem solving
While the landscape may have changed with the COVID-19 pandemic, our goals as your Education Team remain the same: we’re here to help you prepare for, deliver, and improve your teaching and assessment.
Please get in touch:
Theresa Suart email@example.com
Eleni Katsoulas firstname.lastname@example.org
Rachel Bauder email@example.com
Zooming our way through pandemic remote teaching
On March 23 – coincidentally immediately after our students’ March Break – Queen’s UGME moved its classroom-based teaching to all remote learning to comply with social-distancing measures put in place as a result of the COVID-19 pandemic..
This also coincided with the majority of faculty, and administrative and support staff moving to working from home, except for those deemed essential to university operations.
By the end of May, we’d conducted close to 250 learning events via Zoom that would have ordinarily been taught in our classrooms by dozens of faculty members. The Meds Video Conferencing (MedsVC) team, led by Peter MacNeil were instrumental in making this possible, providing technical support for every learning event.
Lectures were recorded to accommodate students who found themselves in different time zones (many having travelled home for March Break and subsequently stayed there rather than engage in unnecessary travel) and those with family responsibilities, for example.
Instructors faced the same challenges most have read about regarding online conferencing. As Dr. Jenna Healey, Chair in the History of Medicine, describes: “Technical issues, navigating the software, making sure there were no interruptions on my end—like my very loud cat meowing!”
Faculty sought creative solutions to previously-scheduled in-class sessions. For example, in MEDS 246 Psychiatry, there were two expanded clinical skills sessions scheduled which each included a Standardized Patient actor (SP) to help demonstrate aspects of psychiatric interviews. Course Director Dr. Nishardi Wijeratne led both sessions – the first before the switch to remote delivery and the second one via Zoom. Each session was 50 minutes.
“Having taught both at the SOM and fully zoom, I did not find a significant difference between the two as a teacher,” Dr. Wijeratne says. “Given that my clinical practice as psychiatrist has moved to mostly virtual care right now, the Zoom version actually felt closer to my daily clinical practice right now.”
She noted three aspects that helped greatly with the session:
- MedVC staff to help with tech issues
- Connecting with the SP about 10 minutes before the session to discuss goals and structure
- Assigning tasks to the students ahead of the session to maintain engagement thoughout the 50-minute classes. Students observed the psychiatric interviews and documented mental status, identified risk factors, and considered possible differential diagnoses.
In addition to his own teaching, MEDS122 Pediatrics Course Director Peter MacPherson pitched in with a solution to a Clinical Skills session – about half the class missed their opportunity to complete a toddler observation session because of the pandemic restrictions.
“Usually, the medical students get down on the floor and play with a toddler while they infer the child’s real age based on their developmental achievements,” he explains. “We were able to cover the same curricular objectives remotely. The students were able to observe and interact with my toddler via Zoom in his ‘natural environment’ (aka our playroom) and do a similar assessment.
“It was a lot of fun to teach while playing dress up with my child!”
One part of the classroom experience that’s more challenging to achieve remotely is direct interaction with students as a class. “In particular, it is rather difficult to judge the level of understanding of the class,” MEDS245 Neurosciences Course Director Stuart Reid notes. “It cannot provide the personal contact that comes with in real life interaction.”
“On the other hand, it has been an invigorating challenge. We introduced more online learning modules and sought creative approaches to making distance learning both active and interactive,” he adds. One such creative approach was a “Jeopardy” style game in place of a hands-on expanded clinical skills session. It didn’t replicate the face-to-face session, but it actively engaged students in the session.
Dr. Healey echoes Dr. Reid’s comments about missing that face-to-face factor. “I very much miss interacting with my students in class. As an instructor, what I have found most challenging is not being able to see student’s faces. I didn’t realize how much I relied on non-verbal communication to adjust my pacing or gauge the level of student’s interest or understanding.”
Dr. Healey started encouraging students to use the Zoom “raise hand” function more often in her classes. “I want students to feel comfortable interrupting me if they have questions or comments.”
Dr. Reid speaks for all of us at UG when he notes that the students were a key factor in the success of our remote curriculum delivery: “They have been patient, accommodating, and enthusiastic enablers of our altered circumstances. Many thanks to them!”
At the end of the semester, the Education Team conducted several focus groups with Year 1 and Year 2 students to get additional feedback on what worked well, what didn’t, and suggestions for improving this type of remote learning. This, combined with the course evaluations (which included additional questions about the new required remote learning activities) will be used to inform teaching decisions in the coming academic year, as the COVID-19 pandemic situation continues to evolve.
Five tips for working and learning from home
We’re now into Week 3 of delivering our UGME curriculum (as much of it as possible, at least) via online teaching and learning as part of Queen’s response to the COVID-19 pandemic response mandates. As well, most staff are also working from home. You may still be trying to find your groove in this new configuration of teaching, learning and working without direct in-person contact with colleagues. With this in mind, I’ve begun making notes on tips for working and learning from home. Here are my initial five:
1. Negotiate your space carefully.
This is especially important if you have housemates. In some households, working-from-home space may be at a premium. In my home, there are four of us working and learning from home – my husband, my Grade 10 son, my graduate student daughter who has de-camped from McMaster, and I are competing for space in our townhouse. I’m in what I call the “basement bunker” – it’s a corner of the basement, near the foot of the stairs. It’s windowless but has everything I need: my desk, electrical outlets, and my three computers I’m using to check-in on multiple learning events. My daughter is at the opposite end of the basement, near a teeny-tiny window.
My husband got the kitchen table—he has a window and is closer to the tea kettle—but I don’t have to pack everything away for lunch and supper. My son is migrating from place to place.
2. Make friends with Zoom.
While there are multiple on-line options for course delivery and meetings, for UGME we’ve been using Zoom predominantly for courses and meetings. Like any other online platform, it has its quirks and protocols. It helps to become familiar with the key commands, like “raise hand”, share screen, chat, and how to “unmute” yourself. Remembering to use these things in a timely way is another story.
What we’ve all discovered over the last two weeks is that online is more exhausting than face-to-face. My Education team colleagues and I coined a new term – “zammed” as in “I’m zammed” meaning fatigued from back-to-back-to-back zoom session as in: “I’m zammed” in place of “I’ve done six hours of zoom today and I am SOOOO done.”) And, yes, we’ve all voiced the Brady Bunch and Hollywood Squares comparisons.
3. Look away!
In regular office work (and classrooms, too), we naturally change from focusing on “up close” versus mid and far. With so much of our work and learning lives moved online, we’ve upset this balance. To help combat screen fatigue, use the 20-20-20 rule: Every 20 minutes, take 20 seconds to look (out the window, across the room) and focus on something about 20 feet away. (To avoid looking disinterested in a Zoom meeting, turn off video before attempting the 20-20-20 exercise (see #2, above). (For more on the 20-20-20 rule, click here: https://www.healthline.com/health/eye-health/20-20-20-rule#definition)
4. Be flexible and patient with each other and with yourself.
We’re all on a pretty steep learning curve and lots of people are juggling extra responsibilities in an environment that isn’t as conducive to learning and working as our on-campus spaces are. (Not to mention our faculty who continue with clinical responsibilities, some of the front-lines with the COVID-19 response). Meetings and classes may start a couple of minutes late; somebody will have lost a link or have an old one; sharing screens may not launch exactly how we want. And everyone has forgotten that mute/unmute button at least once so far (Again, see #2). As much as possible, take things in stride. If you’re caring for children or sharing tech, you may need to reschedule how/when you do certain tasks. Our recording and posting of all learning events (as quickly as possible) is one tool we have to help with any learners who need to “time shift”.
5. Remember working from home isn’t working 24/7.
With the line blurred between home and school/work, it can be easy to lose track of any boundaries. Make time for something besides your work/studying. I don’t mean you have to be super-productive at something like some of the memes going around—just get away from your computer and thinking about work/school at intervals. (In the first week, some nights I dreamt about zoom meetings. I woke up feeling like I’d put in overtime). Turn off your brain. Whether that’s some fluff television (insert your poison of choice here… I hear there’s something on Netflix about a tiger?), an online Zumba class, knitting, meditation, or a vicious game of Bears-versus-babies with your housemates….
What are your best tips for our new home-based curriculum? Feel free to share in the comments below.
Ensuring learners get the point: wrapping up case-based sessions effectively
We often spend a lot of time planning classes, especially case-based small group learning (SGL) sessions. We tailor our sessional learning objectives to the course objectives that have been assigned, selected solid preparatory materials, build great cases and craft meaningful questions for groups to work through.
This makes sense, as the small group learning (SGL) format used in Queen’s UGME program is modeled on Larry Michaelsen’s team-based learning (TBL) instructional strategy that uses the majority of in-class time for decision-based application assignments done in teams.
One comment we often read on course evaluation forms and hear directly from students, however, is that sometimes learners walk away from an SGL session and still aren’t sure what’s important.
Much of the focus in the literature on TBL is on the doing – setting things up, building great cases, asking good questions to foster active learning. There’s not as much written about how to finish well.
Wrapping up your SGL session should be as much a planned part of your teaching as preparing the cases themselves. If you build the time into your teaching plan, you won’t feel like you’re shouting to learners’ backs as they exit the classroom, or cut off as the next instructor arrives. Nor will you find yourself promising to post the “answers” to the cases on Elentra. Sometimes it’s not the answers that are important, but the steps students take to get there.
Wallace, Walker, Braseby and Sweet remind us that the flipped classroom we use for SGL (preparation before class, application in class) is one “where students adopt the role of cognitive apprentice to practice thinking like an expert within the field by applying their knowledge and skills to increasingly challenging problems.” One such challenge is figuring out what the key take-away points are from an SGL session. With this in mind, it’s a good idea to plan your session summary, but then have students take the lead since “the expert’s presence is crucial to intervene at the appropriate times, to resolve misconceptions, or to lead the apprentices through the confusion when they get stuck.”
So, have your own summary slide ready – related to your session objectives – but keep it in reserve. In keeping with the active-learning focus of SGL, save the last 10 minutes of class to have the groups generate the key take-away points, share them, and fill in any gaps from your own list.
Here’s a suggested format:
- Prompt the groups to generate their own study list: “Now that we’ve worked through these three cases, what are the four key take away points you have about this type of presentation?”
- Give the groups 3-4 minutes to generate their own lists
- To debrief the large group, do a round of up four or five groups each adding one item to a study list.
- Share your own list – and how it relates to the points the student raised. This is a time to fill in any gaps and clarify what level of application you’ll be using on assessments.
- If you’d like, preview an exam question (real or mock): “After these cases, and considering these take-away points, I expect that you could answer an exam question like this one.” This can make the level of application you’re expecting very concrete.
Why take the time to wrap up a session this way? Students often ask (in various ways) what the point is of a session. With clear objectives and good cases, they should also develop the skills to draw those connections themselves. This takes scaffolding from the instructor. As Maryellen Weimer, PhD, writes in Faculty Focus, “Weaning students from their dependence on teachers is a developmental process. Rather than making them do it all on their own, teachers can do some of the work, provide part of the answer, or start with one example and ask them for others. The balance of who’s doing the work gradually shifts, and that gives students a chance to figure out what the teacher is doing and why.”
If you would like assistance preparing any part of your SGL teaching, please get in touch. You can reach me at firstname.lastname@example.org
 Wallace, M. L., Walker, J. D., Braseby, A. M., & Sweet, M. S. (2014). “Now, what happens during class?” Using team-based learning to optimize the role of expertise within the flipped classroom. Journal on Excellence in College Teaching, 25(3&4), 253-273.