Author: Theresa Suart
Navigating multiple paths to service-learning projects
Anyone with their ear to the medical education ground in the past year will know that service learning is a very, very hot topic. Ever since the Committee on Accreditation of Canadian Medical Schools (CACMS) endorsed service-learning as an important (but optional) element of the education of future physicians, medical schools across the country have sought to incorporate this as a feature of their curriculum. However, service-learning, by its very nature, can leave students feeling uncomfortable: it’s structured but open-ended.
Consulting with community members to set goals and design projects is not always as straight forward as mastering the objectives of a standard medical course. Unlike other curricular and co-curricular activities, service-learning projects often start with pretty broad objectives. Add in consultation with multiple community stakeholders and the projects themselves can seem quite nebulous at the start.
We’ve written about service-learning on the blog before (here and here) as we’ve continued to develop our approach to encouraging and supporting our students in engaging in service-learning. Service-learning projects are one way our medical students (and pre-medical students, in the case of QuARMS) enhance their understanding of working with community members, explore intrinsic physician roles, and contribute in a very real way to our medical school’s social accountability to our communities.
On a national level, the Canadian Alliance for Community Service Learning (CACSL) provides support and networking opportunities for students, educators and communities engaged in these endeavors. At their recent biennial conference held in Calgary, multiple presenters addressed students’ issues with the ambiguity of service-learning projects compared to other learning activities.
When students have the autonomy to define what is happening with a project in cooperation with an organization, they can feel a little lost, one presenter, Chelsea Willness, an assistant professor at the Edwards School of Business at University of Saskatchewan, noted.
“Students are very uncomfortable with the ambiguity: ‘What do you mean, I don’t know what I’m going to be doing?’”
They want templates and checklists because that’s familiar, she added.
It’s clear that while many students are excited about the opportunity to engage with community partners, they both need and want support. Equally important is providing them with reassurances that each project will have its own path – which includes some levels of uncertainty.
Here’s the Queen’s UGME operational definition of service-learning (as there are multiple interpretations of this term):
“Service-learning is a structured learning experience that combines community service with preparation and reflection. Medical students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens and professionals.”
One key word in that definition is structured. Providing as much structure as possible can help ease students’ discomfort with some of the ambiguous nature of service-learning. To that end, the Teaching, Learning, and Integration Committee (TLIC) has been assigned oversight of service-learning for undergraduate medical students and has implemented three possible avenues students may use to have a service-learning project recorded on their MSPR.
To launch this, a one-hour session on service-learning was added to the first-year Professional Foundations course earlier this year. This learning event included information on why we’re deliberately supporting extra-curricular and co-curricular service-learning activities as well as information on potential service-learning avenues. As part of this session, members of the Class of 2019 were polled to see what types of service-learning projects they might be interested in and how these might fit in the three paths.
Here are the three paths to a recognized service learning project:
- Participate in an existing student-led volunteer initiative and complete the additional tasks necessary to extend this to a service-learning project
- Complete an individual service-learning project, which meets the requirements (including consultation and reflection)
- Take part in a service-learning pilot project brokered by the TLIC
Dr. Lindsay Davidson (Director of the TLIC) and I have met with representatives from several established student groups whose existing activities were quite close to our service-learning definition and threshold to map out ways their participants could extend their volunteer service into a service-learning project (this is always optional). Typically, this meant documenting some form of consultation and implementing some form of reflection on learning. These groups include SwimAbility (formerly Making Waves) and Jr. Medics. Other groups can be added to this list (email me: email@example.com to set up a meeting about this if your group might fit).
The two initial pilot projects are with Loving Spoonful (an organization with the goal of enhancing access to healthy food) and the Social Planning Council (with a focus on social housing in the Kingston area). These will be longer-term projects with sequential groups of students completing phases of a larger, continuing project. (The first participants have already been identified through the PF class poll. Recruitment of UGME students will be through the TLIC, not through the agencies).
For each of the three paths, students must submit evidence of meeting the threshold for each aspect, using forms provided by the TLIC. These will be made widely available in September using a MEdTech community page. Here are the requirements for any project to be recognized:
- The project must serve the needs of a group in the wider community (i.e., not medical school-focused)
- Complete some form of consultation with community participants and/or stakeholders (this will look different depending on the type of project and service)
- Complete between 15-20 hours of service (with no more than 20% devoted to training)
- Completed a required reflection on learning
In the future, as more students engage in formal service-learning projects, students’ reflections on their learning may be presented at a service-learning showcase, similar to the Undergraduate Research Showcase that is held each year.
While having three different routes to recognized projects may seem to add to the ambiguity of “what does a service-learning project look like”, providing multiple avenues for recognition was important.
“Our students have many different interests and we wanted to leverage that by providing multiple avenues for service-learning projects to be completed and recognized by the school,” Dr. Davidson said.
We’re never going to completely eliminate the ambiguous nature of service-learning projects, but we’re working to put structures in place that can meet a variety of students’ interests and community needs.
With thanks to Dr. Davidson for her contributions to writing this post.
CCME 2016: We came, we saw, we presented!
It’s been a busy four days at the Canadian Conference on Medical Education in Montreal – five or six days for those involved in business meetings and pre-conference workshops that started on Thursday.
In addition to attending sessions, plenaries and business meetings, Queen’s contributors were lead authors, co-authors, supervisors, and collaborators with colleagues from other universities. We presented posters, led workshops, and gave oral presentations.
All told, close to 80 members of the Faculty of Health Sciences – faculty, administrative staff, and students – contributed to producing 36 workshops, oral presentations and posters. While not all of these people were in Montreal, Queen’s was well represented in the conference rooms.
We invited those participants to share information on their presentations as well as any thoughts they had about the conference itself. (Keep in mind that it’s been a jam-packed weekend and we weren’t able to track everybody down.) Here’s a sampling of what went on:
Alyssa Lip and Shannon Chun (MEDS 2017) gave an oral presentation on the progress of the Wellness Month Challenge which was developed by the Queen’s Mental Health and Wellness Committee. “This year, this challenge has expanded to 12 medical schools across Canada and reached 1085 medical students,” Alyssa noted. “In addition, we found a significant increase in resiliency in students surveyed before and after participation in the initiative.”
Laura Bosco and Jane Koylianskii (MEDS 2017) presented on the “Impact of Financial Management Module on Undergraduate Medical Students’ Financial Preparedness.”
“We created a novel web-based financial management educational module with the aim to educate medical students on the expenses of medical school, as well as the various sources of available funding, and outline the necessary steps to achieve the most financial support throughout undergraduate medical education,” Laura explained. “Our primary objective aimed to compare medical students’ financial stress prior to and following the completion of this financial management educational module. This issue is important because medical students often make residency and career decisions that are influenced by their accumulated financial debt, and we feel that the process of career selection and development should revolve around students’ interests, not financial barriers.”
Brandon Maser (MEDS 2016) presented a poster on the CFMS-FMEQ National Health and Wellbeing Survey. “The Canadian Federation of Medical Students and the Fédération médicale étudiante du Québec have worked together developing and implementing a national survey on medical student health and wellbeing at all 17 Canadian medical schools,” he said. “With approximately 40% national response, we now have a wealth of data on medical student health, and will be working with faculties and medical societies in order to elucidate risk and protective factors for medical student health, and to create recommendations for the improvement of supports and resources.”
Louisa Ho and Michelle D’Alessandro (MEDS 2017) presented on the Class of 2017’s Reads for Paeds project. “Reads for Paeds is a Queen’s medical student-led initiative that seeks to develop engaging, illustrated, and age-appropriate books for children with specific medical conditions,” Louisa explained. “Our study shows that participation in a student-developed and student-led service-learning project like Reads for Paeds can enhance students’ understanding and application of CanMEDS roles, thus benefitting their overall development as medical trainees.”
Jimin Lee (MEDS 2017) was one of several students who prepared the poster presention on Jr. Medics. “We evaluated the Jr. Medics program at Queen’s medical school as a service learning project,” she said. “We found that while engaging with the community by teaching basic first aid skills to local elementary school students, medical students developed competence in the CanMEDS roles as a communicator and professional. Our findings support the development of service learning opportunities for medical students with explicit learning values for students and quantifiable outcome in the community.”
Justin Wang (MEDS 2017) shared information on “SSTEPing into Clerkship”: A Technical Skills Elective Program for Second Year Medical Students, which was prepared with coauthors Tyson Savage, Peter (Thin) Vo, Dr. Andrea Winthrop, and Dr. Steve Mann“The Surgical Skills and Technology Elective Program is a 5-day summer elective program designed for second year medical students to teach and reinforce both basic and advanced technical skills ranging from suturing to chest tube insertion,” he said. “Anxiety as well as a lack of both knowledge and confidence in the performance of technical skills has been found to inhibit medical student involvement in real clinical settings. Our research found that anxiety was significantly decreased, confidence and knowledge were significantly increased, and objective technical skills were significantly improved immediately after program completion as well as 3-months later, demonstrating retention of these effects. These results support the use of a week-long surgical skills program prior to the start of clerkship for second year medical students.”
Alessia Gallipoli (MEDS 2017) presented her poster on an “”Investigation of the Cost of the CaRMS Process for Students”, completed with Dr Acker. “It looks at the average costs that graduating medical students can expect to pay in regards to different aspects of the residency application and interview process,” she said. “The results of this study may help students make informed decisions throughout the CaRMS process, to balance career ambitions with smart financial planning. It can also inform initiatives to support students both financially and with career planning throughout their training.”
Jason Kwok (MEDS 2017) presented on a novel method of teaching direct ophthalmoscopy to medical students in the current medical curriculum, where there is decreasing emphasis and time dedicated to ophthalmology. “Our learning method, which consists of a peer competition using an online optic nerve matching program that we created here at Queen’s University, effectively increases the self-directed practice, skill, and learning of direct ophthalmoscopy in medical students,” he said. “This learning exercise has been implemented in the first year Queen’s medical curriculum for the past two years with great success.”
Vincent Wu (MEDS 2018) noted, “The CCME serves as an avenue for us to present the accomplishments of the First Patient Program, as well as some of the unintended student learning themes. This research helps to further refine student learning within the undergraduate medical curriculum, in order to better understand healthcare delivery from the patient’s perspective.”
Adam Mosa (MEDS 2018) presented his research on using patient feedback for communication skills assessment in clerkship in a project entitled Sampling Patient Experience to Assess Communication: A Systematic Literature Review of Patient Feedback in Undergraduate Medical Education. “This project highlighted a paucity of studies on how to use patient feedback, which is an untapped source of learner-specific assessment of this fundamental CanMEDS competency,” Adam said. “CCME 2016 was a great place to meet like-minded educators. In particular, my suggestion for an “unconference” was chosen, and I spent time discussing the future of patient feedback with a diverse group of enthusiastic participants.”
Amy Acker (Pediatrics) presented a workshop with two other pediatric program directors (Moyez Ladhani and Hilary Writer from McMaster and Ottawa) to help give concrete suggestions for teaching and assessing some of the challenging non-medical expert competencies. “We came up with the idea and thought it was a session we would have liked to have attended when we started as PDs,” she explained. “We took participants through a blueprinting exercise to identify what they need to teach, resources they will need to teach and how to assess, in case-based format… hopefully everyone learned something!”
Catherine Donnelly (School of Rehabilitation Therapy) was the PI on the Compassionate Collaborative Care project, which was funded by AME “The Phoenix Project”. “The aim of the project is to support the development of compassionate care,” she said. “The output of the project was an online module intended for use by health care students, clinicians, educators and administrators. The module consists of 6 chapters that can be used independently or collectively. The modules have been pilot tested and evaluated with students and health care providers. The modules are open access and can be found here.
Karen Smith (Associate Dean, Continuing Professional Development), shared information on her team’s work: “I am here with my CPD and FD colleagues. We presented at the CPD Dean’s Business meeting on how to meet CACME accreditation standards. We will be sharing some of our scholarly work with posters and a workshop exploring aspects of what makes self-directed learning effective and what CanMEDS competencies are addressed in SDL and the impact of note-taking style on memory retention and reflection,” she said. “In addition to seeking the excellent feedback from our peers to advance our own work, we are learning from our peers. Networking and building relationships with others across Canada is key to our ongoing success.”
Sita Bhella (Department of Medicine) presented a usability study on an online module she designed and created with colleagues in Toronto aimed at improving the knowledge and comfort of general internal medicine residents in managing sickle cell disease on the wards and in outpatient settings. “Presenting at CCME introduced me to new ideas and research methodologies and I hope to continue to present my work there in the future,” she said in an email. “It was an honour to present my work at CCME and to interact and engage with colleagues across the country on research in medical education.”
Kelly Howse (Family Medicine) presented both a poster and workshop. The poster explored issues of Family Medicine Resident Wellness: Current Status and Barriers to Seeking Help.
“Residency training can be a very stressful time and may precipitate or exacerbate both physical and mental health issues. Residents, however, often avoid seeking help for their own personal health concerns,” she said. “The purpose of this study was to assess the current status of resident wellness in our Queen’s family medicine program, with particular attention to identifying barriers to seeking help.”
The Seminar she presented focused on Supporting Medical Students with Career Decisions: National Recommendations for Medical Student Career Advising. “Specialty decision-making and preparation for residency matching are significant sources of stress for medical students. Through the FMEC PG Implementation Project, Queen’s led the development of national recommendations regarding the guiding principles and essential elements of Medical Student Career Advising,” she said. “This workshop helped disseminate these recommendations nationally and will help guide the exploration of relevant career advising resources.”
In addition to presenting their own work, School of Medicine faculty served as mentors for the many student presentations. Lindsay Davidson (Director, Teaching, Learning & Innovation Committee) shared “This year, I’m proudly watching some of our second year students present the poster that we collaborated on, Pre-clerkship interprofessional observerships: evaluation of a pilot project. It has been a pleasure to watch the students come up with the idea, which grew out of their own experiences as participants in a new inter-professional shadowing initiative for first year students, develop the project and reach conclusions that are helping to shape our teaching here at Queen’s. In addition to providing students with experience in conducting educational research, the partnership of students and faculty on such projects is a strength of our UGME program.”
So that’s a bit of what we’ve been up to in Montreal. Oh, and the food was great, too!
With thanks to everyone who was able to make time to send me some information, and apologies to all I’ve left out, especially given that I sent my email request on Friday when many were already in Montreal or enroute. Feel free to send me information I can add as an update (the beauty of blog over print.)
Five great reasons to attend medical education conferences
This weekend many involved in undergraduate medical education at Queen’s are heading to Montreal for the annual Canadian Conference on Medical Education (CCME). From faculty, to students, to administrative staff, we’re attending as presenters, workshop facilitators, and in several other roles.
As described on its website, CCME is the largest annual gathering of medical educators in Canada. Attendees include Canadian and international medical educators, students, other health educators, health education researchers, administrators, licensing and credentialing organizations and governments. The goal is to “share their experiences in medical education across the learning continuum (from undergraduate to postgraduate to continuing professional development).”
This year’s conference in Montreal from April 16-19 is hosted by the University of Sherbrooke (other partners are the Association of Faculties of Medicine of Canada (AFMC), the Canadian Association for Medical Education (CAME), The College of Family Physicians of Canada (CFPC), The Medical Council of Canada (MCC), and The Royal College of Physicians and Surgeons of Canada (RCPSC).)
With the theme is Accountability: From Self to Society, the program includes workshops, posters, oral presentations and plenary sessions designed “to highlight developments in medical education and to promote academic medicine by establishing an annual forum for medical educators and their many partners to meet and exchange ideas.”
Here are five good reasons we take the time from busy spring schedules to take part in this conference:
To present innovations in medical education at Queen’s: We’re doing some great things here at Queen’s and it’s great to share these successes. From early-adoption of the flipped classroom to our First Patient Program, to our Accelerated Route to Medical School – CCME gives a forum to celebrate what we’re doing well.
To learn from colleagues from other Canadian and international medical schools. While we share our innovations, it’s equally beneficial to learn from our colleagues at other schools. We don’t always have to reinvent the wheel.
To wrestle with common issues and gain comfort from being in the same boat. There’s a synergy in working together to sort out challenging issues in medical education.
To network with colleagues from across the country and around the world – this is closely related to both #2 and #3 – networking may not be about a specific challenge at a specific time, it’s making connections with like-minded individuals involved in similar circumstances.
And the food. OK, so this might not be a “good” reason to commit to attend a conference, but it’s certainly a fun part of it. Combining #4’s networking with colleagues with exploring local cuisine is an added bonus.
If you can’t attend this year, consider it for next time. Also, explore conference options closer to home. Our own Queen’s Faculty of Health Sciences Celebration of Teaching, Learning and Scholarship is coming up on June 15.
Improving existing MCQs
By Theresa Suart & Eleni Katsoulas
Writing and editing test questions is an ongoing challenge for most instructors. Creating solid multiple choice questions (MCQs) that adequately address learning objectives can be a time-consuming endeavor.
Sometimes you may have existing questions that are pretty good, but not quite where you need them to be. Similar to a house reno versus new construction, sometimes it might be worth investing the time improve what you already have. How do you know which questions need attention and how can you rework them?
Previous exams are analyzed to determine which questions work well and which don’t. This can provide some guidance about questions that can be improved.
To select questions for an MCQ renovation, you can start with checking out the statistics from last year’s exams (available from your curricular coordinator or from Eleni).
Two statistics are useful indicators for selecting individual questions for tweaking, rewriting or other fixes: Item Difficulty and Discrimination Index.
Item difficulty is a check on if questions are too easy or too hard. This statistic measures the proportion of exam takers who answered the question correctly.
Discrimination index differentiates among text takers with high and low levels of knowledge based on their overall performance on the exam. (Did people who scored well on the exam get it right? Did people who scored poorly get it right?)
These two statistics are closely intertwined: If questions are too easy or too hard (see item difficulty), they won’t provide much discrimination amongst examinees.
If questions from previous years’ tests were deemed too easy or too hard, or had a low discrimination index, they’re ripe for a rewrite. Once you have a handful of questions to rewrite, where do you start? Recall that every MCQ has three parts and any of these could be changed:
- The stem (the set-up for the question)
- The lead-in (the question or start of the sentence to be finished with the answer)
- The options (correct answer and three plausible but incorrect distractors*)
The statistics can inform what changes could be necessary to improve the questions. For one-on-one help with this, feel free to contact Eleni, however, here are some general suggestions:
Ways to change the stem:
- Can you change the clinical scenario in the stem to change the question but use the same distractors? (e.g. – a stem for a question that asks students what the most likely diagnosis is based on a patient presenting with confusion with the correct answer being dementia, can be then re-written to change the diagnosis to delirium)
- Ensure the stem includes all information needed to answer the question.
- Is there irrelevant information that needs to be removed?
Ways to change the lead-in:
- Decide if the questions is to test recall, comprehension, or application.
- Recall questions should be used sparingly for mid-terms and finals (but are the focus for RATs)
- Verbs for comprehension questions include: predict, estimate, explain, indicate, distinguish. How can these be used with an MCQ? For example: “Select the best estimate of…” or “Identify the best explanation…”
- You can use the same stem, but change the lead in (and then, of course, the answers) – so if you had a stem where you described a particular rash and asked students to arrive at the correct diagnosis, you can keep the stem, but change the lead-in to be about management (and then re-write your answers/distractors).
Ways to change one or more distractors:
- Avoid grammatical cues such as a/an or singular/plural differences
- Check that the answer and the distractors are homogeneous to each other: all should be diagnoses, tests or treatments, not a mix.
- Make the distractors a similar length to the correct answer
- Ensure the distractors are reasonably plausible, not wildly outrageous responses
- Skip “none of the above” and “all of the above” as distractors
As you dig into question rewriting, remember the Education Team is available to assist. Feel free to get in touch.
Watch for MCQ Writing 2.0 later this spring.
* Yes, there could be more than three distractors, but not at Queen’s UGME. The Student Assessment Committee (SAC) policy limits MCQs to four options.
Keeping things fresh: Routine doesn’t have to be boring
It’s February, and despite the recent Family Day holiday, we’re still stuck in the depths of winter. Things are just a little harder to get excited about when it’s bleak, cold and snowy. Add in the task of teaching something that’s become routine, and the doldrums can be nearly certain to set in.
It can be a challenge for experts to teach introductory content. This can be further exacerbated by the cycle of teaching: each year brings another round of the same—or very similar—material. When the old adage of reminding yourself that while this is the hundredth time you’ve taught this, it’s the first time for these learners just isn’t enough, how can you get excited about teaching for the 101st time?
Here are five suggestions to ramp up your enthusiasm:
- Back to basics: What do you want your learners to know or be able to do when you’re done? Sometimes when teaching becomes routine, we’ve actually lost focus on the goal. Make a quick list of your key take-away points. If you’re not sure, take some time to reflect and make revisions to your teaching plan.
- Get some feedback: Add in some formative assessment either partway through your learning event, or partway through your sessions if you are teaching multiple times. This gives you—and them—feedback partway through to make sure things are clear. Formative assessment can be individual or team-based and doesn’t necessarily have marks attached. It can be as simple as an online poll to gauge understanding of a key concept.
- Refresh the page: Since the underlying concepts haven’t changed, it’s easy to slip into a rut of repeating yourself. Even if it’s new to this group of learners, you’ll be more engaged if you freshen your cases, or revise the background materials you assign. Is there something in the news that’s timely and on-point?
- Toss in technology: It may strike you as gimmicky, but using technology can freshen “old” material. Consider incorporating PollEverywhere’s polling (which you can use for #2 above) or incorporating a short video for discussion.
- Ask for input: Bounce ideas around with colleagues, brainstorm with others teaching in your course. Ask your course director for feedback. If you’re the course director, that conversation can work both ways: ask for input from your team.
Keeping things fresh for yourself can help your learners. Your excitement and enthusiasm contributes to a climate of learning. If you’re looking for more ways to shake things up but you’d like some customized advice, get in touch with the Education Team. We’re here to help.
7th Annual QHIP Speaker Series underway
The 7th Annual Queen’s Health Interprofessionals (QHIP) Speaker Series launched last week, but there’s still time for students to register for the remaining workshops.
Each workshop takes place on Mondays from 6:30 – 8 p.m in Room 132 at the Medical Building. The series is free, but you need to register to attend. (Here’s the form: http://goo.gl/forms/xgH2k2ao2U). Those who attend at least four workshops are eligible to receive and Interprofessional Education Certificate.
While some of these topics are covered in uni-professional classrooms, this is an opportunity to address these complex issues as an interprofessional group of students.
For more information on QHIP, check out their page on Facebook: https://www.facebook.com/QHIPSociety/
Year in Review? Why wait until then?
When I worked as a journalist (about a million years ago), an annual task was writing “Year in Review” articles. These were summary or “round up” stories with the highlights of the previous year.
The stated intent was historical record, reminders and reminiscing; marking highs and lows, significant events and momentous occasions. On a more practical level, these stories could be compiled fairly easily, mostly in advance, and take up copious column inches in our weekly paper in the week between Christmas and New Year’s when nobody was reading anyway and the editorial staff wanted to take extra time off from covering newer news. Closely tied to these were “Resolutions You Should Make Now!” advice columns.
With this cultural backdrop assigning retrospection to the turn of the year, it’s easy to become cynical about such things—and reduce thoughtful review to top-ten lists and cliché-ridden commentary. For educators, however, the importance of review should not be treated so lightly. Review and reflection are important. We expect our learners to do it. Educators should give it just as much attention.
Review and reflection are integral to effective teaching practice. January is a great time for this, but so is June, or September, or some other month. Right now, for some, a semester has recently ended, for others, it’s just beginning. There are benefits to both retroactive and proactive review – and in doing it more frequently than an annual check-mark on a to-do list.
So, instead of a ‘year in review’ summary, or even a list of new year’s resolutions for medical education, here’s a sample framework for incorporating review into your teaching practice. (Use it annually, or more often, as needed).
Theresa’s Five Step Review and Revise Process
Step 1: Review & Reflect
Whether you’re considering a whole course, a few teaching sessions, or a single seminar or other learning event the process is the same. Consider:
- What happened? What worked? What didn’t? (If you’re forecasting: What could be some pitfalls? What am I worried about?)
- For anything that didn’t go well, or didn’t accomplish what I planned: How can I fix it? (Forecasting: Do I have a back-up plan? Do I need one?)
- What’s a manageable change? Do I have the knowledge, skills and ability to do this? Where can I get support and/or resources? (Forecasting: Do I have the resources I need? What kind of feedback could be helpful to me on my teaching sessions?)
Step 2: Reconsider
Once you’ve reflected on what’s happened, or what you have planned, consider:
- Did I meet my objectives (or will my plan meet my objectives)?
- Are there things I did (or I’m planning) that are just out of habit?
- What should I change to make my course/session/seminar more engaging/relevant/appropriate?
Step 3: Find Resources
When you revise your teaching plans, you may also need additional resources. This could be in the form of your own skills, materials, input from colleagues. Consider:
- What support do I need to get to where I’d like to be?
- Do I have the abilities to do what I plan? If not, how could I acquire the necessary skills?
- Are there existing materials that could help me? Do I need to develop new materials? Who could help with that?
- Who could I call on for support or assistance?
- What sort of time frame do I have?
Step 4: Refine your plan
Sometimes, what we’d like to do just isn’t in the cards this year—there can be a lot of constraints on our teaching in time, materials, scheduling. It’s important to refine revisions into things that are manageable and realistic. Sometimes you are in a position to make large-scale changes to how you deliver your learning events, other times, not. Avoid the “all-or-nothing” plan: Incremental changes are better than no changes. It’s better to be good, than to be perfect. Consider:
- How realistic is my plan?
- Are there things I consider “must haves” and things that are “nice to haves”?
- If I could only make one change in my teaching right now, what would it be?
Step 5: Reflect & Review
At the end (or the beginning) – take another look. Good teaching really is an iterative process with the cycle of review, revision, redeliver.
Sometimes the best way to review and reflect (and plan) is to talk it out with a colleague. Bouncing around ideas can bring new perspectives and inspire you and others to add to your teaching toolbox. If you’d like to chat about your teaching any time, get in touch with the Education Team.
Students compete in 7th Annual Health Care Team Challenge
Three interprofessional teams of students faced off on Monday, November 16 in the 7th Annual Queen’s Health Care Team Challenge.
The teams tackled a case developed by the Health Service Centre team at Canadian Forces Base Kingston. Each team had students from Nursing, Medicine, Occupational Therapy, Physical Therapy and Psychology.
The five-member judging panel included two local clinicians who developed the case, along with faculty, student and patient representatives.
The teams had been preparing for the competition since October 16.
The winners were “Team Three”, which included: Ahyoung Cho, Nursing; Wilson Lam, Medicine; Heather Shepherd, Occupational Therapy; Kayla Hertendy, Physical Therapy; Stephanie Gauvin, Psychology; Additional Team member: Elishea Mardling, Occupational Therapy; Back-up member: Verdah Bismah, Medicine; Faculty mentor: Lynne Harwood-Lunn, MN, RN, School of Nursing.
The two other teams were: Team One: Kyrinne Lockhart, Nursing; Alex Trajkovski, Medicine; Allie Rogers, Occupational Therapy; Heather Greene, Physical Therapy; Melissa Milanovic, Psychology; Additional Team member: Richa Kukkar, Physical Therapy; Back-up member: Shikha Kuthiala, Medicine; Faculty mentor: Brent Wolfrom, MD, School of Medicine. And Team Two: Charlotte Wilson, Nursing; Stephanie Piper, Medicine; Joshua Lee, Occupational Therapy; Erin Makins, Physical Therapy; Robyn Jackowich, Psychology; Additional Team member: Claudia Romkey, Nursing; Back-up member: Greg Smith, Physical Therapy; Faculty mentor: Heidi Cramm, PhD, OT, School of Rehabilitation Therapy.
Co-moderator Anne O’Riordan noted that all three teams’ presentations were exceptional, each presenting the case in a unique way which made for an educational evening for all. Co-moderator Ralph Yeung was a member of the very first Queen’s team in 2009.
The Health Care Team ChallengeTM is an interprofessional education event, originally developed at the University of British Columbia in the 1980s. Students volunteer to participate in order to enhance and practice their collaborative team skills. Each student interprofessional (IP) team is provided with the same case to work on for a period of three weeks, with the goal of developing a collaborative, interprofessional person-centered plan of care. A faculty mentor is matched with each team for consultation and advice.
The Queen’s Health Care Team Challenge is jointly sponsored by the Faculty of Health Sciences’ Office of Interprofessional Education and Practice (OIPEP) and the Queen’s Health Interprofessionals Student Society (QHIP).
Team Three (soon to be renamed the Queen’s Team) will compete in the National Health Care Team Challenge™ in March 2016, hosted this year by Dalhousie University.
“Major Marlene Lefebvre was instrumental in connecting the health services team at the base with OIPEP, after initial email connections made by Alice Aiken,” O’Riordan said. “It really took a ‘health care community’ to do develop, organize, and implement this event and the learning was apparent for everyone.”
Here’s the beginning of the case the teams had to address:
You are a medical officer (MO, i.e. a military physician) in the health care team in Care Delivery Unit (CDU) 2 at 33 CFH Svcs C in Kingston, Ontario. The Base Surgeon (BSurg) informed the team yesterday the she was talking to the task force surgeon in Afghanistan and that an injured female service member would be arriving at the clinic this morning for an assessment. It will be sometime mid-morning before she arrives, hot off a CC-117 Globemaster transport aircraft landing in CFB Trenton at around 0730.
You don’t know much about the case other than that she is a 25 y.o. captain logistics officer who was injured two days previously in Cyprus, where she was undergoing a decompression stop after finishing her tour in theatre in Afghanistan. You note that she is a member of the Canadian Forces Joint Operations Support Group (CFJOSG) based at Canadian Forces Base (CFB) Kingston, and you remember that members of the unit were attached to a provincial reconstruction team (PRT). She is ambulatory as far as you know…
Credit where it’s due:
It takes a lot of effort from a great many people to pull an event like this together. In addition to the teams, here are the folks who made it happen:
Health Services, Canadian Forces Base Kingston
CFB Kingston Liaison:
Major Marlene Lefebvre
Anne O’Riordan, OIPEP Clinical Educator, QHIP Advisor (OT)
Ralph Yeung, HCTC winner, 2009; IP Award of Leadership, 2013 (X-Ray Tech)
Welcoming Keynote Address:
Dr. Alice Aiken, Director, Canadian Institute for Military and Veteran Health Research, Queen’s University, Royal Military College, Kingston. (PT)
Dr. Lucie Pelland (SRT) – Faculty Representative (PT)
L.Cdr. Bradley Stewart, Clinical Rep. (Medicine)
Capt. Dwayne Rennick, Clinical Rep. (Social Work)
Amanda Shamblaw, Student Rep., QHIP Exec., Past HCTC participant (Psychology)
Dr. Peter Dunnett, Community/Patient Rep. (Economics Professor, ret., RMC)
Chloe Hudson, QHIP Executive Member, Past HCTC winner (Psych)
Presentation of Team Certificates & Team Photos:
OIPEP & QHIP
Presentation to Winning Team:
Dr. Rosemary Brander, OIPEP Director (PT)
Museum of Health Care event to highlight “Medicine in the Making”
Medical artefacts from the Museum of Health Care will be on display in the Grand corridor of the new Medical Building on Friday, September 25 from 9:30 a.m. – 2:30 p.m.
UGME Associate Dean Anthony Sanfilippo and Dr. Susan Lamb (adjunct assistant professor of history of Medicine) will be on hand over the lunch hour.
Curated by Museum of Health Care staff and QuARMS student Chantal Valiquette as part of a summer service project, “Medicine in the Making” is open to all to attend.
Get to the point with Ask-Tell-Ask feedback
By Theresa Suart & Eleni Katsoulas
Giving and receiving feedback effectively is a key part of the UGME curriculum. It’s also key in nearly every workplace, which could explain why there are so many different frameworks and recommendations for feedback “best practices”. Some of these are more effective than others.
Have you heard of the feedback sandwich? It’s one of the more popular feedback techniques and involves “sandwiching” negative or constructive feedback with two pieces of positive or complementary feedback. It’s also sometimes known as “PIP” for “praise, improve, praise”.
The idea behind this is laudable – cushion the blow of negative feedback and reassure the individual that they are doing some things well.
In practice, however, it’s fraught with difficulties, making it not very useful for the person receiving the feedback. Think about it:
- I’ve just received two pieces of praise and one of criticism or a suggestion for improvement: what should I focus on?
- The negative feedback is about something I did today, the positive things were from last week – the positive stuff must not be as important.
- Two pieces of praise and one of criticism – guess that I’m mostly doing well!
- The last thing they said was praise – must be doing great!
Writing in Harvard Business Review, Roger Schwarz also points out the fallacies of this approach. Schwarz notes leaders who use the sandwich approach to negative feedback do so for a variety of reasons. These include:
- Thinking it’s easier for people to hear and accept negative feedback when it comes with positive feedback.
- Assuming the sandwich approach provides balanced feedback
- Believing giving positive feedback with negative feedback reduces discomfort and anxiety.
Schwarz then debunks each:
- Easier: Most people on the receiving end would prefer to skip the sandwich – get to the point.
- Balanced: Saving up positive feedback to sandwich negative feedback undermines timely delivery of the positive feedback. As Schwarz points out, research shows that feedback, either positive or negative, “is best shared as soon as possible.” He also asks: “Do you also feel the need to balance your positive feedback with negative feedback?”
- Reducing anxiety: “The longer you talk without giving the negative feedback, the more uncomfortable you’re likely to become as you anticipate giving the negative news.” Meanwhile, the person on the receiving end “will sense your discomfort and become more anxious.
The UGME Education Team advocates the use of a new feedback sandwich replacing “praise, improve, praise” with Ask – Tell – Ask. This method was brought forward by Dr. Ayca Toprak and Dr. Susan Chamberlain, adapted from French, Colbert and Pien (ASE April 24, 2015)
The ATA Feedback Model is similar to the traditional feedback model as it has three parts. After that, it’s quite a bit different. Using Ask-Tell-Ask, the Preceptor asks the learner for their input, then the preceptor tells them their impressions, then wraps up by asking the learner to help develop an improvement plan:
Ask – Tell – Ask
- Ask the learner for their perceptions about strengths and challenges
- Tell them your impressions backed by observations, and specific examples
- Ask them what can be improved and how– assist you in developing a learning plan
Examples of topics to discuss (referencing objectives of the rotation, course, or activity):
- Functioning in the team context
- Skills (communication, technical, clinical)
- Clinical Reasoning
- Record keeping
- Process or Content (knowledge or the way they use the knowledge; application of knowledge).
- Background knowledge (this is knowledge of the discipline, scientific foundations, knowledge base).
The ATA model helps preceptors focus the discussion while scaffolding self-regulation and self-assessment. It also avoids the mixed-messages of the feedback sandwich approach.
The ask-tell-ask oral feedback is best paired with written narrative feedback. Watch for a blog post on this topic in September.
We used PowerPoint slides from a presentation prepared by Sheila Pinchin and Eleni Katsoulas, with slides from Cherie Jones, to prepare this blog. We thank Sheila and Cherie for their contributions.