Disorientation can be the first step to learning

Have your ever found yourself in a new course or job and wondered how the heck you got yourself into this terrible situation? It could be something you strived for actively for years and sought out for yourself. (Yes, I know that describes many medical students, but also people in new jobs, and students in other graduate programs like the one I’m in at the Faculty of Education).

Often, in a new situation – even one we’ve chosen – we can feel less competent than we did in our previous circumstances, and scramble around to figure out why something we wanted has turned out so poorly right off the bat. Generally, adult learners are used to feeling competent in their lives, work, and previous educational endeavors. New situations can rob (or mask) that previously-developed competence.

Using Taylor’s Model of the Learning Cycle can help with these feelings and ensure you stay focused on moving ahead, rather than getting stuck in the “I’ve made a terrible mistake” self-talk.

First articulated by Marilyn Taylor in 1979, then refined in 1987, this cycle explores learning from the learner’s perspective.

Taylor described the learning cycle as one of Disorientation, followed by Exploration, then Reorientation, culminating in Equilibrium – then, for lifelong learners, a new period of Disorientation as the cycle begins again. Within each of these four stages are other predictable and/or possible stages, opportunities and solutions.

Although Taylor focused on inquiry-based learning, I’ve found the model can apply to any new learning situation for adults including, as mentioned above, starting a new job or new professional role.

Here’s Taylor’s Model of the Learning Cycle in a nutshell, based on a chapter from Dorothy MacKeracher’s Making Sense of Adult Learning (2004) (Disclosure of potential for bias: I was introduced to this model by Dr. MacKeracher during my BEd studies and she was later my supervisor for my master’s degree).

Disorientation

The model begins with the learner entering a new situation, often described as a “disconfirming event or destabilizing experience” which highlights a “major discrepancy between expectations and reality”. The change can be starting a new course or program, starting a new job, new technology being introduced at work, or a change of circumstances related to aging or health.

The disorientation comes about when the new situation isn’t routine. The learner no longer feels competent or capable, which can result in a crisis in self-confidence. (The questions of “why did I sign up for this?” or “who thought I’d be good here?” are common in this phase.)

When a learner experiences confusion, anxiety and rising tension, the learner frequently withdraws from others because of feelings of inadequacy.

As MacKeracher notes: “in formal learning programs, the person most frequently blamed is the facilitator” for things such as not providing enough direction or clear instructions, or “not being helpful”.

Some people get stuck in this phase and focus on immediate – but misguided – solutions. For example, assuming the problem is lack of control, so trying to be more organized, but not really moving forward. (I’ve called this my “rearrange the chairs on the Titanic” mode. It’s not a productive place).

Exploration

The exploration phase begins when the learner “can name the central issue and make contact with others,” MacKeracher explains. “The individual becomes engaged in searching for information or ideas that could assist in resolving the identified problem.” The key here is to look for information or ideas that will make things better, not a superficial quick fix. This could involve exploring new study habits, identifying training gaps and solutions, or considering new points of view or attitudes (depending on the learning situation).

Towards the end of the exploration phase, the learner may withdraw from others somewhat to think things over, but this is not the avoidance of the disorientation phase, rather a time for thoughtful reflection and planning to make a transition.

Reorientation

The transition to the reorientation phase is characterized by “integrat[ing] ideas and experience to provide a new understanding of the issue [or circumstance]” that caused the disorientation in the first place. “The learner consciously acknowledges that learning is a process in which he or she is the agent.”

Equilibrium

As implied by its name, this phase is far more settled than the previous three, or, as MacKeracher writes: “this phase involves a much reduced emotional intensity.” Learners may consolidate, refine, and apply their new perspective and skills and share them with others in different context “or tested out as new behaviour in new settings.”

(And then back to disorientation…)

Sometimes people move through these phases instinctively, but if you’re feeling stuck – disorientated – working through Taylor’s Learning Model consciously can be helpful. Sometimes, it’s just reassuring to know “this is a phase” and you’ll come out the other side stronger, resilient, and competent in your new circumstances.

This is, admittedly, a simplified overview of Taylor’s Learning Cycle Model. Feel free to drop by my office for further discussion or to borrow my copy of MacKeracher’s Making Sense of Adult Learning.

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Celebrating teaching and learning

This week the School of Medicine joins the other schools in the Faculty of Health Science for a Teaching & Learning Celebration featuring guest speaker Dr. Nicole Harder.

Nicole Harder, RN, PhD, CHSE, CCSNE

Dr. Harder, Assistant Professor, College of Nursing, and the Mindermar Professor in Human Simulation, Rady Faculty of Health Sciences at the University of Manitoba, will present the Susman Family Lecture on October 3 at 4 p.m. at the Britton Smith Lecture Theatre (Room 132) at the School of Medicine.

Dr. Harder’s position is an interdisciplinary one which includes simulation-based education and research for the Colleges of Dentistry, Medicine, Rehabilitation Sciences, Nursing, and Pharmacy. Her current work is creating, implementing, and studying the use of a psychologically safe debriefing framework following expected and unexpected patient death in simulation and clinical experiences with health care students and practitioners.

For the Susman Family Lecture on Thursday, Dr. Harder’s topic is “Safety for all: Interprofessional simulation and non-technical competency development. 

According to the Canadian Institute for Health Information, in Canada, medical errors contribute in upwards of 23,750 deaths per year, one million added days in hospital, and approximately $750 million in extra health spending.  While various strategies and technologies have been implemented to reduce these errors, they have demonstrated inconsistent improvements or even reductions in patient safety.  In contrast, simulation-based learning has demonstrated effectiveness in improving safety competencies.  In this presentation, Dr. Nicole Harder will discuss the role of interprofessional simulation in patient safety, and argue that a significant shift is needed to ensure that students and healthcare practitioners are afforded the opportunities to engage meaningfully in interprofessional simulation activities that will allow them to grow and develop the skills required for today’s healthcare practitioners. 

Following Dr. Harder’s presentation, teaching innovators from medicine, rehabilitation, and nursing will also share presentations:

School of Medicine –  Using Wikipedia as a platform for teaching EBM, presented by Dr. Heather Murray

School of Rehabilitation –  Innovation in Teaching a Research course to a Large Class with Diverse Backgrounds, presented by Dr. Setareh Ghahari and Dr. Mohammad Auais

School of Nursing -From competence to capability in the clinical setting, presented by  Ms. Jennie McNichols

Friday morning, Dr. Harder will lead Health Sciences Education Rounds ( 8 – 9 a.m.) in Room 104, Richardson Laboratories. Her Friday presentation will exploreUsing simulation as a pedagogy: Who’s who in the (sim) zoo?” Video-streaming is available at Providence Care Hospital: PCH D2.069 Videoconference Rm A. Anyone unable to attend Education Rounds at either Richard Labs or Providence Care Hospital may listen remotely by joining this ZOOM call at the appropriate time:  https://zoom.us/j/165499888

Simulation as a teaching and learning pedagogy is not new.  What is new is the availability of technology and the changing landscape of the education learning environment.  While the term active learning activities are frequently discussed among educators as a means to bring learning to life, there is nothing more active that a simulation based experience.   From students to faculty, to researchers and administrators, we all have different roles in developing and implementing simulation.  This session will discuss the various roles that we all have in developing and implementing simulation as an active learning strategy, and provide the audience with some suggestions on how to make the most of their time with students.


Registration for each event is appreciated but not required.

Thursday: Susman Family Lecture and FHS innovators: https://healthsci.queensu.ca/faculty-staff/cpd/programs/tlc2019

Friday: Health Science Education Rounds: https://healthsci.queensu.ca/faculty-staff/cpd/programs/hsernicoleharder

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8th Annual Medical Student Research Showcase

By Drs. Heather Murray & Melanie Walker

This year the School of Medicine is proud to invite you to the 8th annual Medical Student Research Showcase on Wednesday September 18.

This event celebrates the research achievements of our undergraduate medical students, with both posters and an oral plenary session featuring research performed by students while they have been enrolled in medical school. All students who received summer studentship research funding through the School of Medicine in 2019 will be presenting their work, as well as many other research initiatives. The posters will be displayed in the David Walker atrium of the School of Medicine building from 8 am until 5 pm, with the students standing at their posters answering questions between 10:30 and noon.

The oral plenary features the top research projects selected by a panel of faculty judges, and will run in room 132A from noon until 1:30 pm on September 18, immediately following the poster session Q&A.

This year’s faculty judges included:

  • Dr. Sheela Abraham
  • Dr. Nazanin Alavi
  • Dr. Anne Ellis
  • Dr. Jennifer Flemming
  • Dr. Laura Gaudet
  • Dr. Faiza Khurshid
  • Dr. Diane Lougheed
  • Dr. David Maslove
  • Dr. Lois Mulligan
  • Dr. Chris Nicol
  • Dr. Stephen Pang
  • Dr. Michael Rauh
  • Dr. Damian Redfearn
  • Dr. Claudio Soares
  • Dr. Sonal Varma
  • Dr. Maria Velez

We are very grateful to these faculty members for evaluating our oral plenary applicants this year.

The three students who have been selected for the oral plenary session, and the titles of their research presentations and faculty supervisor names are listed below. Each of these three students will receive The Albert Clark Award for Medical Student Research Excellence.

Alison Michels – von Willebrand factor regulates deep vein thrombosis in a mouse model of diet-induced obesity

Katrina Sajewycz – Multidisciplinary Ambulatory Management of Malignant Bowel Obstruction: A Qualitative Study of Gynecologic Cancer Patients’ Experiences and Perceptions

Mehras Motamed – Inhibiting Pyruvate Kinase Muscle Isoform 2 with Shikonin Regresses Supra-coronary Aortic Banding induced Group 2 Pulmonary Hypertension

Please set aside some time to attend the Medical Student Research Showcase on September 18th. The students will appreciate your interest and support, and you will be amazed at what they have been able to achieve.

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DILs, RATs, and SGLs: a primer on team-based learning

Three-letter acronyms* figure heavily in medicine and medical education. Three of these that are intertwined in much of our pre-clerkship classroom-based learning are DIL, RAT and SGL.

QMed students engaged in an SGL application exercise.

These abbreviations are for three key learning event types that, when combined, comprise Michaelsen’s Team-Based Learning (TBL) model. This form of teaching unfolds in three steps and is designed to make best use of students’ and teachers’ time and expertise. The steps are:

Preparation:

Students receive preparatory materials either in a lecture, in a Directed Independent Learning (DIL) assignment, in a module, in previous courses, or preparatory readings. This material is typically fact/knowledge-based information.

Readiness:

Students’ understanding of this material is assessed in some way. This could be through formal Readiness Assessment Tests (RATs). These tests consist of 10-12 multiple choice questions. Each student completes an individual RAT (iRAT), then complete the same quiz in their SGL group (gRAT). The instructor then takes up any questions with which groups had difficulties. This could also be assessed via an online self-assessment quiz or some other method (e.g. completing a previous unit).

Application:

Having completed the preparation material, been assessed on their readiness, and having problem areas explained, students are ready to apply this knowledge through cases and problem solving application exercises, what we call Small Group Learning (SGL) session.

Directed Independent Learning (DIL) sessions provide content delivery, followed by Readiness Assessment Tests (RATs), culminating in Small-Group Learning (SGL) events where students engage in application exercises.

SGL sessions provide an opportunity for students to apply material they have already learned in order to extend their learning. Specifically, application exercises:

  • Help students develop understanding and apply the course material.
  • Address any misconceptions that may have developed, as students apply and integrate knowledge (Kubitz & Lightner p. 66).
  • Provide opportunities for students through practice, to transfer what they learned to application questions (Kubitz & Lightner p. 67).
  • Ensure students integrate “several different skills to answer application questions that require transfer of learning,” including accessing prior knowledge and identifying which knowledge applies and which does not (Kubitz and Lightner p. 67, citing Ambrose, Bridges, DiPietro, Lovett, & Normal, 2010).

This model means most of non-lecture classroom-based time will be students working in their small groups of seven to eight students. The instructor’s role is to design the cases, ask challenging questions and then emphasize, reinforce, highlight, and clarify key teaching points throughout the session through the case debriefs.

Case application questions balance the line between too easy and too hard:

If questions are too easy: Can’t have spirited discussion when all teams agree on answers.

If questions are too hard: Predictable frustration if groups of well-prepared students cannot arrive at the most reasonable answer because question has design flaws or requires outside knowledge

Here are eight great types of questions that can be incorporated into application exercises:

Key Phrase:

  • What is the key phrase in the case that will cause you to proceed down a particular path?

Change a variable:

  • If variable X is changed in the case, how would your approach change?

Forced choice:

  • You can only order one test from this list. Which is the best one to choose? Why?

Evaluation:

  • What is the BEST choice, given the case history? Why?
  • What’s the NEXT best choice to make?

Justification:

  • Give groups the decision, then ask them to provide a rationale for it.

Backward-looking:

  • Given a particular pathophysiological insult, have groups determine what caused it.

Prediction:

  • Given the case history and a particular course of action, what will the outcome be?

Ranking:

  • Rank tests, procedures, medications, in order of importance vis-à-vis the case history or learned protocol. Have the group explain why they decided on that order.

If you’re a faculty member looking for assistance with preparing to teaching using TBL methods, please get in touch. If you’re a student with feedback on a particular SGL session or TBL in general, please get in touch, too. Reach me at theresa.suart@queensu.ca


* As an aside, TLA is the three-letter acronym for three-letter acronyms.


References

Sweet, M. & Michaelsen L.K. (eds) (2012) Team-Based Learning in the Social Sciences and Humanities. Sterling, Virginia: Styllus Publishing LCC (and Kubitz & Lightner in this volume)

Harris, S.A. and Watson, K.J. (1-1-1997), Small Group Techniques: Selecting and Developing Activities Based on Stages of Group Development. University of Nebraska- Lincoln. digitalCommons@University of Nebraska – Lincoln Paper 378

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Five ways to get moving on your summer reading plans

I worked at my campus’ library to help pay for my first university degree. The evening hours worked well with my coursework, the commute was great (walk across the quad!), and I was surrounded by books.

This last point was both a blessing and a curse: my “to be read” list grew and grew with each shift, whether I was shelving returns or stamping the university logo on newly-acquired tomes for the collection. Each book I came across was ripe with possibilities.

We all have a TBR “pile”: either physically in the form of stacks of books or journals, or virtually as a list (written or mental). Summer can be an ideal time to catch up on “required” reading or savour something from the “just for fun” section but sometimes getting started can stall you in the stacks. Try these five steps to get down to precious reading time.

1. Cull the pile. If it’s been a while since you organized your pile, don’t be afraid to remove titles. Your needs and interests may have changed in the intervening months. And something that seemed highly relevant back in January might not be as appealing now. Also, if you start a book and find it’s not living up to its promise, ditch it. Why waste your time? I give a book 40-50 pages to impress me; otherwise, I move on. (This works for non-fiction and fiction alike).

2. Set the time. We schedule times for meetings, but reading – even to keep up with our professions – often drops to the “squeeze it in somewhere” category. Consider scheduling 30 minutes a day of dedicated reading time. Can’t manage one half-hour slot? If it’s something you plan for, you could break it into two 15-minute chunks. Stow the book in your briefcase or make sure it’s downloaded to your eReader. Experiment to see what works.

Do you have a favourite way of managing your TBR pile? Is there an app or computer program or maybe a filing system that works for you? Please share!

3. Balance topics. Are you reading for professional development or diversion – or maybe both? Make time for each. Feeding your spirit can be just as valuable as the latest journal article in your field. Or, if you’re like me, you’ll set out to read something “for fun” and find that it actually has relevance to your current course work literature review…

4. Curate excerpts. Sure, there are some books that require a start-to-finish reading strategy, but sometimes reading a single chapter can give us the information or tools we’re looking for. Some books are even designed this way. Make use of Introductions and Tables of Contents to find what’s relevant to you and just read that.

5. Turn to tech. How can tools you already use help with your TBR list? I routinely use my iPhone to read journal articles in those “gap” times — when I’m early for an appointment, waiting to catch the bus home or to pick up my son from an activity.

Next on my reading schedule:

Peripheral visions: Learning along the way by Mary Catherine Bateson (1995)

Recommendations from my recent reading (aka, my attempt to add to your TBR pile):

Invisible women: Data bias in a world designed for men by Caroline Criado Perez (2019)

Spark by Patricia Leavy (a novel that explores the challenges of designing and conducting research). (2019)

Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead by Brené Brown (2012)

What’s on your summer reading schedule?

A version of this post original appeared here in July 2014

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How to spend your summer not-vacation

There’s a different rhythm to summer at the medical school. Yes, this involves some vacation time, but it also involves getting many things done that get set aside during the university academic year.

For those involved in classroom-based teaching, the summer interval is an opportunity to review, reflect and revise teaching for the upcoming semesters. With this in mind, here’s my suggestion for tackling this task this summer:

A 4-R To-Do List for Summer 2019

1. Review

What you review will depend on your role in the UGME program. If you’re a course director, for example, re-read your course evaluation report, your own teaching evaluation report, and any notes you may have made through the year about how things went. Did the student curricular reps have any feedback for you during your course? Re-read these emails. Have a look to see if any of the MCC presentations assigned to your course may have changed (we update our list as the Council updates its presentations).

If you’re an instructor in a course, read through your notes on your learning events and your instructor evaluation report. Read through your teaching materials and your learning event pages on Elentra (our LMS, formerly called MEdTech).

Did you set aside any journal articles relevant to your field with a sticky-note saying “save for next year”? Now is the time to pull that out!

2. Reflect

Once you’ve reviewed relevant materials, think about your teaching. Did things go the way you wanted them to? Are there aspects of the past year that you’re really proud of and want to retain? Are there things that didn’t go as smoothly that you’d like to address next time? Are there things that went quite well, but you’d like to shake things up or experiment with something new? For anything that’s changed in your field, how might this impact your planning and teaching?

3. Revise

Decide what you’d like to change or address in next year’s teaching. Think about what’s manageable within the scope of your course or other responsibilities. Maybe you’ve seen some of the e-modules used in other courses and think one would fit with yours and make your teaching more effective. Maybe you’d like to enhance your existing cases to incorporate other curricular objectives assigned to your course. Maybe things are going pretty well, but you’d just like to shift things around a bit. Call me! I can help brainstorm and talk about timelines to set your plan in motion.

4. Relax

Many of us in medical education – and academia in general – have a lengthy summer to-do list that involves not only preparation for the next teaching cycle, but catching up on many other things, too. Sometimes that summer list can become overwhelming, so remember to take some time to relax and disconnect a bit from the “med ed” side of you: take some strolls along the lake, eat a popsicle or an ice cream cone. Do quintessential summer things that have nothing to do with any to-do list.

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The TRC Calls to Action require a personal response

The 94 Calls to Action from the historic Truth and Reconciliation Commission demand response and action from governments and institutions. Seven of these Calls to Action focus on Health and Healthcare issues. For those of us with the privilege to be involved in medical education, there is a particular focus on #23 and #24:

23. We call upon all levels of government to:

i. Increase the number of Aboriginal professionals working in the health-care field.

ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.

iii. Provide cultural competency training for all healthcare professionals.

24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.

Yes, an institutional response is required and is underway and has been and will be written about here and elsewhere. (In particular, look for future Education Team posts about curricular and teaching responses). But the Calls to Action also require a personal, individual response and this is, in some ways, harder.

I’ve been wrestling with my own response. Here’s some of that…

* * *

Near the shore of Lake Ontario, Kingston. (Photo T. Suart, 2018)

The Truth and Reconciliation Commission hearings exposed events long ignored in mainstream history curricula. I prided myself on being a student of history, of recognizing the foibles of historical records – the victor writes the books – and yet I found myself saying over and over again: “How did I not know this?” How was this never a part of the quaint lessons about Indians in my Grade 3 Reader, nor in the more sophisticated history books at King’s and Dal? How is it I could be so oblivious?

At the same time, I wanted to distance myself from any responsibility for these historical wrongs. For example: I’ve been at events where people introduce themselves with descriptors, such as their clan or First Nation affiliation, or, for people like me using the term “Settler”. I’ve always bristled at this. I don’t self-identify as a “Settler.” For me, “settler” implies agency, suggests choice. What choice did I have about where I was born? Extending this further, my pre-Confederation poor Acadian and Irish ancestors in rural New Brunswick likely weren’t concerned with much beyond day-to-day survival, and I’m sure were good people, so, they’re not responsible either. Right?

But I did have a choice when I moved to Kingston in 2006: when I moved to these traditional lands of a different nation. I don’t even know the historical relationship, if any, between the Wolastqiyik (the preferred name of the people I grew up knowing as Maliseet) and the Anishinaabe and Haudenosaunee. I never even thought about it vis-à-vis my discomfort with “settler”.

During his recent three-day visit to Queen’s, sponsored by the Faculty of Health Sciences, Dr. Barry Lavallee, a member of Manitoba First Nation and Métis communities, and a family physician specializing in Indigenous health and northern practice, pointed out that we can’t accept the status quo. We must consider who supports our ignorance and for what purpose. We are also responsible to recognize what phenomena support our own positions of privilege and power. And what to do with that power.

* * *

When I picked my Twitter handle in 2010, I wanted something unique – not @Theresa487 or something like that – and, wistfully, I wanted something that reminded me of home. I opted for the “original” Indigenous name of my New Brunswick hometown (the colonial-corrupted spelling, I later learned, but home nonetheless). So I became @Welamooktook. It reminded me of the place, the land, where I had roots, and family, and history.

But those same reasons I picked it became reasons to let it go. My original feelings and sentiments were sound, but I couldn’t escape the cultural appropriation, the feeling of wrongness it came to mean, as I reflected and wrestled with it.

* * *

A year ago, as part of an Education course I was taking, my classmates and I were encouraged to go to an exhibition of Kent Monkman’s artwork at the Agnes Etherington Art Gallery, Shame and Prejudice: A Story of Resilience.

The entire installation was thought-provoking, emotional, and disturbing. One painting, in particular, haunted me: The Scream (2017). As I stood looking at this large painting depicting “the exact moment Indigenous children were taken from their parents”, I focused on three young people in the background, at the right, running away. Running away from the red-serge Mounties I had grown up looking up to. The trio running in the back are dressed in jeans and hoodies and look like teenagers I would see anywhere in Kingston.

They looked like my son.

This made it real for me. Made it close enough to touch. Close enough to imagine.

My son has a hoodie like that.

* * *

The TRC demands a response but that response is not guilt – or denial. It’s self-reflection. And compassion. And empathy. And action.

It’s relinquishing a cherished Twitter handle because it’s the right thing to do.

It’s stumbling through a territory acknowledgement because I’m still getting my Maritime tongue around Anishinaabe and Haudenosaunee when Wolastqiyik is easier. And trying to go beyond the scripted suggestion to address relationships, and thoughts about land and people.

It’s accepting the self-descriptor “descendant of settlers” because that’s accurate and real and it matters.

It’s working with my physician colleagues to ensure sound curricular and clinical experiences that, as Dr. Lavelle described, gives our students “the ability to treat the person in front of them based on their experiences without judgment.”

It’s wrestling with getting all of these meandering ideas and feelings into words to share in this blog, because we all need to be part of this conversation — all the while worrying it’s arrogant or insulting or inadequate.

In his workshop, Dr. Lavallee urged us to use reflection to address our response to new information. And he challenged us: “When you feel the discomfort, move into it, because that’s where the learning occurs.” 

We tell our students to ask questions and then listen: Patients have the information and will share it. I learned the same in my previous career as a journalist. Ask questions, but most importantly listen to the answers. Even when the answer is uncomfortable, is difficult, is challenging. That’s the personal response.

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The stories we tell…

I’ve been thinking a lot about stories lately.

It’s partly because of an independent study I’m completing at the Queen’s Faculty of Education on narrative inquiry. It’s partly because I’m increasingly conscious of several aging family members whose stories I want to record—and of other members whose stories have been lost. It’s partly because I’ve watched some excellent biographical documentaries on Netflix recently. It’s also partly because I just love good stories.

As an educator, I embrace stories and that’s easy to do since we’re surrounded by stories: The stories we tell. The stories we hear. The stories we learn—and learn from.

We all have stories we’ve seem to have known forever that we know we will share and pass along. This is because stories are personal, usually relatable, and “knowable”—it’s a way to memorize without strict rote memory.

We tell stories to impart lessons, to entertain, to remember. And sometimes all three.

Like the story I tell of leaving a political science essay to the last minute when I was in my second year at the University of King’s College. The one I stayed up until 3 a.m. writing, then got up at 5 a.m. to type it (on my electric typewriter, no personal computers in those days). It was on the Cuban Missile Crisis. Except in my sleep-deprived state, I didn’t type it that way. Instead, I wrote of the Cuban Missal Crisis.

And my professor circled “missal” every single time it appeared through the paper. (Which was a lot). I respected this man profoundly and his was my favourite course. I was mortified when he returned the papers and I saw all the  circles (every single time). Still, he gifted me with a B+ (which was rare for him), so the content, if not the spelling, was fairly sound.

Why do I tell this story? (1) It’s kind of funny. (What would a Cuban missal crisis look like? Too many prayer books? Too few? Typos within them?) (2) It cautions against procrastination. (Which is why I shared it with my daughter when she started university and use it to remind myself, constantly). And (3) it advocates good proofreading – which we should all do, all the time. Plus, it’s relatable to many who have “pulled an all-nighter” who nod and smile through the telling (or reading) of this anecdote.

Medicine, and medical education, relies heavily on stories. Every medical encounter I’ve had as a patient has started with my story – what brought me there. Taking patient histories is one of the first clinical skills our students undertake.

What are case studies if not stories? Some are bare bones, some rich and colourful in detail. Like patients. Like people. We can’t see (or read) all, but we can see (read) enough. Stories are entrées into another person’s life, their point of view, the path they are on.

What goes into a good story? There’s characters, and place, and time, and plot – something has to happen. And woven into this, deliberately or incidentally, is meaning.

Stories can be loud “A-HA!” moments, or a gentle unfolding. They can be meandering streams-of-consciousness (perhaps a bit like this blog post), or a clear, linear narrative. Or something in between.

The best stories are conversations. What are the stories you tell? What stories will be told about you? As a student, as a teacher, as a person?

Do you have a story you want to tell related to medical education? Drop me a line at theresa.suart@queensu.ca – it may fit here in our Guest Blogger posts.

What stories do you want to tell?

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Patients are key to our students’ learning

Students have been part of my health care journey long before I became an educational developer at Queen’s School of Medicine.

When my daughter was born in 1995 in Fredericton, NB, I had not one but two nursing students from the University of New Brunswick assigned to me. For each of them, I was their first ever patient. I was also their only assigned patient. As a first-time mom, this was both gratifying (they pretty much catered to my every need from running baths to making me snacks) and faintly terrifying (like when they, under their preceptor’s watchful eye, demonstrated to me how to give my newborn a sponge bath) and slightly uncomfortable (post-partum abdominal palpations aren’t fun at the best of times, let alone by a learner who isn’t quite sure what they’re looking for).

My mantra at the time was: “They have to learn somewhere – why not with me?”

And it’s true – there’s only so much to be learned in a classroom, a mock clinic, or simulation lab. Ultimately, our medical students consolidate all that learning during their two-year clerkship period where they engage with real patients, in real hospitals and real clinics, supervised by staff and resident physicians.

In my role as an educational developer, this is a part of their education that I don’t typically see first-hand. I’m generally classroom-based in the coaching I provide to faculty, and it’s hard to be an unobtrusive fly-on-the-wall observer of patient encounters when you aren’t a member of the healthcare team.

As a patient (and parent of a patient, and partner of a patient), however, I’ve had several opportunities to see our clinical clerks in action first hand.

I’ve watched a senior clerk valiantly (and ultimately successfully) conduct a physical exam on my pleasant-but-non-cooperative then-nine-year-old son.

I saw another clerk—working on a rotation with anesthesia—get a reluctant laugh out of my grumpy (from fasting) and nervous (because, well, surgery) husband during the pre-op airway examination and checklist.

Most recently, one of our clerks independently led off an appointment I had at my family physician’s office. I’ve hit a milestone birthday (full disclosure: 50) that can trigger a number of screening tests and things. The clerk was well-prepared, asked me good questions, and had good information. It was clear to me that they had at least scanned my file before coming into the room and had done their homework on the types of screening tests that might be relevant to me.

Along the way, I’ve also seen some of the various ways the clinical clerkship preceptors supervise and monitor our students’ learning.

For the clerk who examined my son: after a consultation outside the exam room, the clerk and physician came in together for the rest of the appointment. There was a Q&A amongst all of us which included gentle coaching and good feedback for the clerk.

Prior to my husband’s surgery, after the clerk’s exam, the anesthesiologist followed up with their own exam and pointed out a couple of things to the clerk – who then had another look down my husband’s throat which they and the physician then discussed.

For my encounter, I know my clinic has video monitoring (as there are signs posted in the examination rooms) and the clerk themselves noted they were going out to consult with the physician.

These are all different ways that clinic-based teaching and learning takes place. And that’s due in large part to patients who willingly engage in these encounters. As part of the UGME team, I feel a certain obligation and responsibility for their education and training.  Most other patients don’t have this same motivation and it’s their generosity that makes this learning possible.

Through not only their classroom based studies, but especially their clinical skills training over two years, their simulation lab work, and our First Patient Project, our students are ready to engage with patients and be part of the healthcare team in their clerkship years. A sincere thank you to patients in Kingston and at our regional sites who engage with them as they learn.

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Lectures aren’t inherently bad

In a pedagogical quest for active learning, we’ve somehow cast lectures in the role of arch-villain.

I’ve had conversations with faculty about their teaching which have started out with: “I know lectures are bad, but…”

This is definitely the case of a pendulum swinging too far. While research definitely supports active learning as the optimal way for students to retain learning – applying new knowledge either to simulated or real scenarios – the initial learning has to come from somewhere, and lectures are one of these sources.

Because of our focus on improving small group learning/TBL sessions in our curriculum, I can seem to be anti-lecture. The truth is, I’m actually a closet lecture aficionado. I own DVDs and CDs from The Teaching Company’s “Great Courses” series and love CBC’s Ideas. And the proliferation of podcasts has fed my love of lectures even more, as podcasts are nothing if not fabulous lectures. And TED Talks, who hasn’t lost a few minutes to those? Really, the world loves a good lecture.

Lectures absolutely have a place in universities in general and in medical education specifically. While we can’t – and don’t want to – return to a curriculum with 100% (or near to it) lectures, we can keep great lectures in our menu of methodologies to provide students with optimal learning experiences.

If you’re planning a lecture, or looking to improve an existing one, here are some things to consider:

Why do you want to do a lecture?

It’s ok if it’s just your first instinct, but think beyond that. Is this the best way to convey your content? How will providing this content in a lecture format enhance students’ learning?

Are you comfortable with the mechanics?

Lecturing is a skill which improves with practice. There are certainly standard “do’s” and don’ts”. For example, Don’t read your own slides; don’t keep your nose down in notes. And the classic: Don’t be boring. If you aren’t comfortable, do you have a plan to improve?

How can you keep things fresh and interesting for an hour or more?

Research on attention habits tell us that after 20 minutes of sustained listening, it’s hard to stay focused. With this in mind, how can you pace you lecture to break things up? Consider things like polls (with our PollEverywhere account), short think-pair-share activities, or other creative ideas. At least one instructor I know shows short topic-related videos and has the class stand up to watch them to get everyone out of their standard sitting positions.

What’s your follow-up plan?

If you think of lectures as content delivery, what’s your plan for students to be able to apply this new knowledge? Does your lecture lead into an application session in your own course or in another one? If you’re not the instructor for the follow-up session, be sure to coordinate with the person who is.

As with all your teaching endeavours, you’re not on your own. Get in touch – I’m here to help!

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