All About Learners
I’d like to devote this blog article to our students and learners in our program. They’ve been on my mind a lot lately for different reasons.
For example, Matthew Church, Meds 2015 was recently a Jeopardy star, http://meds.queensu.ca/announcements?id=648, Karen Chung Meds 2016 is a volunteer star http://www.thewhig.com/2013/11/22/a-special-birthday-meal, and Sophie Palmer, Meds 2017, is a writing star. (Her winning entry for the Dalhousie Department of Psychiatry Annual Student Writing Contest, entitled EtOH, will be posted soon at: http://www.medicine.dal.ca/departments/department-sites/psychiatry/education/medical-humanities/writing-competition.html.
Other stars in the firmament are Eric Blanchard, Meds 2015 who is playing in the OUA singles badminton championships on March 7 and Eve Purdy, Meds 2015, who was selected as the inaugural recipient of the Samuel Wigdor Scholarship for pre-clerkship scholarly excellence and plans to attend the Social Media and Critical Care Conference (SMACC) in Queensland, AU from Mar. 15 – 23, 2014 .
And those are just five of hundreds of stars in our program—students who by their volunteer work, their work in student leadership, their work in interest groups, their application to their research, and their focus on their studies are shining, however subtly and quietly.
It’s a pleasure to work with our students and to help faculty learn more about learners, and so I thought I’d write about a few things that have cropped up recently to do with learners.
I’d like to visit some learning theories that we actually use (and can always use more) in our curriculum: Experiential Learning, Learning Retention, and Learning Styles. You can dip into these as you like.
Experiential Learning: What is it? How can it help teachers and learners? How can teachers be involved?
We had a challenge a few years ago, posed by our accreditation review team, and echoed by other pedagogical concerns. Why are the first two years of medical school so lecture heavy, with little experiential learning and the remaining two years are heavy on experiential learning with little traditional but active classroom learning?
What is it?
Experiential learning involves concepts of internship, making discoveries firsthand, learning through observation and interaction, learning by doing, and shadowing as components of the learning. Formally, Experiential Learning Theory (ELT) seeks to pass on the legacy of those twentieth century scholars – notably William James, John Dewey, Kurt Lewin, Jean Piaget, Lev Vygotsky, Carl Jung, Paulo Freire, Carl Rogers, and others – who placed experience at the center of the learning process, envisioning an educational system that was learner centered. ELT is a dynamic view of learning based on a learning cycle driven by the resolution of the dual dialectics of action/reflection and experience/abstraction. (Kolb & Kolb, 2012, 149)
I was influenced by David Kolb’s Experiential Learning Model (Kolb, 1984) years ago, and Meds students may recognize it translated into our sessions on reflection and critical analysis. Kolb defined experiential learning as “the process whereby knowledge is created through the transformation of experience. Knowledge results from the combinations of grasping and transforming experience.” (Kolb 1984, p. 41). His model involves a cycle of concrete experience that looks like this:
Experiential learning involves skills as well as motivation:
- The learner must be motivated to be actively involved in the experience;
- The learner must reflect on the experience;
- The learner must employ analytical skills to conceptualize the experience; and
- The learner must activate decision making and problem solving skills to apply new ideas gained from the experience.
First Patient Program: Our way of bringing experiential learning into the curriculum:
One way to bring experiential learning into the first two years of our program was our First Patient Program, proposed by Associate Dean, Dr. Tony Sanfilippo. This program, where students are paired with a patient from the community who becomes their teacher, has so many benefits. Dr. Sanfilippo literally carries around reports from the students to show people what they are learning that they could not learn so early in a classroom. Here’s an excerpt from a new one I know he will want to carry around from a second year student:
I think the biggest change in thinking for me was a better understanding that care for patients doesn’t end when they walk out the door, not matter what specialty they’re in..
This program has highlighted the strengths and weaknesses of our health care system for me. One the one hand, I have gotten a better understanding of the ways health care professionals of all fields can cooperate in the care of a single patient. On the other hand, I’ve also seen how that communication can break down and how difficult it is for a patient to advocate for themselves in a medical system that is very complex.
I’ve realized that advocacy doesn’t have to be all grand gestures and tidal waves of change; even small things can make a big difference in the lives of your patients.
My overarching goal is to learn enough about the health care system to be able to help patients navigate it…One other goal for me is to have a better idea of the scope of practice of allied health care professionals…
Now you can be sure that the student has written extensively on all these points–I’m just giving you a taste…but you can image what she has learned!
How can faculty become involved? Our learners need patient volunteers from the community, so if you can recommend a patient, please contact Kathy Bowes, so the students can continue to have these insights. (firstname.lastname@example.org)
How do learners retain learning?
Meds student Rebecca Wang asked me recently to answer some questions for writers from the Queen’s Medical Review (http://qmr.qmed.ca/) about ways to enhance student retention of learning. Here are some recommendations I had from educational and psychology literature:
Here are my top 4 tips for students to retain and retrieve knowledge:
- First is paying attention in class and that means no Facebook, games, etc. Multi-tasking is not what it is cracked up to be according to the literature—and we tend to delude ourselves about what we accomplish (Ellis& Jauregui, 2010). While I’m mentioning classes, I should mention pay attention to the learning objectives…either in MEdTech or on the slides—they will give you the outline of required knowledge which will help you study.
- Secondly, and there is some cool data to support this, take notes. If a faculty member provides all the notes, and you “listen” only, you’re not embedding it into your memory well. A great study on partial notes suggests that students who take notes not only do better on the assessment, but also do better on the higher order skills tested. (Cornelius and Owen-DeSchryver, 2008).
- Thirdly, review—and review through questioning. Review on a weekly or “spaced” schedule and incorporate answering mock questions into your review. I know many of you are in study groups. If everyone built 1-2 questions after a session and “tested” your study partners and gave feedback about the answers, you’d be helping your retention and that of others. Don’t forget to try short answer questions as well as MCQ.
- My biggest tip is to manipulate what you’ve learned. My recommendation of this is to shape information into a graphic organizer. You may recall Dr. Lee’s algorithm for hematapoeisis or some of the schemas for approaching a clinical presentation. This is taking information and putting it into a systematic graphic figure or organizer. Anything from a table or “T chart” which compares data, to an algorithm, or a “fishbone” chart (shows cause and effect) to a diagnostic schema or flowchart which you can fill in with what you’ve learned, or a “concept” map which show relationships, will help you retain and understand.
I’d like to say something about concept maps—I used them all the time in education and I don’t know why they’re not more popular in medicine– Complex concepts can be related to one another in numerous ways, and depicting correct relationships among concepts is central to all graphic organizing techniques (Halpern and Hakel, 2010). If some of you try this and find it helps, I’d love to hear about it!
Interested in reading about this? Here are three articles I recommended to the students:
Dunlosky, J. et al. (2013). Improving Students’ Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychological Science in the Public Interest. Association for Psychological Science.
Halpern, D. F. & Hakel, M.D. (2010). Applying the Science of Learning to the University and Beyond: Teaching for Long-Term Retention and Transfer. Change: The Magazine of Higher Learning
Bjork, R.A. et al. (2013). Self-Regulated Learning: Beliefs, Techniques, and Illusions. Annu. Rev. Psychol.
And here’s something about graphic organizers:
Hall, T., & Strangman, N. (2002). Graphic organizers. Wakefield, MA: National Center on Accessing the General Curriculum. Retrieved Feb. 2, 2014 from http://aim.cast.org/learn/historyarchive/backgroundpapers/graphic_organizers#.UvBGgfuwUR8
The Graphic Organizer: http://www.graphic.org/index.html, retrieved Feb. 2, 2014.
How can teachers help students retain their learning?
Here are some suggestions that I’d like to invite you to consider for your teaching:
1. Make your learning objectives apparent and specific (They should be one of the first slides in a slide deck and also on the learning event page.) By the end of your session, what will students know, do, experience?
2. At the end of a session, or at the end of a concept, give students a chance to formulate questions (short answer as well as MCQ) that they can use to quiz themselves and each other. Share these among the groups, and within the class.
3. Become part of a spiral throughout a course and throughout a curriculum. So, refer back to relevant pieces of the course, or other courses. Refer forward to relevant pieces of the course, and other courses. Use links to other events in our Learning Management System, MEdTech to make the spiral approach explicit. In other words, situate the learner, and help them see relationships among the concepts.
4. Use graphic organizers. It helps students to situate material, and it helps them organize what can be a huge sea of learning. It gives them a “life raft.” OR give students a blank organizer and challenge them to fill it in through the class.
5. Not all learning can be retrieved through multiple choice questions. Sometimes a short answer question that requires students to think, evaluate, and put pieces together is a better test of learning.
Learning Styles: What are they? How can they help learners and teachers?
And speaking of learners, recently too, Meds 2015 student Eve Purdy wrote to me asking about learning styles. She’s bumped into them on elective. It’s a controversial topic in educational literature, because on the one hand, it’s so attractively intuitive and lends itself to so many ah-ha moments, but on the other, there are criticisms of learning style theory’s evidence base, its focus on matching teaching to learning styles, and the profit that is being made from many different companies that espouse learning style questionnaires, etc.
I don’t want to get into that debate here. Pashler does it for us, in Pashler, H., McDaniel, M., Rohrer, D.;, Bjork, R. (2008). Learning styles: Concepts and evidence. Psychological Science in the Public Interest 9: 105–119.
What I would like to speak to you about is how you can use literature around learning styles.
Learning styles theories are all very intuitive and make people very excited. I personally find the Kolb inventory based his experiential learning cycle, useful and probably the most evidence based. Here’s a nice summary
http://www.simplypsychology.org/learning-kolb.html and here’s a visual where the learning preferences are mapped to the cycle from above.
Visual Auditory Reading/Writing Kinesthetic (VARK) is another the other popular learning styles model: http://www.vark-learn.com/english/index.asp. Gardner wrote about multiple intelligences as well. And there are other theories.
This article summarizes some them and provides the counter argument. http://chronicle.com/article/Matching-Teaching-Style-to/49497/ It has a chart that summarizes 4 main theories.
Educators have been told there is a problem with the evidence behind these theories. Critics argue that there are almost no randomized control trials to support them except for Kolb’s original research. Other criticisms are that accomplished learners switch styles/preferences due to needs and contexts, that money is being made from these theories as learning style questionnaires proliferate, to name a few.
But what teachers find helpful is that thinking about learning styles alerts them to the concept that learners tend to approach material in different ways, or enjoy/prefer learning in different ways. Therefore it is practical to include a variety of modes of learning to appeal to different learning preferences. Learners approach learning in different ways depending on context, habit and training and most importantly topic. So focusing on the best way to teach a specific skill, concept, etc. is a good use of teacher planning time.
So what do I use learning theory for? I look at is my own style as a teacher and determine if that is serving all students well. (I’m an R in VARK, and Accommodating:) I think it’s safe to say that I need to fine-tune my teaching and add other styles, because I do rely on my own “style” a great deal.
I consider that some topics lend themselves more to kinesthetic learning for example. So I don’t try to lecture too much about skills–I get everyone to practise the skill. I also try to ensure that I balance my different modes of teaching so that I’m not always engaged in one mode. Finally, when students are having trouble understanding, I know that I can switch to another mode or style to give them assistance. And knowing that we all learn differently at different times is in itself very helpful.
And meanwhile, asking students to take learning style inventories helps them become more “metacognitive”, more aware of their own learning, which is a key piece in developing active and self-regulated learners.
We’re at the end!
It (still) Takes a Village
How we do what we do.
One of the greatest challenges we face in the accreditation process is convincing the outside world that we’re actually doing what we claim to be doing. Accrediting councils and review teams, themselves made up of medical school Deans and Associate Deans, are well aware of the needs and challenges involved in recruiting committed and capable faculty leaders. They recognize that our needs in this regard are no less than that of much larger schools, and have trouble reconciling that reality with the number of core academic faculty.
With that in mind, it’s useful to periodically review our governance structure and recognize those who provide key leadership in all the various domains required of a fully functioning medical school.
I last did this about a year ago. At that time, I provided an article on this site describing the various positions and people who are so integral to the growth and ongoing quality of our MD program. The past year has brought changes to our MD Program leadership structure, both in terms of its organization and faculty assignments. In fact we’ve carried a rather extensive review of our governance structures and key responsibilities, recently reviewed and approved by School of Medicine Council. It seems an appropriate time to review both and update all our faculty and students.
In terms of overall organization, we have developed a number of key leadership positions, termed Directorships. Each of these carry responsibility for a discrete component essential to the overall mission of the program. The general responsibilities are described below.
In many cases, Directorships have evolved from positions that existed previously, but in different forms. Many were previously described simply as committee chairs. It’s become clear over the years that the scope of responsibility and need for ongoing oversight has gone far beyond simply chairing a monthly meeting. The Director designation is a more appropriate recognition of the effort, expertise and scope of responsibility required. So, with that introduction, we’ll review these positions.
Director, Undergraduate Admissions
The complexity of our admissions process has increased dramatically over the past several years. In addition to the 4300-plus applications to our MD Program, the Admissions Committee now has additional responsibility for admissions to our MD-PhD, QuARMS and International programs. Each brings its unique challenges, and continuing scrutiny to ensure they reflect appropriate values and fairness to all applicants. Hugh MacDonald has chaired our Admissions Committee for several years through these transitions, and I’m most grateful that he will be continuing in the Directorship role.
The oversight and guidance of our accreditation related efforts is a continuous responsibility, that will be escalating as we move toward our full survey in March of 2015. In addition to guiding our local processes, that individual serves as our representative at national and international accreditation committees. John Drover has been capably filling that role for the past 3 years and will be continuing to do so.
Director, Student Assessment
Michelle Gibson has recently assumed this role, previously carried out capably by Sue Chamberlain. This Director is responsible for establishing policies, processes and oversight of all assessment activities within our program. Having recently completed her Masters in Education, Michelle brings considerable expertise and practical experience to this role.
Director, Teaching, Learning and Innovation
Perhaps the biggest change (and challenge) undertaken by our faculty over the past few years has been the introduction of new and innovative teaching methodologies. Our Director of Teaching, Learning and Innovation (and committee) are responsible for developing policy, processes and oversight that will guide the introduction and delivery of teaching methods. We have also charged that group with developing methods to assist faculty in realizing scholarship opportunities as they provide their teaching. Lindsay Davidson will bring a wealth of knowledge, experience and innovative energy to that position.
Director, Course and Faculty Review
Over the past few years, we have developed a comprehensive process for continuing review of all our curricular courses. We are in the process of expanding that process to provide more targeted and relevant feedback to all teaching faculty. Andrea Winthrop has been integral to this process and will be continuing as Director.
Director, Student Affairs
One of the key changes involved in this governance renewal has been to develop a position that would provide oversight and coordination to our Student Wellness/Counseling, Career Counseling and Academic Counseling portfolios. I’m very pleased that Renee Fitzpatrick has taken on this challenge and is already developing proposals to augment our Learner Wellness program.
Director, Student Progress, Promotion and Remediation
This complex and critical portfolio requires a combination of astute administrative skill and sensitivity to the needs many needs of students who struggle with various challenges. Richard VanWylick has been chairing our P&P Committee with great skill for several years, and will be taking on this Directorship, which better recognizes the expertise and effort required.
In addition to these largely administrative roles, a number of Directorships are required to provide programmatic leadership;
Director, Year 1
The first year of our program introduces our students to a wide variety of material including Basic Science, introductory clinical medicine, Clinical and Communication Skills, Professional Competencies and Facilitated Small Group Learning. It is also a time of considerable personal and professional growth for our students, during which they evolve their learning and interpersonal skills. Michelle Gibson has been guiding Year 1 through our curricular transition process and, I’m pleased to say, will be continuing in this role.
Director, Year 2
In second year, our students undertake more intensive learning within clinical medicine. They are expected to not simply learn facts about various conditions, but to integrate that knowledge into cogent approaches to patient problems. To do so, they undertake more small group approaches, more challenging FSGL cases, advanced Clinical and Communication Skills program, and integrated Professional Competencies. Heather Murray, who has been active in the development of Scholarship in the curriculum, and its integration into Clinical Presentation courses, is very well suited to this role, and will be taking over from Lindsay Davidson who has been guiding Year 2 through our transition.
Director, Clinical and Communication Skills
This program, which runs through the first two years of our curriculum, is key to the development of our students as physicians. It has benefitted over the years from the leadership of Sue Moffatt and Henry Averns. The role requires a high level organizational and educational expertise. I’m very pleased that Cherie Jones took on this role last year and has already brought considerable innovation to the both educational and assessment components. Cherie would wish me to mention that components of the program are ably coordinated by a team of dedicated Course Directors, including Basia Farnell, Hoshi Abdollah, Laura Milne and Lindsey Patterson.
Director, Clerkship Curriculum
One of the major benefits of our curricular reform was to expand the clinical clerkship in a manner that would allow for the provision of three blocks within the clerkship dedicated to formal education on a variety of advanced clinical and professional topics. Susan Moffatt has developed and coordinated the curriculum for those blocks, with capable assistance from Armita Rahmani and Chris Parker. Sue’s dedication and extensive educational knowledge are evident in the quality of those blocks.
Director, Clerkship Rotations
Our clerkship consists largely of a series of clinical placements in the major clinical disciplines. Although largely in Kingston, clerkship rotation options have been expanded dramatically over the past several years, to both expand our teaching capacity, and provide students experience in various contexts and systems. These include our Integrated Community Clerkships (in Perth, Picton, Brockville and Prescott), as well as rotations in Belleville, Oshawa, Markham and even Brisbane, Australia. In addition, our students undertake about 18 weeks of Electives during the clerkship, intended to allow for career exploration and self-directed learning. The coordination of these all these options requires a high level of organizational skill, sensitivity to student needs and attention to detail. Andrea Winthrop has been very effectively coordinating and expanding this program since her return to Queen’s a few years ago.
Co-Director, QuARMS Program
Jennifer MacKenzie has developed and directed a de novo pre-medical curriculum for our QuARMS program which is highly creative, delivering competency based learning in a variety of creative teaching formats. This program, and Jennifer’s continued oversight, will be key to the success of this exciting new initiative.
Chair, Professional Competencies Committee
Ruth Wilson has generously taken on the considerable challenge of chairing our Professional Foundations Committee and coordinating the efforts of our Competency Leads. Her steady leadership has guided and promoted the development and integration of those essential components of our curriculum.
In addition to these positions, our program relies on the contributions of about 40 Course Directors, Competency Leads and Discipline Coordinators. These key people are listed in our MD Program Directory, which can be accessed here.
So how does all this fit together? Most Directors work with committees that are charged with the various areas of responsibility, as well as the accreditation standards that relate. Our MD Program Executive Committee brings together all the committees and Directors to provide integrated program governance. The graph below illustrates these relationships and reporting structures.
In developing these positions, committees and organizational relationships, the underlying principle has been that “form follow function”. Each one, with it’s associated responsibilities and inter-relationships, arises from a need based on the mission of our school – to prepare our students for success in postgraduate training and in their ongoing careers as highly successful and effective physicians. In doing so, we’re guided by our need to meet and exceed all medical school accreditation standards.
Achieving this, as well as all the other varied tasks required to operate our medical school requires tremendous dedication and commitment on the part of our faculty, which has never been lacking. Three examples:
- A need arose last Fall for people to chair our Accreditation Self-Study Sub-committees. Those who came forward to provide fill these valuable roles are among the busiest people in our school: Leslie Flynn (Vice-Dean, Education), Iain Young (Vice-Dean, Academic Affairs), Stephen Archer (Head, Department of Medicine), Michael Adams (Head, Biomedical and Molecular Sciences), and Karen Smith (Associate Dean, Continuing Professional Development).
- This term we are offering a re-vamped Term 4 Clinical Skills curriculum that provides full patient encounters with groups of two students observed and tutored by a two faculty members. This has been creatively developed by Course Directors Hoshiar Abdollah and Laura Milne, and involves no less than 50 faculty members, 37 of whom are members of the Department of Medicine. We have had full support of the Departments and their leadership in this initiative.
- Our Admissions committee and administrative support personnel process increasing number of applications each year, and have developed increasingly complex methodologies to review those applications. The committee itself, document reviews, MMIs and panel interviews require the active participation of about 160 faculty members, who give of their free time to assist in ensuring all applications are reviewed thoughtfully and fairly. They work side by side with members of our first and second year classes, almost all of whom contribute to the process in various ways.
What’s the motivation of all these people: building a better school – their school – in which they are valued members, and in which they take pride.
A village indeed, and an impressive expression of our collective dedication to the education of our students.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Welcome in the new year with some great features from MEdTech
Happy New Year! Our indispensable Special Curriculum Assistant, Alice Rush-Rhodes has put together 3 items in MEdTech Central that will save you time, and help you in your teaching.
Included are links to more detailed instructions. If you have any questions please comment below.
This information is excerpted from the MEdTech Features page of the Faculty Resources community found here. Additional FAQ and information is available on the linked page.
What do I have to complete on a learning event page?
You need to identify what you will be teaching including MCC presentations and curricular objectives. A guide to completing a learning event page can be accessed on that page.
Why do I need to know this? Every faculty member is responsible for completing their own learning event page. Most importantly, you can tailor your session to the curricular objectives for the course. You can ask for help from your curricular coordinator or from Alice or Sheila.
How can I search for learning events on a certain topic or MCC presentation?
You can use the Curriculum Search tool or the Curriculum Explorer tool (both located under the Curriculum tab). Curriculum Search lets you search by keyword and Curriculum Explorer lets you search by MCC presentation or curricular objective. A video about using this function can be found here (look for the Curriculum Explorer video towards the bottom of the page).
Why do I need to know this? If you’re teaching on a specific topic, it’s important to know what has been taught to students prior to your learning event. It’s also important to see what they are taught later on “downstream” in the curriculum. The search or explorer features will do that for you. This way, you can avoid redundancy but plan to revisit some aspects (spiral curriculum) and link to future aspects. It also gives you a heads up as to who is teaching about this topic, with a view to linking up with these faculty to discuss the thread of the topic. E.g. Many of the faculty teaching in year 2 refer back to the Family Medicine Course’s approaches, or link to the Clinical Skills exams, etc. that relate to their topics.
Go to the Courses tab here. All courses currently running (excluding clerkship rotations) will have a small icon beside their names (it looks like a piece of paper). By clicking on this you can download a pdf of the course syllabus. Included in this is a breakdown of the course hours by learning event type.
You can also click on “Download Syllabus” under the Course Navigation menu if you are already on a course page.
You can see the little syllabus icon in the image below.
Why do I need to know this? The syllabus is hugely helpful, especially for Course Directors. It tells all faculty and students what the learning objectives for the course are, what the assessments are, etc. It also lets you know the percentage of lectures, small group learning, labs, etc. that are present in the course.
Holiday Gifts for Teaching
I’m sending you these, from the UG Educational Team, with a wish for peace-filled and joyful holidays with family and friends .
Did you know we subscribe to Poll Everywhere for our year 1 and 2 students?
And that you can use it with up to 40 other learners otherwise? It’s clickers without clickers—students can use their phones or laptops to answer questions anonymously in the classroom. Teachers can use word document, or PowerPoint, or ask a question orally to solicit the answers. Questions can be multiple choice, or they can be open-ended!
To get Poll Everywhere to work, you can visit their site for a demo video: http://www.polleverywhere.com/
Or you can look at their explanation: http://www.polleverywhere.com/how-it-works
Or you can contact Theresa Suart in the Ed Team at email@example.com, or Lynel Jackson at MEdTech at firstname.lastname@example.org
Second Gift: Diagnostic process (and winning points):
Dr. Tony Sanfilippo isn’t only our UGME Associate Dean extraordinaire, he’s also an intuitive teacher. One of his cases, Megan, is one I use for explanations all the time with faculty. Here is a slide from his Megan case that gives the diagnostic process in a nutshell.
And while I’m at it, another gift he gives us is the idea of getting students to rank their ordering of investigations, winning or losing “points” (often in chocolate) depending on how rational their choices were. 2 ideas from Megan
Have you ever wondered if you could synthesize a concept or unit so that students could grasp it visually? Dr. David Lee from Hematology has done a great job of this with my favourite slide of all time: the algorithm for Hematapoiesis. Here it is: hematapoiesis slide Dr David Lee Why not see what you can do with your ideas? And if you need help with graphic organizers, Theresa or I can give you a hand—they’re one of our best tools.
Dr. Lindsay Davidson has won so many teaching awards, I can’t keep track. Here she offers 2 ways you can take your students’ pulses.
In our professional lives, many of us are used to “taking the patient’s pulse”. This, and other clinical observations, inform our assessment and management plans. Similarly, as teachers, we can “take the pulse” of the students – finding out what knowledge they bring into a session or checking in to determine if important concepts have been grasped.
One of the best ways to do the first of these is a readiness assessment test. Readiness assessment tests – or RATs – are used at the beginning of a curricular theme (normally spanning about a week of the curriculum). These 10-15 question tests are designed to assess foundational concepts needed to progress to problem solving – they are quite different from the questions given on midterm and final exams. A RAT should be linked to one pre-defined preparatory resource (such as a section from a textbook, an online module or a review article). Students complete them individually and then re-take them as a team. The whole process is complete in 30 minutes, leaving the teacher time to speak to any questions or topics identified as difficult or confusing.
Another way of checking the class’ vital signs is a “muddy point” exercise. Popularized by former Queen’s Chair of Teaching and Learning Tom Russell as the “ticket out of class”, this exercises asks students to submit a note to the teacher (either on paper or could be electronically using polleverywhere’s open ended question function) outlining the “one thing” they do not understand. A review of the submissions allows teachers to begin the next class clarifying any items multiple students identify as confusing.
Interested in trying a RAT or Muddiest Point? Check in with Sheila or Theresa.
There are several tasteful and (ahem) not quite so tasteful music videos out there where people have created peons to everything from medical careers to organ systems. Perhaps you could use one as a memory tool or a way to introduce a concept. Theresa recently found this takeoff on What the Fox Say, in Harvard Medical School’s What the Spleen Do http://www.youtube.com/watch?v=aEi_4Cyx4Uw. I’ve always loved Pinky and the Brain on the Brainstem: http://www.youtube.com/watch?v=snO68aJTOpM More lyrically, Dr. Jackie Duffin sent this lovely excerpt about the muscles in the gluteous maximus: http://www.spiraldynamik.com/newsarchiv/huefte_1.mp3.
I just found Lullabye for a recovering addict by Jake Silver: http://www.youtube.com/watch?v=PFJ3DMdiEMU&feature=youtu.be (Thanks to U Sask’s Deidre Bonnycastle’s scoop on music videos!) and Dr. Heather Murray and I crossed paths sending each other Viva la Evidence by James McCormack: a parody of Coldplay’s Viva La Vida – a song all about evidence based: http://www.youtube.com/watch?v=QUW0Q8tXVUc
And finally, here’s the song Clouds written by 17 year old Zach Sobiech after being told he has months to live: http://www.youtube.com/watch?v=sDC97j6lfyc and http://www.youtube.com/watch?v=bLhUS_QjcZY
This was really a gift that was given to me, and I’d like to share it with you as a way to close out 2013, and look forward to 2014.
I’m going to have to tell you a little story…Once, long ago…
Some of you will recall the days when we worked hard to infuse small group learning into our curriculum. Going back about 5 years, our students were resentful and confused, and I was concerned our teachers were just confused. Sitting in those classes, week after week, I worried that small group learning would never work—that lectures were too much the pattern of learning and that all the reasons that had bubbled up—too long, too complicated, inefficient, students don’t like it…all these reasons for not teaching this way would overcome our efforts.
Flash forward to a C1 class in September 2013. I was wandering the back of a class given by Dr. David Taylor. He put up a clinical case on the screen. There was a pause—a discernable beat– while 100 students looked at and read from the screen. Then, as one, all of them turned to their group members and began to talk. Books were hauled out, computers fired up, tasks divided, and the usual wrangle about who’s the note-keeper soared overhead. It was a symphony of sound of minds at work. Even more beautiful: it was commonplace and accepted. The students knew exactly what to do. The teacher did what he was supposed to do—stand back and let the students wrestle that learning to the ground before taking to the stairs and moving around the room.
I can’t tell you how wonderful it felt! I saw this again even more recently as Dr. Michelle Gibson had her C2 class working on a graded team assignment, reconciling medications for a patient. Again the class gave their attention to the screen and then again the busy hum. And the results were wonderful—groups passionately prepared to defend their new prescriptions, and scathingly and brilliantly able to articulate why they had taken several prescriptions away.
I guess the gift for me is that after 5 years, small group learning is now part of the status quo. Teachers feel comfortable. Students know how to make this kind of learning work for them and are used to using it. They haven’t abandoned learning from lectures, nor have they stopped reading. But they look at the screen…beat…and they turn to their peers. I tell you, it almost brings tears to my eyes.
So this is my last holiday gift for 2013: our faculty have made innovations in teaching work and our students are making innovations in teaching work. Thank you for that gift!
Do you have any gifts to share? Musical, textual or other? Write back and let us know.
The Challenge of Career Selection
When are Medical Students ready to decide?
Medical students begin their studies believing they have decided upon and achieved their career path, and can now devote their energies and attention to advancing that goal. They soon learn that even greater and more complex decisions lay ahead. The process of career selection has become a major cause of concern and stress for both medical students and curricular leaders at our Canadian medical schools. Students must, by the end of medical school, select from among over 30 postgraduate training program options, which will further differentiate into over 70 approved medical specialty certifications. Are students ready? A recent, informal survey was carried out among the first and second year classes at our medical school. Students were asked to state their agreement with one of three statements:
- I have a single, clear career interest.
- I have narrowed my focus to between 2 and 5 options
- I have no idea
So it would appear only a minority of our students have established a choice by these early years, although it’s unclear how durable these choices will prove to be. It also seems that some further clarity emerges even by second year, but the majority of students remain uncertain. Studies from the British medical educational system would suggest that about a quarter of doctors change their career choice after qualification (Goldacre MJ, Lambert TW, Medical Education 2000:34:700-707). A review of Canadian graduates reports that 83% of graduates felt somewhat or very well prepared to make career decisions, but that leaves a full 17% who described themselves as “not at all sure” by graduation (Columbia B. Can Med Assoc J 1997;156:1248)
To illustrate how much the medical landscape has evolved, it might be useful to consider a “Tale of Three Classes”.
This photograph provided by Queen’s Archives illustrates one of our earliest graduating classes, circa 1870. Students of that era received a common 3-4 years of instruction and clinical training, after which they were fully qualified practitioners. Their scope of practice throughout their careers was virtually identical, determined only by the needs of the communities they served.
Let’s move forward about a hundred years. The second photo was taken at the 25th reunion of my class, Meds ‘81. My classmates and I also undertook a common four year curriculum. With one further year of training, in virtually any “internship”, we were all deemed fully qualified as “General Practitioners”. About half the class remained in General Practice, eventually becoming qualified by the College of Family Physicians when that body and its qualifying examinations came into being. The remainder went on to additional training in one of the limited number of specialty programs and certification examinations offered by the Royal College of Physicians and Surgeons. Importantly, I doubt any of my contemporaries regretted their general training, and even those eventually engaging very specialized disciplines would say that their clinical proficiency and effectiveness was enhanced by that background.
Contrast all this to the graduates of Meds 2009. About a quarter of these students undertook training in Family Medicine. Many will, by now, have completed the minimum two year training program and will have begun practice, having passed qualifying examinations and achieved full certification through the College of Family Physicians. The remainder are still in training, having undertaken further training through the CFP or entered a variety of Royal College programs, all with their own entry requirements, training program and qualification examinations. Although their undergraduate experience would have differed in many ways from that of their predecessors, it was based on a structurally similar four year model, common to all students regardless of career direction.
The routes to practice are, in fact, becoming increasingly tortuous, complex and longer. In order to better understand this, I’ve consulted with my colleagues in our postrgraduate education office. Jordan Sinnett, PG Program Manager, provided me with the accompanying table that outlines the various paths to the current available postgraduate programs. The reasoning by which some programs are direct entry from undergrad whereas others diverge after core training, and the length of time of various programs is all rather opaque, but appears to reside with the individual program committees.
It’s important, in considering all this change, to recognize that the major driver is the increase in medical knowledge, available technologies and vast expansion of valuable service the profession is able to provide to our patients. Our society requires (and demands) physicians who have the highly specialized knowledge and training that’s required to diagnose and manage our ever-expanding array of conditions and provide technologically complex treatments. This is obviously all good. However, as training needs have increased, we have simply added more time and qualifications to those previously available rather than to consider new educational paradigms. At this point, a few questions must be posed:
- Is this a problem? Stated another way, are there unintended consequences of this evolutionary change that should be addressed?
- What, if anything, is being done?
- How will all this affect our learners, and can they be expected to engage career selection in a different way?
1. Increasing focus of attention and stress for medical students. The expansion of career options and requirement to choose from so many postgraduate training tracks is becoming an increasing focus (some would say obsession) of our students during medical school. Observerships, interest groups, electives and even summer voluntary placements are all seen, and used, as opportunities to explore career options and advance one’s suitability for the increasingly competitive application process. Although all of value, these pursuits compete with ever increasing educational demands expected of our students.
2. Unhealthy competition among students. Many postgraduate programs are over- subscribed relative to available training positions. This results in a competitive environment at the very time medical schools are working hard to “undo” the pre-medical focus on superficial academic success and advance principles of patient-centred learning, collaboration and cooperation among colleagues.
3. Subversion of medical education. Medical school curricula are increasingly directed toward career exploration, to the extent that both core content and Electives (18 to 20 weeks at most schools) are essentially devoted to this purpose. Career exploration is, in essence, subverting the educational priority.
4. Increased time required to achieve practice readiness. With the expansion of postgraduate programs and numerous emerging competency tracks, the duration of training is getting progressively longer. Becoming a qualified interventional cardiologist, for example, requires 15 years from university entry (4 year undergraduate degree + 4 years of medical school + 3 years General Internal Medicine + 3 years Cardiology + at least 1 year Interventional fellowship). Given that much of that time is spent in educational pursuits not directly relevant to the eventual practice requirements, the need for such a long training period is, at the very least, debatable, and given the increasing resource limitations of our health care system, will come under increasing scrutiny.
What’s happening that will affect all this?
The Future of Medical Education Postgraduate recommendations included the following:
To implement this recommendation, the Association of Faculties of Medicine of Canada has established three committees with mandates to explore methods to refine processes within undergraduate programs, the transition from undergraduate to postgraduate education, and the transition to practice. Those groups have been encouraged to think beyond current models. Those revisions may involve more “streaming” or specialty-specific teaching during medical school, a more gradual transition from foundational to specialty-specific learning, and effective career counseling processes.
However (and this is a big “however”), any such change in the three or four-year common curriculum paradigm will necessarily require our students to make even earlier career choice decisions. Is this a reasonable expectation? The information I provided above would suggest they certainly are far from optimally prepared at this time. So, what would be required to allow our students to make valid, durable career decisions earlier in their training?
The following would seem at least a reasonable place to start:
Clear and easily accessible information about the various career choices available to them. Students need to understand the scope of specialty options and the essential differences, not only in clinical content, but also credible information about the “life” that goes with each. They’re particularly interested in issues such as call expectations, mobility, and the availability of opportunities to integrate academic interests with their clinical obligations.
An understanding of their own preferences and aptitudes. Students require direction and help in thoughtfully and honestly considering a number of personal issues relevant to career selection, such as:
- Their willingness to engage patients with undifferentiated presentations
- Their comfort with critically ill patients
- Their comfort with continuing care versus issue-specific consultancy
- Their comfort with surgery and procedural work
- Their comfort with certain patient populations, such as children, the elderly, the terminally ill
- Their comfort with various practice settings, such as hospital wards, emergency rooms, ICUs, clinics, and offices
- The degree of flexibility with respect to practice settings and mobility they wish to have
Although it can be very difficult for students, a full and candid consideration of issues such as these will allow them to reduce their reasonable options to a more manageable number.
Knowledge about availability of training and career opportunities. Students have expressed very clearly their desire to know about long-term career availability. Both shared experiences and recent studies (Frechette D et al, http://www.para-ab.ca/upload/files/docs/employment/RoyalCollege_EmploymentSummary_2013.pdf) have suggested that many highly-qualified graduates of postgraduate programs have difficulty finding practice opportunities in certain specialties. Students wish to have such information. In this regard, they are allied with our provincial governments who seek to ensure our production of various medical specialists matches societal needs. Unfortunately, accurate information is very hard to come by, particularly for students whose entry into the workforce is several years in the future.
An understanding of the application process. Students need to understand the process by which they will apply and compete for postgraduate positions. This requires clarity and transparency about both the matching and selection processes. The former is carried out by the Canadian Residency Matching Service (CARMS), and is open, transparent and effectively provided. The latter, which is in the hands of each specific postgraduate program, is considerably less transparent and subject to considerable rumour and “urban myth” among students.
Is there hope on the horizon?
All this requires a fresh, early and much more comprehensive approach to career exploration and counseling than medical schools have provided to date. This week, those directing career counseling curricula and services at the six Ontario medical schools are assembling at the request of the Council of Ontario Faculty of Medicine Undergraduate committee to compare approaches, discuss challenges, and begin to develop more cooperative and effective approaches for our students.
The AFMC and ministry are jointly interested in providing more reliable definition of societal needs for all our specialties. Such information will certainly be informative for our students.
The FMEC sub-committees mentioned above have, as a component of their collective mandate, consideration of improved student counseling and application processes.
These initiatives provide some optimism that students will be better prepared for their career decisions, and for the systematic changes likely to develop within our medical education programs in the coming years. All these discussions and initiatives will be more effective if informed by those involved in (and effected by) the processes under discussion. It’s in that spirit that this article is provided and your feedback is welcome.
Many thanks to Jordan Sinett (Postgraduate Program Manager), Sarah Wickett (Health Informatics Librarian, Bracken Library), Jonathan Cluett (Meds 17 Class President), Sean Henderson (Meds 16 Class President), Jennifer Siu (Meds 16) and, as always, Lynel Jackson, for their assistance in the compilation of information for this article.
UGME (and PG) go to the AAMC: Here’s what we learned
On Nov. 6, a band of intrepid medical educators from Queen’s travelled to Philadelphia to attend the Association of American Medical Colleges’ annual meeting.
Attending sessions from Nov. 6 to 10, Dr. Renee Fitzpatrick, Dr. John Drover, Dr. Laura McEwen, (Assessment Specialist in Post Grad), Ulemu Luhanga (a doctoral candidate working as a research assistant with Laura), Eleni Katsoulas (our UG Assessment and Evaluation Consultant) and I learned a great deal from our American counterparts.
But I would venture to say that they learned some from us too. For example Laura and Ulemu presented their poster Queen’s Multisource Feedback Rubrics: Operationalizing Frames of Reference for Raters and Residents, and judging from the crowd around them during the whole session, their ideas were well-received.
I attended a great morning with the Directors of Clinical Skills group, where milestones were the topic of discussion and I’ve been invited to share our work on the clinical skills milestones we’re developing. I’ll write more about milestones and the work from the AAMC in a later blog.
And Eleni went to hear the speakers of a great article, Jim Crossley and Brian Jolly, who wrote Making sense of work‐based assessment: Ask the right questions, in the right way, about the right things, of the right people.
Here she writes about their presentation and their article. Please feel free to share your thoughts
Multiple Perspectives: finding relevance in idiosyncrasies
What do you see in the picture above?
Do you see an owl? Or coffee beans and two cups of coffee? Some of you might say you see both things! Each piece is only part of the whole. This illustrates how different people can look at the same thing and see different things. Any one of these perspectives might be useful depending on the context!
How are subjectivity and reliability related?
Does every context provide equally valid and reliable data for every domain? Crossley & Jolly (2012) argue that not every context provides good data for accessing every domain! So when might standing back and considering the whole performance give you a better picture than the sum of its parts? Or when are other perspectives just as useful?
The literature demonstrates that those who “have the competence to judge an aspect of performance, and have had the opportunity to observe it, appear to provide more reliable ratings” (Crossley & Jolly,p.35). Since clinical competence is so broad, isn’t it rational to say that multiple perspectives might be equally valid in certain contexts?
What does this mean for those of us teaching and assessing in medical education?
The authors argue that while historically, assessments have often
measured the measurable now we are concerned with measuring the important. Workplace based assessments are often based on subjective judgements. Sometimes the assessors develop an ” instrumental impressionism” whereby he or she makes a judgement that is global but, nevertheless, is vitally dependent on an overall, somewhat merged,
perception of the details (Crossley & Jolly, p. 33) and this is an equally valid if not more valid perspective.
For us, a few things emerge: Some of our finely grained assessments are asking too much of assessors to provide meaningful assessment, especially in cases of concepts that are hard if not impossible to observe in the assessment setting. Our assessors should be those with experience and knowledge in the specific areas of assessment, and their judgements as opposed to objective observations can and should play a large role in assessment. And finally, we should ask the right questions, in the right way, about the right things, of the right people.
Crossley, J. & Jolly, B. (2012). Making sense of work-based assessment: ask the right questions, in the right way, about the right things, of the right people. Medical Education, 46, p-28-37.
History of Medicine 2013: Queen’s Medicine Takes Boston
Thanks to Hollis Roth, Meds 2016, who is our guest writer for today’s blog article, and to Stefania Spano (Meds 2016) and Dr. Jacalyn Duffin for their photos.
This fall marked the 16th annual Queen’s History of Medicine trip; what began as a trip planned by Dr. Duffin in 1996 to the National Gallery in Ottawa has quickly became an annual tradition fondly remembered by many classes of Queen’s Medicine graduates. This year marked the fourth History of Medicine trip to Boston and spots were highly coveted, with a wait-list maintained until the very day of departure.
After classes ended on Friday, students eagerly piled on the coach bus and settled in for the long trip to Boston. While the 9-hour ride proved longer than anticipated, students passed the time in a variety of ways. Some diligently studied, others caught up with classmates and on sleep, and an unfortunate few spent the majority of the trip suffering from motion sickness. Arriving in Boston close to midnight, a cluster of students set off to explore the city, while others decided to wait until morning.
After gathering for a group photo on the steps of Massachusetts General Hospital, students spent the rest of the day exploring Boston. With only 36 hours to explore the city, students made the most of their time. Popular sites included the campuses of the Massachusetts Institute of Technology and Harvard University, as well as Fenway Park, the Boston Central Public Library, and sampling a wide variety of local delicacies. It was a lovely (albeit windy) fall day to wander the city amongst colleagues and friends while briefly escaping the rigorous demands of medical school.
Queen’s medical students explore the Harvard campus. Photo credit: Stefania Spano (Class of 2016)
We began bright and early Saturday morning with a visit to the third oldest hospital in the United States, Massachusetts General Hospital. Massachusetts General is richly steeped in history and houses the Ether Dome, which served as a surgical theatre from 1821-1868 and is a National Historic Site. On October 16 1848, the Ether Dome was the location of the first public demonstration of the surgical use of ether anesthetic by William T.G. Morton. Under the guidance of Professor David S. Jones (MD PhD and the A. Bernard Ackerman Professor of the Culture of Medicine), and Dr. Sukumar P. Desai (Anesthesia, Brigham and Women’s Hospital), students learned how the use of anesthesia drastically redefined surgery.
Queen’s medical students at the Ether Dome. Photo credit: Dr. Duffin
Our final stop on Sunday was Harvard Medical School, where we were privileged to have the Francis A. Countway Library of Medicine opened solely for our use.
Harvard Medical School Photo credit: Stefania Spano (Class of 2016)
The Countway Library is one of the largest medical libraries in the world, serving Harvard Medical School and the Harvard School of Public Health, and contains the Warren Anatomical Museum. Led by Dr. Scott Podolsky (MD and Director of the Center for the History of Medicine), Mr. Dominic Hall (Curator of the Warren Anatomical Museum), and Ms. Joan Thomas (Cataloger, Rare Books), students received guided tours.
Zeyu Li (Class of 2016) with Mr. Dominic Hall, Ms. Joan Thomas, and Dr. Scott Podolsky at the Countway Medical Library. Photo credit: Dr. Duffin
Highlights of our visit included viewing first editions of Andreas Vesalius’ De humani corporis fabrica (1543) and Charles Darwin’s On the Origin of Species (1859) in the Rare Book Library, and viewing the skull of Phineas Gage in the Warren Anatomical Museum.
Dr. Duffin made a very exciting discovery while exploring the Countway Library. Dr. Duffin has long searched for the origins of an image used as a bookplate for books purchased in the 1920s for our medical library, but even after consulting with colleagues across the world the source remained unknown. Happily, Dr. Duffin was astonished to stumble across the very same image in Hortus Sanitatis (1491) while touring a selection of rare books chosen for our viewing. It was an extremely fortuitous discovery – had this book not been selected for viewing or conveniently left open at the relevant page by the student who had previously viewed it, Dr. Duffin may not have made this connection. It can truly be said that this History of Medicine trip was an educational experience for all!
The frontispiece of “Hortus Sanitatis” (1491) and the cause of Dr. Duffin’s jubilation. Photo credit: Dr. Duffin
We would like to extend our deepest thanks to Dr. Jones, Dr. Desai, Dr. Podolsky, Mr. Hall, and Ms. Thomas for taking the time to share their passion in the History of Medicine with us (on a weekend, no less) and for making us feel so welcome in Boston. As always, a huge thank you is due to Dr. Duffin for her continued support of these annual History of Medicine trips, to Zeyu Li (Class of 2016) for organizing the trip, and to the Aesculapian Society for funding. While I will be deep into clerkship at this point next year, I look forward to hearing about next year’s trip!
Educational Resources at your Fingertips: Faculty and Students
As teachers, you may want to find resources that assist you with teaching, or find out what the latest news from the Curriculum Committee is, or find out who to contact about what. As students you may want help about people, places, policies and other “p’s” in the Undergraduate Medical Education program.
We have published two resources recently:
The first is the new Faculty Resources Community: https://meds.queensu.ca/central/community/facultyresources
NOTE: first log into MEdTech via the dashboard URL, then simply click on the community, which would be among those listed on the left side of each user’s dashboard page. All faculty members including community preceptors are members of the Faculty Resources Community, but to “see” it you’ll need to log in first.
The Faculty Resources Community was created to provide faculty members, Course Directors, Year Directors and Committee Chairs with advance notice of topics to be discussed at Curriculum Committee meetings as well as easy access to Curriculum Committee Highlights, links to faculty development on teaching and assessment and materials distributed at Course Directors’ Retreats. Other resources posted in the new community include the Future of Medical Education in Canada reports and the latest LCME accreditation standards. We welcome suggestions for additional resources.
The second resource is for students! The Student Handbook, a brilliant idea from Associate Dean Sanfilippo, and edited by Alice Rush-Rhodes, is now published on MEdTech and is available in a printable pdf format thanks to Lynel Jackson from MEdTech.
To access the Student Handbook, please go to https://meds.queensu.ca/central/community/studenthandbook and to print a copy, scroll down to the bottom of the side menu. The Student Handbook contains information on people to assist students (including peer mentors), advice on careers, CaRMS and the Dean’s Letter, lockers, MEdTech, the Curriculum, and Special Programs to name a few components.
Is there anything we should add to the Student Handbook? Any other way you’d like to see faculty ideas? Just respond to the blog and let us know, or email Sheila Pinchin at email@example.com
Medical Student Research Showcase: Meds student researchers take over the Medical Building
September 26th marked the 2nd annual Medical Student Research Showcase at the Queen’s School of Medicine. This yearly event was brought to us by Dr. Heather Murray (Emergency Medicine and Public Health Sciences), Melanie Walker (Public Health Sciences), and Amanda Consack (UGME) as well as many other members of the UG staff. It showcases research performed by our medical students, during their time in medical school, for other students and faculty. This year’s session had a collection of 54 posters in the David Walker atrium, and three students were selected to deliver their research findings in an oral plenary, moderated by Dean Reznick. It was an inspiring display of innovation, effort and accomplishment.
A wide range of research topics were presented, and over the lunch hour the students were able to go over their work with a crowd of interested faculty and students. Many Queen’s faculty served as poster assessors and completed a structured feedback form so that presenting medical students could understand where their posters succeeded, and also how they might be improved. Additionally, the 10 QuARMS students were introduced to the event through an assignment evaluating the design and findings of 3 posters that appealed to them.
This year, students who attended the poster session were encouraged to vote for their top 3 posters in a “People’s Choice” award competition. We had over 80 ballots cast, and in combination with the poster assessors feedback, a poster winner was selected: Osbert Zalay, with his poster “Foundations of the tricorder: Artificial intelligence solutions for biomedical classification problems.”
Later in the afternoon, the 3 students selected for the oral plenary session delivered their research in the main auditorium. These students were selected after submitting a 5-page summary of their work, each of which was reviewed 3 separate times by a panel of faculty judges: Dr. Albert Clark, Dr. Paula James, Dr. Anne Ellis, Dr. David Lillicrap, Dr. Will Pickett, Dr. Mike Brundage, Dr. Heather Murray, Dr. Tan Towheed and Dr. Rob Brison. Eighteen submissions of extremely high quality were reviewed, and the following students were selected:
Nathan Roth, MEDS 2015 “Inside the brain of an expert: Comparing medical decision making and cognitive processing demands between medical students and experienced medical resident learners.”
Faculty supervisor: Dr. Dan Howes
James Simpson, MEDS 2015 “Patient evaluation of clinical interaction with medical students: A pilot study.”
Faculty Supervisor: Dr. Andrea Winthrop
Yan Xu, MEDS 2015 “Prescribing pattern of novel anticoagulants following regulatory approval for atrial fibrillation in Ontario, Canada.”
Faculty supervisors: Dr.Ana Johnson, Dr.Chris Simpson, Dr.Anne Holbrook (MacMaster) and Dr. Dar Dowlatshani (Ottawa)
These 3 students, and Osbert Zalay MEDS 2015 (“People’s Choice” Poster) have all been awarded the 2013 Albert Clark Award for Medical Student Research Excellence. This award was established in 2012, in honour of Dr.Clark’s longstanding contributions towards the critical enquiry program at Queen’s.
Students at the Queen’s School of Medicine are actively involved in a wide array of research enquiry with impressive results. Our students are asking questions, seeking answers, advancing care and inspiring change. Congratulations to all who presented, and to the faculty who have mentored them.
Help for students reading challenging texts
Many students in medical education are not used to reading large amounts of dense materials, where, as one student put it, “every word is loaded and I end up looking up everything.” When experts read through a reading they have assigned to beginning medical students, they often underestimate the amount of time and effort that is needed.
In other posts, I’ve discussed how it’s important for teachers to preview their assigned reading materials, and to seek out the best material, through help from librarians and educational team members, that accomplishes their goals and is at an appropriate reading level for students.
For today, I’d like to introduce you to a reading method that may assist our students: it’s called SQ3R.
SQ3R stands for Survey, Question, Read, Recite and Review. It’s an approach to reading that can help students retain the information they have been asked to read. It promotes curiosity and a determination toward reading, that is based on the cognitive processes of successful learners. SQ3R is not a new technique–it’s been around since well before I was a university student–which is a long time! 🙂 Credit goes to Francis Pleasant Robinson who in 1946 first published about it in his book Effective study.
So how does it work? NOTE: readers, you may find that this looks like a long process. While it’s longer than skimming, it can become habitual, OR you may want to take pieces of it for your own. Please “read” on.
Survey: Basically, SQ3R asks readers to survey or look over a whole reading paying particular attention to:
- The title, headings, and subheadings
- Captions under pictures, charts, graphs or maps
- Bold print, italics, numbered items, color coded passages, marginal notes, glossaries, outlines, questions, lists, charts, etc.–these are cues that the author regards these as key items
- Review questions or teacher-made study guides
- Introductory and concluding paragraphs
Question while you are surveying:
- Turn the title, headings, and/or subheadings into questions
- Read questions at the end of the chapters or after each subheading
- Ask yourself,
“What did my instructor say about this chapter or subject
when it was assigned?”
- Ask yourself,
“What do I already know about this subject?”
Read, but read for a purpose: look for answers
- Look for answers to the questions you first raised
- Answer questions at the beginning or end of chapters or study guides
- Reread captions under pictures, graphs, etc.
- Note all the underlined, italicized, bold printed words or phrases
- Study graphic aids
- Reduce your speed for difficult passages
- Stop and reread parts which are not clear
- Read only a section at a time and recite after each section or look away from the text and ask a stimulus question–this breaks your habitual reading and allows you to re-focus
Recite after you’ve read a section: ask yourself questions about what you have just read, or summarize, in your own words, what you read through writing
- Take notes from the text but write the information in your own words
- Underline or highlight important points you’ve just read
- Reciting: for difficult passages especially:
The more senses you use the more likely you are to remember what you read: Triple strength learning: Seeing, saying, hearing
Quadruple strength learning: Seeing , saying , hearing, writing!
Recitation requires mental activities far beyond those possible through “stroking the words with eyeballs” in a textbook: a technique so commonly used by students. Reciting promotes and speeds learning while rereading and rereading actually slows, impedes, and in some cases, prevents leaning.
Review: put it all back together again. Very few people a whole chapter by reading it once. The Question-Read-Recite process divides a chapter into sections that can be assimilated separately, into manageable chunks. This allows you to set your own pace.
Regular review puts a chapter back together again. In review, you are answering the question that was made from the chapter title.
Review means regular and frequent recitation (or written recitation) of the material to be learned. This is an excellent check for learning.
So how do you review? Here are review techniques that have worked for me, for my students and from the literature:
- Review one day later, one week later, two weeks later
- Make a Table of Contents for a chapter from your notes or from memory
- Make a point form outline from your larger notes or from highlighted sections
- Put a concept map together: make a visual diagram of what the chapter’s key concepts are
- Review out loud (remember the Triple Strength Learning above)
- Cover up parts of a page and test your self on the corresponding parts.
A Problem and Solutions for Students and Faculty:
One last thing:SQ3R is slow. At least it is slower than the speed at which many students “read.” That doesn’t mean we shouldn’t look at it for medical education. It’s slower than skimming but really effective in retention. Perhaps students who are faced with large amounts of difficult material can take pieces from this process and add to their own. Perhaps teachers can recommend or even put in place requirements for a point form outline or list of key questions or a concept map to be brought to class after assigned reading.
Do any of these techniques strike a chord with you? Do you have other reading/reviewing suggestions?
Concept Mapping. http://ctl.byu.edu/tech-tips/concept-mapping accessed Oct. 7, 2013
Robinson, Francis Pleasant. (1970) Effective study. New York: Harper & Row.
SQ3R reading method. The Reading and Research Series. http://www.studygs.net/texred2.htm accessed Oct. 7, 2013.
SQ3R http://www.mindtools.com/pages/article/newISS_02.htm accessed Oct. 7, 2013
SQ3R Textbook study system. Worcester Polytechnic Institute. www.wpi.edu/Images/CMS/ARC/SQ3R_Textbook_Study_System.pdf accessed Oct.7, 2013.
Weideman, M. & Kritzinger, C. (2003). Concept Mapping – a proposed theoretical model for implementation as a knowledge repository. A working paper from the “ICT in Higher Education” research project.