When your objective is to write learning objectives…
Several times over the last few weeks, I’ve had conversations with course directors and instructors about writing learning objectives.
Many people – from award-winning educators to rookies and everyone in between – find writing learning objectives a challenge. The typical advice of write out who will do what under what conditions is vague, so it’s often not very helpful.
“General” learning objectives – from our UGME Competency Framework, aka the Red Book* – are already assigned to your course, and possibly to your session by your course director.
The key task for instructors is to take these general objectives and annotate them with specific objectives for their sessions, including what level of learning, such as comprehension, application or analysis. (This is from something called “Bloom’s Taxonomy”, if you’re interested in the research behind this).
A natural starting point is: What do you want your learners to take away from your session?
Frequently the response is:
- “I want them to know….”
- “I want them to understand….”
- “I want them to be able to…”
Once you’ve wrestled something like this into sentences, I realize it’s disheartening to have someone like me come along and say, “Uh, no, that’s not up to scratch.”
What’s wrong with “know” and “understand”? Isn’t that exactly what we’d like our students to walk away with – knowledge, understanding, skills? Absolutely. The challenge with these so-called “bad objective verbs” is that we can’t measure them through assessment. How do we know they know?
That’s the starting point for writing a better learning objective. If you want to assess that students know something, how will you assess that?
For example, while we can’t readily assess if a learner “understands” a concept, we can assess whether they can “define”, “describe”, “analyze”, or “summarize” material.
Here’s my “secret” that I use all the time to write learning objectives – I can’t memorize anything to save my life, so I rely on what I informally call my Verb Cheat Sheet. The one I’ve used for many years was published by Washington Hospital Centre, Office of Continuing Medical Education. It list cognitive domains (levels) and suggests verbs for each one. There are many such lists available on the Internet if you search “learning objectives” (here’s another one that’s more colourful than my basic chart, below).
Well-written learning objectives can help learners focus on what material they need to learn and what level of mastery is expected. Well-written objectives can assist instructors in creating assessment questions by reminding you of the skills you want students to demonstrate.
Here’s my quick three step method to annotating your assigned objectives on your MEdTech Learning Event page with your learning-event specific objectives:
- Start with writing your know or understand statements: what do you want learners to know or understand after your session?
- Think about what level of understanding you want students to demonstrate and how you would measure that (scan the verb chart for ideas)
- Write a declarative sentence of your expectation of students’ abilities following your session. In your draft, start it off with “The learner will”. For example: The learner will identify the bones of the hand on a reference diagram. Your objective would be: “Identify the bones of the hand on a reference diagram.”
As a fourth step, feel free to email your draft objectives to me at email@example.com for review and assistance (if needed). I’m happy to help.
Table excerpted from Washington Hospital Center, Office of Continuing Medical Education’s “Behavioral Verbs for Writing Objectives in the Cognitive, Affective and Psychomotor Domains” (no date).
* The “Red Book” got its name because for the first edition (we’re now on the fourth), the card stock used for the cover was red. Over time, everyone started calling it the “Red Book”.
Online modules can enhance curriculum content delivery
Do you want to build an eModule?
Online modules, or eModules, are one of the content delivery methods available for use in our UGME curriculum.
As with any content delivery method, the teacher’s job is to define objectives, then organize and deliver new content to students. Online modules can deliver content efficiently and creatively but they’re not without potential pitfalls, so planning is key.
Unlike traditional lectures, online modules can curate other online content like a museum exhibit: you can select useful works from others and present these with guidance. The potential pitfall here is if not done carefully, modules can be information overload.
Modules can have interactivity, such as multiple choice questions with automated feedback. This can help keep students engaged as they work through the new content. Remember, though, for UGME, we aren’t building complete online courses – our eModules are prefaces to in-class interactive case/problem-based learning.
Carefully created eModules can be particularly useful where there is no resource appropriate for this level of learner.
Using an online module to deliver new content means you can use classroom time for interactive problem-solving: having completed the module, students come in prepared to apply their new knowledge.
Online modules are intended to be fully integrated with the rest of the UG curriculum – they don’t stand alone, but are one tool to deliver content students later apply in other settings, both classroom and clinical. Modules used to deliver new content in pre-clerkship can later be used by students as review during particular clerkship rotations, for example.
Here are some examples of the types of online modules in use in Undergraduate Medicine:
- Collaborative Leadership & Conflict Resolution
- Introduction to Social Determinants of Health & Advocacy
- An Approach to Lung Cancer
- Residents preparing to teach 1: Know your learner (This last one isn’t technically part of the UG curriculum; it’s for residents who teach our UG students).
We also have a newly-created MEdTech community “Queen’s UGME E-Curriculum” designed to provide links to all UGME online modules. (Requires MEdTech log-in to access). As it’s currently under construction, there may be a few modules missing at the moment.
To help avoid some of the pitfalls of online modules – such as content overload, not providing sufficient guidance for students, and lack of linkage to subsequent sessions, the Teaching, Learning, and Innovation Committee, the UGME Education Team, and EdTech have implemented a streamlined process for creating and adopting new eModules for the UGME curriculum.
The process starts with content creation and/or compilation, followed by design, then support and follow-up for incorporating the module in your teaching.
If you already have a good idea of what you’d like to do, you can use the form found here to start the process.
Tips to help with Teaching Dossiers in your upcoming reports:
Here’s a riddle for you:
It may not be the type of writing you’re used to, and it requires thinking and reflection about an aspect of your work that you may not think as much about. It has an intimidating word in the title and is the first hurdle in preparing an outline of your work. What is it?
Answer: A Teaching Philosophy Statement
What is a teaching philosophy statement?
A Teaching Philosophy Statement is a reflective statement of your beliefs about of vision of teaching, your educational goals, and preferred educational practices/approach(es). Included are reasons for your teaching approaches. Critical self-reflection is a key component here. Your Teaching Philosophy can inform all of the subsequent materials in your dossier—acting as the spine of your dossier. It should also discuss how you put your beliefs into practice by including concrete examples of what you do or anticipate doing in the classroom.
Often medical faculty are required to prepare a teaching dossier or portfolio. These are often requirements for awards, for competitions or for promotion.
The actual dossier may be a familiar piece of writing for many of you: Describe what I do, prove what I do, summarize what I do.
But most dossiers start off requiring you to write a Teaching Philosophy Statement.
And this is where you may come up against a form of writing that is somewhat unfamiliar, unless you specialize in narratives or reflection.
Annual reports are coming up, and awards are being bruited about. So I thought it was timely for some ideas, tips and definitions for you, some from a much longer piece I’ve written on the Teaching Dossier for OHSE, and others from readings that have struck me.
(If you’ve done all your thinking and just want some writing tips, skip to TIP 4.)
Tip 1: Don’t do it…first
First of all, I suggest leaving your teaching philosophy alone until you’ve prepared some of the other parts of your dossier. So my tip is: Get your materials, your explanations, proof and evidence of your teaching together. Then…
Look through all your data. What similarities do you see? Any patterns?
What does this say about you as a teacher? What have your students said about you over the years? (or year, if you just started). What have your colleagues or your Course Director or Dept. Head said about your teaching?
These are all other parts of the dossier, necessary, and helpful to reflection.
Tip 2: Reflect
Yes, there’s that word again…Reflect. Or, if you don’t like to reflect, try: Analysing or recalling. You can also mull, ponder or ruminate.
I find it helps me reflect if I have prompts or hooks to anchor my thoughts. Try these 3 questions first, and just jot ideas down as they come to you. (You can “word splash”–just what the phrase says.)
Make your teaching philosophy personal to you
1) Why do I teach?
2) What do I want my students to leave my class with?
3) What do I believe my role is in the classroom?
Now try this: What in your experience and/or in your study of education has lead you to believe this? Describe your preferred approach, practices, and methods.
Need more help with your reflection?
Try these prompts to make your writing soar: (but don’t use all of them to write your statement or it will be a book, not a statement!)
- Put students first: In many courses on pedagogy, teachers are advised to place the students as learners at the centre or forefront of their teaching. If you begin with knowing how your students learn, how does that impact on you? What would be some of the first steps you would take in your classes?
- Learning: What is your definition of learning? How do you facilitate this in the classroom? How have your experiences influenced your view of learning?
- Teaching: What is your definition of an effective teacher? What are the roles and activities of an effective teacher? How do you challenge or engage learners? How do you teach? This should be a reflective statement describing your preferred approach, practices, and methods.
- Your teaching experiences: Think of times when you have been an effective teacher. What were you doing? Why and how? Times when you were ineffective? What were you doing? How can you improve that?
- Your teaching strengths: What are your strengths as a teacher? How will you capitalize on this? What are your weaknesses? How will you improve this?
And lastly, try these prompts:
- What are the chief goals you have for your students?
- What content knowledge and process skills, including career and lifelong goals, need your students achieve?
- How do you help your students achieve their goals?
NOTE: Please don’t try to answer all of these questions in one Teaching Philosophy Statement. Select a few that will guide you personally as they relate to you. See Tip 10 below in #4.
So what we’ve done so far is Collect, Select, and Reflect*. (*Sheila’s patented approach to dossiers and portfolios.)
TIP 3: Use and outline or a graphic organizer
Some people are gifted enough to have full statements spring full blown from their minds. I on the other hand, need an outline. Now, my outline is usually just a mass of words that I start organizing into themes. Thematic organization is actually just pattern recognition. However, you may find some helpers such as word clouds or concept maps useful. Here are some I found on the web as examples:
If we’re still using my approach, now we’ve done: Collect, select, reflect, connect.
TIP 4: 10 TIPS for crafting your writing:
i. Write in the first person with “I”, “my” etc.
ii. Some people use a metaphor to guide their statement. (teacher as coach, fitness trainer, gardener, strike a spark, not filling a pail but lighting a fire, tour guide, 911 dispatcher… Teaching is like….)
iii. Use the teaching philosophy statement as a guide to link with your responsibilities, strategies and effectiveness sections to form a cohesive dossier by drawing connections this statement.
iv. Buff or polish it to ideally 3-4 paragraphs—max. full page for physician educators’ teaching dossiers. (Some requirements are for 2 pages. That violates writing tip # 10.)
v. Provide specific supportive evidence, either from personal teaching experience or relevant teaching literature (See prompts above). Treat this like evidence in a study, if that expository kind of writing is more familiar.
vi. Use language appropriate to the audience.
vii. Work with another person as an editor and/or brainstormer. And view others’ statements as exemplars.
viii. Ensure that you can refer back to the key points of your philosophy in later components.
ix. If you can, make it a narrative, engaging and rhetorically effective text. Whoever is reading this might as well enjoy the experience.
x. Be brief and concise.
OK, I’m pushing it, but we’ve done all these steps: Collect, select, reflect, connect and now we’re beginning to “perfect” or “confect”.
I hope these are helpful tips and strategies for you. Please let me know if they are helpful and also if you have tips and strategies as well! Happy writing!
- Components of a Teaching Dossier, Queen’s OHSE.
- Elements of a Teaching Dossier: the Basics Centre for Teaching and Learning
- Writing a teaching philosophy
- R. Neil Johnson. Assessment Rubric for Teaching/Learning Philosophy. Schreyer Institute for Teaching Excellence. Penn State University.
- My Philosophy
Fall Education Retreat set for December 6
The annual UGME Fall Education Retreat will be held December 6 with plenary and breakout sessions designed to help our faculty improve their teaching and assessment skills as well as to provide opportunities for networking and informal discussions.
The retreat brings together course directors from pre-clerkship and clerkship, unit leads, intrinsic role leads, and administrative staff who support the program. Session topics were developed based on course evaluation feedback, faculty team suggestions and accreditation priorities.
The full-day program will be held at the Donald Gordon Centre on Union Street.
New to the program, this year’s retreat will feature guest speaker Dr. Jay Rosenfield addressing the topic of The future of medical education in Canada and our places in it. Dr. Rosenfield is a professor of paediatrics (and former vice-dean, MD Program) at the University of Toronto and a Developmental Paediatrician at the Hospital for Sick Children and Holland-Bloorview Kids Rehab.
Associate Dean Dr. Tony Sanfilippo will provide an update on UGME news and initiatives and two other plenary sessions will address using a competency-based education lens to frame completion of Years 1 & 2 and incorporating principles of diversity in the curriculum.
Break-out workshops will address effective SGL sessions, Entrustable Professional Activities (EPAs) in clerkship, creating key features questions and improving resident teaching of clerks.
For more information and to register, click here.
- Credits for Family Physicians: This Group Learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by Queen’s University for up to 5 Mainpro+ credits.
- Credits for Specialists: This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada, and approved by Queen’s University, You may claim a maximum of 5 hours.
- Credits for Others: This is an accredited learning activity which provided up to 5 hours of Continuing Education
Applying decluttering principles to learning event planning
My family and I recently relocated from a 2300-square-foot, five-bedroom house to an under-1100-square foot, three-bedroom townhouse to be closer to my son’s school and my office at Queen’s. This has required divesting ourselves of a great many belongings. Some things were easy (no more guest room = get rid of bedroom suite of furniture), but now we’re down to what home organizers call decluttering.
Near the beginning of my downsizing project, a colleague passed along a copy of one such book, Marie Kondo’s The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing. (Yes, there was some irony in acquiring a new book when I was purging others, but that’s another story).
In this bestselling book, Kondo sets out principles for determining how to declutter. Since I’m immersed in decluttering (and unpacking can be a mind-numbing task) I started thinking about applying Kondo’s principles to learning events.
Decluttering principle: Uncover what you want your space to be
Learning Event translation: Uncover what you want your learning event to be
What underlies this principle is visioning: think about what it is you want your learning event to look like before you start making changes. What do you need and want to accomplish in your 60- or 120-minute session? What are your assigned learning objectives? Keep in mind this planning cannot be a solo activity as your events are connected to others – course directors need to balance topics and learning event types throughout a course, so check in with anyone impacted by changes you’re thinking about making. Do you want to add interactive components? Revise case studies? Improve group work? Streamline the order of MCC presentations?
Decluttering principle: Only keep those items that give you a “spark of joy”
Learning Event translation: Only keep those activities that spark learning
Take a good look at the activities and materials you’re using in your learning event: are these aligned with your objectives? Do they provide meaningful learning for your students? Are the points clear? How many cases are you using? Would it be better to have three well-constructed, in-depth cases, or the five you’re currently using? Are you being deliberate in what you’re including, or just force of habit?
Decluttering principle: Have a designated place for everything
Learning Event translation: Have a designated time for everything
Consider making a timeline plan for your learning event to keep everything “in its place.” This doesn’t have to be rigid to the last second, but can help keep things on track. If you have an outline that includes each topic or case, discussion/question time, breaks, wrap-up/summarizing time, it will help keep you on track and ensure finish on time. It also helps let you know when to wrap up discussions (no matter how interesting) to move onto the next important point.
* * * *
Not everyone can – or should – dive into decluttering their home (see this New York Times opinion piece which argues very clearly that there’s class politics involved in the decluttering movement). Likewise, not every learning event is in need of decluttering. However, if you’re frequently going over time, or find that you’re not meeting the learning objectives you have, or you’re just generally dissatisfied with your teaching sessions, decluttering may be a place to start.
One caveat: Decluttering can’t be done in a vacuum – either at home or for a learning event. For every fan of Kondo’s work, there are partners, children and other relatives who complain (rightly) that stuff they needed, wanted or sparked joy for them has been summarily tossed by an obsessive tidier. If you’re interested in decluttering your learning events on a larger scale (for example, does this MCC presentation even belong in my session?), that necessitates conversations and cooperation with your course director and fellow instructors and I’m happy to pitch in, too.
On boy doctors, girl doctors, and advocating for my son
“I hope it’s a boy doctor.”
It was the spring of 2014, and I was walking with my then-10-year-old son from our car to our family health team’s office. Our doctor is part of the Queen’s Family Health team, so we often see residents rather than our assigned physician. For this reason (and because I don’t ask about the schedule when I book appointments), we don’t always know the gender of the person who’ll be providing care on a specific day. (We can always ask to see our doctor, however, I’ve never done this. I’ve always bought into this model of medical education – even before I started working as an educational developer in the undergraduate medical program).
It had never mattered to my son. Until that day in April.
We were heading to an appointment about recurring rectal bleeding. He had first presented with this on New Year’s Day. The digital rectal examination at the child out patient clinic the next day was an uncomfortable experience that he now refers to as “the butt thing”.
If they’re going to do “the butt thing” again today he wants a boy doctor, he said.
“You know,” I said, matter-of-factly (or at least I attempted to be matter-of-fact), “at the Med School where I work they teach boy doctors and girl doctors all the same things. They all learn how to look after everybody.”
“Yeah, I know,” he said. “But if they do the butt thing, I want a boy doctor.”
My son has autism. He’s seen multiple physicians, therapists and interventionists in his short life. Until this point, he had never commented on their genders. This was a new request. I had until his name was called to sort out for myself what I would do.
There was a flurry of news reports the previous fall, in October 2013, about whether patients should have the right to choose their physician based on race, religion or gender. (See here and here for some of this coverage). The news hook was a position statement by The Society of Obstetricians and Gynecologists that argued its members should resist such requests in emergency and other after-hours situations.
Perhaps because the articles were focused on obs/gyn, much of the commentary that followed focused on women, immigrants, and others with religious concerns. I can’t recall any discussion about children and their preferences in the gender of a treating physician. Until that day in 2014, I’d never given it any thought myself. My kids have been “stuck” with whichever family physician I’ve found for us.
Until my son’s request for a “boy doctor.”
Is this a reasonable request? Is my job as his mother to convince him that physicians of either gender will provide him with great care and that he should feel comfortable with either gender? Or is my job to talk with the clinic staff, explain his concerns, and ask to see a male doctor on duty that day?
The resident we were scheduled with that day was, indeed, the “boy doctor” so I was let off the hook of having to ask to have the attending (male) physician replace the other (female) resident. As a woman, as an educator, I’m uncomfortable with the idea of that conversation. As a mother and my son’s advocate, I think it’s something I would have had to do to support him in his request for a “boy doctor” for this invasive examination.
While I was happy to be off the hook that day, I have yet to resolve this conundrum. Is it reasonable for patients (or parents of patients) to make such requests? If gender requests are OK, are other requests OK, too — race, religion, age? Are children a special case?
In my role as an educational developer, I take these mental musings further: What does this mean for medical education? Do our students need special instruction on how to address these patient concerns? Would I have more or fewer reservations speaking up on this for my child if I weren’t involved in medical education? Are there other parents who feel they can’t bring things like this up for other reasons? Is this a problem? How can this be addressed?
These are questions I’ve continued to wrestle with and I suspect I will for a long time. What do you think?
Recognizing our Course Directors
“The People Who Make Organizations Go – or Stop” was the intriguing title of an article that appeared in the Harvard Business Review in 2002, authored by management experts Rob Cross and Laurence Prusak. In it, they describe the key people and largely informal networks that are necessary to the functioning of any organization, regardless of its purpose or product. They make the point that the success or failure of organizations can usually be attributed to the effectiveness of a group of key people they refer to as “central connectors”. In their own words:
“In most cases, the central connectors are not the formally designated go-to people in the unit. For instance, the information flow… at a large technology consulting company we worked with depended almost entirely on five midlevel managers. They would, for instance, give their colleagues background information about key clients or offer ideas on new technologies that could be employed in a given project. These managers handled most technical questions themselves, and when they couldn’t, they guided their colleagues to someone else in the informal network—regardless of functional area—who had the relevant expertise. Each of these central connectors spent an hour or more every day helping the other 108 people in the group. But while their colleagues readily acknowledged the connectors’ importance, their efforts were not recognized, let alone rewarded, by the company. “
In a medical school, these critical central connectors are called Course Directors. They are the folks with the practical knowledge, functional relationships and, importantly, “street cred” required to translate the high level educational goals of our program into the multiple packets (courses) of education that, in aggregate, will come together to produce the fully formed graduate, ready for residency and great things beyond. Their job is basically to take a subset of the overall program objectives that are assigned to them by the Curriculum Committee, and develop the multiple components of teaching and assessment designed to ensure our students achieve the objectives. In doing so, they must engage and coordinate the efforts of their professional colleagues, other members of the educational community, educational specialists and our administrative support staff. By effectively orchestrating all these efforts, guided by the “score” provided by the curricular framework, they develop an effective and coordinated educational experience for our students. They are truly “connectors” as described by Cross and Prusak. They are absolutely indispensible to the success of the program.
Last week, we recognized the contributions of four of our Course Directors who are moving on from those roles, three of whom are retiring. Fittingly, students, representing those who had benefited so greatly from the efforts and dedication of these remarkable people, provided the tributes. In their words:
Elisabeth Merner, Meds 2019, speaking on behalf of Dr. Jennifer MacKenzie:
It’s a pleasure to thank Dr. Mackenzie for all of her work as the inaugural Co-Director of the QuARMS program on behalf of the QuARMS students.
Most people have heard of the QuARMS program, but very few people understand the QuARMS vision as well as you do, Dr. Mackenzie. From the very beginning of the program, you helped to deepen students’ understanding of the role of the physician, the qualities of a leader in the medical community, and the values and ethics that are to be upheld in medicine.
For some, it would be daunting to teach these topics to a group of teenagers, but you were more than ready for the challenge. Your passion for education and innovation has been clear to all of us. We appreciate the fact that you attended every single three hour Wednesday session for the first two years of the QuARMS program. Honestly, with young adults of your own, we would have understood if you claimed that you had administrative duties to perform and missed out on one or two of the sessions – but you were there, leading by example.
We also recognize your role in designing the QuARMS curriculum, which is unlike any other program in Canada. Through service-learning projects, you helped students to understand the importance of social accountability within the medical profession. You also led a transformation in how students think about volunteer work. Your vision and your values have shaped the QuARMS program. Thanks to you, service-learning projects have now become a much more important part of our medical school here at Queen’s.
On behalf of four generations of QuARMS students, we want to thank you, Dr. Mackenzie, for your tireless dedication to the development of the QuARMS program and to shaping our lives, both as future professionals and as mature students.”
Jeff Mah, Meds 2019, speaking on behalf of Dr. Conrad Reifel,
Let me start off by saying, anatomy is one of the most overwhelming topics in medicine. From head to toe, there is a seemingly endless number of muscles, bones, nerves, blood vessels and organs that each serve a specific purpose and thus need to be learned. Needless to say, without a good teacher, this subject can be very difficult to master.
At Queen’s, we have been extremely fortunate to have had Dr. Conrad Reifel as an anatomy instructor for the last 43 years. Over his time here, Dr. Reifel has guided thousands of medical students through the vast, unfamiliar world of gross anatomy and has done so with patience and commitment. What I always appreciated about Dr. Reifel was his ability to take an area of the body that is incredibly complex and systematically break it down so that by the time he finished talking, it seemed quite manageable.
Dr. Reifel also has a fantastic ability to keep a class engaged even when teaching a somewhat dry topic with his unique sense of humour and vast repertoire of personal anecdotes. I’ll never forget Dr. Reifel, standing at the front of the class with his arms outstretched using his own body to demonstrate the anatomy of the uterus. While the memory of that lecture does conjure up some odd images, I’ve never had trouble visualizing the uterine anatomy since then.
Dr. Reifel, on behalf of the medical students of Queen’s University, past and present, thank you for the decades of excellent instruction. Please know that you are respected and loved by the students you have taught and have positively impacted the lives of so many. You will be truly missed and we wish you all the best in your retirement.
Calvin Santiago, Meds 2018, speaking on behalf of Dr. Lewis Tomalty
Dr Tomalty has been teaching in the Mechanisms of Disease course since 2010 and took over as Course Director in 2012. In this role, Dr. Tomalty worked tirelessly to make improvements to the course. He attended all the MoD lectures and met weekly with the class curricular reps. He set up consultations with students and faculty, organized a strategic planning curricular retreat and established a framework to link together a diverse range of subjects including pathology, immunology, microbiology and infectious disease.
In addition to his role as Course Director for the Mechanisms of Disease Course, Dr. Tomalty also previously served as Vice Dean of Medical Education for the Faculty of Health Sciences and is the current Chair of the Course and Faculty Review Committee. As well, Dr. Tomalty is heavily involved in global health initiatives and provides his consultation services on infection control in Mongolia.
On a more personal note, and speaking on behalf of the many students who have had the privilege of knowing him over the years, I have found him to be an absolute pleasure to work with. Even in his last year as the Course Director, he still met with the curricular reps on a weekly basis to discuss ways to fine-tune an already well-received course. I know from their stories that they looked forward to these meetings with Dr. Tomalty, calling it their weekly “T-Time”. To quote another student, he is the “bestest, most efficient chair of a meeting ever.” I look to him as an exemplary role model of a leader and educator and as an inspiration for stylishly funky socks.
Dr. Tomalty, thank you so much for your leadership as Course Director and I wish you all the best in your future endeavours.
Kate Rath-Wilson, Meds 2019, speaking on behalf of Dr. Chris Ward
Dr. Chris Ward was one of the inaugural course directors for our new curriculum when it was introduced in 2009, and was responsible for developing and consistently aiming to improve the Normal Human Function course in Term 1. He has coordinated multiple faculty members, built a strong curriculum for the course, been part of the initiative to bring in Drs Moffatt and Parker to apply physiology to cases (which has added immeasurably to our learning), and helped to build introductory physiology modules for students struggling with physiology. This led him to be asked to join many, many, many UGME committees, including (but not limited to) the Curriculum Committee, The Teaching, Learning and Innovation Committee, and the Student Assessment Committee – currently, Dr. Gibson believes this to be a record for any one course director. He was instrumental in preparing our brief for the CACMS/LCME accreditation, reviewing all the sections that pertained to foundational science and its impact across the curriculum. Dr. Ward is known at Curriculum Committee for being the person to move that the meeting be adjourned! It started with only a few times, but now we look to him for this and he’s become everyone’s favourite motion-maker!
As a medical student, I have not had much of a chance to get to know Dr. Ward personally. His name will always be associated with hypovolemic shock for me – which some may deem as unfortunate but I think is one of the highest honours a teacher can be granted. He elucidated complex cardiac physics with clarity and patience, and acted as a model to the other professors in his course. He expertly managed a complex course, juggling the schedules of many faculty members and even more stressed out A-type students.
Dr. Ward has worked tirelessly behind the scenes to build our medical curriculum from the bottom up. This is a position that often lacks glory and recognition. We owe Dr. Ward a lifetime’s worth of thanks. The positive impact he has had as director of the Normal Human Function course on his colleagues and his students is immeasurable, and we thank him today for his contributions to the foundational medical knowledge of hundreds of medical students and wish him all the best for his future work.
Let me add my thanks and personal appreciation to those of our students. I’d also like to acknowledge the ongoing efforts of all our Course Directors, who carry out their roles so effectively and provide those key “central connections” so essential to our program.
All photographs by Lars Hagberg
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Reflections on reflection on reflection
Hi all: I’m back from a few weeks at our family cottage near Sudbury. Now for those of you from north of Parry Sound, you know that it’s not a cottage, it’s a camp, but I’m translating for all the Southerners here at the UGME blog.
I find that there’s nothing like total exhaustion from installing a new water pump, sanding and staining a deck, staining 6 new Muskoka chairs, and bringing water by hand, up a steep hill, to the garden which one has foolishly planted up that hill. I find total exhaustion quite conducive to reflection. I simply sit and stare at the water. After awhile, my brain starts to work again, and after solving basic issues like food and water (shades of Mazlow), I can even start to get creative. I think about what’s gone wrong, or what needs to be better and I plan. I can plan a brand new cottage (hah!), a new way to pump water (hah!), and even a new garden location. I can plan things to say to my husband when he says, “These Muskoka chairs are so cheap—we couldn’t build them for this money. Let’s get 6.” And then, furtively, because UG at Queen’s is never far from my thoughts, I can even start to reflect on things at UG, and plan to make things even better.
Now this urge to action based on reflection is my favourite perspective on reflection. Unfortunately, I’ve never been one to meditate, or think about the moment, or think about nothing, or “relax”. (However, I did take Dr. John Smythe’s 6 week course on mindfulness and just to show you how good he and the course are, by week 6, I found I actually could be mindful, focus on an object and poof! Gone for 15 minutes! I highly recommend it, and I try very hard to put his precepts into practice!)
But generally, I’m a Kolb-ian. I like Kolb’s model of experiential learning—it speaks to me as a call to action. He advises, in essence, to act, reflect on the action, take it to other reference points and then make an action plan. I think I’ve shown you this before, but just in case…:)
So, on what did I reflect, in my moments of recovery from projects at the cottage? (Did I mention my perennial and consistent devotion to ridding the cottage of mice droppings as part of my activities? I abstractly conceptualize that as draining the ocean with a teaspoon. (See Stage 3 above.)
Well, one thing I did was bring a book that I promised I’d give you some feedback on, up to the cottage. It’s entitled English and Reflective Writing Skills in Medicine by Clive Handler, Charlotte Handler and Deborah Gill (CRC Press). I took some great things from this, to share with you. They are reflections and pieces of reflections, morphed into this article, which is something I strongly advice with reflection. Reflections are private. An action or a blog article, for example, is something that can be crafted from reflections into a public piece of writing.
One thing that really spoke to me was the list of areas and experiences that can generate good critical reflection especially for learners in medical education. I think, too, that even for experienced practitioners these questions can trigger reflection.
About a patient:
- A patient happy or unhappy with their treatment by you or others
- A question of confidentiality, consent or inappropriate risk
- Doing something for the first time
- Communicating with older or frail people
- Consultations involving more than one person (for example, a relative)
- Sudden death or deterioration
- An aspect of a patient encounter that revealed gaps in your knowledge or skills
- An even that caused you anxiety or enjoyment
- An aspect of care that left you surprised, puzzled or confused
- A patient that challenged our assumptions or whose actions are at odds with your personal beliefs and values
About the team
- When you feel an aspect of the treatment or management is wrong
- A dysfunctional team that affects patient outcomes or experiences
- The actions of a team under pressure
Good medical practice
- Times you have exhibited good medical practice or found yourself in a situation that may be at odds with good medical practice
- Times when you have seen medical practice or behavior that may be at odds with medical practice. (pp. 6-7)
What do you think?
Now the authors also tackle the dicey area of marking and giving feedback on reflective writing. Medical students are often extremely concerned about who will see their reflective writing, and whether that will impact on the faculty member’s opinion of the student. This seems to me to be quite understandable, and it’s why I mentioned above, that taking a reflection and crafting it into a set of goals or more concretely, an action plan, with some work already done, is often a very positive spin to put onto a problem area that a student has identified. I used to tell my education students, “It’s not a question of whether any of us will make a mistake or not. It’s a question of how we recover, and deal with the mistake that makes the good teacher.” I think that is also true of the good doctor.
So…in order to create an action plan the authors advise using the Kolb cycle but changing it slightly to:
- Identify and describe a professional scenario
- What are the perceived consequences of these behaviours?
- What are the implications for professional practice? [Sheila’s note: at this point I would challenge students to walk the walk and provide some evidence from medical and medical education literature to demonstrate the implications and help provide solutions for 4.]
- What evidence can you provide to show how you have used this experience to develop your practice and inform your behavior in professional scenarios? [Sheila’s note again: OR What is your plan of action to change the behavior?] (p. 12)
At this point the book delves into how to assess the writing skills of the students and it’s full of good advice about grammar and tons of examples of reflective essays.
Speaking of assessment, I’ve been hearing that some students don’t feel that receiving feedback on the lack of clarity and the amount of spelling and grammar errors in their med ed writing is within the realm of medical education. Well, it is one of our Curricular Objectives (CM 1.3a: Provide accurate information… in a clear, non-judgmental and understandable manner.) And I can only imagine what you readers are saying to yourselves right now, about the importance of clear writing in transitions of care, etc.
What I do have for you is a row for a rubric I created for clarity of expression. So should you ever be assessing student writing, and want to use it, feel free.
10 prompts write reflections
Lastly, here are some ways to write about reflections that give a format or form to the thoughts. Students may find these more enjoyable, or at least more guided. What do you think? Do you have others?
- So What? Journal: Identify the main idea of the lesson or incident. Why is it important? Why is it important to others?
- Analogy (or Simile): Explain the main idea using an analogy. (Has the benefit of making everyone look up “analogy”.) OR could be explain this idea as a simile: It’s as if, or it’s like… Then, folow the thread of the anaology or simile.
- Question Stems
- I believe that ________ because _______.
- I was most confused by _______.
- What surprised me was _______
- A patient (a nurse, a physiotherapist, etc.) would see this incident as _____________.
- When I read up on this, here was one interesting solution____________
- Muddy Moment: What frustrates and confuses you about this incident? What will you do about it?
- Double Entry Journal: Jot down main points, questions, etc. in left hand column. In right hand column write about these, including actions for the future
- Twitter Post: encapsulate in under 140 characters.
- Praise from your Mother (or Father or other person who loves you): “My son’s (daughter’s etc.) done this_______” (In other words, have someone else brag about you if you won’t.)
- Top Ten List: What are the most important takeaways, written with humor?
- Quickwrite: Without stopping, write what most confuses you. Use a concept map or other format to try sorting it out.
- If I were writing a blog about this ____(opinion, incident, topic), I would write__________________.
(Adapted from “Dipsticks: Efficient Ways to Check Understanding; http://www.edutopia.org/blog/dipsticks-to-check-for-understanding-todd-finley)
Well, those are some reflections on reflections from my time up North. I’ve also partially solved the mouse dropping problem (all the dishes are now in bins when we leave!) And I’ve figured out what to say to my husband when he advises buying 6 chairs we have to build and stain: “You are right, dear!” (because he was right, and they look awesome!).
I’ve also once again realized how rejuvenating short physical projects can be (they have an end! 🙂 and how much I love to sit by a lake and think. I just have to figure out how to keep this reflective spirit going all year long! As for the water pump…well, maybe part of the reflection is that some things you just have to live with!
Any reflection on reflections to share? Feel free to write in!
Teaching the Way You Practice: Collaborative Active Learning in Different Teaching Settings
By Michelle Gibson (firstname.lastname@example.org) and Melissa Andrew (email@example.com)
Most health professionals are actively engaged in collaborative practice: working with many different team members from different disciplines to support patients or clients in achieving their health goals.
However, we often teach our learners in isolation from one another, and, if we are being honest, co-teaching and integration between disciplines in an educational setting can be challenging. When it ‘works’, however, it is very rewarding, and it is an opportunity to role-model explicitly for learners how different disciplines with differing approaches can work together to enhance care. When co-teaching is combined with active learning that mimics the wonderful messiness of real clinical practice, learners can start to envision how complex problems are approached in “real-life”. In our experience, this is particularly powerful when we have students also working in teams on complex, real-world cases.
We offer up tips and lessons learned in six years shared teaching between geriatric medicine and geriatric psychiatry in undergraduate and post-graduate settings, to different audiences. We have also co-taught with other health care disciplines but our examples come from our co-teaching.
Examples of what we teach together:
- Second year medical students: We built on-line modules for students to use first on dementia and delirium, and then we co-teach the session that applies this learning to real-life cases. Dr. Andrew co-teaches a 2nd session on “Brain and Behaviour” with a psychogeriatric resource consultant.
- Family Medicine residents: We have 2 half-days which deal with common, complex, outpatient problems in older adults: the patient who arrives on a Friday afternoon with falls, confusion, and a letter from an anxious daughter; the patient who is extremely cognitively impaired, falling frequently, with a nightmarish medication list, and no family members who can provide history; this same patient who has a valid drivers’ license, and who may or may not be depressed.
Tip # 1: Start with being clear about your purpose(s), goals, objectives.
While this is important for all teaching, it becomes essential when more than one individual is involved. For example, when we started to design academic half-days for family medicine residents, we worked out that we were aiming to help them approach complex patients with multiple problems in an outpatient setting, while highlighting how geriatric psychiatry and geriatric medicine are similar, how they are different, and how we work together. These sessions work best with a shared vision.
Tip #2: Be explicit about roles and expectations.
Similar to Tip #1, this does get increasingly complex when more than one (extremely passionate and very dedicated) teacher is involved in any learning event. Who is preparing what? By when? How are the different parts going to be taught? There is nothing worse than realizing the day before that you were the one expected to prepare the quiz. J
Tip #3: Avoid ‘parallel play’.
Some attempts at integration or co-teaching end up being a series of lectures or teaching sessions that happen to be scheduled in approximately the same time period and are not really integrated. The best sessions involve a back-and-forth approach, with many opportunities to address areas of controversy in a respectful manner. (See Tip #4)
Tip #4: Embrace controversy, respectfully.
Junior learners in particular, in our experience, become stressed when it appears there is no one “right” answer. We live, wallow, and celebrate the land of the gray-zone in geriatrics (pun intended), so we rarely have one correct answer. However, how we address this in our teaching is important. We frequently check in with one another: “How would you approach this in your setting?” and acknowledge strengths in differing approaches.
Tip #5: Embrace complexity, carefully.
We have been pleasantly surprised as to how groups of learners are able to work together to approach very complex cases, when there is a safe learning environment. For example, we give learners a very complex medication list, while providing an approach for them to practice, and we emphasize that there are many ‘right’ answers. When we debrief this exercise, we use our different backgrounds/expertise to help students navigate the pros and cons of different decisions. The team setting for teaching appears to allow students to feel safe to address areas of discomfort – that wondrous gray zone in which we revel. We all consult when there is a great deal of complexity, and we should role-model this for our learners.
Tip #6: Play your best cards.
This is a great time to determine who is best at which parts, and use these skills to your advantage. This applies both to clinical expertise, but also to teaching styles: who is the best person to teach X? Who is better at addressing this particular issue? Why not compensate for each other’s’ weaknesses? You also have the huge benefit of learning from your colleague.
Lesson #1: It takes more time up front, but less time the more you do it. The discussions, planning, negotiations about “what is the way we want to approach X” does require more time initially, but it gets easier each time.
Lesson #2: If possible, it’s best (in our opinion), and more fun, to co-teach with people that you work with regularly. The established trust and long-standing respectful relationships, we believe, shine through for learners, allowing them to feel comfortable when we ‘disagree’ on certain issues. This is much easier to do in a collegial way when you know how the other teachers work and think. Plus, teaching with friends is fun.
Lesson #3: Going out for lunch to plan teaching is optimal. ‘Nuff said. Seriously, though – it’s hard to plan teaching in the midst of busy clinical work. Set aside time to think about things, and to meet in a positive environment.
Lesson #4: Where there is assessment involved, co-marking is hugely informative – as in, set aside time, sit down together, and mark together. It allows us to delve into why students thought X, when clearly we thought we were teaching Y. There is also the distinct advantage of being able to share the marking load, whilst sipping on pleasant beverages. More importantly, though, by discussing the answers, we are able to immediately adapt our teaching plans for the following year.
From Bookends to Bookcases: On Finding Some Great Summer Reading
Oh hello! Still in that hammock from our last blog?
Well don’t worry—this time I’m not here to get you up to plan next year’s courses. 🙂 I do have more to say about bookends, but that can wait until closer to September, when you start planning your classes.
For now, I’m here to help with your summer reading list to fill up your bookcase. I’ve asked a few colleagues for ideas, and (as always) I have some ideas of my own.
Dr. Lindsay Davidson contributed: Getting started with TBL by Jim Sibley http://learntbl.ca/book/ as an excellent way to introduce yourself to teaching with small groups as we do in Queen’s UGME.
Dr. Sue Fostaty-Young contributed one of her go-to books on teaching: Therese Huston’s Teaching What You Don’t Know. Sue says, Intended as a book for new and junior faculty members who frequently have to teach large service classes that may be far removed from their areas of interest or expertise, the book is simply one of the best all round books on teaching that I’ve come across.
Paola Durando, librarian at Bracken suggests: How to Teach: A Handbook for Clinicians (Success in Medicine) 1st Edition by Shirley Dobson, Michael Dobson, and Lesley Bromley. (Now in Bracken Library!)
Sandra Halliday, and Suzanne Maranda, also librarians at Bracken, remind us about the reading guides for medical education: http://guides.library.queensu.ca/healthed A quick skim of this really great resource turns up some intriguing titles: Medical education : a dictionary of quotations by Kieran Walsh, Medical Education: theory and practice with Tim Dornan, Karen V. Mann, Albert Scherpbier and John A. Spencer (Editors) (I think I’ve mentioned this one before—it’s another what I call a great “Dipping” book and anything by Karen Mann has my vote),
Dr. Richard Van Wylick contributes these 4 books. He says,
- This one got me off to a good start: Guidebook for Clerkship Directors:
- I have not read it yet, but was recommended and I certainly need help personally with this these days!: Make it Stick by Peter Brown: (Sheila’s note: I’ve read this and it’s really helpful, practical and interesting for teachers as well as learners—turns traditional teaching “beliefs” on their head. Here’s what Amazon says, Many common study habits and practice routines turn out to be counterproductive. Underlining and highlighting, rereading, cramming, and single-minded repetition of new skills create the illusion of mastery, but gains fade quickly. More complex and durable learning come from…
And now you’ll have to read it! SP)
- This is a light read,with funny short anecdotes and stories: The Surprising Lives of Small Town Doctors:
- And well, because I have two of them: The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults by Frances Jensen with Amy Ellis Nutt: https://www.amazon.com/Teenage-Brain-Neuroscientists-Survival-Adolescents/dp/0062067842
Sheila’s completely idiosyncratic picks:
- As for me, I’ve finished dipping into The Question of Competence: Reconsidering Medical Education in the Twenty-First Century, with Brian Hodges as editor. With Competency-Based Education so critical, it’s a great book to get at some of the implications of CBE and it truly is dippable—you don’t need to read it cover to cover in one setting, but can dip into chapters as interest guides you. I call these my “Dipping” books.
2. Someone recently gave me Gratitude by Oliver Sacks (Thanks SM!) which has motivated me to pick up his Musicophilia: Tales of Music and the Brain. I find him an inspiring writer so I’m looking forward to reading this. And Gratitude is certainly worth picking up for its three lovely reflections.
3. Recently, one of our faculty heard that it wasn’t her job to comment on students’ spelling, grammar and syntax as a medical educator. That’s actually not correct (it’s in our Red Book objectives) but to bolster the case, I found this book by Clive E. Handler that looks interesting: English and Reflective Writing Skills in Medicine: A Guide for Medical Students and Doctors. I’m ordering it to read over the summer so I can let you know. But anything that has writing skills and reflection in the same title is a hook for me!
4. Because I’m fascinated by the odd reputation that reflection has in medical education, (I’ve seen medical students blanch and strong doctors flinch at the term :), I’ve been dipping into A Teacher’s Reflection Book, Exercise, Stories, Invitations by Jean Koh Peters, and Queen’s own Mark Weisberg. I’ve just finished Chapter 5, The Teacher and Vocation (I have a bad habit of reading chapters out of sync—I read Margaret Atwood’s Alias Grace, from the end backward—turned out to be a great book!). While the word vocation might make some shy nervously, I’m really liking the exercises. It starts off by asking “What if you had nothing to prove?” What a great question!
Since I’m reflecting on writing about reflecting for a later blog, I’ll save the full review for later, but try this one exercise: Write your personal mission statement or your “call” as a bumper sticker. And here’s a teaser. There is a paradigm shift in viewing your teaching as a vocation rather than a career. Here’s one example: Career = Who am I? What’s in it for me? Vocation = Whose am I? Who am I in teaching for? (James Fowler).
I’ve just started reading When Breath Becomes Air by Paul Kalanithi. Isn’t it a wonderful book? I also have a bad habit of reading 3 books at the same time, but this one is maintaining first place in my reading triad easily! When Breath Becomes Air is a memoir chronicling Paul Kalanithi’s life as he studies at Stanford University, and then at Yale University’s medical school. Kalanithi is close to finishing his training as a neurosurgeon when he is diagnosed with stage IV lung cancer. This is a haunting book for me and one that is inspiring me as well.
And last but not least, because summer and especially vacations are a great time to exercise your right brain, and because she’s a favourite author of mine, may I recommend: The Virginia Woolf Writers’ Workshop: Seven Lessons to Inspire Great Writing by Danell Jones? This is another great dipping book, and I’ve tried each of the exercises—so much fun!
What about you? What great books are you heading for this summer? Feel free to write in with your suggestions! And thanks to my colleagues for their suggestions!
Hope these give you some ideas so you can climb back into that hammock and bury yourself in many good books this summer! Have a peaceful, restful, reading-ful summer and I look forward to seeing you come the fall.