Month: March 2014
MD Program Executive Committee Meeting Highlights Wednesday March 19, 2014 at 4:30 pm
AAMC Curricular Inventory – UPDATE: Data for this initiative was not submitted as it was felt that the submission did not adequately reflect the curriculum. The problem was a result of the categories available for mapping of our instructional methods to the LCME methods. Work will continue on this project with the hope that submissions can be made in the future.
Draft Accommodation Policy – The Director of Progress, Promotion and Remediation presented a draft Accommodation Policy for review. This policy is intended to provide guidance when an applicant or student requests accommodation due to a long term, short term or progressive disability. Requests for Accommodation will be vetted through an Accommodation Subcommittee which will recommend an accommodation plan to the Progress, Promotion and Remediation Committee. The Committee made several recommendations for changes. A revised version of this policy will be posted for faculty review shortly prior to final approval.
Course and Faculty Review Process – The Director of Curricular Review presented a revised process for disseminating reports from the Course and Faculty Review Committee (CFRC). This process will improve the flow of information and provide increased efficiency to the CFRC reporting process. Through this revised process, reports indicating problems such as significant resource issues, repeated negative themes or potentially high risk issues will be reported directly to MD PEC for resolution. Revised terms of reference for the CFRC will be developed to reflect this new reporting structure.
Next Meeting: April 16, 2014
What students have to teach us about lectures
On Feb. 20, 2014, as part of the Queen’s Medical Health Talks, a group of first year students gave a lecture to the community about heart health one of a planned series, with the next coming up March 27. It was a terrific presentation and the students had obviously worked very hard at putting the medical expertise together. I learned a great deal about heart health and obviously from their questions, so did other members of the audience.
But the students taught about more than medical issues. They taught about what makes a good lecture.
Now I know it’s a little conservative in these days of flipped classrooms, collaborative learning, and other very effective teaching and learning methods. And I know that there are alternative and often better ways to teach and learn depending on the purpose. I for one am a proponent of collaborative learning (such as our FSGL and SGL) and it’s the way I have taught about 70% of the time—again depending on why I was teaching. But there is still room for a lecture and there are methods of effective lecturing. The students taught us that last Thursday. I’d like to use their successes as a way to share with you some ideas about effective lecturing.
So…lectures…Their meaning derives from the medieval times: from the late Latin “lectura”, a reading (from Latin “lectus” to read.) In the medieval times with limited written texts, one person would read from the text to a group, who would take notes or more often, commit to memory. The lecture format evolved (traditionally) from that, with the meaning: “a discourse on a given subject before an audience for purposes of instruction” evolving from 1530s. (online etymology dictionary http://www.etymonline.com/index.php?term=lecture )
Have things changed since then?
Well, the purpose of lectures is still to instruct, but with these caveats:
If lectures are devised and delivered properly, there are several purposes for them. Donald Bligh offers these in his work, What’s the use of lectures? (Bligh, 2000)
- They are an effective way of providing information that is not available from other sources
- They can be cost-effective for transmitting factual information to a large audience
- They provide background information and ideas, basic concepts and methods that can be developed later by private study, or in small tutor-supervised group activities
- They can be used to highlight similarities and differences between key concepts
- They can be a useful way of demonstrating processes.
McKeachie and Svinicki (2006) note that lectures:
- Are appropriate for communicating up-to-date information on the most current research;
- Can efficiently synthesize related information from scattered sources rather than sending students out to seek them on their own—a particularly useful technique for novice learner embarking on a new topic;
- Can motivate students to learn more about the topic, particularly if the lecturer shows enthusiasm for the topic.
Thus, harkening back to our February Medical Health Talk, our students Nothando Swan, Nadia Gabarin, Matthew Haaland, Rajini Retnasothie and Tyson Savage, all class of 2017, gave an excellent example of an effective lecture to provide background information and basic concepts, efficiently synthesized a great deal of information and certainly motivated me with their enthusiasm.
Let’s look at 4 points of what they did as a model for an effective lecture for all of us to follow. I’ve listed each point, shown how the students did it, and then provided a “How to do this” piece for each. They’re listed in chronological order of planning a lecture, and point 3 is a critical one for teachers. Along the way, I’ve sprinkled some resources.
I. Work with others to plan: First, the students gave an excellent example of team teaching and planning. It was obvious they had planned together how to divide up the work, and how to present the work. They were seamless in their presentation and each knew what the others had discussed, and referred often to it.
Context: The lesson here is not only for team teaching, although that is an effective method of teaching and planning, but for the way we have to teach within our medical courses where there are many teachers in one course. Ideally members of the teaching faculty within a course would know what each other is teaching, and can make reference to this. They also would know their place in the curriculum, and what has come before, and what is coming next. These are important initial steps for all teachers and we have some excellent examples within our curriculum.
How to do this: faculty can request a curriculum search from the UGME Ed Team, or can try one themselves, inputting key words into the search field in MEdTech: https://meds.queensu.ca/central/curriculum/search The Course Directors and Year Directors can often provide context along with the Education Team, for individual teachers. Working to locate your teaching within the context of a course, or the entire curriculum is an important aspect of any teaching.
Level of Learners: Another part of the students’ planning involved how to align the teaching with the level of the learners. Because the session was open to the community, it was hard for the students to judge who their learners could be. However, they discussed with Dr. Sanfilippo and among themselves at length how best to tailor the material to the potentially novice levels in the audience. Thus they first spent a lot of time thinking about the key points they wanted to make. Then they began to order, and re-order the points, to get the maximum clarity and flow.
How to do this: They broke the material into chunks, and then broke the chunks further into key points creating an outline for their session. They debated about what to leave in and what to leave out. In essence they created a realistic and organized outline. (Here’s a typical lecture outline: http://www.monash.edu.au/lls/inclusivity/Strategies/2.1.1.html)
This time-consuming planning and making choices pays off when teachers consider how important it is to reach the learners that are in front of them. The students worked in a team, and so can our faculty. They can plan collaboratively, with a partner, or with a team. With the Course Director, they can get a sense of whether their material will make its mark. Albert Einstein is famous for saying, “if I had 6o minutes to solve a problem, I’d spend the first 55 minutes figuring out what the problem was.” Planning is key.
In Ken Bain’s “What the best college teachers do,” he writes of his exhaustive study, “Exceptional teachers treat their lectures…and other elements of teaching as serious intellectual endeavours as intellectually demanding and important as their research and scholarship.” (Bain, 2004). They ask themselves what their students are supposed to learn as a result of their teaching, and he cites these 5 questions from his research into effective college teachers:
- What big questions will my course help students answer, or what skills, abilities, or qualities will it help them develop, and how will I encourage my students’ interest in these questions and abilities?
- What reasoning abilities must students have or develop to answer the questions that the course raises?
- What mental models are students likely to bring with them that I will want them to challenge? How can I help them construct that intellectual challenge?
- What information will my students need to understand in order to answer the important questions of the course and challenge their assumptions? How will they best obtain that information?
- How will I help students who have difficulty understanding the questions and using evidence and reason to answer them?
II. Design your slides: Back to our February session, demonstrating another feature of the successful lecture, the students excelled at their slides. They were colourful, informative, but not busy. They were not “slide-uments.” They used clear graphics to make many of their points, while speaking to them. They employed excellent images—clear, distinct, not too complex for the screen, and had sought out and cited copyright for the images. There were an appropriate number for the amount of time they had.
How to do this: In this they had the assistance, as do all teachers in Health Sciences, of Sarah Wickett the Informatics Librarian at Bracken Health Sciences Library. Sarah’s repositories of images, and her ability to find what the students were looking for were a great help to them. Here is one example she has provided: Images.MD brings you a collection of over 50,000 images spanning internal medicine and including histology, pathology, radiographs, original artworks, graphs, and tables.
Consider the amount of slides you have for the time you have. If you’re putting a lot of notes on a slide, factor about 2 minutes for one slide, minimum for learners to process. And, consider a handout or reading vs. “slide-uments”. Make your slides hit the key points and visuals only.
Dr. Bob Connelly, Head of the Department of Pediatrics, and also an excellent teacher, has made the concept of powerful presentation one of his areas of inquiry. He’s helped me make the acquaintance of Garr Reynold’s (Presentation Zen) who writes for the “design mindful” and Nancy Duarte whose research into what she calls “sparklines,” the map of the underlying story narratives of powerful presentations.
Most recently Bob’s shared some great ideas from a new book he’s reading, Designing Science Presentations: A Visual Guide to Figures, Papers, Slides, Posters, and More. May I recommend in turn, these authors to you? They will provide you with provocative ideas for your slides and designs for learning.
III. Plan how to explain difficult concepts: If I had to pick the most important of these 5 points, it would be this. After all, we’re in the business of being explainers and “knowledge translators.” It is not how much is delivered but how much is understood and retained that is most important.
The students presenting spent time sharing their organization and plans with the audience in an outline—the equivalent of a relevant set of learning objectives and an organizer as the first 2 slides of any lecture. They summarized each “chunk” of material, and made reference to prior material to link the learning. And there are some other important tricks too:
How to do this: There are several components to good explanation that I always lean on:
- State the learning objectives up front. By the end of the session, students should be able to have met all those objectives. And check yourself: are there an appropriate number of learning objectives for the time at hand?
- Use plenty of examples: Often it’s the examples that you employ that do the actual teaching for you.
- Repeat: Harken back to concepts; repeat key phrases; remind your listeners of how things are connected.
- Use an outline and signal stages of the organizer: give “warnings” or “cues.” For example, you may say, “Now here is a key concept which I’ll explain,” or “If you recall back to our first concept, I said…” or “in summary there are three main causes…” or “Here’s our outline again…we’ve moved to this point here…”
- Use metaphor: Sometimes we need a concrete example from our own experience to help us understand a new concept. Metaphors have been shown to be of great assistance in learning. The brain is an analog processor (Sylwester, 1995) – liberally sprinkle your lecture with analogy and metaphor.
- Chunk the material. Consult the organizer and build in 10-15 minute conceptual chunks and pauses for questions or other forms of active learning.
- Stop every 15 minutes and ask the students to do something with what you’ve just said. They can answer a question, ask a question, rework their notes, work with a partner, solve a problem, work in a group, fill in a blank in a worksheet…there is a lot of active learning that can be packed into a 2-5 minute period that gives them practice and allows them to manipulate the work you’ve just spoken about. No time for this? Revisit your number of concepts and amount you’re trying to get into the time. Change either the time allotment, or the amount of concepts. And see point II above. Are you pitching this at the right level for understanding?
- Summarize: The February student speakers did this well after each main set of points. It’s helpful for all learners. Want to kick it up a notch? Ask the students to summarize—get them to fill in a worksheet, or note the top 3 points and share with a group or the class—it will be very informative—not only for them, but for you.
- Plan the timing: The students planned the session to last for 40 minutes. And it did. They didn’t go overtime, and they used their time well, in order to have time for questions. Their planning paid off in that they were able to make all their points and still have discussion time for active learning.
IV. Speak well. How you speak is key to effective lectures. Our students were familiar with their material and were comfortable speaking about the material. They didn’t read from a text or from the screen behind them. Rather, they spoke to the audience, making eye contact, and they spoke extremely well. Their words were well-paced and not rushed, they projected (which one has to do even with a microphone), they enunciated clearly and they spoke with inflection. All this contributed to the learning—it’s hard to learn if the teacher can’t be heard or understood.
How to do this: While an analysis of TED talks revealed that speakers spoke on average 163 words/minute (http://sixminutes.dlugan.com/speaking-rate/), acccording to the National Center for Voice and Speech, the average rate for English speakers in the US is about 150 wpm. (http://www.ncvs.org/ncvs/tutorials/voiceprod/tutorial/quality.html) That’s still pretty speedy. Students take notes much more slowly,—on average of 25 words per minute (Stanford Centre for Teaching and Learning http://www.law.harvard.edu/current/student-services/taking_notes.pdf)
We know that taking notes helps students retain. (Bligh, 2000, Kiewra, 1991, Johnstone and Su, 1994). So a deliberate pace is critical to your lecture. And variety of speaking rates during a lecture is an important tool to use to retain attention. Whichever way you slice it, speaking slowly enough to enunciate clearly, using pauses effectively, and ensuring your audience is with you is important. Remember we’re talking about speaking here—not reading out loud!
Here are some tips for modulating your speed:
- Record yourself. Listen. Adjust where necessary. It’s painful sometimes, but a good idea. Almost all our sessions are podcast. Play a podcast and listen to what’s happening. After the first wince, you should get an idea of what your pace, articulation, etc. is like.
- Pause. Every once in awhile. It helps the learner. Make sense of what. He/she’s hearing. (ok, maybe not that much pausing, but you get the idea.) At least pause at the end of a sentence, wherever you’d put a comma, and/ or for breath.
And here are some tips for clarity/enunciation and ease:
- Speak to a large group with slightly more enunciation than you would in normal conversation. You’ll sound odd to yourself, and perfectly lucid to everyone else.
- Use a lapel microphone when you can. And test to see whether you can be heard at the back of a room. A lapel microphone allows you to wave your hands and use a pointer, and do all sorts of things that a hand-held prevents.
- You still need to project with a microphone, especially if you’re soft-spoken. Speak louder than you would in normal conversation—again you may sound like you’re bellowing, but the students at the back will hear you.
- Ask if students can hear you, and if they can’t, speak up and stay spoken up. J
All in all, the students in the February talk on heart health had a lot to teach us—and not only about healthy hearts! Do you have questions or ideas about how, when and why to lecture? Reply here, or contact firstname.lastname@example.org.
To hear another student talk, come to lecture theatre 132A, School of Medicine, March 28, from 6:00-7:00 on Mental Health with Dr. Kevin Varley for Q and A.
Some reading on lectures:
Van Melle, E. & Pinchin, S. (2007). How to Make Lectures Work. The Teaching Doctor. Office of Health Sciences Education, Queen’s University.
Brown, G & Manogue, M. (2001). Refreshing lecturing: A guide for lecturers. AMEE Medical Education Guide No. 22. Medical Teacher, 23, 231-244.
Bligh, D. (2000). What’s the use of lectures? Jossey-Bass.
Bain, K. (2004). What the best college teachers do. Harvard University Press.
Chickering, A.W. & Gamson, Z.F. (1987). Seven principles for good practice in
undergraduate education. The American Association for Higher Education Bulletin, 39, 3-7.
Steinert, Y. & Snell, L. S. (1999). Interactive lecturing: Strategies for increasing
participation in large group presentations. Medical Teacher, 21(1), 37-42
Bland, M., Saunders, G.& Frisch, Jennifer Kreps. (2007). In defense of the lecture. Journal of college science teaching 37(2), 10-13.
Ruhl, K.L., C.A. Hughes, and P.J. Schloss. 1987. Using the pause procedure to enhance lecture recall. Teaching education and special education 10(1): 14-18.
McKeachie, W.J., and M. Svinicki. 2006. McKeachie’s teaching tips: Strategies, research, and theory for college and university teachers. 12[supth] ed. Boston: Houghton Mifflin.
Student Medical Health Talks: “Let’s Talk Mental Health” on March 27
The student lecture entitled, “Let’s Talk Mental Health” is to take place Thursday, March 27th, 2014 from 6:00PM – 7:00PM in Lecture Hall 132A (main floor) in the School of Medicine Building (15 Arch St. in Kingston). Dr. Kevin Varley from the Department of Psychiatry will be there for the Q and A period.
This event is open to the public. All are welcome; simply RSVP to email@example.com.
Beyond Apprenticeship – Lessons from Coach K
I’ve often wondered what makes Mike Krzyzewski so incredibly successful.
For those of you not familiar, he is a highly accomplished college basketball coach. In the 34 years he has coached at Duke University, his teams have won 76% of their games. He has won 4 national championships, 13 ACC championships, been named Coach of the Year 5 times. He has coached the US Men’s National Team twice and won gold medals both times. Incredibly, he’s been admitted to the Basketball Hall of Fame, before he’s even retired! Conclusion: the man knows what he’s doing.
Remarkably, he has remained steadfastly loyal to his school and to the college game, having turned down numerous offers to coach professionally. It’s reported that he most recently turned down $15 million dollars per year to coach the Nets. Conclusion: the man likes his job.
What’s always been a little perplexing is that he doesn’t look like a coach, or even an athlete. In fact, he looks more like a barber or accountant (no offense to barbers or accountants). As a 67 year old son of Polish catholic immigrants and West Point graduate who never played beyond the college level, he would seem to be as culturally, generationally, physically removed as one could imagine from the uber-talented, remarkably athletic young men who come under his tutelage.
Jabari Parker is one of those young men. This 18 year old native of South Chicago is considered by many to be the most talented college player in the nation, and the next rising star of the game. Seems he thinks the world of his coach. To quote: “Coach K and I have a great friendship. We have a father-son relationship. I love the man. And I’ve put my complete trust in him.”
In considering all this, I can’t help but draw a parallel to those of us engaged in the education of medical students. We also find ourselves challenged to connect with exquisitely talented young people who’s educational and cultural experience is very different than our own. How do we connect? How do we ensure we’re helping them reach their full potential? What might we learn from Coach K?
For most of these weightier educational issues, I turn to one of my favourite sources – Sports Illustrated. In “The Education of Jabari Parker” (Feb 24, 2014), Jeff Benedict provides an account of the relationship between these two. Reviewing that article provides some intriguing parallels to the principles of medical education. For example:
1. They have established common goals. This happened at their very first meeting and, interestingly, was motivated by Jabari’s mother who told the coach in no uncertain terms “Jabari needs to know how you are going to play him and what goals you want to set.” The wisdom of a mother! Clearly, the coach and the student are on the same page. They have a common understanding of what they hope to achieve. Developing a medical education program and curriculum similarly begins with established objectives and the acceptance of those objectives by all teachers and learners. It’s been my experience that most of the tensions and problems we encounter with our teaching sessions and assessments relates to a lack of clarity with respect to objectives.
2. The coach provides useful, relevant feedback with direction as to how errors can be corrected. After reviewing game videos: “Look at your feet. They are in the wrong position.” “Look at your hands. They are not ready.” Followed by the justification: “It’s not personal. It’s the truth.” Jabari’s response: “I never realized I looked that bad. I gotta change that.” Coach K seems to understand that simply telling a student they are not performing adequately is not only useless, but damages the teaching relationship. Students accept criticism if they know how and why they went wrong (hence the importance of understood objectives) and are given the necessary instruction and opportunity to correct the problem.
3. The coach understands the student on a deeper, personal level and uses those insights to help him improve. The coach recognized early on that Jabari’s desire to fit in was causing him to play hesitantly and below his potential in order to avoid standing out among his teammates. He also picked up on an unwillingness to admit to nearsightedness, again motivated by a fear of appearing different than his peers. We recognize that medical school is much more than a time during which information is learned and skills acquired. It is also a time of personal growth for our students, during which they develop the self-awareness and professional confidence that will enable them to become effective physicians. Excellent educators recognize limitations or personal barriers and are able to help students grow despite them.
4. They are open and honest with each other, and out of that honesty comes trust. Benedict describes an incident where the coach confronts the student: “I think you love it here so much that you want to be good, but not too good…I’m a little bit angry with you…I don’t think you’re giving me all you can give me. Agreed?” “Yes,” Parker replied. Another time, the coach is suffering through a personal loss that affects his attention and interest. He’s open about his grief, and about his distraction. To quote the coach: “Overall this will be a great experience for them because they see someone who in their minds is very powerful who can’t be penetrated…and they see me being penetrated to where I’m moved to tears.”
Most physicians seem to have the desire and instinctive ability to pass along what they know, and what they can do. These qualities underlie the apprenticeship model that characterized pre-Flexner medical education, and continues to drive our clinical training, both in medical school and residency. A fundamental limitation of this model is that the “upper limit” is the expertise of the teacher. The introduction of educational principles and the focus on the professional development elevates the relationship to one which provides the learner not simply with knowledge and technical skills, but with insights, self-awareness and inspiration that propels them forward and sustains them through their careers
Mike Krzyzewshi is, first and foremost, an educator, and he has something to teach all of us who hope to influence the young and gifted among us.
MD Program Executive Committee Meeting Highlights – Wednesday March 5, 2014 at 4:30 pm
CaRMS – The CaRMS match was highly successful with only one Queen’s student unmatched. The students matched to a wide variety of specialties and of note there were only six unmatched positions at Queen’s.
AAMC Curricular Inventory – Work has been undertaken to submit data to the AAMC curricular inventory portal. The team working on this project has encountered some difficulties in preparing the data for importing into the portal. However, it is believed that participation in this initiative will benefit future Accreditation reporting.
Diversity – The Committee is reviewing the need for a Diversity policy. Diversity is one of the many accreditation standards which the School is working towards implementing policies and standards to ensure compliance. It was determined that a committee will be established, which will include students, to develop a diversity policy.
Communicable Disease & Immunization Policy – An updated Communicable Disease & Immunization Policy was reviewed and approved by the Committee. The changes in the policy were made to match the immunization form currently being used. The updated policy can be seen on the UGME website at http://meds.queensu.ca/education/undergraduate/policies
Service Learning – The topic of service learning was discussed and noted that it is a key accreditation issue. The Professional Foundations Committee has developed a discussion paper on service learning. A commitment statement on service learning was presented and approved by the Committee. It was noted that some service learning opportunities are currently within the curriculum. It was decided that the Professional Foundations Committee would serve as the overseer and developer of service learning.
Next Meeting: March 19, 2014
First Annual Med/Law Games
This report comes from Ellen Miles,Women’s Athletic Stick.
On February 7th, 2014 the faculties of Medicine and Law came together on a Friday afternoon for the first annual Med-Law Games. The first of its kind here at Queen’s, Med-Law Games was designed by a committee of students from both faculties to foster inter-professional competition while raising funds for local charities.
The event was hosted by our two emcee’s Craig Lynch (Meds, 2017) and Naheed Yaqubian (Law, 2016) who entertained the crowd while the two faculties competed in 4 sports over the course of the afternoon. Friends watched from the sidelines, with baked goods and raffle tickets in hand.
It was an exciting day for QMED onlookers, starting out with a strong showing from the Meds Volleyball team made up of Daniel You (2016), Mike Baxter (2016), Trevor Morey (2017), Nick Latham (2017), Michael Yang (2016), Jocelyn Boyley (2017), Jillian Cottreau (2017), Cassy Graham (2016), Allie Engelhardt (2016) and Lydia Farnell (2017). Things took a turn however, with the Faculty of Law coming out on top in dodge-ball. The day continued to favour the law students, with strong performance in both soccer and basketball, ultimately winning the tournament.
Though our egos were bruised, QMeds should take pride in our fundraising efforts headed up by Alana Fleet (2017), where we managed to raise over $3300 which will be donated to the Cancer Centre of Southeastern Ontario. Special thanks to all the volunteers who helped bring this event together, the athletes for putting on a good show, and everyone who came out to support their friends.
See you all next year!
– Ellen Miles (Women’s althetic stick), Kevin Morash (Men’s althetics stick), Alana Fleet (VP External Jr.)
Tell me a story : Qualitative Research in Health Sciences Education
This week, I invited Libby Alexander, Research Assistant in the Office of Health Sciences Education to talk about what she and Dr. Leslie Flynn have been working on to provide our faculty with new learning about qualitative research. Here’s what Libby wrote to us:
I am not a health professional but probing people is a key part of what I do.
In interviews, I mean.
That is to say, as a research assistant in health sciences education, my main task is to elicit different kinds of information from learners in order to inform the practice of teaching, learning and scholarship. Some of this information is in numerical form, measuring knowledge, attitudes and beliefs. I invade your inboxes with countless invitations to electronic surveys. These are followed by cheerful “reminders” that my carefully crafted survey has yet to be graced by your keystrokes. Translation: Please enhance my sample size! Ten minutes, I promise.
Yes, I’m that girl.
But sometimes, the numbers game is neither sufficient nor appropriate for the question under investigation. We are textual creatures after all, as illustrated in loving gazes bestowed upon phones everywhere. It can also be demonstrated in the clinical encounter. When I come in for an appointment, while inquiring about my symptoms, a physician must quickly make sense of my “patient text” which is all over the place, trying to re-assemble my descriptions into a coherent narrative with the objective of identifying the underlying patterns. When I say “But let me explain, doc”, I’m not simply listing my ailments but trying to contextualize them so that you understand what I’m experiencing.
In educational research, we can use this approach to examine the “lived experience” of learners and teachers as they go about the business of developing expertise in health care. Qualitative inquiry enables us, not only to explore the impact of educational strategies, but also unpack the processes that promote or inhibit learning. Going beyond “Does it work?” to “How does it work?”.
Expertise is a process of development, an unfolding story that integrates skill acquisition and identity formation within the bigger picture of becoming a health professional. From the standpoints of learners and teachers, we can gain a picture of the learning environment and identify the complex aspects that shape the “outcomes” that anchor our work.
For example, Kennedy, Lingard, Baker, Kitchen and Regehr (2007) were interested in the relationship between clinical supervision of medical trainees, patient safety and the quality of patient care. A traditional, outcomes-based study might ask “Does increased supervision of trainees improve quality of patient care?”
But look at the big concepts embedded in this question: “supervision of trainees” and “quality of patient care”. Kennedy et al state that the concept of supervision is multifaceted and poorly operationalized making it difficult to picture what an increase would look like. So what they chose to do, through observation and interviewing of several teaching teams, was to create a model of “patterns of supervision” that occurred in clinical teaching programs.
This represents a Grounded Theory approach used to develop an explanatory framework of clinical supervision. In their analysis, different levels of supervision emerged: routine oversight, responsive oversight and direct patient care.
In this example, the “results” did not point to outcomes but rather unpacked the complex nature of clinical supervision to provide concrete components for programs to target through policy, faculty development and further research.
The Qualitative Research Series from the Office of Health Sciences Education and Office of Faculty Development
Interviews, focus groups, observation and document analysis constitute some of the qualitative approaches used in education research. These methods can sometimes be met with skepticism or accusations, even, of subjectivity, lack of rigour and general wishy-washyness. These concerns and assumptions may inhibit educational researchers from seeing a broader range of scholarly possibilities in their work.
This is why under the guidance of Dr. Leslie Flynn, the Office of Health Sciences Education worked in conjunction with the Office of Faculty Development to offer a series of workshops entitled “Qualitative Research Series: Approaches for Healthcare Leaders”, designed to provide a general overview of qualitative methodology. In doing so, we hoped to de-mystify the murkiness to reveal what is, in fact, a systematic, yet non-linear approach.
We started in October of 2013 with an introductory session by Drs. Richard Reeve and Christopher DeLuca from the Faculty of Education. Next, Dr. Flynn and I put on 2 workshops covering the development of research questions, data collection and analysis. The final one in April will feature Dr. Lorelei Lingard discussing writing for publication.
So what did we talk about? In a blog, it is difficult to summarize the intense processes of qualitative research simulated in our workshops. Instead I will briefly describe some key points.
1. Qualitative inquiry is a different way of seeing your area of interest
This type of methodology allows us to make implicit phenomena visible.
Some of the types of things in education that we can look at include processes, meanings, structures, perspectives, cultures and relationships. These new ways of seeing enable us to ask different questions.]
In the workshops we introduced 5 main approaches in qualitative research, briefly described in the table below.
|Narrative||Describing the development of an experience by telling a story|
|Phenomenology||Capturing an essence or core features of an experience|
|Grounded Theory||Generating an explanation based on people’s described experiences|
|Ethnography||Describing shared cultural meanings|
|Case Study||Illustrating an issue through bounded cases|
Cresswell (2007) provides a comprehensive overview of these approaches. He recommends using them to “foreshadow” your research question as they specify what kinds of data to collect. In using the example from Kennedy et al above, they asked “What does clinical supervision look like?” More specifically, they looked at in-patient teaching wards of two academic health sciences centres. Grounded theory starts from what is observed to build explanatory frameworks. Their data collection was shaped to generate a rich, detailed picture of the types and conditions of supervision that occurred in teaching teams. This allows further research to look at more specific relationships between supervision and patient care.
2. The importance of developing a solid research question to anchor your project
Based on the literature and our own experiences in research and consultation, we developed a framework to help participants in focusing down an area of interest into a workable research question. We got them to consider the purpose of their inquiry and breaking down their topic into key components. In small groups, participants discussed their ideas with each other as they navigated the process. We then moved on to linking the research question to data collection by learning to create an interview guide.
In actual practice, this is a long, intense, iterative process. From our experiences in both practicing and consulting with others about research, we have seen the struggles in moving things forward, if you don’t have a sufficiently focused, well-articulated research question. Think of the research question as a roadmap for the journey of your inquiry. It drives the steps for data collection, analysis and presentation. A lack of clarity and focus can lead you astray.
3. Interpreting data and building meaning: Identifying, Organizing and Connecting
When lived experience becomes tall stacks of paper, it’s easy to become overwhelmed: “Isn’t this all just subjective? How is this evidence of anything?” In qualitative research, “themes” aren’t just common sense bullet points gleaned exclusively through intuition. They are the product of systematic identification, filtering, comparison and classification. But at the same time, we must be vigilant not to sever this abstraction from the lived realities of our participants—so there is a place for intuition.
We guided workshop participants through some core procedures in analysis as briefly described below.
|Immersion||Reading and summarizing|
|Identifying units of Meaning||Coding|
|Organizing codes to make sense of the data||Defining categories and concepts|
|Building connections between ideas||Developing themes to answer your research question|
While workshops are a linear format, qualitative research is an iterative spiral where you are constantly moving between literature, theory, interpretation and methods—all with the research question in view. In developing your concepts and themes, you are trying to arrive at the “best fit” for your data based on systematic comparison, classification and revision.
The process yielded some rich conversation with the group who asked a lot of great questions. Interpretation is a social process, so we incorporated a lot of group work in our workshops. In breaking down the process into key components, we hoped to demystify analysis and spark new ways of thinking about educational topics. The room was abuzz with energy as faculty, educational specialists and research associates engaged with the possibilities of a different paradigm to shape their scholarly work.
Community of Practice
This was our first run at the workshops and we definitely learned a lot. Taking a complex, intense, constantly evolving process and translating it into a set of introductory workshops was certainly challenging. But building in opportunities for dialogue among participants and with the facilitators revealed an amazing potential for building community. The experience drove home that creating such spaces are essential for fostering the scholarly imagination in teaching and learning.
Creswell, J. (2007). Qualitative Inquiry & Research Design: Choosing among five approaches (2nd Ed.). Sage: CA.
Kennedy, T., Lingard, L., Baker, G., Kitchen., L & Regehr, G. (2007). Clinical oversight: Conceptualizing the relationship between supervision and safety. Journal of General Internal Medicine, 22(8), 1080-1085.