Curricular Goals and Objectives

In an article entitled “The Case for Core Curriculum”, author James Bradshaw raises concerns regarding university teaching that should cause some unease as we consider our medical courses and curriculum.  “The tide seems to be turning”, he writes, “with business leaders lamenting that, although the new talent arriving at their doorsteps has deep technical knowledge, it lacks the skills needed to put this knowledge to full use”. (http://www.theglobeandmail.com/news/national/time-to-lead/why-university-students-need-a-well-rounded-education/article4610406/)

Rather disturbingly, this observation echoes the growing concern among postgraduate training directors and clinical faculty that our graduates seem adept and comfortable providing factual information, but considerably less so when challenged to assess undifferentiated patient presentations and integrate factual information into cogent and practical management plans.  Lest we dismiss such commentary as isolated rumblings, it’s useful to keep in mind that the results for Queen’s graduates on the MCC Part 2 examination would seem to support the contention that our graduates struggle in the domains of clinical reasoning and comprehensive patient management, in sharp distinction to their well above average performance in knowledge-based components of the Part 1 examination.  Although the effects of our revised curriculum and enhanced assessment practices are not yet influencing examination results, it would seem unwise to simply dismiss these observations.

Bradshaw goes on to point out that, at the university undergraduate level, there exist political, logistic and economic barriers to providing integrated educational experiences that address what we, in the medical education context, would term “competencies” rather than traditional discipline-based content.  Indeed, we are well aware of the challenges of blending traditional disciplines and developing both content and assessment that address what many refer to as the “softer skills” relevant to medical practice, such as critical thinking, communication with disparate populations, collaboration, and the ability to advocate effectively for patients, health system delivery, and oneself.

Our curricular goals and objectives, as well as our Competency Framework (see “Curricular Goals and Competency based Objectives”), was developed in 2007 and has served as the central focus for the restructuring of curriculum and assessment methods that has allowed us to both develop a much more effective learning experience for our students, and achieve compliance with all accreditation standards.  The principles it espouses should remain our central guiding force.  However, the observations noted above should cause us to consider whether a clearer definition of the expectations we have for our graduating students is in order, recognizing that many of the competencies we espouse (professionalism, advocacy, communication, collaboration) are not ends in themselves, but necessary components of a graduates “competence” to assess, diagnose and manage patients with a variety of clinical presentations.

I’ll be encouraging a dialogue on this issue at our major committees and among our Course Directors.  This blog seems an appropriate place to start.  Feel free to provide feedback.

 

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Can Students Multitask?

You may have noticed an occasional student referring to his Facebook page, or her ipod or ipad while also apparently listening to your lecture, or working with her/his team-mates in small group learning.  They are multitasking, as part of the “M” generation.  But are they really multitasking?  And is it working for them as successful learners?  Dr. MaryEllen Weimer has collected evidence in her article that students compromise their learning by multitasking and suggests we present them with the evidence to help them re-evaluate their approach to learning.  For a synopsis of the research she has collected, go to Faculty Focus.

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Pager service in the New Medical Building

When the New Medical Building was completed in 2011 it did not take long for physicians to notice that their pagers were not reliably receiving hospital pages while they were in the building. This was a big issue because it meant that if you were on-call neither your pager or your cell phone would work. Once this problem was brought to our attention, Queen’s IT Services worked with PageNet to install an amplifier that would boost the PageNet signal within the building, thus solving the problem… for PageNet customers. We later discovered that some physicians were using Alliance paging services and were still encountering pager reliability issues.

After a brief discussion with Alliance about the issue they came up with a solution for us to distribute, so we thought this blog would be a good way of letting folks know.

If you are an Alliance paging customer and you would like your pager to work while you are physically located in the New Medical Building please contact Rita Peters (Alliance paging specialist) at 613-546-1141. Rita will assist you with upgrading your Alliance pager to one that is compatible with the PageNet signal. There is a small monthly price increase associated with this upgrade; however, your pager will work in the New Medical Building with this plan.

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Curriculum Matters: Giving Feedback

“Learning without feedback is like learning archery in a darkened room.” (Cross)

The terms feedback and formative assessment have been used frequently in our UG curriculum both in clerkship and pre-clerkship. It’s important that we all recognize a consistent definition of feedback, as well as consider some effective tips and strategies from the educational literature. Sue Fostaty-Young weighs in with some helpful ideas.

Feedback is information regarding students’ performance that is offered with the express purpose of improving their learning and future performance. It is considered one of the most powerful influences on learning and achievement (Hattie & Timperley, 2007).

Tips for Giving Effective Feedback:

  1. Prepare students to receive the feedback you’re about to give
    • Unfortunately, students do not always recognize feedback as such, especially oral feedback during rounds, or in clinic, etc. Consider starting your end of the conversation by saying “I have some feedback for you”.
    • Alert students at the beginning of a rotation or any workplace teaching to the fact that feedback may be oral, and part of ongoing bedside teaching.
  2. Ask a student how he/she thinks they’re doing
    • In asking a student to comment on their own performance you initiate the process of self-reflection and emphasize the learner’s active role in the feedback process.
    • You may ask them to prepare some notes prior to the feedback session or create a structure for this dialogue.
  3. Be specific and objective about what you observed
    • Begin by identifying what students are doing correctly in their performance.
    • Provide examples of what you observed, not what you inferred. For example, rather than saying “You’re shy” (an inference), you might say “I noticed you made very little eye contact with the patient and you spoke very quietly, making it difficult for her to hear your questions” (an observation).
  4. Give feedback in a timely fashion and in time for students to improve
    • Feedback offered almost immediately after an activity has more meaning because the event and the students’ behaviours during it are fresh in their minds.
    • Timely feedback allows for students to alter their performance, to practice, and improve. Set a time to review improvement if possible.
  5. Outline specific targets or goals; articulate expectation
    • Feedback has the most impact when learning-specific information is offered.
    • Offer specific feedback that is within the student’s ability to improve and a rationale for your suggestions. For example, rather than say, “Stop being so shy,” you might offer specific suggestions such as “Try to make eye contact more regularly so patients know you’re engaged and to gauge their reactions. Speak louder so your instructions can be heard.” You may want to suggest that they practice with a peer or videotape their own practice.
  6. Invite the student to respond to the feedback you’ve just given
    • Initiating this dialogue can help establish whether the student has interpreted the feedback as it was intended, and will be able to use the feedback in a meaningful way.
  7. Help the student develop an action plan with timelines for improvement to help them use the feedback in a constructive way.

Adapted from:
Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77(1), 81-112.

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New Faculty Resources Community

You are invited to view the new Faculty Resources Community:

The Faculty Resources Community was created to provide faculty members, Course Directors, Year Directors and Committee Chairs with advance notice of topics to be discussed at Curriculum Committee meetings as well as easy access to Curriculum Committee Highlights, links to faculty development on teaching and assessment and materials distributed at Course Directors’ Retreats. Other resources posted in the new community include the Future of Medical Education in Canada reports and the latest LCME accreditation standards. We welcome suggestions for additional resources.

The School of Medicine would like to provide all of its faculty members with opportunities to comment on draft policies and procedures prior to their finalization and implementation. It is our aim to post Curriculum Committee agendae to the Faculty Resources Community 48 hours in advance of each meeting. Highlights of each Curriculum Committee meeting will be posted as soon as the minutes of the meeting have been approved. All faculty members are welcome to attend Curriculum Committee meetings, although advance notice is appreciated so that appropriate space can be booked. Faculty participation in Curriculum Committee discussions is at the discretion of the Chair Dr. Michelle Gibson. Requests may be communicated in writing prior to a meeting.

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Educational Development and Faculty Support

Welcome back to another academic year–and welcome to new faculty and to new students! The Educational Development and Faculty Support Team is available to assist you.

Our role is to assist faculty in development and implementation of courses, sessions, assessments, teaching methods, and generally to assist with any educational concerns you have. We work in partnership with MEdTech and with the Bracken Health Sciences librarians to help you.

We are:

  • Sheila Pinchin, Manager of the Education Team, sheila.pinchin@queensu.ca ext. 78757
  • Theresa Suart, Educational Developer, theresa.suart@queensu.ca ext. 75485
  • Eleni Katsoulas, Assessment and Evaluation Consultant, eleni.katsoulas@queensu.ca
  • Alice Rush-Rhodes, Special Curricular Assistant, arush@queensu.ca
  • Catherine Isaacs, our Coordinator of Accreditation is also a part of the team, and helps us keep accreditation and quality assurance as part of our focus.

Feel free to contact any of us. We look forward to meeting you!

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RATs (Readiness Assessment Tests): To time or not to time?

A very recent study at Regis University School of Pharmacy, which won best poster at the Team Based Learning Cooperative’s Annual Meeting, determined that students preferred timed tests vs. tests with no time limits.  Students also indicated that they preferred to be told that five minutes remained once fifty percent of the class had completed the iRAT (variable time limit) vs. being informed of the ttal time allotted to complete the iRAT (defined time limit).  (Richetti, C. et al, 2012)

This has value for us to explore.  The investigators were addressing the problem of “down time” in RATs where some students have finished and others have not.  Of the students surveyed (74) 97% responded to suggest that using the strategy of variable time limits was useful, and not likely to induce as much anxiety as the defined time limit.

Why not try this method with your students when you give a RAT?  Carefully observe, (and if there is another facilitator with you, use her/his observations) to determine when half the class has completed the RAT.  Some of our faculty ask students to raise a hand when the group or individual has finished a RAT, or use some other signal like a green card attached on their group clipboard.  That will enable you to give a “5 minute warning” to the rest of the class.

If you try this, please let us know what your findings are.

By the way, the investigators also found some additional benefits of timing RATs from their survey:

Our survey determined that the timing of iRATs decreases “down-time”, helps students increase their confidence in their ability to perform well on timed exams (e.g. board exams) and provides more time to focus on applications[tasks]. While students reported an increase in anxiety caused by the timing of iRATs, they reported they preferred the timed iRATs over the iRATs that were not timed.

Richetti, Charlotte, Brunner, Jason M., Fete, Matthew, Luckey, Stephen. & Nelson, Michael. (2012). “Student Perceptions on the Value of Timing Readiness Assurance Tests.  Poster presented at TBLC Annual Meeting, St. Petersburg.

 

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RATs (Readiness Assessment Tests): To time or not to time?

A very recent study at Regis University School of Pharmacy, which won best poster at the Team Based Learning Cooperative’s Annual Meeting, determined that students preferred timed tests vs. tests with no time limits.  Students also indicated that they preferred to be told that five minutes remained once fifty percent of the class had completed the iRAT (variable time limit) vs. being informed of the ttal time allotted to complete the iRAT (defined time limit).  (Richetti, C. et al, 2012)

This has value for us to explore.  The investigators were addressing the problem of “down time” in RATs where some students have finished and others have not.  Of the students surveyed (74) 97% responded to suggest that using the strategy of variable time limits was useful, and not likely to induce as much anxiety as the defined time limit.

Why not try this method with your students when you give a RAT?  Carefully observe, (and if there is another facilitator with you, use her/his observations) to determine when half the class has completed the RAT.  Some of our faculty ask students to raise a hand when the group or individual has finished a RAT, or use some other signal like a green card attached on their group clipboard.  That will enable you to give a “5 minute warning” to the rest of the class.

If you try this, please let us know what your findings are.

By the way, the investigators also found some additional benefits of timing RATs from their survey:

Our survey determined that the timing of iRATs decreases “down-time”, helps students increase their confidence in their ability to perform well on timed exams (e.g. board exams) and provides more time to focus on applications[tasks]. While students reported an increase in anxiety caused by the timing of iRATs, they reported they preferred the timed iRATs over the iRATs that were not timed.

Richetti, Charlotte, Brunner, Jason M., Fete, Matthew, Luckey, Stephen. & Nelson, Michael. (2012). “Student Perceptions on the Value of Timing Readiness Assurance Tests.  Poster presented at TBLC Annual Meeting, St. Petersburg.

 

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Think Different

In 2004, a young securities advisor named Salman Khan began tutoring his 10 year old cousin in basic math.  Despite her obvious intelligence, Nadia was having difficulty academically, was falling behind her classmates, and beginning to believe “I can’t do math”.  He began by talking to her by phone every evening for about an hour.  Between talks, he would send her emails with lessons or exercises to complete.  Before long, Nadia was doing much better in school and, in fact, surpassing her classmates and getting eager to learn more.  In addition, a number of other cousins began to join in on the lessons.  When the number reached about 15, Salman realized he needed a better method to post the lessons.  A friend suggested You Tube.  Although he admitted to a sense at the time that You Tube was “just for videos of cats playing the piano”, he began to use it.  In addition to reaching more of his cousins, this allowed him to develop lessons in other areas of need, such as history, English and general science.  In addition, the lessons started getting picked up by other people worldwide.  He began to develop a somewhat ambitious vision of providing “free education to anyone, anywhere”.  He quit his job to devote himself full time to his rather lofty goal.  The initiative began to grow and catch the attention of some prominent benefactors, notably Bill Gates.

The result of all this is the Khan Academy, a not-for-profit organization with no headquarters but about 40 employees who have developed and posted thousands of video lessons in a variety of subjects that reach about 43 million users world wide and now provide their on-line educational material at no charge in 16 languages.   The lessons are interconnected so that they build incrementally and allow learners to work at their own pace and develop expertise analogous to school courses.  The material has gone beyond individual usage and is now being picked up by school boards to supplement their curriculum.  In most cases, this is leading to a change in the teaching philosophy, since teachers can devote class time to group activities, consolidating experiences, or individual instruction.  Teachers have been particularly impressed with the ability to track individual student progress, and identify various patterns of learning and needs.  There are numerous personal testimonies from adults who had returned to learning after having given up themselves as a result of failure in the traditional school system.

Are there lessons here for medical schools?  I think a few:

  1. We now have technology that allows us to do things in drastically different ways.  Although we don’t have to change because of the technology, we no longer need to feel constrained by traditional models.
  2. The world belongs to those who are willing to set a goal and to engage solutions with an open mind, imagination, and a sense that anything is possible.  Steve Jobs changed the world with the philosophy that we need to  “Think Different”.
  3. We all learn differently, as children, as university students, as adults.  Our methods should identify and encourage those differences rather than limiting learning to those who happen to fit the traditional model.
  4. Learners need to consolidate the basics before moving on to advanced learning.  Khan identified early on that his students were having difficulty in traditional schools systems because the class had to move on to new topics before the basics were completely mastered by all students.
  5. The learning method Khan has developed is not only more effective, but, amazingly, requires less resources and expense to support than the traditional model.

The world is providing opportunities to do things better, and not necessarily by consuming more resources.  We need to Think Different.

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Think Different

In 2004, a young securities advisor named Salman Khan began tutoring his 10 year old cousin in basic math.  Despite her obvious intelligence, Nadia was having difficulty academically, was falling behind her classmates, and beginning to believe “I can’t do math”.  He began by talking to her by phone every evening for about an hour.  Between talks, he would send her emails with lessons or exercises to complete.  Before long, Nadia was doing much better in school and, in fact, surpassing her classmates and getting eager to learn more.  In addition, a number of other cousins began to join in on the lessons.  When the number reached about 15, Salman realized he needed a better method to post the lessons.  A friend suggested You Tube.  Although he admitted to a sense at the time that You Tube was “just for videos of cats playing the piano”, he began to use it.  In addition to reaching more of his cousins, this allowed him to develop lessons in other areas of need, such as history, English and general science.  In addition, the lessons started getting picked up by other people worldwide.  He began to develop a somewhat ambitious vision of providing “free education to anyone, anywhere”.  He quit his job to devote himself full time to his rather lofty goal.  The initiative began to grow and catch the attention of some prominent benefactors, notably Bill Gates.

The result of all this is the Khan Academy, a not-for-profit organization with no headquarters but about 40 employees who have developed and posted thousands of video lessons in a variety of subjects that reach about 43 million users world wide and now provide their on-line educational material at no charge in 16 languages.   The lessons are interconnected so that they build incrementally and allow learners to work at their own pace and develop expertise analogous to school courses.  The material has gone beyond individual usage and is now being picked up by school boards to supplement their curriculum.  In most cases, this is leading to a change in the teaching philosophy, since teachers can devote class time to group activities, consolidating experiences, or individual instruction.  Teachers have been particularly impressed with the ability to track individual student progress, and identify various patterns of learning and needs.  There are numerous personal testimonies from adults who had returned to learning after having given up themselves as a result of failure in the traditional school system.

Are there lessons here for medical schools?  I think a few:

  1. We now have technology that allows us to do things in drastically different ways.  Although we don’t have to change because of the technology, we no longer need to feel constrained by traditional models.
  2. The world belongs to those who are willing to set a goal and to engage solutions with an open mind, imagination, and a sense that anything is possible.  Steve Jobs changed the world with the philosophy that we need to  “Think Different”.
  3. We all learn differently, as children, as university students, as adults.  Our methods should identify and encourage those differences rather than limiting learning to those who happen to fit the traditional model.
  4. Learners need to consolidate the basics before moving on to advanced learning.  Khan identified early on that his students were having difficulty in traditional schools systems because the class had to move on to new topics before the basics were completely mastered by all students.
  5. The learning method Khan has developed is not only more effective, but, amazingly, requires less resources and expense to support than the traditional model.

The world is providing opportunities to do things better, and not necessarily by consuming more resources.  We need to Think Different.

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