AMEE conference, 2011 (day 1)

Today was the first day of AMEE 2011, and a great start to my first international conference. Here are the notes I took.

Donald Clark – 21st century medical learning

“Death of the compliant learner” – almost all of my students are compliant, I hope Clark doesn’t buy into the idea that all of today’s students are somehow different? Even Prensky has moved on from the Digital Native debate

When the cost of education goes up, and the deliverable stays the same, you have the characteristics of a bubble → is higher education / medical education in a bubble (Malcolm Gladwell)?

Clark shows excerpt from Ferris Bueller’s day off to demonstrate poor lecturing style, gets a laugh but is caricaturing the format useful in terms of solving the actual problem?

Psychology of learning:

  • Spaced practice
  • Attention
  • Assessment
  • Learn by doing
  • Collaboration

“The internet is shaping pedagogy”, this is the wrong way around. Effective teaching practice should make effective use of the internet.

“Lectures are ineffective for teaching”

  • don’t inspire or motivate
  • no critical thinking
  • doesn’t emphasise values
  • no social adjustment
  • or behavioural skills
  • only useful for transmitting information

Student and lecturer’s attention begins to fall off after 25 minutes, yet lectures often continue for much longer. Clark’s solution → record lectures! OR…change teaching practice to make use of that time more effectively

Cultural reasons for not changing teaching practice

Assessment is skewed towards favouring cramming

Is technology supporting assessment?

Surgeons who play video games perform better with laparoscopic procedures than those who don’t

I think Clark’s emphasis on technology misses the point. This isn’t the right audience to make assumptions about what technology should be used with what teaching approach. The message he’s sending is that we should use digital tools because they’re better. But he hasn’t spent enough time explaining what it’s better for and how.

 

The future of online continuing medical education: towards more effective approaches
Panel discussion (John Sandars, Pat Kokotailo, Gurmit Singh)

How do we get the new evidence base to change behaviour in health professionals? By delivering content and hoping → behavioural change

Online CME is about transmitting content from an “expert” to the person at home, and competing with their social lives. Does this have the intended impact of actually changing clinician’s behaviour? Sandars says “No”

How can the intended impact be achieved?

CME vs CPD
CME process whereby people keep updated regarding medical information
CPD includes CME but is more broad

e-learning implies that technology is used to enhance T&L but no definition of what technology is. I wish people would stop talking about e-learning until we demonstrate that it’s fundamentally different in terms of changing learning behaviour

List of digital tools and blending them with f2f spaces

Issues in obtaining evidence of effective CPD:

  • Differing content in med ed → differing ways of delivering / teaching
  • Traditional curriculum vs no curriculum
  • Rare comparison between e-learning intervention and traditional intervention
  • Difficulty with educational RCTs (very “medical” to think that RCTs are an important evaluative tool in education)

Kirkpatricks model to categorise the level of evaluative outcomes

Majority of research looks at participant satisfaction, but limited research demonstrating performance change in practice, no studies demonstrated that web-based CME had any effect on clinical practice

Internet learning associated with large positive effects compared with no intervention, but the effects were heterogeneous and small (internet learning interventions were broad in terms of content)

Comparison of different virtual patient desings suggest repetition, advance organisers, enhanced feedback and explicitly contrasting cases can improve learning outcomes (Cook at al, Academic Medicine, 2010)

Which “e-learning” techniques enhanced learning experiences?

  • Peer communication
  • Flexibility
  • Support of a tutor who was also a moderator
  • Knowledge validation
  • Course presentation
  • Course design

Effectiveness of the online course is mediated by the learning experience

Cost effectiveness of online CPD is mainly based on self-report, so data not robust (Walsh et al, Education for primary care, 2010)

Most to least effective approaches (Bloom, International Journal of Technology Assessment in Health Care, 2005):

  • Interactive techniques (audit / feedback, academic detailing / outreach, reminders)
  • Clinical practice guidelines and opinion leaders less effective
  • Didactic presentations and distributed print material have little to no effect

Therefore, not much evidence for the use of online learning, and the effects that do exist, are small (smaller than traditional), course design is important, and interactivity appears to be key

Improving knowledge and skills without an associated change in behaviour, is useless

Discussion:

  • Isolated, invidualised online CME is focused on delivering content more efficiently but that misses the point
  • We need to integrate social components into the learning experience
  • We evaluate episodic events and expect to find behavioural change
  • It’s not about one approach or the other, we need to blend different teaching methods
  • We need to stop talking about e-learning, we don’t talk about overhead projector learning

Problems with CME (currently)

  • Exisiting models do not improve patient care
  • Current models are incomplete, and are used for different reasons
  • Use is unco-ordinated
  • Participation is low
  • Much research names existing models as “largely irrelevant”

Moving from knowledge and skills to changing behaviour. What is the / a new model?

The outcome must be: improving patient care. This comes about through supporting information exchange, opinion and advice to make sense of the complexity of practice

Technology used must be useful and relevant

Technology + pedagogy = outcome (is it this simple?)

Should move psychological learning theory to sociological theory

Professionals learns as they go about doing things, sharing tacit knowledge, discussing and interacting with others in social networks. As people interact they share ways of thinking, feeling and acting in daly life, which influences their behaviours and habits. We are living, learning and changing in practice. They are reflexive. Learning, behaviour and change are all dynamically connected in networks and make practice complex.

Learning practive should be embodied and emergent

Reflexive networks used in teaching and learning

We should be more strategic in collaboration, rather than having collaboration forced.

How do you evaluate outcomes?

  • CME credits
  • Self-report: was it relevant and useful?
  • Patient care audit: do patients have improved outcomes?

Tacit knowledge = useful knowledge

Practice and learning are inseparable

If individual practice is only part of the team approach, is it reasonable to expect that changing an invidual’s approach will actually impact on patient outcomes?

Interprofessional workplace-based learning using social networks
JM Wagter

Difference between in/formal learning

80% of learning is outside the formal context. How do we make the informal learning explicit?

Between whom is learning taking place i.e. identifying actors within the network by mapping relationships between teams, professions, etc.

Look at density and information and communication flows

Everybody is involved in informal learning within networks, but the relationships are assymetrical and not collaborative or reciprocal

Network analysis is a useful method to identify relationships between professionals, but what do you do with the information i.e. how do you change the relationships?

Patient attitude to medical students experience in General Practice
H Cheshire

Patients lack confidence to ask students to leave when receiving a personal physical examination by a GP

Female patients are less likely to have positive attitudes with regards a medical student conducting an assessment, although the numbers are quite high nonetheless

The context of the examination changes whether or not patients are happy to have students present e.g. sexual health, etc.

Learning at a clinical education ward: first and final year nursing students’ perceptions
K Manninen

Final year students have an emphasis on supervisor relationships and are more dependant on feedback and affirmation but don’t experience internal authenticity, which is what drives the understanding of the nursing role.

First year students focus on patient relationships with concomittant feedback

Creating a student ER
A O’Neill

Highly integrated, student-centred, emphasis on PBL → creation of a student ER

Organisation based on teams, rather than a hierarchy. Team sees the patient concurrently, rather than consecutively

Approach allows the student to manage the patient with a focus on structured feedback. Tried to avoid students managing those with obvious serious pathology, cognitive dysfunction, etc.

Supervisor behind the student, not the other way around

Received positive feedback from students, in addition to significant improvement in student note-taking ability, among other clinical skills

Evaluating medical grand rounds – 10 years later
Mary J Bell

High numbers of repeated evaluations in order to determine reliability

We tend to give colleagues higher evaluator ratings

Highest scores had less to do with knowledge and presentation of objectives, and more to do with presenter style, level of presentation and enthusiasm → edutainment

When grand rounds were done using digital video, overal presenter ratings went down, seeming to concur with social learning theories i.e. we want to be in the same room as those we’re learning from (but is social just about physical presence?)

Posted to Diigo 08/21/2011

    • “ ‘Thunks’ are deceptively tricky little questions that ‘make your brain go ouch!’

      Ian’s examples of ‘Thunks’ include:

      • ‘Is a broken down car parked?’
      • ‘If you read a newspaper in the newsagents without paying for it, is it stealing?’
      • ‘Do all polo’s taste the same?’
      • ‘Can you be proud of someone you have never met?’
      • ‘Is a hole a thing?’
    • Active Learning-I ask students to use their prior experiences (interests, hobbies, coursework) in a service learning project for my class, using what they know, and connections they have been able to make, to benefit others. They propose their own projects.


      This idea has all 5 components:
      a. Incorporating peer feedback into a course.
      b. By giving students the opportunity to learn how to give feedback to classmates’ works-in-progress, this motivates students to perform at the same or higher level or their peers in a non-threatening way.
      c. It is also an activity which reinforces learning of the subject matter (active & challenging).
      d. It can create a sense of support and community because the students are helping each other improve their own works (and grades!)
      e. And peer feedback allows students to gain an appreciation for classmates’ efforts and a glimpse of the instructor or professor’s role.

    • When students are stressed by the lesson, find a way to show how you (the teacher) messed up learning the topic
    • First day of class: When introducing class & trying to establish rapport, have the students say where they see themselves in 3 to 5 years
    • I give several smaller “low-risk” assignments in addition to “high-risk” mid-terms and finals
    • Share with my students some of my personal stories as a student, my stories and failures
    • I teach a 3rd year/level class and on the first day of a particular subject, in this case hydraulics, I give them an exam of what they should know from 1st year. I eventually let them take it home to complete it on their own
    • review some student work in class in front of the class, inviting student input. It challenges many students to work harder on their own work
    • I give an exam which I grade and return as soon as feasible to the students. I identify the learning outcomes that most students missed and offer students another test that focuses ONLY on those learning outcomes using different test items. They know they have a chance to improve their exam grades with the subsequent test score.

    • apply newly acquired knowledge to themselves or someone they are familiar with
    • In many sciences, students are concerned about memorizing information (ex. Periodic Table). I tell them that we never used to memorize an atlas, but we learn how to use it as a tool/reference
    • At the end of each lecture topic, students hand it a slip of paper with two items: “Got it”-what they understood and “don’t get it”-what they don’t understand. Once a week, results are posted on Moodle and explanations given for the “don’t get it” items
    • Collaborative learning: I found that students learn better and smooth out their rough edges when they combine conflicting analysis to produce a bounded unit of learning
    • When composing homework assignments, I combine questions of varying difficulty. I ultimately include a problem or two beyond the difficulty required for my course and offer extra credit for solving these problems. The number of students that choose to step up to the challenge is so incredibly refreshing and motivating
    • Have students take responsibility for their learning by applying lesson concepts to their occupations, field of expertise, and personal experience
    • The student gets to choose a topic they feel they could teach the class (for 15 minutes), they become the expert with certain guidelines to follow. Motivation—they are the “star” for 15 minutes. Active learning—they research. Task—they choose the topic. Community—they all practice with each other to get feedback before their 15 minute presentation. Holistic—they learn all types of things; respect, confidence, professionalism, body language, etc.
    • In a writing course, students receive each others drafts throughout the semester and one by one the whole class peer reviews the drafts. Students learn from other student papers and gain critical feedback on their own paper. In other words, every paper is read by every student, and every student must provide feedback.
    • Start each class with a “hook”—something that is contextual and related to the day’s concepts—provides relevancy and captures interest and involvement
    • I engage students to choose a concept from the course and teach a segment of the class.
    • Take students’ pictures 1st day of class and memorize their names. Call students by name from the 2nd class on. Use their names frequently. This instills community and aids in engagement because students cannot hide
    • Allow students to text you with questions
    • I am a student—I am tired (flight came in late). I am hungry (I missed lunch), I can’t concentrate (my daughter keeps texting me). How will you engage me? Tell me a story, a story with characters facing shocking/new or interesting challenges. Then ask me about it, allowing me to be a little grumpy, but encouraging me to continue to participate and reward my efforts. I will cheer up and feel transformed by your class session
    • “Self-correcting exams”: Students are able to alter test answers after the fact—through additional research/working with other students—and resubmit exam responses for additional partial credit.
      • Can the Ethics oral exam use a similar approach? After the exam students go and write a short reflective essay on what was discussed during the exam?
    • Clarify how knowledge that is being taught is important to students’ future work and/or life. Students will value only what they believe they need to know and will use in work/life
    • Problem based learning in groups. Assigning a facilitator in the group and then pick an idea that there isn’t a right answer. You can use concept mapping. First, students present the problem. Second, they find resources and list them. Third, they investigate solutions to the problem and list them. Fourth, they identify the three best solutions. Last, they pick the best one and provide the reason
    • I ask my students (every week), why are you here? I note week one and compare it with the final week. Typical observation: growing ambition.

    • Motivation and Value: I get my students to stop thinking like a student, rather think like a teacher (or a professional in their field) to see the value of the activities and assignments in the course
    • People respond to genuine concern for their well-being
    • Active Learning: I occasionally divide the assigned chapter up among the students, and give everyone 10 minutes to come up with a 1 minute presentation to the class. The students have at least read a few pages, and they talk to each other instead of listening to me
    • When a student engages in course dialogue, I write a note thanking them as their classmates and I enjoyed their participation and how important their questions and comments are to educators and their students. I also include that I hope they continue to share in all courses. This helps encourage participation, especially from those who seldom do
    • Recognize and sustain the “cool” in everyone and challenge the students to move from “pretend cool” to “cool.”
    • Remove fear/anxiety and increase expectations of success by: allowing students to redo/resubmit work or problems for regarding/assessment. They work and learn from their mistakes, but are not punished for their mistakes.
    • Living Concept Maps: During a case study, have the students in groups of 4-5, actively create a concept map as the case study is unfolding—adapting and changing it as new data becomes available. At the end, share the concept maps and see how different/similar they are and explore those.
    • the selection and use of technologies for teaching and learning is driven as much by context and values and beliefs as by hard scientific evidence or rigorous theory
    • There are deep philosophical, technical and pragmatic challenges in trying to provide a model or set of models flexible but practical enough to handle the huge range of factors involved
    • theories and beliefs about education will influence strongly the choice and use of different technologies
    • it is a mistake to focus solely on the educational characteristics of technologies. There are social, organizational, cost and accessibility issues also to be considered
    • what is best done face-to-face and what online, and in what contexts? What is the role of the human teacher, and can/should/will he/she be replaced by technology?

Posted to Diigo 08/17/2011

I did a lot of reading and highlighting the other night, which is why this is so long. I’ve been bookmarking a lot of articles (about 400 at the last count) over the past 6 months or so, and will be trying to get through them over the next few months. There might be more long posts like this one (aggregationsof Diigo highlights) as a consequence.

    • I truly believe that a combination of actively influencing a story line in combination with a reaction upon the decisions taken would make learners feel more appreciated or valued if you will and encourage them to continue learning with that program instead of only getting negative feedback in from of a summary assessment when a chapter or course is finished
    • According to Rita Kop PLE is a UK term and PLN an American term. Dave Cormier questions whether the term personal should be used at all. Stephen Downes points out that personal is an OK term if you think about [Personal Learning] Network as opposed to [Personal] Learning Network – and similarly for PLE
    • the words are not as important as the process
    • a Personal Learning Environment (PLE) is more concerned with tools and technology and that Personal Learning Networks (PLN) are more concerned with connections to people
    • The PLE takes me to my PLN through various gates and paths
    • they’re the ticket and ride, not the destination
    • The PLN is then more akin to a community, but with much looser connections, described in the literature as “weak ties”
    • possible roles involved in networked learning that the teacher may be classified as (Expert: Someone with sustained contribution to a field, Teacher: experts with authority, Curator: play the role of interpreting, organizing, and presenting content, Facilitator: able to guide, direct, lead, and assist learners, not necessarily being a subject matter expert
    • why focus on PLEs? Shouldn’t we be trying to figure out how to make PLN work better?
    • Development of your PLE is about working with technology, refining your use of tools to give you more keys or more efficient access to your network of people and resources
    • “Pundits may be asking if the Internet is bad for our children’s mental development, but the better question is whether the form of learning and knowledge-making we are instilling in our children is useful to their future.”
    • we can’t keep preparing students for a world that doesn’t exist
    • The contemporary American classroom, with its grades and deference to the clock, is an inheritance from the late 19th century. During that period of titanic change, machines suddenly needed to run on time. Individual workers needed to willingly perform discrete operations as opposed to whole jobs. The industrial-era classroom, as a training ground for future factory workers, was retooled to teach tasks, obedience, hierarchy and schedules.
    • Teachers and professors regularly ask students to write papers. Semester after semester, year after year, “papers” are styled as the highest form of writing.
      • And yet they will probably never have to communicate anything in that format ever again…unless they also become academics
    • question the whole form of the research paper
    • “What if bad writing is a product of the form of writing required in school — the term paper — and not necessarily intrinsic to a student’s natural writing style or thought process?”
    • A classroom suited to today’s students should de-emphasize solitary piecework
    • That classroom needs new ways of measuring progress, tailored to digital times — rather than to the industrial age or to some artsy utopia where everyone gets an Awesome for effort.
    • Blended learning lets designers split off prerequisite material from the rest  of a course
    • Blended learning lets instructional designers separate rote content focusing  on lower-order thinking skills, which can be easily taught online, from critical  thinking skills, which many instructors feel more comfortable addressing  in the classroom
    • Learners can have more meaningful conversations about these  topics because they have developed a familiarity with basic management  policies and procedures and have had time to integrate what they know into  their thinking
    • We cannot have it both ways: quality of thinking and speed are anathema to each other.
    • Covering content is daunting enough, but providing the time necessary to indulge in the quality conversations that make learning truly engaging is almost impossible
    • the challenge of articulating thoughts quickly
    • post two dynamic questions online each night. These questions have many possible answers, require analysis of content and the creation of unique ideas
    • when we revisit these discussions in the classroom, students have a plethora of ideas to share. They are no longer scared to speak out because they have a confidence born from their online discussions and the validation of their peers
    • weave those online conversations back into the classroom
      • “Some students have great ideas, but they experience difficulty expressing those ideas clearly.
    • Good practice in undergraduate education:
    • We address the teacher’s how, not the subject-matter what, of good  practice in undergraduate education. We recognize that content and pedagogy interact in  complex ways.
    • An undergraduate education should prepare students to  understand and deal intelligently with modern life.
    • 1. Encourages Contact Between Students and Faculty  Frequent student-faculty contact in and out of classes is the most   important factor in student motivation and involvement. Faculty   concern helps students get through rough times and keep on working.   Knowing a few faculty members well enhances students’ intellectual   commitment and encourages them to think about their own values and   future plans.
    • 2. Develops Reciprocity and Cooperation Among Students  Learning is enhanced when it is more like a team effort that a   solo race. Good learning, like good work, is collaborative and social,   not competitive and isolated. Working with others often increases   involvement in learning. Sharing one’s own ideas and responding to   others’ reactions sharpens thinking and deepens understanding.
    • 3. Encourages Active Learning  Learning is not a spectator sport. Students do not learn much just   by sitting in classes listening to teachers, memorizing pre-packaged   assignments, and spitting out answers. They must talk about what they   are learning, write about it, relate it to past experiences and apply   it to their daily lives. They must make what they learn part of   themselves.
    • 4. Gives Prompt Feedback  Knowing what you know and don’t know focuses learning. Students   need appropriate feedback on performance to benefit from courses.   When getting started, students need help in assessing existing   knowledge and competence. In classes, students need frequent   opportunities to perform and receive suggestions for improvement. At   various points during college, and at the end, students need chances   to reflect on what they have learned, what they still need to know,   and how to assess themselves.
    • 5. Emphasizes Time on Task  Time plus energy equals learning. There is no substitute for time   on task. Learning to use one’s time well is critical for students and   professionals alike. Students need help in learning effective time   management. Allocating realistic amounts of time means effective   learning for students and effective teaching for faculty. How an   institution defines time expectations for students, faculty,   administrators, and other professional staff can establish the basis   of high performance for all.
    • 6. Communicates High Expectations  Expect more and you will get more. High expectations are important   for everyone — for the poorly prepared, for those unwilling to exert   themselves, and for the bright and well motivated. Expecting students   to perform well becomes a self-fulfilling prophecy when teachers and   institutions hold high expectations for themselves and make extra  efforts.
    • 7. Respects Diverse Talents and Ways of Learning  There are many roads to learning. People bring different talents   and styles of learning to college. Brilliant students in the seminar   room may be all thumbs in the lab or art studio. Students rich in   hands-on experience may not do so well with theory. Students need the   opportunity to show their talents and learn in ways that work for them.   Then they can be pushed to learn in new ways that do not come so easily.
    • tell real stories from your own life in a way that is relevant and engaging to your audience. If more people could just remember that great speeches or presentations leverage the power of the speaker’s own stories
    • we must not talk ourselves out of being who we really are
    • People do not care about your excuses, they care only about seeing your authentic self
    • People crave authenticity just about more than anything else, and one way to be your authentic self and connect with an audience is by using examples and stories from your own life that illuminate your message in an engaging, memorable way

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