Applying theoretical concepts to clinical practice

Concept map about concept mapping taken from IHMC website

I just finished giving feedback to my students on the concept mapping assignment they’re busy with. It’s the first time I’ve used concept mapping in an assignment and in addition to the students’ learning, I’m also  trying to see if it helps me figure out what they really understand about applying the theory we cover in class to clinical contexts. They’re really struggling with what seem to be basic ideas, highlighting the fact that maybe the ideas aren’t so basic after all. I have to remind myself that clinical reasoning is a skill that takes many years to develop through reflection and isn’t really something I can “teach”. Or is it?

For this assignment I wanted the the students to set a learning objective for themselves (I gave examples of how to do this, including using SMART principles of goal setting). They also needed to highlight a particular clinical problem that they wanted to explore and how they would use concepts from the Movement Science module to do this. They needed to describe a clinical scenario / patient presentation and use it to identify the problem they wanted to explore. From that short presentation, they should derive a list of keywords that would become the main concepts for the concept map.

Here’s a list of the most common problems I found after reviewing their initial drafts:

  • Many of them lacked alignment between the patient presentation, the learning objective, keyword / propositions and the final concept map
  • Many of the learning objectives were vague. They really found it hard to design appropriate learning objectives, which meant that their whole assignment was muddled
  • There were two processes going on in the students’ minds: patient management, and their own learning. This assignment was about student learning, but most of the students were focused on patient management. This was especially clear in the learning objective and actual maps they created, which all had a clinical focus on the interventions they would use to treat the patient, rather than the learning concepts they would apply
  • Most of the students created hierarchical maps which failed to identify complex relationships between concepts

After going through their initial drafts, I had another session with them to go through the feedback I’d given and providing more examples of what I expected from them. This assignment is proving far more difficult for the students than I’d expected. However, I’m not sure if it’s because they can’t apply theoretical concepts to clinical scenarios, or if they just don’t have a good understanding of how to create concept maps. I think that they’re having difficulty thinking in terms of relationships between concepts. The maps they’ve been drawing are appropriate in terms of the interventions they’d choose to manage their patients, but the students can’t seem to transfer the concepts from the classroom into clinical contexts.

They’re used to memorising the content because that’s how we assess them i.e. our assessments are knowledge-based. Then they go into clinical contexts and almost have to re-learn the theory again in the clinical environment. There doesn’t seem to be much transfer going on, in terms of moving knowledge from the classroom context to the clinical one. I haven’t researched this yet, but I wonder what sort of graduate we’d get if we scrapped classroom teaching altogether and just did everything on the wards and in the clinics? I understand the logistical issues of an apprentice-based approach to teaching large groups but if we didn’t have classroom time at all, maybe it’d be possible?

Twitter Weekly Updates for 2011-08-01

  • Cities Are Immortal; Companies Die http://bit.ly/pEWOmx. Masie briefly mentioned this Kelly article (I think)  in his great presentation at #cityafrica # (link updated after the fact)
  • Historic medical manuscripts go online http://ow.ly/1v9v0b #
  • Omniscient Mobile Computing: What if Your Apps Knew Everything About Where You Are? http://ow.ly/1v9tkE. Reminded of Masie at #cityafrica #
  • Is RT a form of legitimate peripheral participation? Attended #tedxstellenbosch yesterday & did a lot of RT, wondering “did I padticipate”? #
  • @Sharoncolback not sure if it’s so simple, see @jeffjarvis who is very public re. personal stuff & who inspires many in similar situations #
  • Am I addicted to the internet? Maybe, but so what? http://ow.ly/1v8Cd0 #
  • Before iPhone war, Samsung sells 5M GS2′s in 85 days http://ow.ly/1v8BPZ. Got my samsung galaxy S2 last week and loving it so far #
  • Are there some things that shouldn’t be tweeted about? http://ow.ly/1v8BDT #
  • Feds Will Pay Doctors For Using Medical Records iPad App http://ow.ly/1v8AYl #
  • Electronic medical records get a boost from iPad, federal funding http://ow.ly/1v8AH5 #
  • The current impact agenda could consider the impact of inspirational teaching, not just research http://ow.ly/1v8An8 #
  • Mendeley 1.0 is here! http://ow.ly/1v8y0T #
  • Learning spaces haven’t changed much since structured education emerged centuries ago. #cityafrica providing inspiration for change #
  • @wesleylynch venue is packed, hard to find 5 seats next to each other, realm team always inviting 🙂 #
  • @wesleylynch re-designing cities to be integrated spaces for working, learning and living #
  • @wesleylynch not sitting with #realm team, but chatted a bit #
  • @hotdogcop “quality teaching” isn’t going to happen without policy change that affect salaries and other factors related to job satisfaction #
  • @hotdogcop interest groups aren’t confined to academia though…some academics seek radical change, institutional structure makes it hard #
  • @hotdogcop “academic” doesn’t have to mean “top-down” or “policy maker” #
  • @hotdogcop agreed, but we train the people who will be called on to implement change #
  • @hotdogcop Mokena has some great ideas re. the city & education. would be interesting have him talk to our academics #
  • RT @TEDxStellenbsch: The future city already exists <- no, the technology exists, it’ll take a few years to implement #cityafrica #
  • Mokena Makena the best speaker so far at #tedxstellenbosch #CityAfrica #
  • Classrooms are not inspiring #cityafrica #
  • How could learning spaces change if city / community / nature were more fully integrated? #cityafrica #
  • How would the world look if cities were planned to integrate nature? #cityafrica #
  • Cities and nature don’t have to be mutually exclusive #cityafrica #
  • @vivboz hi vivienne, I’m not sure what writing group you mean? #
  • If the world can’t see or hear you, are u relevant? Do gangs and violence allow young people to be feared, if not seen & heard? #cityafrica #
  • How do our living and working spaces change the way we think and what does that mean for how we live? #cityafrica #
  • At #tedxstellenbosch trying to better understand the relationship between city and community #cityafrica #
  • Using social media: practical and ethical guidance for doctors and medical students – The British Medical Association http://bit.ly/nHBIyj #
  • Sites for the QR-enabled Tourist http://bit.ly/qcMuan #

Posted to Diigo 12/10/2010

    • The zone of proximal development is the area between what an individual can achieve on their own and what they can achieve with assistance
    • A student should constantly be reaching slightly beyond their capabilities rather than working within them
    • students should lead their learning and teachers simply assist and rather than judging students on what they know in standardised tests, learning should be done through looking closely at their zone of proximal development
    • If informal learning is as important as formal learning, then varying the way students are assessed can only work in their favour
    • Relevant, meaningful activities that both engage students emotionally and connect with what they already know are what help build neural connections and long-term memory storage
    • it’s necessary for learners to attach a new piece of information to an old one
    • If a student acquires new information that’s unrelated to anything already stored in his brain, it’s tough for the new information to get into those networks because it has no scaffolding to cling to
    • a solid amount of research also links personal relevance and emotional engagement to memory storage
    • “the learner’s emotional reaction to the outcome of his efforts … shapes his future behavior,”
    • if [a student] doesn’t believe a particular activity is interesting, relevant, or within the scope of his capabilities, it’s probably not going to sink in
    • too much emotion can be as detrimental to learning as too little: distractions and stress can also block receptivity to new ideas
    • Make it student directed. Give students a choice of assignments on a particular topic, or ask them to design one of their own. “When students are involved in designing the lesson, they better understand the goal…and become more emotionally invested in and attached to the learning outcomes.”
    • Connect it to their lives and what they already know. Taking the time to brainstorm about what students already know and would like to learn about a topic helps them to create goals — and helps teachers see the best points of departure for new ideas. Making cross-curricular connections also helps solidify those neural loops
    • With no reference point and no intrigue, information is fairly likely to go in one ear and straight out the other
    • Happy learners are healthy learners, if students do not feel comfortable in a classroom setting, they will not learn. Physiologically speaking, stressed brains are not able to form the necessary neural connections
    • The amygdala, for instance, processes emotions, stores the memories of emotional reactions, and reacts so aggressively to stress that it will physically prevent information from reaching the centers of the brain necessary for absorbing new knowledge
    • Even feelings like embarrassment, boredom, or frustration — not only fear — can spur the brain to enter the proverbial “fight or flight” mode
    • The amygdala goes into overdrive and gets in the way of the parts of the brain that can store memories
    • it makes sense — on many levels — to cultivate the learning atmosphere as much as the learning itself. “Reducing stress and establishing a positive emotional climate in the classroom is arguably the most essential component of teaching,”
    • Make the classroom stress free. Lighten the mood by making jokes and spurring curiosity; create a welcoming and consistent environment; give students frequent opportunities to ask questions and engage in discussions without judgment; and determine achievable challenges for each learner
    • Encourage participation, not perfection. A classroom in which mistakes are encouraged is a positive learning environment, both neurologically and socially speaking
    • “Students will allow themselves to experience failure only if they can do so within an atmosphere of trust and respect.”
    • This kind of positive reinforcement from the get-go allows students to let their guard down (known in neuro-speak as calming their “affective filters”). Listening to students in general, and listening to their intentions in particular, can help relax anxious brains.
    • Practice active listening. “Focus on what students are trying to say
    • Intelligence is not fixed, it turns out, nor planted firmly in our brains from birth. Rather, it’s forming and developing throughout our lives
    • neuroplasticity is defined as the selective organizing of connections between neurons in our brains
    • neuroplasticity is defined as the selective organizing of connections between neurons in our brain
    • “cells that fire together, wire together”
    • “Practice makes permanent. The more times the network is stimulated, the stronger and more efficient it becomes.”
    • both morale and grade points increase when students understand the idea that intelligence is malleable
    • Practice, practice, practice. Repeating an activity, retrieving a memory, and reviewing material in a variety of ways helps build thicker, stronger, more hard-wired connections in the brain
    • Put information in context. Recognizing that learning is, essentially, the formation of new or stronger neural connections, it makes sense to prioritize activities that help students tap into already-existing pathways
    • “Whenever new material is presented in such a way that students see relationships between concepts, they generate greater brain cell activity and achieve more successful long-term memory storage and retrieval.”
    • Let students know that this is how the brain works. “Especially for students who believe they are ‘not smart,’ the realization that they can literally change their brains through study and review is empowering.”

Posted to Diigo 05/09/2010

    • In simplest terms, Kohn insisted it was time to destroy the teacher-centered, control model that focused on classroom management and replace it with a version that is often equated with what one sees in elementary school, particularly at the youngest levels.
      • For example, under his possible reasons to worry, he offered the following:
      • Chairs all facing forward and worse yet, desks in rows.
      • Packaged instructional materials orderly and prominently displayed.
      • Classroom visuals featuring commercial posters, lists of rules, sticker and star charts or samples of flawless student work posted only from the best youngsters.
      • Periods of silence interrupted by only the voice of the teacher.
      • An in-control, authoritative and highly visible teacher typically front and center.
      • Students waiting quietly for the next set of teacher-initiated activities, responding to teacher-directed questioning.
      • All students focused on the same activity working on their individual skills.
    • In the Kohn classroom, the teacher is no longer the focus – instead everything centers upon the students and what it is they need to learn:
    • Multiple activity centers featuring various classroom structures including open spaces and large tables for group work.
    • Room overflowing with a variety of materials, apparatus and supplies.
    • Displays of student projects demonstrating student collaboration or personal memos initiated by the students.
    • A buzz or low-level hum of activity featuring students exchanging ideas.
    • A warm, respectful teacher mingling with students.
    • Students eager and excited about learning as they actively question one another.
    • Multiple activities taking place simultaneously with students working in pairs or groups.
  • It is interesting to note that for many children, middle school and high school becomes the place where school is no longer enjoyable. It is, of course, at that time that students traditionally have been subject to a shift from student-centered classroom to a teacher-centered, content-driven academic approach.
  • The result is that school, instead of being a place where students look forward to going each day because it features an exciting atmosphere where learning new things is enjoyable, becomes a chore at best, a problem at worst. At the very age when students most resist compliance and teacher-centered approaches, too many teachers, and, by default, too many schools insist on employing such a format.