SAFRI 2011 (session 2) – day 3

Began today with a session on workplace-based learning, spent some time “developing a model” for learning a new skill after actually trying to learn (what was for many) a new skill…spinning a top. My group came up with the following model which, truth be told was obviously based on Kolb’s learning cycle.

Reviewed educational model of Teunissen et al (2007)

Models are fluid frameworks that help to develop understanding, not algorithms that need to be followed

Readings:

  • Teunissen et al, (2007). Attending doctors’ perspectives on how residents learn. Medical Education, 41: 1050-1058
  • Teunissen et al (2007). How residents learn: qualitative evidence for the pivotal role of clinical activities. Medical Education, 41: 763-770

 

One minute preceptor / 5-step micro-skills

Has led to modest improvements in teaching skills (Furney et al, 2001), has been found to be equal to or better than traditional methods of clinical teaching in time-constrained environments e.g. bedside, ward rounds (Aagaard et al, 2004).

The one-minute preceptor is a framework (Neher et al, 1992):

  1. Get a commitment: statement of understanding / intent, should be verbal (“What do you think?”)
  2. Probe for supporting evidence: question student for further depth / detail i.e. probe the statement (“Why do you say that?”)
  3. Reinforce what was done well: provide feedback on appropriate behaviour / performance
  4. Give guidance about errors or omissions: error correction
  5. Teach a general principle: extrapolate the situation / event to more general terms
  6. Conclusion: end with clear steps for moving forward

Readings:

  • Furney et al, 2001. Teaching the one-minute preceptor: a randomised controlled trial. Journal of General Internal Medicine, 16: 620-624
  • Aagaard et al, 2004. Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: proof of concept. Academic Medicine, 79: 42-49
  • Neher et al, 1992. A five-step “microskills” model of clinical teaching. Journal of the American Board of Family Practice, 5: 419-242

 

Portfolios

What is a portfolio? A collection of learning objects / experiences, aggregated over time, directing at documenting the achievement of developmental objectives. Demonstrates progress. Must be measurable although this is hard to do.

Short session on designing portfolio tasks, asked to design a task for something we currently teach. This is a useful framework for an assignment. I chose a task for Movement Science:

  • What – To understand the relationships between concepts in movement science and apply those concepts to clinical practice (challenging for students)
  • Activity – Develop a concept map of an activity (e.g. observed movement of a patient with a movement disorder), using concepts from module to explore / explain the activity
  • Where – Clinical setting / patient encounter
  • How – Short patient history, with an associated concept map
  • Reflection – Each link on the concept map must have a note explaining the observed movement / activity, it’s relation to the module concept, and be linked to the patient history
  • Measure – concept maps can demonstrate understanding of relationships between concepts (theory) and their application to practice (patient presentation)

Type of learning taking place in above example:

  • Clinical reasoning
  • Professionalism (i.e. note taking and patient presentation)
  • Reflective practice
  • Interpreting data

Assessment is a snapshot of learning

Students worry that they didn’t learn something that you might ask them in an assessment

Be strategic in what you’re going to measure

Portfolios are about “doing”, there should be consideration of patient management involved

Portfolio assessment is often not feasible in a resource-constrained environment as it can be labour intensive. The document should serve as an indicator to guide assessment of the student. It must assess something different to what is already being assessed.

Assess reasoning. Knowledge is better assessed with other methods e.g. MCQ

Portfolios are not just another thing to do

 

Reflection

Reflection raises awareness → exploration of alternative methods

Asked to do a short reflection on personal / professional development since beginning with SAFRI programme:

“My SAFRI project began as a study that would look (in retrospect) quite superficially at the use of a social network to development clinical / ethical reasoning skills.

Over time it became clear that the method involved little more than describing “what students did”, which I found deeply unsatisfying. “Is there more to this?”

I began looking into theoretical frameworks that could help to structure the research. I’m now analysing the data with a structure (i.e. theoretical framework) that is helping me develop a deeper understanding of the process.

This has played a role I changing how I think about research. I find myself questioning a lot more in other parts of my life…”Why is it like that?”

We discussed the challenges of evaluating personal (and often deeply personal) reflections. Giving marks clouds the issue, as students then write what they think you want to hear in order to get a better mark, in contrast to sharing honest, open, authentic experiences.

It’s important to link their reflections with expected outcomes

In the community block that I supervise, students share and discuss their reflections in a group. I do this because I think it’s important to hear what others are going through (i.e. to “normalise” the experiences and emotional responses). I understand that this can change the reflections that students produce i.e. will they be honest and open if they know the reflection will be shared? I’ve found that students give still give honest reflections when they realise that the feedback is non-judgemental and that it can help them to move to deeper understanding

Does reflecting actually change practice? Is there a difference between what they say and what they do?