A recent article in The New York Times Education Section
http://www.nytimes.com/2009/01/13/us/13physics.html?partner=permalink&exprod=permalink described an enormous change in the way the introductory science courses are taught at MIT; yes, Massachusetts Institute of Technology! Rather than the traditional crowded lecture hall, small groups of students explore the problems of science by interacting with peers and using faculty as resources and facilitators. The “50 minute expert lecture” is dead; instead, professors engage students in small group work while clarifying key concepts as they roam from table to table.
How’s it working out?
“Last fall, after years of experimentation and debate and resistance from students, who initially petitioned against it, the department made the change permanent. Already, attendance is up and the failure rate has dropped by more than 50 percent.”
What does this have to do with Medical Education and Grand Rounds?
Everything!! For years, many of the Basic Science and Clinical teachers in medical schools and residency programs across the country have been “bucking” the “case-based and/or collaborative teaching” trends by saying that there is simply too much to “cover” to use these more interactive concept-based teaching approaches. It is true that you can cover more ground with a lecture, but if no one is awake, much less learning, what is the point?
Will medical and residency education be “brave enough” to follow the example of MIT? Can we resurrect interaction, clinical reasoning discussions and vigorous debate at some of our education meetings?
Can we change “Grand Rounds” into something really GRAND? Click on the link above and read the whole article. It is fascinating. We want to hear what your think?
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18 comments:
I'm pretty sure that you are not just talking about "Grand Rounds" Do I think that my residents learn alot from lectures, problably not. do I have the time and skill to completely change how education is given, probably not. Do I think we need to change, Yes
All our Grand Rounds are case-based now. Some do it better than others and it is still didactic, but at least the residents are somewhat engaged.
This is not reinveting the wheel by any means. Many ofus who have been instructors in higher ed for some time have seen this come back into vogue from time to time. What is really being advocated is the concept of a Learning circle -- providing the student with the ability to engage in dialogue, creaction of a safe and respectful
context for sharing ideas,knowledge, views, and experiences. A Learning Circle is a format for dialogue that invites participation that goes beyond conversation and didactic presentation, when utilized correctly, can be a foundation for deep dialogue. This format
has been used since the mid-80's (Invisible College) founded in the
mid-1980’s to promote idea exchange of ideas that can then lead to deeper learning.
It's a great idea to shake up a paradigm. Barriers include expectations ('what is this, not what I'm used to'), physical location (for example Bunt's auditorium reduces interactions), and willingness of 'speakers' to take a risk. Given this there's room for trying out new things.
I think your question "what is the point?" is key. We go to conferences for breakfast, or lunch, CME (funny thing that), socialization (to see and be seen), and sometimes for information. Would more of us go if we had to interact? Hard to say, especially if it's at 7 AM. I have found the audience response system (ARS) a good tool both as an instructor and a learner. Even that little nudge gets the competitive edge going and makes the lecture format more stimulating. So, I vote yes for more educational innovations and interaction!
The wonderful thing is to have recognition that learning is, in fact, an active pursuit. The old dependence on lectures as the main modality for transmission of information assumed a vessel into which we poured content; that students learn simply because teachers "teach". While some form of "lecture" is still an efficient means of transmitting information in bulk, discussion, interpretation, and interaction would seem to promote the distillation and synthesis of ideas and concepts that is necessary for real learning. Intuitively, this method allows a truer assessment of the learners' understanding of material.
This is a great way to learn but is also the hardest to teach.
There are 3 concepts that I try to keep in mind when teaching
1. Make sure the students know what they are going to learn and why
2. Make sure the process of learning is interactive (not passive)
3. Make sure that at the end of the session there is an opportunity for transformation (students take the textual/literal content and change it to a more visual or tabular format). The final product does not matter as much as the process of Transformation.
This is more relevant for "mandatory" session like coursework for a medical school.
Grand Rounds generally tend to be voluntary, people attending them know the topic and decide to come there because of the speaker or the topic. Thus the setting is already teed up for success and most attendees go away with at least some new information or even knowledge.
Problems occur when
1. The speaker does not tailor the talk for the audience
2. The time is inconvenient (so the people who are most interested cannot make it
3. There is not enough time for Que/Ans
It would be great if we could make all Grand Rounds into small group sessions that are highly interactive but that is very time and effort intensive and would require a huge amount of faculty development. But if we can address the issues listed above, the Grand Rounds as they exist can still serve a valuable function.
Some suggestions:
1. Allow invitees to GRs to submit questions to the speaker a few days PRIOR to the GRs to allow them to customize their presentations.
2. Archive the presentations in a way that can be accessed later by non-attendees.
In medical education at all levels, the learning process is fascinating and attempting to convey the information in a non threatening and didactically effective way is challenging.
We have a strong responsibility of ensuring a real and ready assimilation of the information provided.
Grand Rounds by itself, is a way to deliver information to a large audience, however the quantification of the academic impact in each individual attendee is difficult to ascertain.
For instance, attending a Grand Round doesn't mean an actual learning process, especially when the subject involves information that is the current state of the art in the research environment, but perhaps impractical in the clinical setting.
Teaching to smaller groups provides an opportunity to engage all participants in a discussion that presumably, enhances an active learning; the lecturer, acting as a moderator, can gauge the level of understanding and effectively ensure the learning of the information.
I think this creates a setting where people becomes eager to learn and to the lecturer to provide a more personalized teaching.
Given the amount of knowledge required in any given medical field, to attempt to "cover everything" in a lecture series seems like it would likely fail every time. What one needs to consider in developing curriculum is how to teach the medical students and residents the tools and foundation they would need to find the answers to questions they encounter in real life situations. Case based studies/ small groups do just that.
It's hard to get much interactive learning in when you have only one hour. Some grand rounds are poorly attended, where others are standing room only. It would be nice to have a longer time, and more time to ask questions. I have enjoyed the GR's where there is a team of presenters, with a chance to ask questions at the end.
full disclosure - i plan our grand rounds - so i'll take the question literally.
i view grand rounds like i view reading the sunday new york times - an intellectual luxury, exposure to areas of medicine and science that i may (or may not) ever need to know. but if i dont hear about it i may never know its out there (i dont need to travel to every place i read in the travel section to make reading it useful; ditto the book reviews). as i lecture other places, i realize a decrement in attendance - and the constancy of 1 row almost everywhere of a group of emeritus, retired docs - who seem to also enjoy reading the sunday times.
In FCM the combination of interactive lectures (sometimes) and small group session seems to work. It allow the course to expose the students to new information (didactic session) while also allowing them to try to make this new information their own (small group). It doesn't always work but when it does it can be an exceptional learning experience, even for the faculty.
I don't think there's ever 1 answer, 1 way of teaching, that fits all situations. Answers need to be designed to fit the questions. The first question to ask is what is the "teaching experience" supposed to accomplish and the second question is who is the audience. I think 1 of the problems with grand rounds is the diversity within the audience--some may be very knowledgable about a subject, some may be curious but with little knowledge, etc. Given that situation--maybe the style has to be basically didactic so that there is something for everyone. But given that compromise, how does the audience become engaged? That's where the interactive piece has to happen during the lecture, not at the end, when so many may have tuned out. But it takes a skilled teacher to know how much of each to do. I'd love to see these personal response clicker kinds of things used to guage what is working & what is not working, how to create these balances--maybe with a feed-back mechanism set up on the speaker's computer so she could see when she's losing the audience, when they're engaged--maybe like a functional MRI of participants' brains--science fiction or a research project?
There is plenty of evidence in the literature showing that "the one hour lecture" is far from an ideal medium, and length of time, to impart knowledge and foster understanding. However, let us not forget that "Grand Rounds"-- when given by residents and fellows and arranged properly so that feedback can be given-- can serve the very important function of allowing trainees to hone their public speaking skills. It is important for doctors... as teachers... to possess such communication skills.
I'd like to address my comment to brian's posting. With duty hours, limiting our didactic time, I don't think we can afford an intellectual luxury. We need real learning sessions. I like what you said, but just think another appraoch might be better use of our time
constraints of duty hours and the pressures on staff for clinical productivity and timely discharge of patients noted and fully recognized..there will always be compromises that need to be made. but i'd counter that we cant afford (at least periodically) to NOT take the luxury of reflective intellectual inquiry - or we just accept our profession as "just" a time clock job, and surrender any harbinger of scholarly endeavor or personal inquiry.
some may prefer to "compromise" by engaging in these activities in an alternate venue (podcast, webcast etc) at a different time period - and activity directors need to keep that in mind.
these comments are far afield from the thread of whether there is an "ideal" method of teaching /learning.. of course i think not (i personally am generally bored by interactive sessions, i'd much rather hear from a true content expert and process the info internally than hear other learners interact with the material/speaker - thats my solution to the limitations on my time to devote to the luxury of intellectual pursuit)
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