If we want individuals to learn, they must be engaged in the process. Learning can occur with us serving as a guide, or without us as students review their readings, notes and try to make sense of the material and experience alone or with others. Of course we hope it is both!! I personally like being part of the process.
Teaching should be purposeful; that is, teachers should have a learning goal (general principles) in mind. Teaching in groups can be challenging, as your "audience" might be composed of learners at different knowledge levels and experience. Please take a few minutes to comment on your reading, class discussion or experience with teaching in groups. CT
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It't time for me to practice what we learned. Tomorrow I am scheduled to presentto our senior (PGY-4) resident group on anesthetic management of endovascular aortic surgery. Instead of my usual pp slide presentation, I plan to use an illustrative case based teaching.
Since I have 90 minutes, I will start by rying t get the " inside out" so I can tailor the objectives towards the learner needs. I will then share the organization of the learning activity and provide the objectives.
Using the think/pair/share methodology, I will attempt to engage learners in a non-intimidating format.
I plan to prepare and ask open ended questons that achieve the objectives and stimulate a clinical discussion to help apply their knowledge towards patient care (problem solving questions).
At the end, I will leave time to revisit the objectives, reemphasize take home emssages and answer any further questions.
I will also recommend additional resources based on the objectives that will be presented. (I already uploaded resourced on Medhub for them to read prior to the learning activity)
I'm excited and will let you know how it goes.
I find the hardest audiences to address are those where the learners are variably experienced. How does one design a session that simultaneously accommodates the learners who need the fundamentals, the learners who may be knowledgeable and the learners who already have expertise? This is often a challenge when presenting a national meeting, where the attendees for any given session may run the gamut from junior residents to seasoned practitioners. For better or worse, I usually try and pitch the overall presentation a bit more to the fundamental principles but periodically try to incorporate information that might be more appreciated by the experienced learners. Another challenge in a national meeting venue, where the audiences may be large, is that it is much harder to actively engage the learners. I don't think learners in this venue expect to have to actively participate and are somewhat surprised when one tries to actively engage them. The culture of the learning environment in this setting is the standard lecture, typically driven by powerpoint slides (often overloaded with information). Strategies that help in this venue include the use of rhetorical questions and occasionally you can get some audience participation in answering specific questions. Asking the experts to share their experiences with the group works well. Inviting the audience to answer a question brought up by one of the learners sometimes works. Regularly stopping (and planning for) questions is helpful; it can be useful in gauging whether the audience is with you and when the audience may not be clear on what was said or where the interests if the audience lie.
Kathy Baker
I think it's great that Maged is utilizing what we all have learned over the last two semesters tomorrow during his presentation and seeing how effective it can/will be. I agree with Rich in regards to finding it dificult to teach an audience of variable experienced learners. I assisted in training the new employees during their two weeks of "class time" orientation, as we had seven new employees. I personally practice teaching how I learn and the things that I appreciate and find useful as a learner. I know this can get us into trouble at times, as everyone learns differently, but personally, I find myself more capable to adapt and adjust to the learner easier this way. I utilize the ask/tell/ask method almost daily with the staff and encourage active participation in the non-traditional learning areas within the unit. One thing I took from today about getting people involved is it is tougher than most think. It is very difficult when you hire people and are investing your time into ensuring they are being trained appropriately and utilzing all the resources avaiable, and then they sulk, or complain, and act like they could care less. The lack of interest that radiates from some people is mind boggling at times. I think one thing I really connected with during class was the ways to increase active participation with detailed diagrams and boards. Brian Johnson and I spoke in our group time about teaching utilizing monitors and asking open ended questions about "what do you see wrong here?" and then have the students question and teach the teacher back what they learned. I thought today's class provided a lot of useful information and techniques that could be essential in multiple learning capacities.
I appreciated the chance to reflect on what I have been doing to involve students in their learning and what I can do better. Several of my PAs will be taking on students for the first time and I can share these tools to make a more meaningful experience for all. Our students would be at the expanding core concepts learner level. Approaching students with a plan for their rotation and finding out what prior rotations and healthcare experiences they've encountered including how they felt about those experiences is a way to get the inside out. I write a short bio on each student, which they dictate to me, and I post in our ASC. Handouts explaining the R&R of what we do with examples of instructions and formats we use familiarize the student with our terminology and culture. Readings ahead of surgeries are suggested to familiarize student with anatomy and OR procedures. Questions are encouraged and if answers not readily available research is encouraged and reviewed at next encounter. I try to connect students with areas of interest when able. Feedback is given during and after each patient encounter. I can improve on being consistent with observations of student history taking and closing the learning intervention successfully. I think an end of week review of what student has experienced will be a new strategy.
Our class today gave us a lot of information about how to engage and help our students make meaning during educational activities. I like the format that Maged is going to use in tomorrow's class: first trying to get the inside out, followed by sharing the organization of the learning activity and revisiting objectives at the end. I have been thinking about revising a group of lectures that I teach to PGY-3 anesthesia residents when they rotate to pediatric anesthesia. The challenge that I am running into is that these group of lectures are short (30 minutes) and they occur at 6:30AM. They are usually broad, high yield topics of basic concepts in pediatric anesthesia. For a while I have been trying to make them more interactive but I am still using the power point format. I have to share that somehow I am afraid to try something new and then feel quickly discouraged by the potential lack of preparation of the learners. I think that at the level of our trainees they should have ownership of their education and I would like for them to play a more active role during these sessions. I have thought about short case scenarios; I will give them some prior reading with questions to guide their reading; during 10 minutes of the activity they can work in groups; the following 20 minutes would be for discussion and questions. Any thoughts or ideas from my classmates on how to do a 30 minute educational activity engaging at 6:30AM in the morning?
Good luck in your presentation Maged. Please be sure to share your experience with us in class. I think that engaging our learners is as problem that all teachers struggle with. Always reflecting on teaching opportunities and trying to make them better the next time. Elias and I discussed the Goodenough article this morning in class. One of the staying points of the article was when the author was describing how he drew inspiration from an energetic teacher from his youth. A teacher that we all have had that was engaging, knowledgeable, and made learning fun. I like to think of myself as that same type of teacher.
I know that when I was teaching a subject to a few classes of students throughout the day, my first group of students were always the guinea pigs. By the second and sometimes third time giving the same interactive lecture, I knew were all the pauses, probing questions, and examples needed to be. This made teaching seem effortless and exciting.
I think that teaching is like any other complicated task. It takes practice and careful thought to become great at it. Interactive teaching is no different. One must always be mindful of the audience to which one is teaching. Spark their thinking with an engaging opening. Assess their prior knowledge to give you an idea of where your learners are. Good teachers have immense knowledge in their fields that make them credible to their learners and allow them to answer any questions that may arise during the teaching. Balancing the right amount of instruction (slides, group activities, discussion, ect..) in order to hold their audiences’ attention. Delivering a summative closing to their teaching that reviews the key points covered and allows for further thought. Engaging in powerful teaching is vary labor intensive on the part of the teacher an a big risk for some. I’m sure that changing a teaching style that has proven success will be difficult. Hopefully as more medical educators are exposed to alternative teaching philosophies we will see Interactive Teaching taking a larger role in the hospital setting.
Matt Celmar said the previous comment.
This topic seems to have enlivened the group. I enjoyed reading the blog entries and look forward to hearing Maged’s impressions of his experience. I started using an interactive approach with my didactic lectures on head and neck cancer topics about 6 years ago, and have loved it. The residents give good feedback immediately after, but I can’t say that I have data to prove it improves learning. It certainly is more fun and I never have residents fall asleep anymore.
Here’s how I do it (just one approach). I assign a chapter to read the week before the lecture that covers the basics of the subject matter, eg. on workup of a neck mass. At the lecture, I give a 5 minute introduction on the outline of the topic and major things they will need to know for board certification and practice. This gives them the take home points early and should guide their study later. I present real cases and make the residents provide the care and rationale for it, with directed questions to the group. If no one volunteers, I pick specific residents to answer. For the initial (easy) steps, I direct questions to the junior residents/medical students and work up the ladder of seniority. The more complex questions, eg. surgical management of a laryngeal cancer, are asked of the senior residents and fellows. I never work down the ladder, but I thought the idea of making that clear during our session was key. In this way, the group makes their way through the cases in a proper way, with my guidance. We can usually work through two complete cases in 75 minutes, and then I provide a short conclusion with 4-5 key points. And I rarely use a powerpoint slide, just a chalk board. The extra time it takes to draw anatomy and key points allows the residents time to answer questions and digest the material.
I hope this technique helps the residents not just know the facts but learn better how to apply them. It does take longer this way to present the material and requires that the residents do prereading, but in the end, more knowledge is gained (at least that is my belief). I have not gone back to my old ways, because it is more fun for me and it seems more fun for the residents. BB
As always, I appreciate the discussion, information and worksheets provided in this week’s seminar. Although I do not currently teach or lecture to groups, the content provided helps to take what can be a challenging task, like teaching in a new format, and break it down into more manageable pieces. The thought of teaching a group and looking at it as three sections (Opening, Learning Intervention and Closing) seems quite helpful. Sometimes when faced with a new challenge, it can be difficult to know where to start. Using some of the tips and techniques provided in class seem to help organize thoughts, respond to comments and answers by participants and direct class activities. It is nice to leave a class and have content that is applicable and can be used to improve the work we do each day.
I liked the increased amount of detail in hte presentation on last wednesday. I have heard many overviews on the use of the interactive teaching method but seldom have they included the tools needed to implement the practice months latter after the introduction. I appreciate the tool set Chris has given us to use. I have tried case discussions in several classes with variable results. Even when it feels like pulling teeth to get participation it feels better and more natural for me to use within my teaching practice.
Felecia:
As a trainer utilizing the Processes Activated Learning system it is very similar to interactive teaching. This system holds both the learner and trainer responsible for educating and introducing new and old concepts to the trainee. Alot of the concepts discussed in this seminar (ask-tell-ask, high yield questioning, power points, pre-reading assignments) are all utilized with the PALS process. An instructor will first introduce the topic to the learner, explain core concepts and assign pre-reading assignments. Once the preliminary reading assignments have been met the student(s) are required to explain their current understanding of the concepts introduced. The next step in the process is for the trainer to demonstrate the concepts and skills using hands on scenarios. The trainees are required to demonstrate back to the trainer their ability to accomplish the same task while explaining their understanding of concepts. This type of interaction gives the student(s) immediate feedback, constant and consistent observations with immediate evaluation of the student(s) understanding and knowledge of the core concepts. Peers are able to evaluate each other as well as themselves in a group setting verbalizing their understanding of what was done right or wrong and what they would do if in the same situation. As concepts are mastered, more concepts are introduced. The student(s) are continously engaged in his or her learning. Assessments are also given at the end of each module to access what the student(s) have retained. Students learn at different paces, the PAL system allows for the students to learn from each other as well as the instructor. As one masters a concept they can actively engage in helping their peers who may need more help in mastering the skills and concepts assigned. As a trainer I constantly try to observe and engage each student to optimize their training and hopefully achieve success.
David Wheeler
Unfortunately, I was out of town last week doing of all things giving 2 lectures at a critical care conference. I agree with the sentiments of my classmates in that the learning experience should be geared towards the learner. It is incumbent upon the lecturer/instructor/coach to create a learning session or experience that engages learner while accomplishing the goals of knowledge transfer, skill acquisition or reflective inquiry. I like constructivists at heart and as such a tie concentrate on creating meaning for the adult learner who already has some knowledge in the field or discipline I will be discussing. I began to give a mixed medium lecture concerning iatrogenic lung injury utilizing PowerPoint, lecture, Socratic inquiry and a porcine lung model. These been remarkably successful as they combine the intellectual experience with a visceral experience to reinforce the lesson and hopefully create meaning for the adult professional learner.
I agree that learning can occur individually or with the facilitator guide, but I also enjoy being a part of the learning experience that can occur during a group setting. I appreciated the group discussion surrounding advice for confronting mis-information and how to handle "wrong answers". I agree with others that the inquiry methods to engage learners and validate and confirm key points is an important part of the learning transaction. I also liked the reminder of having a beginning, middle and end with closing strategies.
Shelley Frost
Like Shelley mentioned, I enjoyed the emphasis on structure we had last session. I don't have a lot of lectures or presentations that I expect students to learn from, but even in my personal or school work, I often struggle with determining a solid beginning, middle, and end to my projects. Like Dr Taylor said, often times we skim over the the ending portion to our educational material due to time issues, or end of the day fatigue, or what have you. I personally think it's important for retention to just skim over the highlights of the material a bit before ending the session. I found the class very informative and interesting.
This teacher has an excellent way of teaching(learning by the students). Learning how to 'learn' quicker and easier is priceless. This method should be implemented in grade school. More info at this web site.
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