Assessing Clinical Performance

Clinical Performance, really any performance, can be assessed using a number of methods. The choice of methods really depends on the level of the learner and your expectations.  In most cases, we expect the naïve learner to "know about", while the advanced learner should be "able to do" in practice.  Being clear about expectations can be your "best friend" when setting up a system for clinical assessment.  BLOG AWAY... I look forward to reading your reflections on the session.

Strategies for Interactive Teaching

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

Raising the Bar for Clinical Teaching

Today we observed a committed physician educator share his insights about what it means to be "present" as a clinical teacher.  I'm not sure what you will remember from the required readings and the PP slides and practice opportunities, but what is reinforced for me each year when I work with Bud on this session is that it is possible to be both a dedicated practitioner and an effective teacher.  Is time a factor.. of course.  Is context a factor... of course.  What I loved hearing was the different ways proposed for modifying what you heard from Bud into your own setting.  The principles supporting  "teach general rules", asking "high yield questions" and "reflection on action", are universal.  They don't just pertain to teaching in a General Internal Medicine outpatient setting, or even clinical teaching. 

This session, I suspect, was a more difficult session for our non-clinical masters students.  I hope the cases helped, but I can imagine you had to work harder at extrapolating principles and tips to your own setting.  Comments on the readings, presentation or your own wonderful inspired thinking are welcome.

Using Narrative Assessment Methods to Give Feedback

I spoke with Dr. Pien and she mentioned a couple areas of narrative feedback about which there was much discussion.  See below for possible stimuli for discussion:

• "Another feature about written assessments that the class talked about was the fact that narrative assessment is a permanent record, hence the difficulty and reluctance with providing modifying feedback and why most written feedback is focused on strengths, even if the assessment is formative".
• "The faculty mentioned the need to balance the narrative assessment with face-to-face dialogue with trainees especially with regards to areas for improvement".

Use these as a springboard for discussion or choose another issue

Education Needs Assessment

DON'T BE A "LONE RANGER" could also be an appropriate title for this Post.  As you may have noticed from listening and interacting today with your colleagues, content expertise was never questioned in the Needs Assessment presentation.  You might think that it should be, but most of the time folks that are asked to develop an instructional unit have content expertise.  The problem arises when their expertise is not congruent with the audience needs and goals.... hence NEEDS ASSESSMENT.  Lots of other potential obstacles can be addressed early through just talking and listening to others.  Remember.. A new curriculum is not the answer to every problem.  Your Thoughts?

Competency-Based Education Systems

I wish I could have been there, but I read the evaluations and it sounds like most of you enjoyed the topic and the exercises.  For many of you who were educated in a traditional norm-based, knowledge-centered educational systems, CBE may seem very different and perhaps an unnecessary change in focus.  For example you might ask "What is so wrong with knowing a lot".  The fathers  (and mothers) of CBE would answer that question..."Nothing, as long as you are able to use that knowledge to solve a problem, help a patient, communicate better, etc.  What do you think about the rise of CBE in medical and health science education?

DESIGNING INSTRUCTION

Well, Here we go again. 

Last Semester, a few of you voiced the opinion that my opening post with a specific question limited  options for online discussion.  In response, I will try to write an opening post that brings up several issues that are on my mind, but will not expect that any of you will respond directly to those issues unless they are of interest to you as well. 

Today we had the second section of the "Instructional Design" mini-retreat.  Both Lily and I made small adjustments that gave our learners more time in the exercises that we prepared.  That seemed to work well and the evaluations were very positive.  When I think about how I plan instruction, I find that the theories I draw upon are now leaning more toward constructivism.  I still give some information, but now spend more time planning exercises that allow the learner to consult others in the group as they form their own opinions and apply the new understanding to problems. Of course I am always their to consult and clarify.  I don't think I ever will change my direction completely, but a good pre-reading with questions and purposeful discussion and exercises seem to give better results for my area of expertise.  Now is medicine different; as Lily pointed out in her discussion of Cognitive Load, the sheer density of the information shared in the medical lectures that I have heard makes one think that the lecture with high intrinsic load and low germaine and extraneous load makes sense......or does it?

Technology and Learning

That was one freewheeling session!  We covered a lot of ground from Bandura's self-efficacy to Vygotsky's scaffolding to Shirky's filter failure and finally to Seimen's Connectivism.
While we all would agree on the need to be life-long learners, it does not come easy.  The soccer coach who tells the wannabe soccer player to juggle the ball 100 times without letting it hit the ground risks creating a very frustrated kid.  Even the most passionate person needs to believe that s/he can achieve "mastery".  Telling the soccer player to instead count the number of attempts s/he took to reach 100 is a way to avoid that disappointment.  [Read here for a more on this story].

What has technology got to do with this?

When used appropriately technology can make the task just a little bit easier, a bit more efficient, (possibly) a bit more fun, just enough to overcome those doubts about self-efficacy.  So what do you think about using Google Reader to stay up to date with biomedical literature in your area of interest?  What about using Google+ or Twitter to create your personal learning network?
Do you see potential?  Anyone ready to bite the bullet?

What about connectivism?  How does it fit with your concepts of learning and knowledge?

Self-Regulation, Goal Setting and Mastery

I was not at the session, but did talk with Lily afterwards.  She was really impressed with the group's grasp of the concepts.  One concept however that seemed more difficult was the difference between Mastery and Performance Goals.  For what it is worth, this is the way I make the distinction. Excuse my use of sports metaphors but it is in my DNA.  A runner with "Performance Goals" would look at the results of each race individually "a win is a win and a loss is a loss".  To a runner with "Mastery Goals" their personal time would be most important.  A win with a slower time would not be viewed as positively and a loss with a "personal best" time would be viewed more positively.  

Let's see if I can translate this into an educational example....hmm.  OK  The student with Performance Goals would receive a 92 on an exam and be happy for his/her "A".  The student with Mastery Goals receiving the same 92 would want to know what he/she missed so that she could correct mistakes and better understand.  We want to encourage a "Mastery Perspective" because this orientation should lead to a life-long learning habits so vital to the health professions.  I believe "grades" promote a "performance orientation". that is why I really like CCLCM assessment system

Performance Goals are not bad.  They are perfectly appropriate for casual interests or discreet challenges.  It would be exhausting needing to master everything!!!!  Do you know anyone like that?  

Motivation: Can We Trigger Motivation in our Learners

I think we all had fun in class yesterday thinking about the many factors that may stimulate our learners to set a goal, extend effort even when something is difficult, and persevere in an effort to accomplish a learning goal.  We found that it is more than just the difficulty of the goal, it is also how we feel about ourselves. Do we think we can do it?  It is the goal itself; is it something we value?  What are the consequences of meeting the goal; will there be fame and fortune?  I've never understood when friends or colleagues would not try something new until this year when  a colleague of mine wanted me to try working with avatars.  You know, I just did not want to learn this.  I didn't perceive that I wanted to use the time I have to learn this new IT trick.  Maybe it is the first sign of getting old, I hope not, but this is the first time that I can remember that I was not motivated to learn something new.  Have you ever felt like that?  Is that how our students feel?  What can we do when they do?

Purposeful Observation & Feedback

Two of the most important gifts you can give your learners are... a) your attention and b) your feedback.  As we know from reading the Merriam text, observed experience is vital to assessing learning.  Some might say that anything else is just a proxy for understanding what the learner has truly learned.  Observation, however needs to be purposeful.  We need to know first what behaviors are expected then find "High Yield" situations likely to produce those behaviors if learned.  The other side of the coin is useful feedback; that is, feedback that would be useful in improving or sustaining good practice.  This session provided the opportunity to think about and practice observation and feedback... any comments?

Emotional Intelligence and Teaching

At the end of the session today, one of your class members came up and asked if I had any articles on teaching and Emotional Intelligence.  In trying to clarify this request, we found that we had two related but different questions.

• What has been written about teaching Emotional Intelligence?
• What has been written about how Emotional Intelligence can help improve our teaching?

There is a growing literature on strategies for teaching components of Emotional Intelligence.  Most prominent being teaching around developing empathy.  As to the second question, there is not a lot out there. 

Using Goleman's adapted 4 quadrant model, we could, as a group, write a rough draft of a "new article" by hypothesizing on how addressing each component of the model would translate into transformational teaching performance.  Try reflecting on this stimulus, or address other EI thoughts and issues

ALD 701 First Session

We had a busy morning and talked about ideas (my favorite things to discuss)

We talked about Constructivist Learning Theory and Social Cognitive Theory.  We talked about philosophies and beliefs about learning and teaching.  We talked briefly about Learning Styles and the impact of Learning Styles on instruction.  We did not address your chapter reading on Behavioral Learning Theory, so I hope at least one of you addresses the contribution Behaviorism has had on teaching and learning in the US. (although out of favor, it is still very much alive). 

I look forward to reading your posts...  Be sure to respond to one of your colleagues ideas

Teaching "Persona"

At our Education Group meeting this week the topic of "Teaching Persona" came up as a topic for discussion. Teaching persona was defined by one source as "beyond technique or curriculum.. the teacher's own way of being with students"*. Another source suggested that a teacher's persona was "an image that the teacher presents to the class**" that could be actively chosen. Of all that I read, it seemed that authenticity was considered important. However, one school of thought was that one could be authentic and still provide different "images" to different groups or contexts. The most common example was the differing contexts of giving a grand rounds versus teaching on the inpatient service. In this example, the attending could exhibit a formal "expert" persona during grand rounds and a more relaxed informal teaching persona during teaching rounds. Our group was split on this topic with some feeling that persona changes could lead to confusion and uncertainty on the part of learners who may withold sharing their "true self" because they don't feel they have a handle on the "true self" of the teacher. Others shared their own experience of "getting up" for a teaching encounter minimizing their own more introverted side and maximizing their ability to engage and interact with their students. Do you have any thoughts on this topic?

Together or Apart, Is There a Better Way to Teach?

I subsribe to the DR-ED Listserve out of Michigan State University. This is a really good listserve of mainly medical educators, although others chime in every once in awhile to liven things up a bit. Over the past two weeks there has been a lively thread concerning the best way to teach. The choices given were 1) interactive facilitation or independant reading with lectures. Each side provided literature to back up their beliefs. The usual arguements were posed. "You may learn more stuff by attending a lecture, but the depth of understanding will be superficial" and "Knowing facts (stuff) is important, you can't problem solve without knowing the underlying facts." I think maybe I've been in this education business too long, as I have seen these arguements surface time and again. Since I have access to this BLOG, I'm going to share my thinking on this.



From all my years of study and practice, I have distilled all of the equivical literature about how best to teach down to three commandments>

1. Thou shalt engage the learner - If students (at any level) are not engaged, they will not learn. What engages learners depends on the content, the learner and the context. Learners can be fully engaged by interacting with an interesting essay, a well designed textbook, a computer learning module, short excellent lectures and small group activities.
2. When teaching about complex concepts, thou shalt offer opportunities for learners to "elaborate" on new concepts - When topics are complex or controversial learners usually benefit from hearing others point of view and having the opportunity to articulate their understanding and receive feedback from experts and peers. Although the norm is face-to-face during discussion groups, on-line electronic discussions work well for certain content and learners. The disadvantage of "solitary study" is that the learner is stuck with only 2 perspectives (the teacher and him or herself)
3. Thou shalt design and share goals for any instructional activity - Purposeless chats about anything that crosses our minds may be therapeutically beneficial, but are not a good basis for learning. Carefully crafted cases can provide the goal as can experienced facilitators.

Perhaps overly simplistic, but I've found these three commandments to be very serviceable.

Simulation in Medical Education

We had an interesting talk about the use of simulation in medical education this morning and it made me think about how far we have come from the "apprenticeship model' of the late 19th and early 20th century. The concept of practicing medical procedures on inanimate objects rather than on patients (especially me) seems a "no brainer", yet medicine has been slow to take full advantage of simulations. Perhaps the allure of the "cadaver lab" was lost on previous generations of medical students and residents, even though these labs provided the only opportunity to "do no harm" while developing skills. Today's high-tech simulation labs provide the opportunity for students and residents to practice everything from interviewing skills with standardized patients to intubation and team ACLS with high-tech mannequins.

We are designing a multi-purpose, multi-site simulation system here at the Clinic that appears to take full advantage of modern technology, all the while honoring the tradition of low-tech human-human interaction. I was impressed with the fore-thought and planning that went into the design. ...My generation marvels at robotic surgery, social media and high tech simulators, imagine the simulations that could be conceived by future generations who interact with avatars in pre-school. Will it be better medicine?? I don't know.

ACGME and vocabulary

I just returned from the ACGME Annual Education meeting in Nashville on Saturday. It was a really good meeting with great plenary speakers, and the opportunity for me to network with others who are interested in developing Program Director Training Programs at there institutions.

I want to start out positive, because I will quickly reverse direction and explode with frustration. As a faculty development professional, I have spent many years "translating" the educational concepts central to the "Outcomes Project" to our PD's and faculty. Competencies, competency-based learning objectives, and benchmarks were all new concepts to many of the PD's. All are smart people, many of whom sincerely wanted to understand how this new approach to education would benefit their residents. Ultimately we have made great progress.

Now,... new leadership, new vocabulary! The "Milestone Project" has recently been established. I went to one meeting at which a whole new set of terms were identified. Entrustable Professional Activities (EPA's), Landmarks and Milestones were introduced. The presenters had good slides and spent time educating us about the use of these new concepts in planning program development and evaluation. All the concepts seemed educationally sound.

That said, where do we start? Are milestones, that are determined by each specific discipline (Internal medicine has identified 142) like objectives or are they different? What is the difference between "landmarks" and "benchmarks". If after 25 years in education, I'm confused... imagine our PD's who have a few other things on their minds.

Things change... I get it! However, it sure would be great if these changes came with a logical "bridge" between old and new language and rationales for change.

Cleveland Clinic Teachers' BLOG Rises Again

Now in our third year (with a few months off here and there) the Cleveland Clinic Teachers' BLOG is back! Here are the differences. First, it will be more like a traditional BLOG rather than our first iteration which more like an informal curriculum. Neil and I and some others will post ideas in medical education. Second, after today, there will be no email reminders. If you want notification when a new message or comment is posted, click on the archives for August 2010 and follow the simple directions (I even got this right). I hope you read the BLOG and respond to ideas that interest you.

Best Regards

Christine

Staying Up-to-date with Blogs and Medical Literature

There is no debate that we are all swamped with data being sent to us via e-mail and we often feel like we are drowning in this deluge.  This can cause several problems:

1. The stress generated by trying to keep up
2. Time spent/wasted going through unwanted/useless e-mails
3. Difficulty in separating the wheat from the chaff - the signal-noise ratio is getting progressively lower.  
4. Missing out on critical information that gets buried amongst other useless data - losing the proverbial needle in the haystack

The solution is to get some control over the e-mails being sent to you and increasing the signal to noise ratio.  One way to do this is RSS (Real Simple Syndication).  This solution has been around for a long time and several of you may have heard of it or use it already.  The reason I write about this today is to point out how you can use this functionality to: 

1. Get updates from blogs that you find interesting - using this blog as an example.
2. Get updates from journals in your area of interest - using medical education journals as an example.
3. Presently we are sending out e-mails to a vast group of people (about 1000) and we don't want to add to the deluge problems listed above.  So if users start subscribing to this blog, we can stop sending out e-mails to folks who may not want to receive them.

So what is RSS?

A simple way to think about it is to compare junk mail that fills up our mail boxes with subscriptions to magazines and newspapers.  RSS is a way to subscribe (for FREE) to information streams that you want.  Again this is FREE and most blogs and journals provide a way to subscribe to their updates, abstracts etc. but you do need a way to receive this stream.  There are multiple options but the one that I use is called Google Reader.  It works for me because:

• It is accessible via any browser and most data enabled mobile devices 
• It lets me share items from my subscriptions with others in multiple ways
• It lets me create a simple way to share my subscriptions with others (we will see this shortly)
• It takes advantage of Google's search engine
• It allows classification and organization of the data in multiple ways.
• I already have a Google account and use various Google applications like Gmail, Blogger and Buzz.
• I am (almost) always plugged into the Net and thus don't need to store these subscriptions on my hard drive - easier to leave them in the "Cloud" and access them from anywhere.
• I don't want the data to get interspersed with my regular work applications like Outlook.  I prefer to choose when I want to review this information (like reading the NY Times on a Sunday morning).

So if these seem like reasonable reasons, then read on.

Subscribing to blogs:

This blog has two ways to subscribe to it

1. Just enter your e-mail address where you want to get notified of new posts on this blog and follow the steps. You can then set up rules in your e-mail inbox to handle these messages in a specific manner e.g. move them to a folder.
2. Use RSS.  Make sure you have a Google account (create one HERE).  At the top right corner of this blog is a link to Subscribe to Posts or Comments.  Click on the down arrow next to it and choose Google.  On the next screen choose Google reader.  You may have to sign in using your Google account and then you will be taken to the Google Reader screen with a summary of posts from this blog.  You can use the same steps with most other blogs.

Subscribing to Journals:

There are several ways to subscribe to journals

1. Use a subscription bundle created by someone else.  I have created a bundle of medical education journals.  You can access and preview it HERE. It has feeds of abstracts from 7 journals including Academic Medicine, Teaching and Learning in Medicine, Medical Education etc. Click on subscribe to get these feeds into YOUR Google Reader. That's it, you are done! My bundle of Medicine Journals is accessible HERE
2. In Google Reader you can click on the down arrow next to Subscriptions and click on Add Subscriptions and then type in name of Journal.  Some journals may have multiple listings while others may not show up.
3. On the Journal Web site, there is a button to subscribe to RSS feed.  Clicking on this may give you a an option to subscribe using google reader.  Others may take you to a page with the feed.  Copy the URL of that page and paste it into the add subscription box mentioned in step 2 above
4. If the Journal website does not have an RSS button, go to PubMed and type in name of journal.  Then click on RSS (top of page orange button).  Click create RSS and then click XML.  On the page that loads, copy the URL of the page and then paste it into the add subscription text box mentioned in step 2.

You can use the PubMed step to create a custom query (search) and save the RSS feed to Google Reader.  Thus if you area of interest is prosthetic valve infections you can create a feed for this and get an abstract of any article indexed by PubMed on this topic.

Almost done; now you have to just remember to go back periodically to review all this information flowing into Google Reader.  If you want to read up more about how I personally use Google Reader to tag and classify and search for information click HERE and HERE.

Dear to My Heart

I had an experience the other day that was just so incredibly cool that I have to share it. I am the Director of Faculty Development and so my "students", for the most part, are the faculty. I was sitting at an early meeting, half asleep, when I heard one of the faculty raise the issue of "instructional alignment" and the need to align learning objectives, instruction and assessment process for an old course that had received sub-standard reviews. Now my ears always perk up when I hear any of the faculty using educational terminology, but this case was classic. Not only had he used the terms correctly, he was descibing in great detail how and why this was so important. And... in a moment of pure egocentrism I thought... "he learned that from me'!

Well this has certainly happened before, but this was a special case. This particular individual had let me know early in our conversations that he thought "all this education mumbo-jumbo" was just that. He had attended two or three faculty development sessions and seemed to be changing his opinion; then stopped coming. This meeting was the first time I had seen him for a few months, so hearing him describe "instructional alignment" to his peers was one of those "peak moments".

Now, I'm sure my clinical colleagues have those moments all the time as they teach residents, students and patients. You get the chance to see daily the intellectual growth of your learners and the progress that patients make based on your careful management. In my field, however, those moments don't come everyday. I'll bet that if you devote your time to faculty development, you are smiling right now and thinking about a moment like this that you have had. It is great isn't it