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

A Case for High-stakes Summative Examinations?

The role of examinations like the USMLE Step 1 has been called into question due to:

1. Tests only medical knowledge - not the other competencies that go towards making a "good physician"
2. Forces students to memorize content just to regurgitate it at exam time
3. Most physicians may not need to use the content memorized for this test in later life.
4. Biomedical science information is growing so fast that there is no way to cover all this content within the span of an average medical school curriculum

Medical Education recently published a very interesting study [pdf; abstract] regarding year 4 medical students in Germany learning EKG interpretation.

Summary of the study:

• Cohort 1 - winter 2008-09 - Summative assessment at end of EKG course - randomized to:
• Traditional lectures
• Small group peer teaching
• Cohort 2 - summer 2009 - formative assessment at end of EKG course - randomized to:
• Traditional lectures
• Small group peer teaching

In addition to a test before and after the EKG course, each cohort had an unannounced test 8 weeks after the EKG course.

Thus the study was designed to look at the impact of 2 types of learning (traditional lecture vs. small group peer learning) and the impact of a high stakes summative examination on the learning.

They found that in the Cohort 2 where there was only a formative assessment at the end of the course (performance did not count towards grades) the small group peer learning group did better at the immediate post test and also retained the information better at the 8 week surprise test.
On the other hand in Cohort 1, the high stakes summative test seemed to eliminate all the differences between the 2 groups.

The question:
What is it about the summative test that improved learning and retention?  Did it force students to spend more time in self-study preparing for the test or did it force them to concentrate better at the lectures, taking notes etc?

Reading this study made me think about how this might apply to even higher-stakes summative tests like the USMLE Step 1.  Scores from this one test can determine a student's career.

One student who had spent the first 2 years in small group PBL sessions, told me that as he was preparing for the USMLE Step 1 at the end of year 2, everything seemed to fall in place.  We discussed this further and it seemed that having to read all the different subjects in a concentrated time span helped him to develop mental connections between various pieces of information in his memory thus improving his understanding.

So what do you think?  What is the role of high stakes summative tests in medical education?  Are they good, bad, a waste of time, a distraction, or something that we should have more of?