| Director's Message |
Shared Discovery Through Learning Communities
Shared Discovery is a fundamental principle of the new curriculum, and the establishment of learning communities is the primary structure for supporting and promoting shared discovery. Learning communities are intentional groups of faculty and students engaged in learning from one another. While learning communities are relatively recent in undergraduate medical education, they have been a part of higher education for over 30 years, having first come to the US in the 1930s.
A survey published this year reported that 66 medical schools had established learning communities and another 29 medical schools were considering them. The rationale is that through intentional small groups, long-term relationships between faculty and students are possible; these relationships can be used to facilitate learning, establish mentoring and coaching, enhance role-modeling and provide educational continuity to the often fragmented lives of medical students and their faculty. This approach represents a logical evolution in the small group instruction characteristic of CHM's curriculum, formalizing an approach that offers students continuous and meaningful relationships with faculty and peers. Learning communities promote active, student-centered learning, and provide a natural model for integrated interdisciplinary education. Proponents of this approach to education report better student outcomes in terms of academic, social and personal metrics. It is a more personalized medical education and promotes shared discovery for students and faculty.
|Learning communities are a key structural component of the new curriculum.|
For many medical schools, learning communities are the focus of social and wellness activities. A smaller number of schools use learning communities to provide curriculum and support related to professionalism, career advising and leadership development. Still fewer use them as the delivery model for clinical and patient skills education. In many medical schools, students have the same advising faculty members for all four years; the learning communities provide a means of vertically integrating students across years.
Learning communities are variously referred to as houses, societies, colleges, cells, docent groups and academic communities. The variability in how learning communities have been implemented and incorporated into the educational programs of their sponsoring medical schools is a testament to the flexibility of the model. The document describing the learning community programs at a sample of medical schools can be accessed here. This document also provides a listing of medical schools participating in the Learning Communities Institute as well as a brief bibliography and other learning community resources.
Brian Mavis, PhD
Associate Professor and Director
Office of Medical Education Research and Development
College of Human Medicine
- MSU College of Human Medicine to Test Core EPAs Before Students Begin Residency
The AAMC has announced the 10 medical schools selected to participate in a five-year pilot to test the implementation of the Core Entrustable Professional Activities (EPAs) for Entering Residency
published in June. These guidelines are intended to ensure that medical students are prepared to perform certain patient care activities without supervision on the first day of residency training. It is very gratifying that more than half of our member medical schools applied to participate in the pilot program.
This enthusiastic response demonstrates the energy and commitment within academic medicine to close the gap between expectations and performance of residents. Given the broad interest in the pilot, we are committed to engaging all our applicants in creating a robust learning community so we can share the lessons learned.
- ATTENTION: Teaching and Lecturing Faculty
The MSU Course Materials Program was recently notified by Wolters Kluwer's permission coordinator that all Lippincott Williams & Wilkins (LWW)-published works will see their royalties rise from $0.27/figure/user to $0.36/figure/user beginning November 1st, 2014. These charges are incurred whenever a figure is used from a LWW textbook that is not a required textbook for the particular course, or is not a part of the Library's LWW Health Library of e-textbooks.
The issue is not substantial for this Fall 2014 semester, as for-royalty LWW images will be charged under the lower rate. However, all Spring 2015 courses containing for-royalty LWW images will be charged at the new royalty rate. To read more information, please see PDF doc.
- Allowing Medical Student Documentation in the Electronic Health Record
Electronic health records (EHRs) provide opportunities to improve patient care and increase the accuracy of communication. For the full potential of EHRs to be realized, they must become part of the educational experience from the beginning. Medical students need to have hands-on experience--including entering and retrieving information in the medical record-as a first step toward preparation for residency and beyond.
The Compliance Advisory, Electronic Health Records (EHRs) in Academic Health Centers, encourages institutions to educate medical students about documenting and using electronic health records while minimizing the compliance risks. If you have questions about the Advisory, please contact Ivy Baer, senior director and regulatory counsel, at [email protected] or (202) 828-0499.
How To: Debriering Simulation-Based Learning Experiences
Some simulation-based educational experiences do not require formal debriefing. If the goal is for a student to demonstrate sterile technique when donning a pair of surgical gloves, for example, the only feedback necessary would be to either confirm the student's success, or demonstrate proper technique if the student failed. Likewise, if a student is asked to complete a physical exam checklist, reviewing the items missed or demonstrating items performed incorrectly may be all that is called for. As the learning goals and decision-making become more complex, however, more elaborate feedback is necessary.
Debriefing is widely considered to be a key component of simulation-based learning (1,2), and simply refers to the dialog that occurs between instructors and learners following these encounters. The goal is to facilitate a conversation that ultimately promotes improved clinical performance in similar future encounters. Many techniques for structuring this discussion have been described, but they commonly include three phases:
- initial reactions and data gathering,
- analysis of the simulation experience, and
- summary of the discussion.
Most techniques also encourage instructors to engage learners in guided self-reflection using open-ended questions ("how did that go?," "what happened?," "what were you thinking when you did that?"), and making objective observations ("I noticed that you did not examine the patient's abdomen," "the parents seemed uncomfortable when you asked about smoking in the home").
During the initial phase of the debriefing, learners should first be given an opportunity to vent any strong emotions that might impede their ability to engage in thoughtful discussion. They can then be encouraged to express their initial impressions of the encounter, and to summarize their recollection of what happened in more detail.
The analysis phase comes next and is meant to help the learner identify gaps between actual performance and expected or desired performance. The instructor's goals here are to ensure that the learner comes away with a clear understanding of when these gaps occurred, but also to assist the learner in exploring why they occurred. Voicing an objective observation ("I noticed that you failed to check for costovertebral angle tenderness"), or asking a probing question ("what was your working differential when you started doing your physical exam?") helps keep the focus on the learner. The goal is to explore the learner's thought process. Did they intend to check for CVA tenderness and simply forgot? Was their differential too short? Had they already decided to treat for pyelonephritis and believed that confirming CVA tenderness was unnecessary?
The summary phase should focus on improving future performance. This might involve brief didactic instruction, assisting in the creation of concrete learning goals, a review of take-home messages, and reinforcing areas of excellent performance. Instructors can initiate this phase by asking the learner to name two or three things that went well, and two or three things that might have gone better. If the learning objectives of the encounter have not already been made explicit, they can be clarified here.
Throughout the debriefing process it is helpful for the instructor to convey support for the learner by critiquing actions rather than the individual. It has been suggested that preceptors treat mistakes as puzzles to be solved rather than crimes to be punished. This video (http://vimeo.com/32874886) shows how an instructor adopts a supportive and curious tone to lead a team debriefing, and demonstrates many of the other techniques described above as well. The same techniques can generally be applied to one-on-one debriefing sessions.
References three and four listed below provide a good starting point to further explore the debriefing literature.
- Cantrell MA. The importance of debriefing in clinical simulations. Clin Simul Nurs. 2008; 4(2):e19-e23.
- McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Med Educ. 2010;44(1):50-63.
- Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115-25.
- Rudolph JW, Simon R, Dufresne RL, Raemer DB. There's no such thing as a non-judgmental debriefing: a theory and method for debriefing with good judgment. Simul Healthc. 2006;1:49-55.
Featured B-CLR Project: Mobile Medication Safety Guide (MMSG-APP)
The Mobile Medication Safety Guide (MMSG-APP) is a web-based application that was designed to replace the printed Medication Safety Cards normally introduced to CHM students during the Block III orientation session on Medication Safety and Prescription Writing.
One of the major motivators for creating the MMSG-APP was to take advantage of the ubiquitous nature, computing power and communication features found in today's smartphones and tablets. Prior to the development of the application, the Medication Safety Guide was provided in printed cards that made updating, printing and distributing costly and cumbersome.
Replacing the printed cards with an easy-to-use, easy-to-update application provides convenience and the following benefits:
|Fig. 1. Original design and presentation of the Medication Safety Guide cards |
- portability and access to informational resources in a single device
- on-demand education and training for medical students
- support for clinical decision-making at the point of care
B-CLR offers free instructional design consultations and project development to CHM faculty needing help with blended and online curricular materials. To find out more about B-CLR services, visit the http://omerad.msu.edu
If you have questions about this project, please contact Geraud Plantegenest at [email protected]
- Ventola CL. Mobile devices and apps for health care professionals: uses and benefits. P T. May 2014; 39(5): 356-364. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029126/
Geraud Plantegenest, MA
Manager, Blended Curricular Learning Resources (B-CLR)
Office of Medical Education Research and Development
517-353-3455 | [email protected]
| CHM Program Evaluation|
Student and Faculty Perspectives of the Early Clinical Elective
The third-year clinical curriculum was recently modified to include an elective rotation. The Senior Associate Dean and Block III Director organized a task force to evaluate this new elective and the challenges it poses. With input from the task force, OMERAD conducted a survey of faculty and students participating in the elective.
Depending on a given student schedule their elective rotation may come as early as the first clinical clerkship or late in their third-year clinical curriculum. Since various electives may require prerequisite skills gained in specific third-year clinical clerkships, there was a concern students whose third-year elective experience was scheduled early in the year would be limited in the electives they could choose. We were also interested in the views of the faculty who were preceptors for the students, in particular, we asked if the students were adequately prepared and able to participate effectively in the elective.
We emailed surveys to 78 students and 54 faculty who participated in third-year elective rotations during the first half of the 2013-2014 academic year. A total of 53 students (68%) and 42 faculty (78%) completed the survey.
Summary of the feedback from students
Two-thirds of the students were satisfied with the timing of their elective rotation. While only 28% of the students indicated they would have preferred to have had the rotation later in the year, the comments suggest a number of the students were frustrated in attempting to get a rotation they would have liked due to a lack of the required prerequisites. It should be noted that these students all completed their elective rotation during the first half of the academic year. A few students also indicated they would have liked to have had more experience prior to taking their elective.
Eighty-five percent of the students were either satisfied or very satisfied with their elective and only 4 of the 53 students indicated they had difficulty scheduling their elective, though some students indicated in the comments they had to go pretty far down their list of choices. A couple of students commented that having to make their selections before beginning the third year before gaining any clinical experience was frustrating.
Over 70% of the students felt they had adequate prerequisite skills and knowledge to participate in the elective while less than 5% disagreed with the statement.
About half of the students indicated the experience impacted their career plans. Interestingly, several students commented the elective experience helped them decide they did not want to go into the specialty they had previously wanted to pursue.
Summary of the feedback from faculty
Seventy percent of the faculty indicated they did have sufficient knowledge of the student's background to be able to provide a meaningful experience for the student while 76% said they were informed that the student taking the elective was in the third year.
Approximately three-quarters of the faculty reported students had sufficient knowledge and skill base to benefit from the elective. When asked about prerequisites, 78% said they were "about right" for the elective; 20% indicated there were too few prerequisites. When asked to list prerequisites for the elective, faculty respondents had a wide variety of observations though the most common suggestions focused on completing the general surgery requirement before taking a technical/surgical elective.
Although the survey results suggest there are some areas that could be improved, it appears that overall the new elective has been well received by both faculty and students.
| Faculty Development|
Free Online Course on Assessment from NBME
The National Board of Medical Examiners (NBME) has set up an online university containing a collection of lessons about high quality assessment. NBME U has been developed in conjunction with NBME's 100-year anniversary. These brief, interactive lessons are combined into a course titled Assessment Principles, Methods and Competency Framework.
Current lessons include:
Section 1 - Principles
- Test Blueprinting I: Selecting an Assessment Method
- Test Blueprinting II: Creating a Test Blueprint
- Test Score Reliability Overview
Section 2 - Methods: Multiple Choice Questions
- Assessing Application of Knowledge
- Structuring Multiple-Choice Questions
- MCQ Flaws and How to Avoid Them
- Writing MCQs to Assess Application of Clinical Science Knowledge
- Writing MCQs to Assess Application of Basic Science Knowledge
Section 3 - Methods: OSCE
- An Introduction to the Use of Generalizability Theory in OSCEs
- Reality Check: Promoting Realism in Standardized Patients
The course is free, but registration is required. For more information and to register.
go to: https://nbmeu.desire2learn.com/d2l/le/content/6621/Home
|Hot Off the Press|
- Crites GE, Gaines JK, Cottrell S, Kalishman S, Gusic ME, Mavis B & Durning SJ. Medical education scholarship: An introductory guide: AMEE Guide No. 89. Medical Teacher. 2014; 36(8): 657-674. (doi:10.3109/0142159X.2014.916791)
- Mavis B, Assessing Student Performance, (pp. 209-241). In Jeffries, W.B. & Huggett, K.N. (Eds), An Introduction to Medical Teaching (2nd Edition). Springer Dordrecht Heidelberg: New York, 2014.
The Office of Medical Education Research and Development is a unit within the College of Human Medicine at Michigan State University. Its mission is to improve medical education and related service programs through evaluation and research consultation, relevant instruction, and programs of faculty development.
Established in 1966, OMERAD is the oldest continuously operating office of medical education in the United States.
A-202 East Fee Hall
965 Fee Road
East Lansing, Michigan 48824
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