[The following notes were generated by Mark Slivkoff, PhD]

IAMSE Webinar Series, Spring 2019

Speakers: Kim Dahlman, PhD
Assistant Professor of Medicine Co-leader, Integrated Science Courses Vanderbilt University School of Medicine Nashville, TN USA

Title: Role of Foundational Sciences in Clinical Years
Series: The Role of Basic Science in 21st Century Medical Education

During last week’s webinar, we learned of the unique curriculum of Boonshoft School of Medicine at Wright State University. This week’s presentation by Dr. Kim Dahlman also focused on a non-traditional approach to medical education, specifically on the curriculum at her U.S. medical school, the School of Medicine at Vanderbilt University in Nashville, Tennessee. Most medical schools have clear course distinctions between the basic foundational sciences and clinical sciences; first- and second-year students usually spend their time studying the former while “post-board-exam” students in the third and fourth years usually are in clinical rotations and out of the classroom. At Vanderbilt, however, as Dr. Dahlman explained, third and fourth year students are required to take classroom-based courses which are heavily grounded in the foundational sciences.

Dr. Dahlman laid out her agenda for her presentation and subsequently discussed the rationale for foundational science integration, the specifics of the Vanderbilt Medical curriculum (C2.0), the details of the Integrated Science Courses (ISCs), and then the challenges and solutions behind their curriculum.

There is growing evidence that a deep understanding of complex foundational science plays a crucial role in effective clinical decision making.

References:
• Dahlman et al. (2018). Integrating foundational science in a clinical context in the post-clerkship curriculum. Med Sci Edu, 28(1): 145-154.
• Baghdady et al. (2013). Integration of basic sciences and clinical sciences in oral radiology education for dental students. J Dent Educ, 77(6): 757-763.
• Bandiera et al. (2018). Back from basics: integration of science and practice in medical education. Medical Education, 52: 78-85.
• Goldman and Schroth (2012). Deconstructing integration: A framework for the rational application of integration as a guiding curricular strategy. Acad Med, 87: 729-734.
• Kulasegaram et al. (2013). Cognition before curriculum: Rethinking the Integration of Basic Science and Clinical Learning. Acad Med, 88: 1578-1585.
• Kulasegaram et al. (2015). Cause and effect: Testing a mechanism and method for the cognitive integration of basic science. Acad Med, 90: S63-S69.
• Kulasegaram et al. (2015). The mediating effect of context variation in mixed practice for transfer of basic science. Adv in Health Sci Edu, 20: 953-968.
• Mylopoulos and Woods. (2014). Preparing medical students for future learning using basic science instruction. Medical Education, 48: 667-673.
• Mylopoulos et al. (2018). Twelve tips for designing curricula that support the development of adaptive expertise. Medical Teacher, 40:8, 850-854.

[The following notes were generated by Mark Slivkoff, PhD]

IAMSE Webinar Series, Spring 2019

Speakers: Brenda Roman, MD
Associate Dean for Medical Education, Wright State University
Mary Joe Trout, Pharm D, BCPS, BCGP
Director of Foundations Curriculum, Wright State University
Irina Overman, MD
Director of Therapeutics Curriculum, Wright State University

Title: Lecture Free for Gen Z
Series: The Role of Basic Science in 21st Century Medical Education

The curriculum of the Boonshoft School of Medicine at Wright State University was the focus of IAMSE’s second thought-provoking webinar in the Spring 2019 Series. During their presentation, Dr. Brenda Roman, Dr. Mary Joe Trout, and Dr. Irina Overman discussed many facets of the unique lecture-free curriculum.

The curriculum was designed for students of “Generation Z”, a population made up of individuals born between 1995 and 2010. This generation has grown up with access to more information than any other generation before them. They are technologically advanced since they have grown up with smart iPhones, iPads, and fast internet with immediate access to Google. They are heavy users of social media and value privacy as well as security. Social justice movements such as legalization of same-sex marriage and “Black Lives Matter” have led this generation to believe that they have the power to change the world. Their concerns center around the well-being of everyone around them rather than just themselves, a mindset which differs from the previous “Millennial” generation.

So, Dr. Overman continued, what do we medical educators do, knowing Gen Z is in our classrooms? We should embrace their generational characteristics and capitalize on them in the classroom. Knowing that information is readily available and that these students thrive on independent learning and technology, we can design classroom projects which allow for independent learning. In addition to the value they place on independent learning, these students prefer “hands on” learning, application to “real life”, and a focus on community engagement. They also view their peers and instructors as valuable resources. Our presenters emphasized that health care requires group interaction, therefore these students must also be involved with group learning which works well after the students have been observers first.

The curriculum at Boonshoft School of Medicine allows for all of these preferences. Besides the focus on learning preferences, the curriculum was also designed with activities which maximize retention. Our presenters pointed out that that lectures—although an easy way to transmit information from faculty to students—are quite ineffective ways to learn. Therefore, the school removed them from the curriculum.

How do Boonshoft’s instructors guide the students in learning the massive amounts of information without lectures? They use low stakes engaged learning sessions in which the students are involved in the discussions, teaching others and practicing their craft. Students, Dr. Overman continued, set the stage for their own lifelong learning. Mandatory sessions occur daily and are not recorded. Since the majority of learning occurs in these sessions, students recognize that a missed session is a missed learning opportunity, and therefore overall attendance problems are very rare. Students are allowed up to four unexcused absences per semester.

At the beginning of the first year, students are required to read Make It Stick by Brown et al. The initial session centers on the science of learning, specifically the students learn how to instruct their peers. The following sessions involve a mix of various learning strategies that have been proven to work, including:

• Interleaved practice (practice multiple skills at once)
• Elaborative integration (learn until you understand it well enough to teach)
• Self-explanation
• Distributed practice
• Practice-testing (quizzing yourself, flashcards)
• Retrieval-based learning (working towards understanding builds memory)

The instructors explain to the students that learning is difficult and that the curriculum is challenging. Students are encouraged to foster a growth mindset; they need to have a willingness to learn from reading and must be comfortable with not having a mastery of the material before each session.

Dr. Trout continued the discussion and described that the curriculum is built around four major modalities:

• Peer instruction
• Team-based learning
• Multiple choice questions
• WrightQ

At the beginning of most sessions, a USMLE-style multiple choice question is projected on the screen. The students have 1.2 minutes to read and answer the question on their own (captured by their student response system, Turning Point). Students are then given time to discuss their answers among themselves. Afterward, a student is selected at random to explain their choice. At this time, the faculty member can clear up any misconceptions and address topics the student found challenging.

Dr. Trout explained that this type of engaged learning requires paying attention to some important considerations since students are not used to this type of learning. Students must know how to read a textbook to maximize learning, and instructors need to be careful not to overload them with too much or too complicated pre-assignments. Students are told that each 1-hour session requires about 2-3 hours of preparation time, and that they should set aside time immediately following the session to consolidate their knowledge.

Dr. Roman took over the final portion of the webinar during which she described the design of the curriculum, comments from students, and their success in the program. Overall, the curriculum has proven to be very effective but further analysis of the data (a process currently underway) should help them understand why learning (and Step 1 scores) are on the rise.

When designing the new curriculum, faculty members and administration had to all be “on board” with the switch to a lecture-free environment. Most faculty members made the switch, but some clung to their belief that being a “sage on a stage” is most effective, and parted ways with the college. Dr. Roman went through a list of what the college did right, including:

• Utilizing true backward design of the curriculum
• Establishing a policy of 20 hours face time per week
• Holding firm for faculty NOT doing lectures
• Establishing consistency across modules for the teaching/learning sessions
• Getting constant feedback from students
• Being flexible when possible
Dr. Roman also explained what they should have considered when moving completely to a lecture-free curriculum:
• Better anticipate faculty needs (preparation time is very large)
• Do not adopt other significant changes (like an LMS) at the same time
• Better explain the “Why” and “Positive Impact” than Gen Z students require

At the conclusion of the webinar, a large number of questions were asked and answered, but a much larger number were logged but not answered due to time. Clearly, the presentation captured the attention of literally hundreds of educators most of whom are not teaching at a college which has done away with lectures.

For more information about Drs. Roman, Trout and Overman’s May workshop on Peer Instruction, please visit this link.