Learning in Context: Developing Case Scenarios for the Preclinical Curriculum
Professional training programs typically begin with a study of fundamental underlying principles, followed by apprenticeship experiences of skill refinement. Indeed, the Flexner report on medical education, published a century ago, stressed the need for adequate basic science education by medical schools as a prelude to clinical training. However, as managers and instructors of present-day preclinical phases struggle to squeeze in the essentials of an exploding catalog of biomedical information, a further problem seems too often ignored: helping students learn to use what they’ve been taught. Clinical practice is an active, decision-making profession that relies on transduction of facts and concepts to resolve clinical problems. But how can non-clinician scientists promote this next step? Where can one gather pertinent clinical applications of molecular interactions or complex fundamental concepts? How can one phrase useful clinical scenarios in an accurate fashion? The purpose of this session is to provide some approaches to developing these clinical illustrations and applications of basic science principles. A variety of strategies will be elaborated, including insertion of clinical pearls into platform lectures, large-group sessions of active learning or review discussion with a case context, case-based small group tutorials and learning environments, and the case-oriented assessment process.
Script Concordance Assessment of Clinical Reasoning in Medical Students, Five Years Out
Part of a clinician’s competence is the capacity to solve problems that deal with the complex and ambiguous nature of patient care. The Script Concordance Test (SCT) is a method for evaluating data interpretation, one of the measurable dimensions of problem-solving skill. Developed as a collaborative project between two large allopathic medical schools, this preclinical SCT has been used for a number of years as a benchmark for student learning. New data from two additional medical schools will be presented, along with a practical approach to utilizing outcomes.
This presentation will allow participants to:
- Discover the SCT, an innovative competency-based assessment.
- Consider the application of this tool for the evaluation of clinical reasoning in medical learners.
- Appreciate the SCT as a validated assessment instrument for differentiating among students along a continuum of learners from medical novice to resident physician to expert clinician.
Progress Testing – concept, history, and recent developments
Progress testing was developed simultaneously at both sides of the Atlantic Ocean in the 1970s. We will outline how the concept came to birth as a tool aimed to solve the problem of discongruency between a new instructional method (problem based learning) and traditional assessment methods.
A progress test is aimed at the end objectives of an educational program, and repeatedly measures the students’ knowledge with respect to the complete domain of interest of the program. Thus, it enables to monitor the growth of knowledge of individual students and the average growth of cohorts of students across time. Individual growth patterns indicate whether a student is performing well or needs to improve, while average growth patterns provide information on the performance of the educational program. We will demonstrate how this information is provided and how it can be used for benchmarking and to improve education.
Certain requirements should be fulfilled for a progress test to be viable, the corresponding organizational and logistic requirements may be demanding, (lack of) item relevance is a returning issue, the use of a ‘don’t know’ option and negative marking may have its drawbacks, and the efficiency of the measurement may be questioned. In addition to the achievements of progress testing, we will discuss these issues and some attempts to solve them.
Challenges and Opportunities of Independent Learning
Healthcare education programs are challenged with developing mechanisms to address the ever-increasing volume of medical knowledge, the desire of students to take ownership of their learning process, and a mandate from accrediting agencies to develop independent learners with life-long learning skills. Systems such as online micro lectures, e.g. the Khan Academy, programmed instruction texts and web-based modules often focus on providing a definable curriculum, while offering the flexibility to allow students to progress at their own pace. Students benefit by having control of their learning, being able to set the pace and remediate any self-assessed deficiencies. Such flexibility in learning methods is often accompanied by a decrease in integration of material and an overall lack of less tangible qualities that are difficult to measure. While students are adept at leveraging technology for their learning, the onus is on the healthcare educational institution to help students:
- move beyond program-dictated sequential podcasts and web-based curricula to help students develop the life-long learning skills;
- integrate and coordinate multiple disciplines in a self-paced independent curriculum towards a more comprehensive understanding of concepts;
- develop skills in communication, teamwork and collaborative thinking in an independent learning curriculum;
- assess competency, especially noncognitive skills and attitudes and higher-order thinking skills, in an independent learning curriculum.
Social Media Competencies for Medical Educators
The popularity of social media websites (Twitter, Facebook, YouTube, etc.) has grown dramatically in the last decade providing powerful methods to communicate and establish new connections based on common interests and needs. The vast majority of today’s medical students and residents are part of the millennial generation, the first generation that has grown up with digital technology. They have been labeled “digital natives.” There are currently four generations of faculty members at US medical schools, the “Millennials,” “Generation X,” “Baby Boomers,” and the “Silent Generation. The latter three did not grow up with digital technology, and if they utilize it, do so with more difficulty. These generations are labeled as “digital immigrants” as using digital technology is analogous to learning a new language later in life. In addition to differing levels of competency, faculty and students also differ in their perception of professionalism boundaries on social media sites. This webinar is designed to explore the social media competencies needed by faculty to work with medical students and residents who utilize social media on a regular basis. The types of competencies needed, opportunities for training, and professionalism issues that arise from the use of social media will be discussed.
J. Charles Eldridge, Ph.D., Professor of Physiology & Pharmacology, has been at the Wake Forest School of Medicine for 35 years as a leader and innovator in both medical and graduate school education. He was a founder and eventually co-director of the problem-based, case-based Parallel Curriculum, used as the pre-clinical phase by a portion of Wake Forest medical classes in the 1980’s-90’s. He then became an architect of the present integrated curriculum, serving as overall director of the first two blocks (28 weeks), and as director of the faculty-facilitated small group course now known as Case-Centered Learning (CCL). He has also received numerous teaching awards from student classes for his instructional series in endocrine pharmacology.
Dr. Johnson is Associate Dean for Academic Affairs and Professor of Microbiology and Immunology at the Des Moines University College of Osteopathic Medicine. She is responsible for assisting the faculty as they implement all aspects of the curriculum, in the classroom, through technology, and in the medical sciences laboratories. Dr. Johnson has more than 20 years of experience as a basic sciences educator and course director for medical microbiology and infectious diseases. She has been a leader in the evaluation of competency-based medical education for over a decade. Dr. Johnson graduated with a Ph.D. in Life Sciences from Indiana State University in 1991, and then completed a post-doctoral fellowship in molecular virology at Indiana University School of Medicine. She received a faculty appointment there and served as Statewide Competency Director for Problem-Solving as well as course director for medical microbiology at the IUSM-Evansville and IUSM-Terre Haute campuses. In 2009, Dr. Johnson moved to the Florida State University College of Medicine, Tallahassee, where she served as Assistant Dean for Faculty Development, and later Associate Dean for Medical Education. She moved to Des Moines, IA in 2012.
Arno Muijtjens was trained in Electrical Engineering (Measurement and Control) at the Eindhoven Technical University and has a PhD in Medical Informatics from Maastricht University. In 1999 he joined the Dept. of Educational Development and Research with a major interest in methodology and statistics in educational research, educational measurement, and assessment. More specific areas of interest are progress testing and computer based testing.
Robert Noiva has been the Associate Dean for Medical Education and Associate Professor of Biomedical Science at the Oakland University William Beaumont School of Medicine for the past three years. He oversees all aspects of the medical student curriculum at OUWB, including course planning and evaluation, managing schedules and educational resources, student and faculty assessment as well as continuing to stay active in the classroom teaching Biochemistry. Dr. Noiva spent 18 years in the Division of Basic Biomedical Sciences at the University of South Dakota Sanford School of Medicine where he taught Medical Biochemistry and Molecular Biology and ran several K-12 science outreach programs. Following his position in South Dakota, Noiva served as Director of Medical Biochemistry at Lake Erie College of Osteopathic Medicine, where he contributed to the lecture/discussion and independent studies curricular pathways.
Douglas Gould is currently a Professor and Vice-Chair of the Department of Biomedical Sciences at the Oakland University William Beaumont School of Medicine (OUWB) in Rochester, MI. He serves as the course director for the first year medical student neuroscience course. Dr. Gould has a longtime interest in the creation and evaluation of ancillary tools for independent learning – including 3 texts, a programmed learning tool for neuroscience, flashcards and a host of software packages. He has received a number of awards for teaching, including the excellence in teaching award from Ohio State University College of Medicine and all 5 Abraham Flexner Teaching Awards from the University of Kentucky College of Medicine. In the past he has served as the Editor-in-Chief of JIAMSE; completed the Aspire, Achieve, and Lead Leadership Development Program as part of his role as Chair of the Anatomical Sciences Section of the American Dental Education Association; and most recently has been appointed to the OUWB School of Medicine Management Committee.
Martha S. Grayson, MD, received her MD from the Albert Einstein College of Medicine, and completed the Residency Program in Social Internal Medicine at Montefiore Hospital in the Bronx. She completed the Michigan State University Primary Care Faculty Development Fellowship Program and the Executive Leadership in Academic Medicine (ELAM) Fellowship for Women at MCP. She was the PI for several grants which focused on training medical students, residents and community physicians in the fundamental competencies needed for the practice of high quality primary care. Dr. Grayson’s research interests include analyzing factors which determine medical student career choice, and on the assessment of educational programs. She currently serves as the Senior Associate Dean for Medical Education and Professor of Clinical Medicine at Albert Einstein College of Medicine. Her responsibilities include the oversight and management for the four year curriculum leading to the MD, assessment of learners, and evaluation of program effectiveness. She also provides oversight for faculty development programs for medical educators. She is a member of her institution’s task force that is creating a new curriculum on social media and related faculty development activities.
Dr. Katherine Chretien earned her medical degree from Johns Hopkins School of Medicine, where she was inducted to Alpha Omega Alpha and Phi Beta Kappa. After completing her internal medicine training at the Johns Hopkins Hospital in 2003, she joined the academic hospitalist group at the Washington DC VA Medical Center where she is currently Chief of the Hospitalist Section. She has held the role of medicine clerkship director since 2005. In 2007, she completed the Master Teacher Leadership Development Program, a graduate-level year-long certificate program for medical educators through George Washington University. She is associate professor of medicine at George Washington University. Katherine’s research interests include social media, professionalism, narrative medicine, and medical education. Her educational focus is on using innovation and technology to promote learning, reflection, and professional development. She is the recipient of the 2012 Charles H. Griffith III Educational Research Award from Clerkship Directors in Internal Medicine and the 2013 Women Leaders in Medicine Award from the American Medical Student Association. She is an associate editor of the Journal of Graduate Medical Education.