Learning on the Wards - Indiana Universityfaculty.medicine.iu.edu/.../05/Jose-Roig-FINAL-Mobile-Classroom.pdf · • Discuss Learning and Teaching on Wards ... • Medical Students

Learning on the Wards

Jose Roig Indiana University School of

Medicine

Agenda

• Discuss Learning and Teaching on Wards – What are the factors affecting learning – What is the best model

• Look at an example of technology to support the mobile classroom

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Learning on the Ward Late 1950’s – Early 60’s

Learning on the Ward Late 1950’s – Early 60’s Pictures

Learning on the Wards Today

Fungal Infections Late 1950’s - Early 1960’s

Fungal Infections Today

Learning on the Wards Next Year

Threats to Ward Based Learning • Pressures to increase clinical

productivity • Increasing documentation

requirements (EMR) • Insufficient funding

available for medical education.

• Ambiguous Roles and Responsibilities – Are Residents Teachers ?

• Legal Issues (Malpractice, Copyrights)

The Hospital Ward as a Classroom

• Patients come first – As a priority, teaching is last – Patient desires

• Very Unstructured • Informal Team Meetings • Lectures Unprepared • Time consuming and Less Informative • Unequal Exposure / Unbalanced • Dependent on the Resident/Attending skill, time, and

interest • Review Texts are not detailed enough for NBME exams

Didactic Methods

Medical Learning – Cognitive Dissonance

• ….In developing her student environmental fit model, Thompson (1999) reinforced the belief that cognitive development occurs during challenges and periods of stress, items she labeled as instances of cognitive dissonance. Cognitive dissonance can be either positive, causing students to mature, or destructive, causing students to remain stagnant.

Thompson concluded that students develop cognitively when challenges and stressors are met with adequate support….

-Leslie Allen, Papers of the Western Family Economics Association 2003, Vol.18, Texas Tech University -J. Thompson, J Instruction Psychology, 1999; 26 (10 56-64)

All these issues are a product of evolution

• Mobile based learning is an innovation that can combat these restrictions

• More effective team based learning with defined roles and objective measures of success

• A platform that can provide structure and organization by meeting TBL initiatives but considers the constraints of the WARDs and Clinics

Teaching in the Doctor Patient Relationship

• Large part of the doctor patient relationship involves teaching

• With the advent of “Patient Empowerment” and increased autonomy in medical decision making, teaching students is even greater more time consuming process

Mobile Classroom Are Residents …Teachers?

• Medical student perceive residents as having a significant teaching role.

• Medical Students estimates one-half to one-third of teaching is from residents

• Residents/Students themselves seek out and desire teaching roles for which they have no training.

• Still the relationship is ambiguous.

Mobile Classroom – Support?

• Areas of cognitive dissonance are greatest on the ward

• With support, learning can be improved given the constraints.

The Mobile Classroom

• Empowers Student Educators – Force Multiplier • Better connects needed clinical learned skills with

NBME testing. – teaching in specific clinical contexts

• Shorter more pertinent cases • Organized / Structured • More details than review texts • More memorable details with applied concepts • Makes most of Physicians, Residents and Students

time

Wards Closely Resemble TBL

• Assessments on clinical reasoning ability, such as Computer based Testing (NBME), and OSCE were found to be significantly higher in TBL students compared with non-TBL students.

• TBL helped form problem solving and reasoning abilities in students with limited clinical exposure.

–Journal of Experimental Medicine, 2012, 227 (1) 23-29

• TBL Wards are not TBL friendly learning environments, they are much more dynamic

Support On the Wards – Organized small team lectures

• With preparation for Clinical Problem Solving and NBME • Positive Social Pressures

– Organized clinical procedures training – Readiness Assessment

• Testing complex decision making skills in simplistic format

• Objective Actively Quiz – Frequent and Timely feedback – with constructive

criticism and goals for resolution – Minimizing barriers to group cohesiveness

Residents / Students As Teachers

• Putting this concept into practice, it has been shown that formal teaching responsibility improves residents’ knowledge acquisition more than self-study or attending lectures (First et al. 1992).

• A trend has been demonstrated for residents rated as better teachers by students to perform better

• on in-training examination scores (Seely 1999). • The process of preparing to teach may help them

organize and solidify their knowledge (Bensing et al. 2000).

Clinical Teaching Skills

• One-one-one tutoring • Teaching in specific clinical contexts • Teaching procedural skills • Giving honest and useful feedback • Fairly Assessing Medical Students • Understanding curricular transformation of

clinical teaching using mobile technology

Implementation

Sharing Content

Mobile Flash Cards

• Share important facts, mnemonics, epidemiology, symptoms, differentials

Mobile Ward Cases

• Empowers Teachers • Directed Content –

“TBL Lite” • High Yield • Supported by Level

1 Research • Exposure to

Imaging used on NBME tests

Mobile Ward Cases

Mobile Quiz

Dictated Feedback

• Dictated Feedback • Recorded for Posterity • Iterate Review Process • More Accurate and Fair

Assessments • Time saving for

Physicians / Residents / Students

• More valuable for students

Mobile Classroom • This technology supports the new paradigm of

WARD based TBL format • Empowers Teachers – organization, structure

thought, time management • Empowers Students – time and location

applicable, iterative feedback • Force Multiplier – improves learning in the

hospital setting where computers are at a minimum and cognitive dissonance greatest

• Creates reusable content

Contributors Thanks

• Krista Hoffman-Longtin

References

• “Team-based learning, a learning strategy for clinical reasoning, in students with problem-based learning tutorial experiences.” Tohoku J Exp Med. 2012;227(1):23-9.

• “Getting Started with Team Learning” Larry K. Michaelsen med.wright.edu

• “The educational theory basis of team-based learning” Med Teach. 2012;34(10):796-801. doi: 10.3109/0142159X.2012.687120. Epub 2012 May 30.

• “IUSOM Internal Medicine Sub-I Orientation Presentation” Vu, T, et.al.

Questions