LSI Pilot20110615 - USMLE Customized Assessment • Turning Point Team Competitions • Student-generated question bank • Twitter for class communication Curriculum goal: Design

6/15/2011

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Asynchronous Learning – Lessons Learned

From a Curriculum Pilot

Doug Danforth, Ph.D.

Larry Hurtubise, M.A.

“What doesn’t kill us, makes us stronger”

Friedrich Nietzsche, 1888

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Endocrine and

Reproductive

Disorders

Gastrointestinal

and Renal

Disorders

Host

Defense

Clin

ical F

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Skin, Bone,

and Muscle

Disorders

Medical

Practice

and Patient

Care

Neurological

Disorders

Cardio-

pulmonary

Disorders

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Part One

Clinical Foundations

Part Three

Advanced Clinical

Management

Part Two

Clinical Applications

ProjectsSmall Group

Discussions

Ste

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Pa

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Bre

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Host

Defense

Part 1 Design Guidelines

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• Design learning resources around defined objectives

• Significantly reduce the standard lecture with a faculty

member and students in the lecture hall.

• Present (real time) turning-point sessions that have questions

covering the objectives.

• Utilize case based clinical correlates

• Utilize several TBL sessions as part of the block evaluation

process.

Additional Components

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• Longitudinal Anatomy Curriculum

• Collaborate with CAPS for Clinical Skills Sessions

• Wiki for course packet

• USMLE Customized Assessment

• Turning Point Team Competitions

• Student-generated question bank

• Twitter for class communication

Curriculum goal: Design learning resources around

defined objectives and provide multiple resources

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• Handout with all objectives and several resources for each

• Suggested study schedule

• Dedicated web site with answers to objectives

• eLearning Modules

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Curriculum goal: Design learning resources around

defined objectives and provide multiple resources

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• Outcomes:

– Studying from objectives vs lectures was challenging

– Multiple learning resources led to confusion

– On-line course packet was an unneeded change

– eLearning Modules were highly rated

• Require considerable time and effort

Bloom’s Taxonomy

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Curriculum goal: Reduce emphasis on lectures

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Curriculum goal: Reduce emphasis on lectures

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Face-to-face time

Face-to-face time

Curriculum goal: Reduce emphasis on lectures

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Learn first in class and go

home to review notes

Curriculum goal: Reduce emphasis on lectures

Study at home and come

to class prepared for a

higher level discussion

Shift in emphasis

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• Traditional lecture hours reduced from 32 � 10

• Of 22 hours removed

– 10h were replaced with TBL, CRIS, CPC

– 12h were deleted

• 2/3 basic science

• 1/3 clinical content

• Total in-class time was reduced from 34h � 22h

Curriculum goal: Reduce emphasis on lecturesReproduction and Development 2010

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Time Monday 3/8 Tuesday 3/9 Wednesday 3/10 Thursday 3/11 Friday 3/12

8:30 RD

Female

Reproductive

Pathology

Dr. N. Ramirez

(3 hrs)

RD

Physiology of

Pregnancy

Dr. D. Danforth

(2 hrs)

RD

Sexual Differentiation

Dr. D. Danforth (1 hr)

RD

Maternal Physiology in

Pregnancy

Dr. P. Samuels (1 hr)

RD

Gestational and

Placental Disorders

Dr. N. Ramirez (1 hr)9:00

9:30 RD

Fetal Development

Dr. M. Prasad (1 hr)

RD

Normal Labor

Dr. W. Trout (1 hr)

RD Developmental

Pathology

Dr. N. Ramirez

2 hrs10:00

10:30 RD

Control of

Reproduction

Dr. L. Keder (1.5 hrs.)

RD

Prenatal

Diagnosis/Genetics

Dr. B. Rink (1 hr)

RD

Obstetrical

Catastrophes

Dr. G. Essig (1 hr)11:00

11:30

12:00

12:30

1:00

1:30RD Small Groups

Group A: 1:00-2:30

Group B: 2:30-3:00

Graves Hall

classrooms as

assigned

CAPS

1:30 – 4:30

Small Group A

CAPS

1:30 – 4:30

Male and Female GU

As Assigned

RD Small Groups

Group B: 1:00-2:30

Group A: 2:30-4:00

Graves Hall

classrooms as

assigned

CAPS

1:30 – 4:30

Small Group B

CAPS

1:30 – 4:30

Male and Female GU

As Assigned

RD Small Groups

Group A: 1:00-2:30

Group B: 2:30-4:00

Graves Hall

classrooms as

assigned2:00

Reproduction and Development 2011

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Time Monday 3/7 Tuesday 3/8 Wednesday 3/9 Thursday 3/10 Friday 3/11

8:30 Introduction to Pregnancy

Dr. D. Danforth (1hr)

Normal Labor

Dr. W. Trout (1hr)Gestational and Placental

DisordersDr. N. Ramirez (1hr)

TBL Exercise

Group BSexual Differentiation

NO PODCAST9:00 CPC - Breast Disease

WestmanHitchcock

AckermanNO PODCAST

9:30 Maternal Physiology in

PregnancyDr. P. Samuels (1hr)

Prenatal

Diagnosis/GeneticsDr. B. Rink (1hr)

CRIS – Clinical Reasoning

and Integration Session

10:00

10:30

11:00

11:30

12:00

12:30

1:00 Anatomy lab

Female reproduction1:30

2:00

Clinical Skills

Demonstration and practice (CAPS)

(2:00 – 5:00)• Pelvic exam

• Breast exam

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• Outcomes:

– Significant challenge for students

• “Block seemed disorganized”

• Students struggled to identify important material

• Three questions per hour of lecture

– Significant challenge for faculty

Many issues specific to pilot

Curriculum goal: Reduce emphasis on lectures

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Curriculum goal: Provide interactive case-based

clinical correlates to emphasize clinical reasoning and

integration.

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Developed three Clinical Reasoning and Integration Sessions (CRIS)

1) Introductory lecture followed by quiz questions

2) Case-based approach following single individual throughout

reproductive lifespan

3) Students had to solve problems based around specific

physiological concept (oxygen delivery to fetus)

Utilized Turning Point Team Competitions

1. Students worked in existing TBL teams and competed

against classmates for fabulous prizes

2. No impact on grades

Curriculum goal: Provide interactive case-based

clinical correlates to emphasize clinical reasoning and

integration.

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Developed three Clinical Reasoning and Integration Sessions (CRIS)

1) Introductory lecture followed by quiz questions

2) Case-based approach following single individual throughout

reproductive lifespan

3) Students had to solve problems based around specific physiological

concept (oxygen delivery to fetus)

Utilized Turning Point Team Competitions

1. Students worked in existing TBL teams and competed

against classmates for fabulous prizes

2. No impact on grades

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Curriculum goal: Provide interactive case-based

clinical correlates to emphasize clinical reasoning and

integration.

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Outcomes:

1. CRIS Sessions were generally highly rated

2. Students wanted more questions during the sessions and

additional information before class to prepare

3. TPTC were relatively low-yield

Curriculum goal: Utilize several TBL sessions as part

of the block evaluation process.

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Approach

• Utilized three TBL sessions – one each week

• Traditional TBL format except that both the IRAT/GRAT and application

exercises were completed in one 90 minute session

Outcomes:

• Students enjoy TBL

• TBL during first week was challenging but effective

• TBL requires a minimum of 2 hours to effectively finish.

Other Curriculum Features

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• Exams

– USMLE Customized Assessment

– Faculty generated exam

• Clinical Skills Sessions

– Male GU

– Female GU

– Ultrasound

• Anatomy Sessions

– Male and female pelvic anatomy prosections

• Student-generated questions

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Part 1 Design Guidelines – How did we do?

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• Design learning resources around defined objectives

• Significantly reduce the standard lecture with a faculty

member and students in the lecture hall.

• Present (real time) turning-point sessions that have questions

covering the objectives.

• Utilize case based clinical correlates

• Utilize several TBL sessions as part of the block evaluation

process.

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Part 1 Design Guidelines – How did we do?

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4

2010 2011

Overall Evaluation

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2010 2011

Danforth Evaluation

LSI Pilot - How did the students do?

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• Overall class average = 87%

– Faculty exam = 82%

– NBME Customized Exam = 92%

– 2 failures

Summary

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Faculty/Block Leader challenges

• Designing cohesive block of IP/ISP approaches was difficult

• CRIS/TBL – good options for active learning but …

• Lecturers struggled

• Integration of knowledge and skills

Summary

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Student challenges

• Prioritizing from objectives vs lectures was challenging

• Multiple learning resources was confusing

Key Points and Implications for Implementation

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• Faculty change will be difficult

• Focus/limit learning resources

• Training and support for eLearning will be critical

• Standardization of content delivery may be important

• Integrating ISP and IP styles is challenging

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Bloom’s Taxonomy

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Explain the endocrinology of the male reproductive system and the physiological processes of testosterone

production and spermatogenesis

Learning Resources:

Rhoades and Bell (RB) Chapter 36

WebMic (WM) Study Unit 17 Male Reproductive Tract and Organs

Gartner and Hiatt, Textbook (H) pp. 481-510

Gartner and Hiatt, Atlas (G) Chapter 18

Second Life – Tour of the testis

Reproduction and Development Pilot Wiki – Male Reproduction/Endocrinology

Apseloff lecture – 3/2

Endocrine Regulation of Male Reproduction (RB 669-72)

Objectives:

1. List the important hormones of male reproduction and describe the functions of each. Describe the

intracellular signaling (second messenger) systems for Gonadotropin Releasing Hormone (GnRH,) the

gonadotropins, and testosterone.

2. Describe the regulation of luteinizing hormone (LH) and follicle stimulating hormone (FSH) secretion by

GnRH. Recognize that GnRH (and thus LH/FSH) secretion is pulsatile and that pulsatile GnRH secretion is

REQUIRED for physiological LH and FSH secretion.

CLINICAL CORRELATE – GnRH analogs are used clinically to control gonadotropin secretion. GnRH agonists are

engineered to bind to the GnRH receptors and stimulate LH/FSH secretion. They also have a very long half-life.

GnRH antagonists are designed to bind to the GnRH receptor but not stimulate gonadotropin secretion – they

compete with endogenous GnRH for GnRH receptors on the pituitary gonadotropes and thus inhibit LHG/FSH

secretion. QUESTION - What would be the long-term effects of GnRH agonist treatment on LH/FSH secretion?