Medical, Biomedical & Health Professions Education: FIVE ......Health Professions Education: FIVE CHANGES That Can Make A Big Difference Presented by: L. Dee Fink, Ph.D. International

Medical, Biomedical &Health Professions Education:

FIVE CHANGES That Can Make A Big Difference

Presented by:

L. Dee Fink, Ph.D.

International Consultant in Higher Education

Author: Creating Significant Learning Experiences

4th Annual Education Conference and Celebration

April 17, 2015

5 Changes That Can Make A Big Difference

Pressures for CHANGE in Medical Education

A. Inside Medical Education

ACGME & New LCME Competencies

o Complexity – rapid change – team work

o Active learning

Medical practitioners: Feeling a greater need for “meaning” in their work

B. Outside Medical Education

Public Image Issues: Doctors with poor “people skills”? Know more than “drugs & surgery”?

Increasing need and demand > supply

Greater range of roles and responsibilities

Need to work with different nationalities, cultures


5 Changes:

I. Changes by Whole College

1. Create a Learning-Centered Curriculum

2. Establish a Teaching-Certificate Program for Junior Faculty

II. Changes by Individual Teachers

3. Design Your Courses for Significant Learning

4. Use Team-Based Learning

5. Use Learning Portfolios


5 Changes:









Traditional Pattern in Medical Curricula:

• 2 years of basic sciences – then start applying (in clinical work)

• “Courses” consist of series of “segments”

Problems?

• Learning:

separates (a) learning new knowledge, (b) learning how to use it, (c) getting feedback

Fragmented

no integration

no building of knowledge


Solution?

• Create a curriculum that is:

Learning-Centered

Integrated


A Learning-Centered Educational Program:

Map Goals into

Curriculum

Assess the CW-LG’s

College-Wide Learning Goals

(CW-LG)



Map Goals into

Curriculum



(CW-LG)

Taxonomy of Significant Learning


Caring

Developing new…

Interests

Values Feelings

Learning HOW to Learn

Becoming a better student

Inquiring about a subject

Self-directing learners

Human DimensionsLearning about:

Oneself

Others

IntegrationConnecting: Ideas Learning experiences Realms of life

Foundational KnowledgeUnderstanding and remembering: Information Ideas

Application

Skills

Thinking: Critical, Creative, & Practical

Managing projects


Current ACGME Core Competencies

Fink’s Taxonomy: ACGME Competencies:



Foundational Knowledge

Application

Integration

Human Dimension: Interacting with Others

• Human Dimension: Learning about One-Self

• Learning How to Learn

Caring, Values




Foundational Knowledge 1. Medical Knowledge

Application 2. Patient Care

Integration 3. Systems Based Practice

Human Dimension: Interacting with OTHERS

4. Interpersonal and Communication Skills

• Human Dimension: Learning about ONE-SELF

• Learning How to Learn

5. Practice-Based Learning & Improvement

• Constant self-evaluation

• Life-long learning

Caring, Values 6. Professionalism



Current LCME Curricular Content (Std. 7)

Foundational Knowledge

Application

Integration

Human Dimension: A. Learning About One-Self

Human Dimension:B. Interacting with Others

Caring, Valuing

Learning How to Learn

Fink’s Taxonomy: LCME Curric. Content:


Current LCME Curricular Content (Std. 7)

Foundational Knowledge Biomedical, Beh., & Soc. Sci.

Application

• Diagnosis & Treatment• Critical Judgment, Prob.-Solv.

Skills• Communication Skills

Integration Soc. Problems with Medic. Conseq.

Human Dimension: A. Learning About ONE-SELF

Personal Biases

Human Dimension:B. Interacting with OTHERS

• Cultural Competency• Health Care Disparities• Interpersonal Collaboration Skills

Caring, ValuingMedical Ethics

Learning How to Learn Scientific Methods, Research

Fink’s Taxonomy: LCME Curric. Content:

Improving Your Educational Program

Curricular Learning Objectives for Medical School:

1. Foundational Knowledge – Medical Knowledge

• Understand fundamental bio-medical concepts, terms, processes, and system interactions

• Understand determinants of health• Understand the process of evidence-based medicine

2. Application – Patient Care, Clinical Skills

• Conduct patient interviews and physical examinations• Diagnose patient health problems• Propose evidence-based therapeutic treatments

3. Integration – Systems-Based Practice

• Connect knowledge of patient populations and health delivery processes in making diagnoses and therapeutic recommendations

• Advocate for the humane, just, and prudent care of persons• Adapt to the complex economic and social structure of health

care delivery


4. Human Dimension - Interpersonal Skills and Communication, Personal Growth and Professional Development, and Inter-professional Collaboration

A. Learning about and developing: ONESELF

• Reflect upon one’s personal strengths & weaknesses to make changes in one’s behavior

• Find one’s own meaning in medicine

B. Learning about and interacting with: OTHERS

• Deliver effective patient presentation and document in the medical record

• Communicate and work effectively with others, e.g., patients, families, health care team members, peers

• Demonstrate appropriate leadership skills in a variety of settings


5. CARING/VALUING – Professionalism

• Care deeply about becoming an excellent physician

• Value and behave in a manner consistent with the highest ethical standards of the profession

6. LEARNING HOW TO LEARN – Practice-Based Learning

• Develop a personal plan to become a better medical professional

• Nurture intellectual curiosity to question and advance knowledge through scholarship

-Boonshoft School of MedicineWright State UniversityDayton, Ohio, USA



Map Goals into

Curriculum



(CW-LG)


Medical School-Wide Learning Goals:

Medical

Knowledge

Patient

Care

Inter-Pers.

Communi-

cation

Prac.-Based

Learning &

Improv.

Profess-

ionalism

(And So

Forth)

1st year

2nd yr.

3rd yr.

4th yr.

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX


Medical School-Wide Learning Goals:

Medical

Knowledge

Patient

Care

Inter-Pers.

Communi-

cation

Prac.-Based

Lrng. &

Improv.

Profess-

ionalism

(And So

Forth)

1st year

2nd yr.

3rd yr.

4th yr.

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX

• XXX


Benefits??

• Allows you to focus more effectively on high-quality learning, e.g., the full range of ACGME & LCME Desired Learning Outcomes

• Provides a structure for more focused assessment & feedback

• Enables the College/School to know what is working well and what needs curricular attention


5 Changes:









Situation of Faculty Now:

• Assumption about teaching faculty: “Knowing medicine” = “Knowing how to

teach medicine to others”

• Little or no preparation for teaching

Problem:

• Many new, powerful ideas on college-level teaching

• NOT being widely used in medical education

• LCME Stds #4, 9


“New” Ideas on Teaching in Higher Education:

• How students learn

• Learning-centered teaching

• Designing learning experiences

• Identifying what students might learn

• Using active learning

• Using small groups

• Assessing student learning

• Motivating and enabling students to learn

• Using powerful teaching strategies

• Teaching large classes

• Using instructional technology

• Evaluating teaching

• Reflecting on your work as a student [teacher]


Solution: A Teaching Certificate Program

• A program for ALL junior faculty members

• They learn about the “Basics” of good college-level teaching – at the beginning of their careers as college teachers

• Includes:

• Seminars on 7 to 9 topics

• A classroom observation by a trained specialist in college teaching

• Project: Start using one of the new ideas – make a report to other members of Seminar


Possible Seminars Topics:

1. Active Learning

2. Classroom Assessment Techniques

3. Course Design

4. Teaching with Technology

5. Developing and Using Rubrics

6. Diversity in the Classroom

7. Using Small Groups Effectively

8. Reflective writing


Benefits:

• Junior faculty learn the basics of good teaching – at the beginning of their teaching careers

• They become motivated to continue learning about teaching after the program

• Better teaching Better learning

• LCME Standards - #4, 9


5 Changes:








Designing Courses for Significant Learning

2 Ways of Designing Courses:

1. Now: “List of Topics”

• How does it work?

• Pros & Cons??

2. Need: A way of designing courses that is:

• Systematic

• Integrated

• Learning-Centered


“Learning-Centered Course Design”


2 Major Ideas in Fink’s Book:

1. New Framework for identifying major desired learning outcomes

2. Model of: Integrated Course Design

= How to get the desired learning outcomes to happen – more frequently and more intentionally


1. Frameworks for Identifying Learning Outcomes

Bloom’s Taxonomy

Fink’s Taxonomy of Significant Learning


Caring

Developing new…

Feelings Interests

Values

Learning How to Learn

Becoming a better student

Inquiring about a subject

Self-directing learners

Human DimensionsLearning about:

Oneself

Others

IntegrationConnecting:

Ideas People Realms of life

Foundational KnowledgeUnderstanding and remembering: Information Ideas

Application

Skills

Thinking: Critical, Creative, & Practical

Managing projects


1. Framework for Identifying Desired Learning Outcomes

2. Model of “Integrated Course Design”

S i t u a t i o n a l F a c t o r s

INTEGRATED COURSE DESIGN:

Key Components

Learning Outcomes

Feedback & Assessment

Teaching &LearningActivities

Criteria of “GOOD” Course Design

S I T U A T I O N A L F A C T O R S

In-Depth Situational

Analysis

Learning Outcomes

SignificantLearning

EducativeAssessment

Active Learning

Integration

Feedback & Assessment

Teaching andLearningActivities

3-COLUMN TABLE:

Learning Outcomes: Assessment Activities: Learning Activities:

1. Found. Know.

2. Application

3. Integration

4. Human Dim.:

• Self, Others

5. Caring

6. Learning How to Learn

3-COLUMN TABLE:


1. Found. Know. • Multiple-choice tests

2. Application • Case studies

3. Integration • Essays, focused on Integration

4. Human Dim.

• Self, Others

• Reflective essays

5. Caring • Statements of preferences


• Learning portfolios

3-COLUMN TABLE:



• Reading

2. Application • Case studies • In-class problem solving, with fdbk.


• Discussion (small group?)

4. Human Dim.:

• Self, Others

• Reflective essays • Reflections, essays


• Community projects



• Project: learn something new

3-COLUMN TABLE:



• Reading

2. Application • Case studies • In-class problem solving, with fdbk.


• Discussion (small group?)

4. Human Dim.:

• Self, Others

• Reflective essays • Reflections, essays


• Community projects



• Project: learn something new

Week #: Mon Wed Fri

1

2

3

4

..

..

12

13

14

15

WEEKLY SCHEDULE

?? ?


1st Set of Learning Activities

2nd Set of Learning Activities

4th Set of Learning Activities

3rd Set of Learning Activities

S E M E S T E R


1

2

Learning Outcomes1. Xxx2. Xxx3. Xxx4. Xxx5. Xxx6. xxx

Learning

Outcomes

Ass’m’t

Activ.

Learning

Activ.

1. Xxx

2. Xxx

3. Xxx

4. Xxx

5. Xxx

6. Xxx

3

3-Column Table

Week: Mon Wed Fri

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Weekly Schedule

Learning ACHIEVED

4

5

Learning IMAGINED


Designing Your Courses for Significant Learning

Benefits??

Greater quantity and quality of student learning

• Reason? High quality learning is intentionally and systematically designed into the course

Also get: “Learning that lasts”

Teaching – and learning – become more enjoyable


5 Changes:









Dominant Form of Teaching Now:• Lecture – 1:1 Drill – Exam

Problem:

• Isolates students

• Short-term memory – short half-life

• Fails to use the power of “Social Constructivism” – Small groups

Warning About Using Small Groups:• When used improperly, using small

groups can have negative effects!


Qualityof

StudentLearning

TraditionalTeaching(lecture, textbook focused)

CasualUse

PeerInstruction

TBL

Different Ways of Using Small Groups

TEAM-BASED LEARNING: A Special Use of Small Groups

TBL: Main Features

1. Classic Sequence of Activities

2. 3 Boxes

3. What it is and what it isn’t


TBL: Main Features


2. 3 Boxes



• Covering a 2-3 Week Block of Time

• Covering One Major Topic Within the Course

Three Phases of Team Learning:

R.A.P.:1. Individual test (Continue

2. Team test Group Work Group Work pattern as long

In-Class: 3. Appeals (Simple) (Complex) as desired)

4. Corrective

Instruction

Out-of-Class: Reading Homework Homework Review

Approximate Level of Content Understanding at Each Phase:

Assessment

The Sequence of Learning Activities in Team-Based Learning

Preparation

Activities:

Application (Practice with Feedback)

40% 90-100%50% 60% 70% 80%) ) ) ) ))

CULMINATING PROJECT

EXAM: Individual or

Group


TBL: Main Features


2. 3 Boxes



3 “DIALOGUE” BOXES OF TBL

Dialogue

WITHIN

Groups

Dialogue

AMONG

Groups

High

Quality

LEARNING

xDialogue

BY

Oneself

x


TBL: Main Features


2. 3 Boxes



TBL: What It Isn’t and What it IS

≠ Weekly RATs all semester long

≠ Just a Group RAT

≠ Graded group work without Peer Evaluation

• Permanent, intentionally-formed groups

• Individual & Group RAT

• In-Class, SG Application Exercises

• Graded Group Assignments

• Peer Evaluation

=


Increasing Use of TBL in Medical Education:

A. Where being used college-wide:

• Duke U./NUS – Graduate Medical School in Singapore

• Nanyang UG Medical School (Singapore)

• Oakland University (Michigan)

• Pharmacy Schools:

• California Northstate (Sacramento)

• Regis Univ. (Denver)

• Bradford (UK)

• KwaZuluNatal University (S. Africa)

B. Plus: Being widely used in other medical schools, e.g., Wright State Univ.


Reasons TBL is Spreading So Widely in

Medical Education??

It solves four of your major challenges:

1. Lots of information to learn about and comprehend

2. Want students to learn how to USE that information

3. Want students to learn how to work well with other people

4. Large classes



5 Changes:









Now??

• What do we hold students responsible for?

• Passing tests – Passing larger exams.

Problem with This??

• They don’t see themselves as being in charge of their own learning.

• They worry about tests and exams and passing courses – not the larger picture of whether they are learning what they need to be learning.

Solution??• Put them in charge of their learning – via

Learning Portfolios.


What IS a Learning Portfolio??

• A document that students create at the end of a course.

• The document has two parts:

1. A reflective essay

2. An appendix


What do we want students to do and be able to do –

as students?

STUDENTS


St1 St2

Teacher/Coach


St1 St2

Meta-Learner:?

Teacher/Coach

•


St1 St2

Own Learning/Development

Meta-Learner:?

Own Knowing/Beliefs

Own Thinking

Own Performance

Own Caring/Values

Teacher/Coach

•

One Who Takes Charge of their…


70

Developing STUDENT

Capabilities:

What do we want students to be able to do, as students?

Answer:

Become META-LEARNERS


Learning Portfolios: KEY QUESTIONS

1. WHAT did you learn?

2. HOW did you learn?

• What helped you learn? What didn’t help?

• What does that tell you, about yourself as a learner?

3. SIGNIFICANCE FOR YOU, of what you learned?

4. Plan for FUTURE LEARNING:

• WHAT ELSE do you want/plan to learn?

• HOW will you learn that?


Impact of Using Learning Portfolios??

Students…

1. Become more focused on “Learning” rather than “Passing Tests.”

2. Become more aware of the “Nature of Learning” and “Themselves as Learners”.

3. Start taking charge of and responsibility for – their own learning.


REVIEW


1. Learning-Centered Curriculum• Provides a curriculum structure that is

focused on dynamic learning outcomes

2. Teaching Certificate Program for Jr. Fac.• Provides junior faculty with the basics of

high quality teaching – at the beginning of their teaching career.

3. Designing Courses for Significant Learning• Builds high quality learning into your courses

– intentionally and systematically

4. Team-Based Learning• A teaching strategy that addresses/solves

your major educational challenges

5. Learning Portfolios• Puts students in charge of their own learning

5 High Impact Teaching Practices

BENEFITS TO…

• Your Students

• Your Institution

• Society

• Yourselves


THE END!

Medical Education:

Let’s make it all that it can be and needs to be!


THE END!

Medical Education:

Let’s make it all that it can be and needs to be!

??


OR, A NEW START?

Teaching for the 21st Century . . .

Medical, Biomedical & Health Professions Education: FIVE ......Health Professions Education: FIVE CHANGES That Can Make A Big Difference Presented by: L. Dee Fink, Ph.D. International

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