Transcript Slide 1

Teaching Formats for the
Pre-clerkship Curriculum
Overview
And
Presentation of Hybrid Model
HMS Academy
Professional Competencies
“competency” – “an individual’s ability to
make deliberate choices from a repertoire
of behaviors for handling situations and
tasks in specific contexts of professional
practice”
Govaerts MJB. Medical Education, 2008;42:234
How do we best achieve this for physicians?
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Goals Today
At the end of the session, you should be able:
• To describe the educational principles underlying
PBL, CBL and TBL
• To link these principles to the goals of the new
HMS curriculum
• To explain how CBCL blends elements of each of
the other teaching approaches
• To design a teaching session that uses some or all
of these elements.
HMS Academy
Our Curricular Goals
• Enhance accountability and responsibility of
students for learning
• Enhance student preparation for learning
sessions
• Shift bulk of “transfer of content” from faculty to
self-study and small group study
• Emphasize creation of frameworks, application
of knowledge and problem solving/analysis in
teacher-student interactions
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Expertise and Creativity
Cognitive process
Dimension
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Problem-based Learning
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Problem-Based Learning: Theory
• Open inquiry
• Exploration/journey:
students generate
learning objectives
and means to reach
them
• Construct knowledge
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PBL Principles
Norman and Schmidt, Acad Med, 67:557, 1992
• Student’s prior knowledge of the problem is
insufficient to understand it in depth
• Questions arise which serve as learning goals
for self-directed learning
• Teacher as “guide”
• Learning knowledge in setting of problems
fosters retention
• Enhanced motivation to learn
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PBL and Cognitive Theory
• Activation of prior knowledge facilitates
subsequent processing of new information
• Elaboration of knowledge at the time of
learning (e.g., discussion, answering questions)
enhances subsequent retrieval
• Transfer: “….concept or principle learned in one
context can be transferred or applied to a
problem…different in initial
appearance…requires the same principles for
solution.”
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Enhancing Transfer
Expt: A) Solve a problem and receive feedback
about the approach taken to solve the problem
vs. B) read and remember a problem and have
the solution explained to you
• Group A – transferred concept to new
problem 90% of time
• Group B – transferred concept to new
problem 60% of time
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Thinking Approaches
Modified from Pottier et al. Med Ed 2010
Inductive Reasoning
Deductive Reasoning
Analytical Reasoning
Boshuizen and Schmidt 1990
• PBL vs traditional curriculum
• Task: Example: explain how a metabolic deficiency and a
specific disease could be related
• Groups: students, biochemists, internists
• PBL students and biochemists  explored underlying
biochemical principles, then linked to clinical prob (inductive;
reasoning)
• Traditional students/internists  searched memory for direct
answer to question (pattern recognition)
• PBL students and biochemists more accurate
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Problem-Based Learning: Concerns
• Content gaps
• Tutors: content vs. process
experts (facilitators) –
studies show more errors
possibly linked to limited
knowledge of “guides”
• Only do this for few
sessions/week – will it
really have an impact?
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Case-based Learning
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Case-Based Learning
• Guided inquiry
• Tutor as discussion
leader
• Teacher > student
determines learning
goals
• More focused
discussion
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Principles of Case-Based Teaching
• Creative problem-solving with some
advanced preparation
• Students and facilitators share responsibility
coming to closure in key learning points
• Students may ask clarifying questions of
faculty during session
• Guided inquiry; elaboration of knowledge
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Comparison of PBL and CBL
PBL
• Preparation: None for
students; lots for faculty
• Control: student direct
discussion; faculty
provide no direction
• Data seeking: students
lots of additional data
sought; faculty some
CBL
• Preparation: some to lots for
student; lots for faculty
• Control: students provide
some direction; faculty
provide some direction
• Data seeking: students
some; faculty no additional
data sought
Srinivasan et al. Acad Med 82:74;2007
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Case-Based: pros/cons
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Pros
Cons
Open-ended
• Stifles curiosity?
discussion, debate
• Requires intensive
Efficient, goal directed
faculty development
Focus learners on key • Spoon feeding
points
mentality (always
expect experts to
Structured approach
have answers)?
to problem-solving
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PBL vs CBL
Srinivasan et al. Acad Med 82:74;2007
PBL
CBL
Focus on the journey or the destination or both?
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Team-based Learning
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Team-Based Learning
• Practice using concepts
to solve problems
• Requires explicit
preparation –
Readiness
assessment process
(RAP) with frequent
“tests” and feedback
• Allows for fewer faculty;
peer instruction
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TBL – Key principles
• Accountability: students must be accountable for
preparation & quality of individual and group work
• Feedback: students must receive frequent and
timely feedback
• Assignment design: group assignments must
promote learning and team development
Michaelsen et al. Team-based Learning: Small group
learning’s next big step, 2008
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TBL Sequence
• Preparation: learners study an advance
assignment
• Readiness assessment: learners
demonstrate knowledge through individual
and group readiness exercises
• Application: learners apply concepts to
problem-solving exercises
Koles et al. Acad Med 85:1739;2010
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TBL Process
Michaelsen et al. 2008
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TBL: Nature of Tasks
• Stimulate higher-level cognitive skills
(student makes a judgment based on
application of a concept, not just identify a
concept)
• Requires broad participation within small
group to achieve consensus
• Leads to competing solutions among
groups
Haidet et al. Acad Med 77:40;2002
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TBL Advantages
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•
•
Preparation and accountability
Mandates commitment to an answer
Peer instruction
Debate and defense of solutions to
problems; enhance thinking skills, analysis
• May be particularly useful for weaker
students (Koles et al., 2010)
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Is there one right pedagogical approach?
“From a cognitive perspective, to achieve
the goal of acquiring facts and concepts, it
may be equally efficient to have students
approach written problems individually or in
small groups without a tutor, and then use
faculty teachers for synthesis and
explanation of the problems’ solutions.”
Norman and Schmidt, Acad Med 1992
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CBCL
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Case-Based Comparative Learning
(CBCL)
CBL
PBL
TBL
Peer instruction
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Elements of CBCL - Proposed
• Self study: explicit assignment for study of content with
“thought questions”/task(s) –must have answer (commit)
• Readiness assessment (personal) – content based,
MCQ (delivered electronically in evening)
• Small group (next morning, tutorless, PBL-like) – 45
mins. Review assignment, achieve consensus on task
• Intermediate group – 90 mins
– Simultaneous reveal by group; discussion – 15 mins
– New case vignette: TBL approach (individual, small
group consensus, large group discussion) – 30 mins
– Additional cases(s) discussed CBL format – 45 mins
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Gas Exchange – An example
• Assignment (afternoon and night):
– Read syllabus notes and think about embedded quests
– Review virtual histology of lung tissue and path slides of
emphysema and pulmonary fibrosis; review anatomy of
pulmonary circulation; concept videos: A) CO2
elimination; B) hypoxemia
– Do readiness assessment exercise
– Answer thought question: Create a physiological
hypothesis to explain why a patient with V/Q mismatch
is more likely to have hypoxemia than hypercapnia.
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Gas Exchange – An example
• Small group (tutorless session)
– Discuss readings and
anatomy/histology/pathology assignment;
review anatomy models/resources as needed
– Discuss answers to thought question; achieve
group consensus
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Gas Exchange – An example
• Intermediate size group
– Discuss answers to assigned task –
simultaneous reveal of group hypotheses
– New TBL assignment: Create a physiological
hypothesis to explain why chronic
hypercapnia would reduce dyspnea in a
patient with emphysema.
– Additional CBL discussion: Breathing pattern
and gas exchange; EtOH
intoxication/vomiting/gas exchange
HMS Academy
Our Curricular Goals
• Enhance accountability and responsibility of
students for learning
• Enhance student preparation for learning
sessions
• Shift bulk of “transfer of content” from faculty to
self-study and small group study
• Emphasize creation of frameworks, application
of knowledge and problem solving/analysis in
teacher-student interactions
HMS Academy
Summary
• Keep our eye on key principles
– Demand preparation by students
– Accountability for their learning
– Value of peer/team learning
– Readiness assessment; frequent feedback
– Push for understanding, application, analysis
• A hybrid model (PBL + CBL +TBL = CBCL)
or variants thereof can work.
HMS Academy