Thursday, December 8, 2011

Paper vs Pixel - Use of On-line or traditonal books in medical education

I was at at team meeting yesterday to orient faculty to the neuroscience course I'm co-directing next year.  We were going through the section where I was relaying to them our required texts for the course.  One of the faculty (who happens to be a physiologist) asked which physiology text we were using for the course.  On the list we have a nice neuroanatomy text, a brain atlas, a psychiatry text, a pathology text, and Harrison's.  He felt the neurophysiology discussions in our clinically minded neuroantomy text were lacking, and the other faculty in the room agreed with him.

So this left me with a dilemma.  Do I have switch from our current neuroanatomy text with a definite clinical foundation a more comprehensive text with neurophysiology covered more completely?  Such a text was used in the past, and was felt to be too dense for the needs of medical students.  Do we have them buy a text that focuses only on neurophysiology in addition to the neuroanatomy text?  I think this would likely just lead to them not buying this text as we'd only need a few chapters, and I'm not sure it would be very useful for them in the future honestly.  It would likely be more dense than the book we already rejected.  Do we just give them the lecture notes to study from?  Or do we search for/develop online references for them to use.

This last point led me to the rebuttal I had to requiring the students to buy another textbook.  My impression from talking to fourth year students is that the majority of them do not buy textbooks any more.  I can actually see good reason for that.  First, textbooks are and always have been expensive.  Textbooks are also notoriously slow to adapt to new information (new editions come out every few years, and take a year or so to develop, so are at best a year out of date, and at worst 2-3 years out of date when they are read).  Compare that to most online resources which are free (or available for free through institutional subscriptions).  Online resources aren't guaranteed to be updated frequently, but at least the possibility is there for them to be updated frequently.  Also, with the advent of more interactive pages, there is a chance for things to be updated as new information is developed through crowd-sourcing.  Hence, my idea that asking students to buy another text is foolish, as I'm not convinced that their all going to buy the first 3 books that are already on my list.

Wednesday, November 30, 2011

Lessons learned from video conferencing didactic sessions

I've been using two different video conferences platforms over the last few years to beam our didactic sessions on the neurology clerkship to students who are at remote sites - in our case community sites in Bend, and Eugene.  I've had mixed success, and wanted to see if other people have found ways to improve the use of the technology to overcome some of the hurdles I've found.  Our didactic sessions are really set up to be a series of cases which the facilitator works through with the students.  They are usually an hour, and are intended to be very interactive with the students working together as a group to learn about various disease states from a case described by a facilitator.

Here are some things I've learned:

1)  Tech savviness is good.  I'm MUCH more likely to succeed at getting the student to keep coming back to the didactic sessions, and find that they are satisfied with the experience if that student has some technical savvy.  If the student is relatively not as literate with navigation of the web or more in depth programming than a word processor, it is more likely to fail technically.  Also, there is a much lower tolerance if problems start with the less savvy student bailing out earlier.  We're now using Abobe Connect and had used Microsoft LiveMeeting in the past.  Both are decent, but both have a bit of a learning curve, which less computer literate students aren't often willing to overcome.

2)  Better microphones = better experience.  Much more involvement when I spent more money (around $100) on a nice area mic that covers the whole conference room than trying to squeak by with cheaper mics.

3)  Works better with help.  I don't always have help, but I think the whole experience works better if you have some tech help who can monitor the feed, and problem solve for you if issues arrive.  When I'm the only tech help, I try a few things, but often just tell the student to try again the next time, as I can't hijack the whole lecture to spend even 5 minutes finding out what's wrong.  I'm not saying I have help now...

4)  Video feed can just provide a distraction.  Students have said that if the only thing they can see is my head, but there are lots of people talking at a table, it can almost take away from the experience.  I'm going to just sending the slides/whiteboard to try to get around that.  I don't have a whole table cam, and don't have help to run an external camcorder to focus on the person whose talking.  Haven't found a great way around that.

5)  Bigger computers are better.  I recently switched to using my newer, faster, sleeker laptop from an older one we had stowed in the conference room.  Audio has been our main tech issue, and it seemed to run better with the combination of a better computer and a hardwired line on the presenter's side.  We don't always have students hard wired in, but it is harder for them to do that as they have a netbook with them, and are not always in a predictible spot to participate in the lecture.  With that limitation, I'm not sure how to get around the student side of the problem.

What are your insights or experiences?  Have you found other ways to get around the problems I've had?  I hope to be able to improve my abilities to run this over time (as I'm hoping the software will become more reliable, and the hardware will become cheaper and smarter).

Thursday, November 17, 2011

Is having residents do most of medical student teaching bad?

It's surprising when a statistic comes out that at face value looks a bit shocking, but if you reflect a little, it's absolutely obvious.  Dr. Vinny Aurora just posted a tweet from a conference she is at about the percentage of teaching medical students on inpatient wards receive from residents.  This was then retweeted numerous times within a few minutes of when she posted it, meaning people felt this was useful and important information.  She followed up with several other tweets about how this makes it imperative that we teach residents how to teach.  I completely agree with this.  What I find a bit odd is that people still are excited to know that the bulk of clinical teaching for our students in the third and fourth year comes from residents, and not faculty.

I would venture that there are probably more junior faculty who populate the ward posts where students are learning than senior faculty.  I have no data to prove that, but if I look at my own department's attending schedule I would hazard to say that over half of the ward attendings are junior faculty.  This is the reality of academic medicine.  Most of the teaching on inpatient wards comes from the junior third of the clinicians in the facility.

I would then argue that it really is not bad.  There seems to be this unstated implication that education provided by residents is somehow less useful, and almost dangerous.  I know the LCME emphasizes having faculty be actively involved in teaching students, and I completely agree that having a completely absent faculty member on an inpatient service is not only a poor learning environment, it can lead to disastrous clinical care consequences.  What I would argue against is the notion that residents have nothing to offer in the realm of education.  Some of the best teachers I worked with as I went through third and fourth year were residents (and even the fourth year sub-intern when I was a third year student on my internal medicine rotation).  I realize that just like faculty, there are some are more engaged in teaching, and some are more knowledgable than others.  On the whole, I think we underestimate the power of resident teaching.  Most students will never go into neurology.  Thus, they really don't need me as a Parkinson's subspecialist to pontificate about the idiosyncracies of what anatomical target to choose for DBS.  They need someone who can show them what a resting tremor looks like, and how to distinguish that from an essential tremor.  Our neurology residents can all do that.

That being said, I again totally agree that our residents are on the whole under-prepared for the teaching role they assume on July 1 of their intern year, and we need to invest much more in teaching them how to teach.  But along the way, we need to appreciate them for what they are.  They truly are the front lines of clinical year teaching for medical students.

Friday, November 11, 2011

The value of teaching and testing medical trivia in 2011

I'm a first year course director for the basic neuroscience course for second year medical students.  With my co-course director, we're gearing up for the course to start in a few months, and are in the process of tweaking the schedule, and looking over who will cover what as the course proceeds.  As we are going over the details of each session, we stop every once in a while to ask what are our main goals with this course.  It's a bit daunting to think about a major course like neuroscience and come up with over-riding goals, but I think it is a useful exercise.

I'm trying to do things better than they were done when I went through medical school.  It seemed to me going through courses like my neuroanatomy course that the goal of the course was recall of very minor details of neurological anatomy, physiology, and pathology.  This was due to the fact that the majority of our assessment was through a multiple-choice test which primarily asked questions about what minutiae. Thus, we all envied our classmates who had the ability to look through notes once and be able to recall all the little details without any trouble.  Those people were always then rewarded with high test grades.  Tests seemed more like a medical "Jeopardy" competition than a review of facts that will actually be useful in caring for patients.  However, life has changed since that time.

The advent of search engines and a whole library of research articles being available where ever you are has made it harder to argue for drilling in facts to the level we used to do.  I was always told that the reason for doing this is that you will likely not remember everything you've learned, so if you oversqueeze information into your head, the important stuff will likely stick.  And, it is true, that every physician I've ever met has moments where they will be presented with a case, and dredge up some unmined factoid from medical school that will help them with a case they are seeing right now.  So, I don't think we can get entirely rid of the feeling that medical training is much like trying to drink from a fire hose of information.  But, I think we can be more targeted in which factoids are required to be known, and I'm not the only one with this opinion.  It's not really important to know what chromosome the defect for Huntington's disease is on, or even the name of the protein affected.  What is important is to know the basic clinical presentation of Huntington's disease, and it's variants.  This is far more useful.  It's also important to know those rare medication side effects so you can monitor if needed for them, and be aware of what medications can do.

I'm not sure I know all the answers to how much is too much detail for a medical school lecture.  But, hopefully in the course I'm directing, the weird stuff the students will be memorizing will all be stuff that one day may percolate up when their seeing a patient.  And, hopefully when that thought percolates up, they'll stop and say out loud, "Thanks, Dr. Kraakevik."

Friday, October 28, 2011

From theater seating to studios - Medical education reform of learning spaces

I took the above picture from a blog outlining recent University of Virginia School of Medicine's curricular changes.  These changes in part integrate learning theory ideas that participatory learning creates better retention than passive learning (read small group discussions are better than large group lectures), and also incorporates the use of new technology seamlessly into the curriuculum.  This includes a physical learning space change from a tiered lecture hall to a learning studio with multiple tables to foster small group discussion.

The medical school I am at (OHSU) is looking to build a new medical education building.  The current plans call for learning studios for the first and second year courses as opposed to the traditional theater-style lecture hall we now have.  I had asked in my last post for some feedback on curricular reform, but I think I may not have given a focused enough question to get a good discussion going.  So, this time I'll be more to the point on what I'm REALLY interested in here.  So, what I'd like to know is:

1) Has your medical school (or other higher education institution) already switched to the learning studio format for large group presentations in the first and second year or are you planning on switching soon?
2)  What have been successes/hurdles if you have implemented this style of learning space? 
                    -  Our course directors have specific concerns about the amount of faculty development needed to   pull this off given our current heavy reliance on lecture)
                    - Are there innovative teaching methods you have implementing using this type of space which is not possible with a traditional lecture hall?

I'm personally thinking this will fit my emerging person style of large group lectures quite well, as I've moved much more to giving introductory statements, and having learners figure out the rest as they work through a case study or an example.  I appreciate your comments (as does our basic science sub-committee)!