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)!

Curricular changes on the horizon?

I'm sure the institution I work at is not alone.  The last major curricular upheaval at our school about 15-20 years ago.  Think about the changes which have taken place in medical science, education technology, and clinical practice over that time span.  In 1990, I was just starting college, and had never had an email account.  I did my senior thesis paper to get my undergraduate biology degree by looking up articles at the University of Minnesota medical school library by using the Index Medicus followed searching through the bowels of the library hoping I had correctly copied down the volume and issue number of the journal correctly.  When I saw a doctor, they wrote things down by hand into a chart that consisted of a manila folder.  My computer still had floppy disks, and I was only semi-aware of this thing called the internet.  This is the setting framing the genesis of the current curriculum at our medical school.  At that time most lecturers still carried their presentations in big boxed of 35 mm slide carousels.  A bit has changed since then.

Hence our school is primed for change.  And, as I said before, I don't think we're alone.  Many medical schools have already started the process or are thinking about starting a major reform.  There is great talk about bringing clinical application even more prominently into the first two years of the curriculum, and at the same time as the basic science concepts are being made more overt in the third and forth years.  Teaching and instructional styles are changing with the trend to relying even less on the formal lecture, and more on group or individual problem solving.  There is also talk of more individualization of marking progress from one level to the next with the current concept of time being the major driving factor between a junior and a senior medical student (ie marked by number or years) to a view that students must achieve benchmarks and outcomes to be advanced.  There is a lot of talk about whether to integrate the clinical coursework so the students are learning through a patient's experience moving from one specialist to the next in place of isolated assignments to one department at a time.  As with most curricular reform, there's not a lot of data out there at present for the new way of doing things, and people are feeling their way along.

Hence this blog post.  Our basic science sub-committee has been faced with a new building which will be open in a few years.  The new building is going to have learning studio style lecture halls.  The chair of the committee has asked those of us on the committee to find out what other schools have already done or are thinking about doing in the realm of curricular reform.  Please post here about your school's experience or links to other blogs/articles about your school's experience so we can all learn from each other.

Thanks!

Does there need to be a professional association specifically for medical education?

Academic medical educators often find themselves a bit isolated in our day to day lives.  Most of us are one of only one or two people in our academic department who have a strong interest in this area.  Getting together regularly with like-minded individuals is often hard on a local level as you increase the layer of complexity of meeting with other educators due to their own teaching and clinical activities combined with their separate departmental conferences and grand rounds.  Hence, finding a time to meet can be as difficult as trying to get the average academic physician to deliver timely formative feedback to a student on their performance.

I've been thinking about ways to improve connections between educators at a local level, and thought it may help to have a national (or international) level organization to add legitimacy that this is a worthy area of academic pursuit.  This could in turn foster more resources to help educators get together on a local level.  I am not aware of a major national professional association that is solely dedicated to improving medical education techniques and theory.  When I have asked which meeting to go to to present and learn about medical education research, I've been pointed to the AAMC meeting.  However, from looking at this meeting it is very large in terms of number of attendees, and includes much the administrative and policy side of running a medical school.  Thus, I see it as being a valuable meeting, but the work on education theory and practice is only a part of a much bigger whole.  The journal of the AAMC reflects these diverse interests, and again, is a worthy journal to read, but is more like JAMA than the Neurology.  Each journal has its place, but one is able to present a wider breadth of research as it has more focus.

I would propose an association of medical educators with the goal of sharing and disseminating information about advances in medical education learning theory, and teaching skills.  I would think including some ideas about administrative skills as they relate to running a clerkship or a basic science class would be included without losing focus.  I'm not aware that such an association currently exists.  Does anybody know of such a group?  Is there a meeting that I have missed?  I know there are some regional meetings (usually sub-groups of AAMC), but I don't think there is truly a national/international meeting about this.  Anybody want to join me as the first members of a new Medical Education Society?

Journal club: Do patient logs improve student performance?

I wanted to highlight recent research in neurology education to create awareness of this research, and also open up broader discussions of how this research should impact the way neurology clerkship curricula are designed. I hope that educators outside the field of neurology will also share insights into comparative work which has been done in their own area of interest so we all can be better educators. (Phew - goals and objectives discussion done).

The first study to look at is by Dr. Doug Gelb and colleagues at the University of Michigan. His premise for doing the study was based on a recent requirement for students to keep a log of their patient experiences while on clinical clerkships to verify that they have seen a wide breadth of disease as they go through the fourth year of medical school. The idea behind the logs is that students in the third and fourth years of medical school are assigned to rotate through various hospital wards. Thus, unlike the first and second year where the courses are much more structured and learning content is fairly tightly defined, the majority of the experience of the third and fourth years are reliant on the student seeing patients in the clinical setting. Although there is an effort to assign students to a wide variety of services and clinics, there is no absolute guarantee that a student will be exposed to a patient with any single disorder. Thus, a student may potentially be on a neurology service for 3 weeks, and never see a patient with painful diabetic peripheral neuropathy as these patients by chance were not in the clinics or wards the student to which the student was assigned. Thus, the idea is that a log of patient encounters with a specific disease theoretically can be used to assess the curriculum as a whole, and also to assess each learner's activity.

Dr. Gelb and colleagues wanted to challenge the notion that counting the number of patients a student was exposed to would correlate with their clinical competence. The premise here is that the students are not isolated to only the specific patients they care for. There are lectures and student conferences, as well as readings in the curriculum which will fill in any gaps which may come from lack of exposure to a given topic. The idea is also that perhaps you don't need to see a patient with diabetic neuropathy to learn about diabetic neuropathy. You may see a patient with Charcot-Marie-Tooth type 2, and in reading about that patient, you will learn that diabetic neuropathy is in the differential diagnosis. This will then prompt you to look for more information on diabetic neuropathy.

He put this hypothesis to the test by looking at each student log from the neurology clerkship at U of M over the course of one academic year (05-06). The logs recorded every patient seen by each student while on the four-week clerkship, as well as chief complaint and comorbidity information. The chief complaints were blocked together into sub-categories (ie stroke, neuromuscular, etc). Each students score on the final examination (which was a locally prepared 100 item MCQ test), and their clinical evaluation scores from their ward faculty were correlated with the number of patients seen on the log. They also separated out sub-scores of the exam based on the sub-categories of disease. What they found was that there was no correlation between student performance measures at the end of the clerkship - either knowledge-based with the exam, or clinical-skills with the clinical evaluations. In fact, the trend for the test scored was moving towards the students who saw more patients doing worse than students who saw fewer patients.

Now, obviously, this is a place to start on examining if patient logs are a good thing or a bad thing, but I think it does raise questions about whether our measures of student success are actually measuring something useful.

Abstract:
Gelb, et al. Experience may not be the best teacher: Patient logs do not correlate with clerkship performance. Neurology. Feb 24,2009, 72(8):699-70