Workshop: Instructive Methods

1
Workshop Instructive Methods

• Maryellen E. Gusic MD, Penn State College of
  Medicine
• Daniel Rausch MD, Albert Einstein School of
  Medicine
• David Keller MD, UMass Medical School

2
Disclosure/Conflict of Interest

• Drs. Gusic, Rausch and Keller have documented
  that they have nothing to disclose.
• Drs. Gusic, Rausch and Keller have documented
  that their presentation will not involve
  discussion of unapproved or off-label
  experimental or investigational use.
• We would, of course, be happy to develop a
  disclose-able relationships with anyone with
  funding to spare!

3
Objectives

• To review briefly the underlying theories that
  inform our understanding of medical education.
• To use our understanding of learning theory to
  inform teaching in lectures, small groups and
  clinical settings.
• To identify specific changes that will improve
  the quality of your teaching or of medical
  education within your institution.

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Five Key Theories of Learning

• Behaviorist Change in behavior
• Cognitivist Internal mental process (including
  insight, information processing, memory,
  perception)
• Humanist A personal act to fulfill potential
• Social Learning Interaction with and observation
  of others in a social context
• Constructivist Construction of meaning from
  experience

From Latha Chandran How do we learn as adults? A
peek into various theories ESP 2006
5
Five Key Theories of Learning Manifestations in
Adult Learning

• Behaviorist
• Behavioral objectives
• Competency-based education
• Skill development and training
• Cognitivist
• Cognitive development
• Intelligence, learning, and memory as function of
  age
• Learning how to learn
• Humanist
• Andragogy
• Self-directed learning

• Social Learning
• Socialization
• Social roles
• Mentoring
• Locus of control
• Constructivist
• Experiential learning
• Self-directed learning
• Perspective transformation
• Reflective practice

From Latha Chandran How do we learn as adults? A
peek into various theories ESP 2006
6
Seven principles of cognitive learning

• Prior knowledge is key
• Prior knowledge must be activated
• The links are more important than the elements
• Making more and stronger links require time
• Context provides important cues for storing and
  retrieving info
• Intrinsic motivation is associated with deep
  approaches to learning, extrinsic motivation with
  surface approaches
• Teaching should be geared towards development of
  learner autonomy as well as intellect

From Latha Chandran How do we learn as adults? A
peek into various theories ESP 2006
7
Learning Styles Kolb
Accommodating Feel and do
Diverging Feel and Watch
Perception Continuum How we
think about things?
Consider different perspectives/alternate
possibilities
Put ideas into action/find additional uses
Processing Continuum How we do things?
Assimilating Think and watch
Converging Think and do
Absorb information into larger framework of ideas
Gather info to solve problems
From ME Gusic, Learning to Teach Teaching to
Learn, ESP 2006
8
2006 ESP Results Summary
Diverging 11
Accommodating 37
70
Assimilating 19
Converging 33
Results for 27 Scholars Response rate 90
From ME Gusic, Learning to Teach Teaching to
Learn, ESP 2006
9
Planning Your TeachingArmstrong, EA and
Parsa-Parsi, R. Acad Med, 80(7) July 2005

• educational planning should create an
  environment in which all styles are accommodated
  and fostered in a sequence moving from a
  definition of personal meaning and needs to the
  acquisition of new knowledge, followed by
  practical application and then synthesis and
  extension.

From ME Gusic, Learning to Teach Teaching to
Learn, ESP 2006
10
Teaching Perspectives

• Transmission Lead learners to content mastery.
• Developmental Help learners link new knowledge
  with old
• Apprenticeship Find learners zone of proximal
  development/help learners become independent
  workers
• Nurturing Support learners as they achieve
  through their own effort
• Social Reform Teacher leads learners through
  critical deconstruction of content so that
  learners are empowered to take action to create
  change that will benefit society

From ME Gusic, Learning to Teach Teaching to
Learn, ESP 2006
11
2006 ESP TPI Results Summary
Results for 25 Scholars Response Rate 83
From ME Gusic, Learning to Teach Teaching to
Learn, ESP 2006
12
Irbys Article

• Medical teaching needs different knowledge
• Knowledge of medicine
• Knowledge of patients
• Knowledge of context
• Knowledge of learners
• Knowledge of teaching principles

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Knowledge of teaching principles

• Actively involve learners
• Capture attention and have fun
• Connect case to broader framework
• Go to the bedside
• Meet individual needs
• Be realistic and focused
• Provide feedback and evaluation

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Scholars Talk Back

• The article struck a chord
• It was nice to see techniques I have observed
  and incorporated into my teaching actually
  published as research.
• Actively involve learners and ask lots of
  questions. This is my motto, my main style of
  teaching. Its also been my main style of
  learning as well.
• I dont see my role as a transmitter of wisdom
  and knowledge, but to encourage clinical
  reasoning and importantly being able to model to
  the learner basic skill in areas of
  communication, leadership, conflict resolutions,
  self-directed learning, etc.

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Scholars Talk Back

• And highlighted our challenges
• I tend to underestimate what medical students
  know, but I often overestimate what residents
  know.
• Providing feedback, as noted in the article, is
  a difficult thing. This is an area I have to make
  more time for. I often do not think it will take
  long and then end up not having time to sit down
  with the learner for summative feedback.
• One of the biggest challenges I have is
  teaching for different levels of learners
  especially medical students. Sometimes a script
  just doesnt work, unless the script is geared
  for the level-specific learner.
• Have I really had a lasting effect on my
  learners? Have I changed their actual behavior
  for the good? Thats what I struggle with. I
  hope I do, but I may just be someone they like
  and get along with.

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So, lets get practical

• Forays into the practical in small groups
• Group 1 Lectures for Learning
• ME Gusic
• Group 2 Small Group Teaching
• D Rausch
• Group 3 Precepting at Bedside or Clinic
• D Keller
• 40 minutes each.