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Issue 02 SEP 2013

Electronic Newsletter for for Faculty Instructional Development

|Med/Ed News
Editor Karen Spear Ellinwood, PhD, JD, EdS

this issue

Cover story P.1 Scoop: Update on the RAE Program P.2 Cover Story (contd) P.3 Upcoming Events P.6

he new RAE program is well underway. Drs. Pritchard and SpearEllinwood have been collaborating with several residency programs to design and deliver educator development activities tailored to meet the needs of the specific department. All residents are required to complete two hours of educator development each year following the Residents as Educators Orientation. Participating in the RAE Program is one way to help your residents meet the requirement. Its also a great way to provide support for teaching and assessing medical students. If you would like residents in your department to participate in the new RAE program, please contact Karen Spear Ellinwood, Associate Specialist, Faculty and Resident Instructional Development (626.1743) or Gail Pritchard, Senior Interim Learning Specialist, OMSE/GME (626.2390). If youre a resident or other faculty member and youd like to meet with Karen or Gail to get one-on-one instructional support, please use our online form.

Tools for teaching students how to think like reflective practitioners

ow do students learn how to think like doctors?

Theres an old saying, practice makes perfect. But where would students get to practice thinking like doctors? CBI. Case-based instruction provides an opportunity for medical students in preclinical years to practice the kind of strategic and reflective thinking required of physicians in professional practice. UA COM has established a pedagogy and online tools to help forge that bridge between preclinical and clinical years. Students are using online tools to cultivate a habit of reflection before, during and after each case. Students work through cases online in an asynchronous format, able to share their thinking as they prepare for facilitated sessions. These eTools, as we call them, utilize a structured approach to medical problem-solving in CBI as part of a developmental curriculum. A developmental curriculum fosters a movement away from instructor-dependent learning toward selfregulated learning, progressively removing scaffolding initially in place as students learn new practices and skills. (Read more about UA COMs developmental curriculum.) Thus, in CBI, the content of cases as well as facilitation methods present increasing challenges over the course of two years. Physicians are life-long self-directed or selfregulated learners. Metacognitive engagement is a key component of self-regulated learning, which involves an awareness of not only what one thinks but how one thinks. Reflective habits Continued on page 3
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About the new RAE Program

Residents are working to find their place in the health care delivery system, develop medical knowledge and clinical practice, establish themselves within their teams and departments, studying for exams, trying to have a life and teaching medical students. Balancing these professional and personal responsibilities requires strategic planning and reflective thinking. The new RAE Program is designed to assist departments in developing and implementing educator development programs and activities for residents. RAE is a voluntary, quality improvement program that began this academic year (2013-14) and was developed by Karen Spear Ellinwood, PhD, associate specialist for FID, and Gail Pritchard, PhD, Interim Senior Learning Specialist for resident development. Gail has an appointment in Graduate Medical Education, as well, and assists residents in studying for exams or developing clinical practices (read more). UA COM policy requires that all residents engage in instructional development for a minimum of 2 hours each year following their orientation to

SUBMISSION
Med Ed eNews has 1,789 reads through Scribd.com, our publishing host!, in addition to the UA COM faculty readers. If you would like to submit a piece, please follow these guidelines: 1) 1500 words maximum; 2) include references to scholarly works on (medical) education; 3) describe relevance to other educators.

teaching prior to starting their residencies (see Policy for faculty instructional development). Participating in this program can assist your residents in developing sound teaching and assessment practices and help meet the policy requirement. We have begun working with 5 departments in Tucson (Obstetrics and Gynecology, Family and Community Medicine, Emergency Medicine, Pediatrics and Psychiatry), and FCM residents at St. Josephs in Phoenix. The RAE Program offers follow-up services, including one-on-one educator mentoring, and consulting in the development of department level programming. The August issue of Med/Ed eNews published a more detailed description of the program (Vol. 2: Issue 1, August 2013). Find out more about the program. /kse/

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Call for submissions Faculty Development Events Calendar online! Would you like to share your ideas or experiences about developing or enhancing clinical or classroom teaching and assessment practices? Please submit your manuscript to Karen Spear Ellinwood.

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assist practitioners in addressing and managing unexpected situations and challenges for which there is no one right answer and enable them to learn and grow (Butani, et al. 2013, 206). Thus, curriculum must offer strategic opportunities for students to reflect on not only what they are learning but why it is significant and how to apply acquired knowledge in practice. The purpose of building a reflective habit is to support students in their transition to the reflective practice of medicine. In short, we hope that reflective learning will become reflective professional practice. Evidence-based decision making is a form of reflective practice and is key to developing competencies and dispositions for acting adaptively in problem domains (Pea 2006, emphasis in original). To make decisions based on evidence, students must learn to engage in critical reflection, a form of metacognitive engagement. Critical reflection occurs when one not only explores ones own beliefs, biases, and approaches but also those of others who may have contributed to the way events unfolded (Butani, et al. 2013, 204). Schn (1983) found that professionals in a variety of fields (e.g., law, medicine, engineering) demonstrated a habit of reflecting in action and on action, that is, while performing responsibilities and after completing their work. Butani, et al. (2013) state that one strategy to promote reflection in action is to ask [a student] to think of an additional diagnosis for this patient besides pneumonia and reprioritize the differential based on the defining and discriminating features of the case. To promote reflection on action , Butani et al. proposed that asking the student to use a tool that structured their thinking process (such as SNAPPS* or IDEA**) would foster development of a structured and systematic clinical reasoning process that encourages the student to defend diagnoses based on key features in the patients history and physical examination, and avoid assumptions or supposition. The UA College of Medicine emphasizes the importance of engaging in such reflection as an instructional practice and a learning strategy. Using a Before -During-After model, an extension of Schns (1983) reflection-in and reflection-on action suggested by Plack & Santasier (2004, 2005), UA COMs 5-step problem-solving structure for medical cases expects students to engage in reflection before facilitated sessions, during and after. The 5-step structured problemsolving approach integrates reflection with scientific method, problem-solving and clinical practice. For example, it emphasizes processes involved in developing a differContinue on page 4

receptor

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error.

esources
There are a variety of

resources online for clinical and classroom educators, including links to learning modules, a guide for engaging students in inquiry learning, Microskills for teaching, and encouraging students to examine for cognitive

The 2012-13 AMES\OMSE Faculty Instructional Development (FID) Series has come to a close, but you can access recordings of all 13 seminars onlinesimply Click&Go! - Use your UA NetID to access the videos! Find out more about team learning , CBI and other instructional methods and the recently developed online tools, ThinkSpace and GroupShare. Check out our Faculty Instructional Development Calendar online!

AMES/OMSE FID Series #4

Designing Educational Activities
Dr. Pritchard and Dr. Martinez will address issues concerning the design and implementation of educational activities, including how to draft learning objectives, align learning activities with assessment methods, and related issues.

Gail Pritchard, PhD Senior Interim Learning Specialist OMSE/GME Dr. Pritchard helps prepare residents for examinations and develops and implements resident instructional development.

Lupita Martinez, PhD Assistant Professor Medicine Dr. Martinez designs and implements instructional development for residents, fellows and faculty in the Department of Medicine.

Date: October 29, 2013 Time: 12:00 pm1:30 pm Location: COM-3230

RSVP: Karen Ellinwood, PhD Ph. 520.626.1743

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ential diagnosis by asking students to define the nature of the problem, formulate at least two hypotheses and articulate rationales. Students are expected to craft and pose questions to resolve each case and consult the ideas of peers to advance their own thinking. During sessions, facilitators are expected to engage students in an inquiry-learning process, rather than rote learning. At the close of each session, students debrief the case in group and then write a personal reflection on case, self and process before moving on to the next case. Reflective habits assist practitioners in addressing and managing unexpected situations and challenges for which there is no one right answer and enable them to learn and grow (Butani, et al. 2013, 206). The CBI 5-step process is designed to foster students development of clinical reasoning by asking them, at every juncture, to explain their reasoning, synthesize information, and strategize to resolve the case, and to reflect back on how they might have committed cognitive error or why and how particular strategies might suggest more effective approaches for future medical problem-solving. Toward the close of each session, the small groups discuss the challenges presented by the case or process and what they might have learned from that struggle. After the groups debriefing, each student writes a personal reflection, entering their thoughts in Step 5 of ThinkShare Pro. Students often describe their strengths or challenges as well as offer themselves advice, if you will, for problem-solving. Students post-case reflections often demonstrate an awareness of the process (e.g., I narrowed my differential too early in the case; it was helpful to share articles during the session), an understanding of the implications for clinical practice (e.g., in reality we wont get all the information so neatly packaged so its good that we have to request it), and how they might improve their approaches to problem -solving (e.g., I need to be more open minded, research the bases for my hypotheses). Preceptors, residents and attendings should expect, then, that UA COM medical students will be able to translate these CBI problem-solving talents into reflective practice in clerkships or sub-internships. To foster such development, you should ask students to continue to articulate their reasoning. And provide opportunities for them to write or verbalize post -case reflections and offer constructive feedback on their clinical reasoning process. /kse/

thinkSharePro

*T

hinkShare Pro is a webbased social networking tool developed under an award from the NSF (DUE-0942277), entitled "Social Networking to Support Scientific Problem Solving" for use in a UA course called The Art of Scientific Discovery (Principal Investigator, Herman Gordon, PhD) (Research Specialist, Karen Spear Ellinwood, PhD, JD, EdS; Developer, Mike Griffith, MS, Associate Director, AHSC Biomedical Communications) For a discussion by clinicians of the concept of reflection and critical thinking in clinical reasoning processes, please see the books, How Doctors Think by Jerome Groopman, and How Doctors Think: Clinical Judgment and the Practice of Medicine, by Kathryn Montgomery. Click here to view additional practical and scholarly resources. he

References

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FID Series #3
Teaching Evidence-based Decision making Date: October 18, 2013 Time: 8:3010:00 am Location: COM-3230
Samuel M. Keim, MD, MS Professor Department Head Emergency Medicine Director Arizona Emergency Medicine Research Center

Dr. Sam Keim, Emergency Medicine, teaches first year medical students about the concept of evidence-based medicine. Dr. Keim will share his reflections on how to prepare medical students to think more like doctors, to develop the habit of critical, evidence-based and reflective reasoning.

RSVP: Karen Spear Ellinwood, PhD Em. kse@medadmin.arizona.edu Ph. 520.626.1743 Refreshments will be served.

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Butani, L., Blandkenburg, R. & Long, M. (2013). Stimulating Reflective Practice Among Your Learners. Pediatrics 2013, 204-06.
Plack, M.M. & Santasier, L.G. (2005). The Reflective Practitioner: Reaching for Excellence in Practice. Commentary, In Pediatrics. pp. 1545-1553. accessed at http://pediatrics.aappublications.org/content/116/6/1546.full.html Plack M. & Santasier A. (2004) Reflective practice: a model for facilitating critical thinking skills within an integrative case studies classroom experience. J Phys Ther Educ. 2004;18:412. Schn, D. (1983). The reflective practitioner: How professionals think in action. NY:Basic Books.

ThinkShare Pro

How do the eTools work?

In the first few blocks, students use ThinkShare to share their thinking with peers and their groups facilitator. Students address the first 3 steps of the problem -solving structure in one submission, about 24 hours before the first of two sessions. Each small group receives an email containing a document with each members submission, giving facilitators and students a sense of not only what the students are thinking but HOW they arrived at their tentative diagnoses and how they propose to resolve the case. In the spring of the first year, students switch to ThinkShare Pro*, which asks students to articulate their thinking for each of the five steps in the problem -solving structure. After submitting contributions to Steps 2 and 3 (see figure, left), students obtain additional information about the case, usually the history and physical exam. Facilitators retain additional pertinent case information for release during sessions. Students must request the information and present an appropriate rationale to obtain its release.

How could you foster reflective thinking in clerkship?

We hope that ThinkShare will be available to clerkship directors in the near future. In the meanwhile, there are several ways to foster students continuing development toward reflective practice, including the following asking students to: Keep a journal of reflections on their development over the course of each week or the duration of the clerkship; Actively participate in didactic conference (teaching day); Draft SOAP notes and engage them in feedback; Write post-case reflections on key experiences.

TWT Workshop Series #1

Using Poll Everywhere for classroom teaching Date: October 9, 2013 Time: 9:00 am11:00 am
Mike Griffith, MS Associate Director Biomedical Communications AHSC

Mike Griffith, MS, assists in designing and developing innovative instructional technologies. Mr. Griffith will conduct a series of workshops in 2013-14 on how to use specific technologies for classroom and clinical teaching. The first workshop will introduce you to Poll Everywhere. Please bring a laptop or a friend with whom you can share a laptop.

Location: COM-3116 (MDL) RSVP: Karen Spear Ellinwood, PhD Em. kse@medadmin.arizona.edu Ph. 520.626.1743

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Save the date!

Date/Time 18 October 2013 8:3010:00 am (COM-3230) 29 October 2013 12:001:30 pm (COM-3230) Presentation Title FID Series Teaching evidence-based medicine Presenters Sam Keim, MD

P rofessional D evelopment
The AMES\OMSE FID Series presents a topic relevant to teaching, assessment and/or medical education research from August through May each year. Please subscribe to our newsletter for current information on topics, presenters, and special events.

FID Series Designing educa- Gail Pritchard, PhD, & Lutional activities pita Martinez, PhD

Director, Faculty Instructional Development Chris Cunniff, MD Office of Medical Student Education (Comstock House) Em. ccunniff@peds.arizona.edu

If
R

you would like to volunteer to present a topic, contact Karen Spear Ellinwood >

Ph. 520.626.5173

Instructional Development for all teaching faculty Karen Spear-Ellinwood, PhD, JD, EdS Associate Specialist for Faculty Development Office of Medical Student Education (COM-3215) Em. kse@medadmin.arizona.edu Ph. 520.626.1743
equest instructional development and support

If

Educational Support for Residents and Fellows T. Gail Pritchard, Ph.D. Interim Senior Learning Specialist Office of Medical Student Education (COM-3210) Em. tpritcha@medadmin.arizona.edu Ph. 520-626-2390

you would like to consult with a professional educator or discuss

opportunities for your department or community based faculty at your site, please click here to complete the online form. OMSE Faculty Instructional Development staff will work with you to design a customized plan for faculty instructional development for you, your department or site.

Assessment of Student Performance Susan Ellis, MA, EdS Program Manager for Assessment of Student Performance Office of Medical Student Education (COM-3215) Em. sellis@medadmin.arizona.edu Ph. 520.626-3654

MedEd eNews Volume 02 Issue 02 September 2013

Office of Medical Student Education ~ 1501 N. Campbell Avenue ~ Tucson, AZ 85724 ~ 520.626.1743 ~ Omse.medicine.arizona.edu