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In This Issue:
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Dr. Randi N. Stanulis
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Questioning for Student Thinking
Questioning is at the heart of discovery, yet learning to integrate effective questioning into our teaching is a complicated enterprise. OMERAD faculty are here to help!
Below are some tips for thinking about planning for questioning to promote student thinking:
Rationale: Questioning is not just about the getting the correct answer, but how the student arrived at the answer. Good questions get students talking about their thinking.
Advanced Preparation - Good questions are prepared in advance of a lesson to ensure that they support goals and emphasize key points.
Range of Levels - Teachers ask questions at all cognitive levels, depending on the instructional objectives and desired learning outcomes of the lesson. See Costa's level of questioning (
PDF)
Think Time - Students are given time to think before they respond.
Thought Process - It's not just about getting the correct answer, but how the student arrived at the answer.
Evidence - Students are encouraged to support their ideas with evidence.
See article about Inquiry and Scientific Explanations: Helping Students Use Evidence and Reasoning (
PDF)
Social Learning - Students are encouraged to learn from one another by listening and responding to the ideas of others.
Mistakes - Mistakes are opportunities to learn for both students and the teacher.
Questioning is an integral part of our medical school curriculum. When you consider the questions that you pose to your students, think about whether you want to help your students clarify, refine, explain, justify, predict and/or speculate about their growing understanding. Planning specific questions that you pose, and how students respond to those questions, is an integral part of effective teaching.
Sources:
- Launch into Teaching, Dr. Randi Stanulis, Director. Based on ideas from Stronge, J.(2007) Qualities of effective teachers (2nd edition). Alexandria, VA: ASCD and Matsumura, L. C., Slater, S. C., Junker, B., Peterson, M., Boston, M., Steele, M.,et al.(2006) Measuring reading comprehension and mathematics instruction in urban middle schools: A pilot study of the Instructional Quality Assessment. Los Angeles, CA: Center for the Study of Evaluation, National Center for Research on Evaluation, Standards, and Student Testing.
Director
Office of Medical Education Research and Development
College of Human Medicine
Professor, Department of Teacher Education
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- 2017 CGEA Call for Mini-Grant Proposals
The Call for Central Group on Educational Affairs (CGEA) Mini-Grant Proposals is now open. The CGEA seeks to promote scholarship in medical education and advance the community of scholarship within the Central region.
A maximum award of $7,000 is available for multiple-institution projects and $5,000 for single-institution projects. Consistent with the requirements of scholarship, all funded projects must be collaborative and investigatory in nature, and their results must be made public, available for peer review, and freely available for others to build upon.
Deadline for submission is September 30, 2017.
For more information see the CGEA Mini-Grant Proposals section on the CGEA web site.
https://www.aamc.org/members/gea/regions/cgea/
- Academic Medicine's "Last Pages"
Academic Medicine's "Last Pages" features clear, concise, and
arresting infographics that explain issues pertinent to the field of
academic medicine. Covering a wide variety of topics important to
medical education, clinical care, and health policy, Academic Medicine
Last Pages explain everything from physician workforce shortages and
the federal budget to biomedical research and international medical
education. Taking advanced subjects and issues and explaining them
in plain English, these infographics serve as thorough refreshers for the
experienced and lucid primers for those new to academic medicine.
Click link to download a PDF of AM Last Pages.
- NBME Stemmler Research Fund Call for Letters of Intent
In support of innovation in medical education assessment, the Edward J. Stemmler, MD, Medical Education Research Fund of the NBME is pleased to announce that the 2017-2018 call for Letters of Intent has begun.
The application deadline is July 1, 2017.
Purpose and Goals: The purpose of the Stemmler Fund is to provide support for research and development in innovative evaluation methodologies or techniques, with the potential to advance assessment in medical education or practice. Expected outcomes include advances in the theory, knowledge, or practice of assessment at any point along the continuum of medical education, from undergraduate and graduate education and training through practice. Both pilots and more comprehensive projects are of interest. Collaborative investigations within or among institutions are eligible and encouraged, particularly as they strengthen the likelihood of the project's contribution and success.
Eligibility: Eligible applicants for Stemmler Fund grant awards are medical schools accredited by the LCME or the AOA. The number of Letters of Intent submitted by any eligible school is not limited.
Budget Information:
In the 2017-2018 funding cycle, applicants may request up to $150,000 of NBME funding support for a project period of up to two years.
Applicants may go to
http://www.nbme.org/research/CFLOI.html for more detailed information. Please note the change in the submission process. There is a direct link to the online Stemmler Fund online system where applicants will create a brief profile, store their application, and have the ability to track their progress throughout the process of the cycle. If you are a previous applicant, we invite you to create your account now to familiarize yourself with the new system even if you do not plan to submit this cycle.
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Spotlight: Match Results Show the Impact of Preceptors
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C
HM clinical faculty members teach, mentor and write dozens of recommendation letters for fourth-year students each year. The Class of 2017 was very successful in the residency match process. Thank you to the community physicians who work tirelessly teaching the next generation of physicians, inspiring their specialty choices and encouraging their efforts throughout the match process.
Highlights of the 2017 Residency Match and Appointments:
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B-CLR: IAMSE Webcast Audio Seminar Series
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From January thru April 2017, OMERAD hosted a series of faculty development webinars presented by the International Association of Medical Science Educators (IAMSE). The IAMSE webinar sessions presented participants with a great opportunity to learn something new and exchanged vital information on timely topics in medical education with local colleagues and other professionals across the country and around the world. Sessions were theme-based and geared towards those who have responsibility from teaching basic sciences to those in medical training.
The winter series theme revolved around "Creating a Culture of Well-being at an Academic Health Center", and the spring series around the topic of "Remediation in Health Sciences Education."
The webinars were offered for free to all CHM faculty and staff only. This included anyone who had an MSU-CHM appointment, interacted or worked with CHM students
. Interested participants were asked to complete a brief online registration to receive weekly reminders and access instructions to the weekly webinars.
The most recent recordings of the IAMSE webcast audio seminar series are now available for on-demand review. Please see the list of available webinars below and follow instructions to request access to the archives.
January 5
Begin spring series |
Physician burnout and distress - causes, consequences, and a structure for solutions |
| January 12 |
Improving Medical Student Mental Health: A Multifaceted Approach
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| January 19 |
Strategies for promoting personal health & wellness and leading change at the individual level |
| January 26 |
The Imperative for Incorporating Mind-Body Medicine in Health Professions Education |
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February 2
End spring series
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Cultivating Resilience and Reducing Burnout for Health Professionals: The Power of Presence, Reflective Practice and Appreciative Dialogue |
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March 2
Begin winter series
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Remediation of Basic Science in integrated blocks |
| March 16 |
Trust and Remediation: Entrustable Professional Activities and Trust Decisions |
| March 23 |
Sharing Assessment Information: Why, How, and What to Consider |
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March 30
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Remediation of Gaps in Clinical Skills--One Size Fits One |
April 13
(rescheduled from March 9)
End winter series
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Remediation of High Stakes Professional Exams |
To request access to the archived recordings of the IAMSE webinars, please contact Geraud Plantegenest at:
[email protected]
Note: Free access to the archived seminar sessions is limited to CHM faculty and staff only. This includes anyone who has an MSU-CHM appointment and interacts or works with CHM students.
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CHM Program Evaluation: Curricular Change - Everybody's Doing It
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Perhaps ironically, curriculum change is one of the constants of medical education. The curriculum is the part of the educational process most susceptible to change because it is the most recognizable part of the educational process.
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Many voices have advocated for reform of the education of medical students, residents and physicians in practice.
2-6 Medical schools are constantly revising, reordering, realigning and reimagining their curricula in light of feedback from students and faculty, accreditation requirements, favored pedagogical approaches, changing resource allocations as well as local health system opportunities and constraints. Coupled with broader contextual changes in the organization and financing of health care, breakthroughs in technology and biomedical informatics, advances in diagnosis and treatment, increased patient participation in health care, and population shifts from acute illness to chronic multisystem disease, the reasons for curricular change are both many and complex.
The curriculum of a medical school is a reflection of the mission of the school, tying together content and learning experiences.
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The content is a representation of how the school organizes relationships
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among the necessary (basic, social and clinical) sciences. Learning experiences are the means for delivering curricular content; they are the points of intersection for students, faculty and content. The AAMC Curriculum Inventory currently defines 30 instructional methods from case-based instruction to workshops.
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Comparatively, most curricular content is relatively stable, but is frequently repackaged to accommodate the needs for the chosen instructional approaches.
The AAMC Report,
Curriculum Change in US Medical Schools
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is based on data from the 2012-2013 LCME Annual Medical School Questionnaire and clearly illustrates the prevalence of curricular change. Only 7% of medical schools indicated that they were not planning a curriculum change or that they had not already had a curriculum change in the past five years (Figure 1). In contrast, 27% reported having implemented a curriculum change in the past five years and a similar number of medical schools (29%) reporting having initiated a curriculum change. Over one-third of medical schools (37%) indicated that planning for curriculum change was underway.
Figure 1: Implementation of Curriculum Change
When asked about the nature of the curriculum change, schools could indicate more than one response, and the resulting summary information provided is open to interpretation. At the time of the survey 82 schools were engaged in a total curriculum change (Figure 2), representing 67% of all U.S. medical schools. Pock, Pangaro and Gilliland
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have outlined four imperatives-derived from the recent Carnegie Foundation Report
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-that they believe are driving the current cycle of curriculum change. They suggest that current curricular reforms are a result of efforts to (a) standardize learning outcomes and individualize the learning process; (b) integrate knowledge and clinical experience; (c) enhance learners' habits of inquiry and innovation; and (d) focus on professional identity formation. In many cases, the resulting new curricular models have evolved away from the post-Flexnerian two plus two model
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with two years of preclinical science education and two years of clinical education.
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Figure 2: Location of Curriculum Change
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t is perhaps unsurprising that many schools (N=58, 48%) indicated changes to their preclinical (Years 1 and 2) curriculum, with relatively fewer reporting changes to the required clerkships (N=43, 36%) or the fourth year of the curriculum (N=33, N=27%). What has historically been referred to as the "preclinical curriculum" also has been the part of the medical school curriculum most often the focus of change and innovation: "In analyzing curricular change over the last generation, what is most striking is the paucity of attention given to the clinical years (p.80)."
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Based on this survey data, the most frequently reported changes addressed the preclinical curriculum, such as enhancements related to the use of active/engaged learning formats (N=116, 91%) and clinical correlations in the preclinical years (N=101, 80%). Other reported changes, though not specific to the preclinical curriculum, typically have been implemented as part of the preclinical curriculum. These included changes around inter-professional education (N=93, 73%); expanded use of simulation (N=93, 73%); integration of basic science content such as organ system or case-based curricula (N=102, 80%); and increased community engagement (N=61, 48%).
The only clerkship-specific change included in the questionnaire was enhanced integration or coordination of clerkships such as longitudinal clinical clerkships (N=70, 55%). The worksite-based apprenticeship nature of clerkships, where learning occurs in health care settings rather than educational settings, tends to result in curricular innovations that are more subtle and incremental. Large-scale clerkship change has been relatively rare; the most recent examples being longitudinal integrated clerkships,13 longitudinal spiral curriculum14 and combined clerkship/residency programs.15, 16
Papa and Harasym
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have characterized medical school curricula from a historical perspective, describing a progression of curriculum organizational approaches. Current medical school curricula-primarily the "preclinical curricula"- are the products of one or more of these models: apprenticeship-based (1765 to present), discipline-based (1871 to present), organ-system-based (1951 to present), problem-based learning (1971 to present) and clinical presentation-based (1991 to present). In the related curriculum report,
Curriculum Structure During Pre-Clerkship Years
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data from the 2015-2016
LCME Annual Medical School Questionnaire Part 2 provides an illuminating snapshot of the current prevalence of various curriculum models. Of the 141 medical schools included in the summary, 86% described their curricula as organ system based. A more traditional discipline-based curriculum was reported by 35% of medical schools, while the newer approach of a curriculum organized by patient presentations/schema/symptoms was reported by 13% of schools. To the extent that the integration of knowledge and clinical experience continues to drive curricular change,
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it is likely that curricula organized around clinical presentations will be the next evolutionary step of curriculum renewal for many medical schools.
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Does curriculum matter? A study by Hecker and Violato
8 used a decade of longitudinal data from 116 medical schools to compare the academic outcomes of various curricular models. They found that the curricular models accounted for little variance in
competence, as measured by licensure examinations, and that student characteristics were more predictive of outcomes. They studied
competence narrowly defined in terms of licensure examination scores, and did not consider competence more broadly in terms of communication skills, data gather skills, team work, patient safety and other dimensions. Hecker and Violato echo others who have suggested that the quality of curriculum implementation might be more important than the specific curricular
approach.
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The current period of curricular change represents some very exciting opportunities for medical education. As new curricular models emerge far removed from the traditional two plus two model, assumptions and traditions are being questioned. The familiar language of medical education also will need to adapt and grow. For example, early clinical experience is one of the current pillars of curricular reform
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and some medical schools are moving beyond early patient-based experiences to establish longitudinal meaningful clinical experiences as early as the first semester.
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We might need to rethink what is meant by "clerkship" as we try to describe and compare our curricula and its impact on learners. When it comes to curriculum change, it appears that we have to rethink many things.
References
Open PDF to see list of references.
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Faculty Development: Designing Courses to Meet Faculty Needs - Convenient Time, Place, and Interaction with Others
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The OMERAD Seminar Series (formerly called the Faculty Development Seminar Series) for years offered workshops and seminars at a set time and set place in East Lansing. These seminars have been on varied topics such as:
- Funding
- Small Group Teaching
- Collaboratively Producing a Massive Open Online Course (MOOC)
- Using EndNote and EndNote Web
- Creating Electronic Course Packs
- Digital Distribution of Academic Journals and Its Impact on Scholarly Communication
Over the years attendance at seminars such as these dwindled. Needs assessment surveys by OMERAD and FAD (Faculty Affairs & Development) showed that faculty wanted the instruction, but they did not have the time for it.
Trying Different Formats
The Seminar Series tried varied formats to alleviate this problem: offering the seminar at different times, meeting in communities other than East Lansing, using video conferencing, recording seminars for later viewing. Still attendance and use were low.
We decided to try something else. To provide instruction that was available when and where faculty wanted it, OMERAD created several self-paced online tutorials on topics such as:
- Effective PowerPoint for Medical Educators: Designing Slides According to Principles of Learning
- Creating Posters Using PowerPoint
- Presenting a Poster
- How to Develop a Curriculum
- Program Evaluation
Again, few faculty went through the tutorials. Why? Literature suggested that four things needed to be taken into consideration:
- Convenient time
- Convenient place
- Instructor presence
- Topic of importance to the faculty member
Blended Course
We decided to try blending self-paced instruction with an instructor presence, all at a distance for convenience of time and place. We used a flipped classroom approach to save time, using an online tutorial as the didactic portion. We then added a human presence by having participants meet with the instructors via telephone or video conferencing. Participants would also meet once or twice in a group via video conferencing to introduce themselves, hear about others' projects, and give their feedback.
We decided that the first blended course would be on developing instruction. We felt it would be important to faculty at that time because the new Shared Discovery Curriculum would soon start, and some faculty were given the responsibility of designing a new course or intersession for it.
In the spring semester of 2015 we offered a blended course on
How to Develop a Curriculum. Participants were required to have an idea for a curriculum they wanted to develop. They would go through the online tutorial videos required for the first week, and complete worksheets that allowed them to apply what they had just learned. Then they would meet with the instructors to talk about their curriculum project and receive feedback on their worksheets. This same format was followed for the remaining three weeks of the course.
To recruit participants, the Dean's office sent out an email to all faculty and staff in all communities. Because this was an intensive course for the instructors in giving feedback, a maximum of eight participants was set. Seven people signed up, four from East Lansing, two from Flint and one from Grand Rapids.
To make this a pilot test of the course, we invited others to take the online tutorial on their own, without instructor feedback. We used them as a control group and those in the blended course as the intervention group. The results were striking: six of the seven in the intervention group finished the course, while only one from the control group finished.
Why did most of the people in the blended course finish, while most of those in the control group did not? Those in the blended course said they liked the individual meetings with the instructors, and felt that the deadlines of those meetings kept them on task. One person in the control group said:
Since I didn't get through this on my own, I would definitely
be interested in the blended course.
Results of Seven Classes
We have offered the course every semester since then, seven times, but have shortened it to four weeks from the original six weeks. Since Spring 2015, 36 people have enrolled and 33 have completed it in these communities:
- East Lansing - 14
- Flint - 6
- Grand Rapids - 10
- Midland - 1
- Ionia - 1
- Southeast Michigan - 1
The curriculum projects designed by the participants have been varied as to audience: residents, clinical faculty, medical students in both the legacy and Shared Discovery curricula, and workshops. Topics of curricula designed by participants were:
For Medical Students
- Geriatrics Assessment for students, residents and fellows
- Procedures Day FM Clerkship
- Revised Surgery clerkship
- Research Elective
- Addiction Medicine elective
- Cultural Competency in the Clinical Setting: Rural Subpopulations elective
- Pre-Clinical Portable Ultrasound elective workshop
- Communication Theories (for Master's in Public Health)
- Anatomy ECE
- Personal Finances for Medical Students
- Emergency Medicine rotation MCE
- Pediatrics EM Rotation MCE
- Diagnosis of Undifferentiated EM Patient for EM Rotation MCE
- Pharmacology/Physiology Intersession
- Fundamentals of Pain Evaluation Intersession
- Dermatology intersession
- Manage Acute EM Patients according to Principles of Medicine, Law and Ethics
For Clinical Faculty
- Fill Out DHS 49/FMLA Form in 30 Minutes workshop
- Pediatric ICU Medicine Fellowship
- Identify and Manage Psychophysiologic Disorders workshop
- EBM for Professionals workshop
For Residents
- QI in a Residents' Clinic
- Relationship-Based Care (Patient Interviewing)
- Community Medicine
- Basic EKG
- Revised Behavioral Science curriculum for FM residents
- Teamwork and Communication Skills for Delivery Room Management of High Risk Newborn Infants
- Behavioral Science Principles in Orthopedic Surgery
For Community Health Care Providers
- Financial Education for Persons with Mental Illness
The Future
We have consistently received good reviews for this course and this format, so we hope to offer it again. If you are interested in participating, tell us by emailing us at
[email protected].
We are also interested in topics for courses. Let us know if you have a topic you would like us to offer in this blended, flipped, distance format. We can also offer a group course to people wanting to work on a topic together. Again, send all comments, suggestions and questions about the OMERAD Seminar Series to
[email protected]
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- S
tanulis, R.N. & Bell, J. (2017). Beginning teachers improve with attentive and targeted mentoring. Kappa Delta Pi Record, (53) 59-65.
- Hamilton, E. & Kaneene J.B. Characterization of MRSA Isolated from Companion Animals, Healthcare Providers and Environmental Surfaces of a Veterinary Teaching Hospital. Ann Infect Dis Epidemiol. 2017; 2(1): 1010.
- Cuthbertson, C.A., Newkirk, C., Ilardo, J. et al. Angry, Scared, and Unsure: Mental Health Consequences of Contaminated Water in Flint, Michigan J Urban Health (2016) 93: 899. doi:10.1007/s11524-016-0089-y
- Taylor DK
, Lepisto B, Lecea N, Ghamrawi R, Bachuwa G, LaChance J and Hanna-Attisha M. (2017) Surveying resident and faculty physician knowledge, attitudes and experiences in response to public lead contamination. Academic Medicine 92(3):308-11.
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An interactive gallery featuring examples of CHM blended and online learning projects by B-CLR.
Resources are arranged by topic, addressing issues common to educational scholarship, including definitions of scholarship, formulating resource questions, methodology and research design as well as dissemination via poster or publication.
A medical education listserv maintained by OMERAD.
Peer-reviewed international open access journal for disseminating information on the education and training of physicians and other health care professionals.
Click on the link to view past issues of our newsletter.
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