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Educational Methodology Click to edit Master title style § Click to edit Master text styles • Second level - Third level - Fourth level - Fifth level Jennifer C. Kesselheim, MD, Ed. M
Outline: edit Content Guidelines Click to ABP Master title style § Click to edit Master text styles Educational Theory § • Second level Evaluation Feedback and - Third level § Teaching Methods - Fourth level § Educational Planning - Fifth level
Educational Master Click to edit. Theory title style § Click to edit Master text styles Adult learning principles • Second level learning Self directed - Third level § The optimal learning environment - Fourth your § Motivatinglevel learners - Fifth level § Reflective practice (Kolb’s cycle) § The hidden curriculum
Why Consider Master title style Click to edit Adult Learning Principles? of adult learning principles will help § Consideration § Click to edit Master text styles optimize your time spent on teaching • Second efficiency and effectiveness • Increases level • Facilitates achievement of learning objectives - Third level • Improves learners’ experience - Fourth level § ABP - Fifth level is important!! also thinks this
Adult to edit Master title Click Learning Principles style § Malcolmedit Master text styles Click to Knowles § • Second level 1980 text: Modern Practice of Adult Education - Third level § Androgogy - Fourth level • Art- and practice of teaching adult learners Fifth level • Distinct from learning in childhood - Pedagogy Knowles M. Modern Practice of Adult Education: From pedagogy to androgogy. The Adult Education Company, New York: 1980; 390 pages.
Click to edit Master title style Androgogy vs. Pedagogy § • Click to edit Master • text styles Pedagogy Androgogy • – Formal level Second – Learners are dependent - Third level teacher and directed by – - Fourth is external Evaluation level (teachers, tests) - Fifthextrinsically level – Learners motivated (grades) – Informal and cooperative – Learners are independent and self-directed – Learners intrinsically motivated (self-assessment) – Practical – Learning optimal when built on existing framework Knowles M. Modern Practice of Adult Education: From pedagogy to androgogy. The Adult Education Company, New York: 1980; 390 pages.
The Learning Environment Click to edit Master title style § Click to editfor self-direction Must allow Master text styles § • Second level are autonomous and Adult learners - Third level goal-oriented - Fourth level • Come to educational experience with goals already in mind - Fifth level • Teachers facilitate the meeting of those goals Knowles M. Modern Practice of Adult Education: From pedagogy to androgogy. The Adult Education Company, New York: 1980; 390 pages.
Self-Directed Learning Click to edit Master title style § § Adult learners must bestyles set their Click to edit Master text free to • own learning goals Second level - At the start • Third level of each rotation Fourth level • -On a bi-annual basis with program leadership - Fifth level • Mentors • Scientific Oversight Committee (SOC)
Self-Directed Learning Click to edit Master title style § Adult learners. Master text styles § Click to edit must assume responsibility for their own learning • Second level • Presentations • - Thirdleadership Group level - Fourth - Rounds level - Family and team meetings - Fifth level • Patient “ownership” - Daily management - Approach to complex care • Individual literature review and critical thinking
The Learning Environment Click to edit Master title style § § Teachers as. Master textset the right tone Click to edit facilitators, styles • for adults to learn Second level • Third level respect for learners - Demonstrate • Solicit learners’ perspectives - Fourth level - Needs assessment must be part of the routine - Fifth level • Bring them to learning opportunities that reflect their interests and meet their needs • Show learners’ that the experience will help them attain learning goals - Be explicit
Click to edit Master title style The Learning Environment Get to know your learner, shows styles § §Click tocrave Master textpartnership that adult edit learners • • Second level to feel like equals with their Adult learners want instructors - Third level § Three questions - Fourth level • What are you hoping to learn? - Fifth level • Where will your future career steps likely take you? • How can today’s learning serve you in that future? § Useful in many settings • Multi-week rotation, single weekend, day in clinic • Before beginning a small-group teaching session
Practical and Relevant Click to edit Master title style § Click to edit Master text styles learner Focus on what motivates your § • Second level Relate each lesson to learner’s goals - Third your § How willlevel lessons be used to solve - Fourth level actual challenges? - Fifth level • Case-based learning • Simulation • Learning at the bedside and during rounds
Click to edit Master title style Individualized Learning Plan § Click to edit Master text styles (ILP) Put forth by • • Second level the ACGME and the - Pediatric Resident Review Third level Committee - Fourth level –-A requirement for pediatric training Fifth level programs • Trainees must update their ILP and review with mentor regularly • Self-directed, goal oriented,
Click to edit Master title style Kolb Cycle of Experiential Learning § Click to edit Master text styles • Second level - Third level - Fourth level Experimentation Reflection - Fifth level Concrete Experience Reflection Abstract Conceptualization David A. Kolb. Experiential Learning: Experience as the source of learning and development (1984)
Steps in Reflective Practice Click to edit Master title style § Concrete experience § Click to edit Master • § § text styles gets directly The learner, after hearing your instruction on this procedure, • involved with the activity Second level Reflection • - Third level the experience…what went well? At what point did I Thinks critically about run into difficulty? - Fourth level Abstract conceptualization • Tries to link your message from teaching with what was just experienced - Fifth level § Experimentation • Improve performance now with better understanding of your lessons
Missed edit Click to. Steps. Master title style § Optimal learning text styles § Click to edit Master requires time for all fourlevel steps • Second §- Rushed learners often skip Third level reflection and abstract - Fourth level conceptualization - Fifth level § Oscillation between experience and experimentation is far less effective Concrete Experience Experimentation Reflection
Elements of Master title Click to edit. Reflection style § Based largely on the work of John Dewey § Click to edit Master text styles § Think about an experience in greater detail • Second level • Elaboration - Third level § Stems from self-doubt, uncertainty - Fourth level • Helps us to work out a difficult problem § Resolve to do it differently next time - Fifth level • New action or change in attitude § Processing of an issue without resolution • Improve without solving the problem Wear D et al. Reflection in/and writing: pedagogy and practice in medical education. Academic Medicine 2012 May; 87(5): 603 -9
Hidden edit Master Click to. Curriculum title style § Click to editeducation literature since Concept in Master text styles 1960’s • Second level - Third level § Fred Hafferty introduced hidden curriculumlevel - Fourth to medical education community 20 years ago - Fifth level • Applicable concept for medicine § Must be acknowledged • Powerful influence o behavior and attitudes of learners
Hidden edit Master Click to. Curriculum title style § Click to edit Master text styles Teaching that is inconsistent with and may contradict • Second level the formal curriculum - Third level § Discordance between what is taught formally and what is implied informally - Fourth level - Fifth level § Creates tension for learners and has negative impact on the learning environment Gaufberg EH et al. The hidden curriculum: what can we learn from third-year medical student narrative reflections? Academic Med 2010 Nov; 85(11): 1709 -16
Hidden edit Master Click to. Curriculum title style § Unwritten edit Master text styles § Click to § Exists in everyday experience of learners • Second level elevator • Heard in cafeteria, • - Thirdbehavior of role models Seen in level • Implied by tacit attitudes of beliefs that are infused into - Fourth level the culture - all part of it, § We are Fifth levelyet many are unaware § Trainees notice hidden curriculum • Influences them as they socialize into medicine • Gaufberg EH eton professional role learn from third-year medical student narrative reflections? Take al. The hidden curriculum: what can we Academic Med 2010 Nov; 85(11): 1709 -16
Feedback and Evaluation Click to edit Master title style § Click to edit Master text styles Approach to feedback § • Second level summative feedback Formative and - Third level § How it differs from evaluation - Fourth level § Competencies and milestones - Fifth level
Approach to Master title Click to edit. Feedback style § Skills in giving and. Master feedback are essential for § Click to edit receiving text styles adult learning • Determines level • Secondwhether learning goals are being met § - Thirdbarriers exist level Numerous • Not Fourth level - enough time • Lack of comfort - Fifth level - Inadequate knowledge and skills - Difficult conversation - Fear the recipient may react poorly • Limited observations • Faculty buy-in • Result…. trainee dissatisfaction!
Types of Feedback Click to edit Master title style § Formative Master • text styles Click to edit • Summative • – Second level Informal – - Third level Halfway point - Fourth level – Provides opportunity for-improvement Fifth level – May be more formal – Reflects formative feedback (no surprises!) – Content may mirror what ends up on evaluation forms
Expectations Click to edit Master title style § Click to edit Master textwhen learners Feedback works better styles already know • Second level what is expected of them - Third level § Chat with your learners in advance - Fourth level § Identify their goals and clarify your - Fifth level expectations for them § Know the goals and objectives of the learning experience
Guidelines for Feedback Click to edit Master title style § Plan ahead Master text styles Click to edit • • Prepare level Second yourself and the receiver Choose time and place - Third level Receiver has chance to reflect on own - Fourth level performance - Fifth level • Establish learning goals - What do you want to be working on? § Identify it as feedback § Allow receiver to self-assess first Ramani S and Krackov SK. Twelve tips for giving feedback in the clinical environment. Med Teac. 2012; 34: 787 -91.
Guidelines for Feedback Click to edit Master title style § Click what he or shetext styles well Note to edit Master has done § • Second level for improvement Identify areas - Third level § Concrete examples - Fourth level • Avoid “hear-say” - Fifth level § Address behaviors, not the person • Focus on modifiable behaviors § Create plan for improvement Ramani S and Krackov SK. Twelve tips for giving feedback in the clinical environment. Med Teac. 2012; 34: 787 -91.
Guidelines for Feedback Click to edit Master title style § Click to editfor discussion Leave time Master text styles • Second receiver's understanding Assess level - Third level own words…. State in your • Agree upon plan for improvement - Fourth level - Fifth level § Solicit feedback on your own performance § Set time for follow-up Ramani S and Krackov SK. Twelve tips for giving feedback in the clinical environment. Med Teac. 2012; 34: 787 -91.
Click Feedback and Assessment to edit Master title style § Click to edit Master text styles • Second level - Third level - Fourth level - Fifth level Duffy et al. Academic Medicine 2004; 79: 495507
Assessment Click to edit Master title style § Click to editcollection of styles Systematic Master text data about performance • Second level - Third level § Measurement of outcomes or skills - Fourth level § Often written/form-based - Fifth about assessment instrument level § Decision to use based on what needs to be measured
Selecting Instruments Click to edit Master title style § What areaedit Master textyou want to § Click to of performance do styles measure? • Second level • Task • - Third level Competency • Define scopelevel - Fourth as narrow or broad § Who is the ideal observer? - Fifth level § When and where will the measurement occur? § Which instrument or form best meets your needs? • Validation • Refine as needed • Pilot
Evaluation Click to edit Master title style § Patient care: § Click to edit • • • § Master text styles for the rotation Rotation-specific faculty evaluations that parallel the goals • Observed history and physical examination Second level Critical incidents (an event/outcome that was particularly good or bad) - Third level Procedure logs Case logs - Fourth level Medical Knowledge: • Rotation specific faculty evaluations that parallel the goals for the rotation - Fifth level • • In-training examination of the American Board of Pediatrics Self-assessment of rotation specific objectives Evidence-based practicum and presentation Critically appraised topic (formal exercise in evidence-based medicine that forces the writer to critically evaluate an article in the medical literature)
Evaluation Click to edit Master title style § Practice-based Learning and Improvement: § Click to edit Master text styles • Focused practice improvement • Summary statement • Second level of intervention and outcome, reflective statement of change in practice • - Third level Critical incidents • Conference attendance log § - Fourth level Interpersonal and Communication Skills: - Fifth level • Rotation specific faculty evaluations that parallel the goals for the • • • rotation 360 -degree evaluation Patient/Parent surveys Faculty evaluations
Evaluation Click to edit Master title style § Professionalism § Click to edit • • • § Master text styles Critical incidents Portfolios Direct observation Patient/Parent surveys Self-assessment or Peer-assessment Second level - Third level - Fourth level Systems-based Practice: - Fifth level • Documentation of a systems error with strategies to positively impact the system and eliminate the error
The Milestone Project Click to edit Master title style § Click to edit Master text styles Spearheaded by ACGME in partnership with member • Second level boards of ABMS - Third § Charge: level - Fourth level • Refine the competencies in the context of the specialty - Fifth level • Set performance standards for GME • Identify or develop tools for assessment of performance
Pediatrics Milestone title style Click to edit Master Project § Click to edit Master text styles explicit Adds critical competencies not in original ACGME competencies • Second level (N=51) level - Third § Describes level competency in terms of - Fourth each behaviorslevel a developmental - Fifth along continuum from novice to master § This hierarchy of behaviors are known as “milestones”
The Pediatric Milestones Click to edit Master title style § Click to edit Master text styles levels 4 -5 milestones or performance for each level • Second competency - Third level § Each milestone provides specific behaviorallevel - Fourth expectations that form the substrate level - Fifth of formative feedback § The series of milestones for each competency serve as a learning roadmap
Educational Master Click to edit. Planning title style § Click to edit Master text styles goals Determine the desired outcome, § • Second level Needs assessment - Third level § Learning objectives - Fourth level § Teaching methods - Fifth level § Evaluation of outcomes
Determine the Desired Outcome Click to edit Master title style § Click to edit big picture styles Look at the Master text § • Secondthe problem you want to solve What is level - Third your through level teaching? - Fourth yourself what the ideal would § Define for level be - Fifth level § Desired outcomes are known as goals • Ensure that each patient receiving chemotherapy receives adequate prophylactic medications to minimize chemotherapy-induced
Needs Assessment Click to edit Master title style § § Essentialedit Master text styles Click to first step, too often missed Document the • Second levelgap between the ideal and the. Third level - actual § Collect datalevel all stakeholders to define - Fourth from educational needs - Fifth level • Learners • Teachers, educators, professional societies (eg: ASPHO, ABP) • Patients • Nursing § What kind of barriers exist? Where are the
Learning Objectives Click to edit Master title style § Click to edit Master text a written plan Learning objectives are styles for meeting those needs, achieving • Second level desired level - Third outcome § By -the end of this session, learners will Fourth level be able to… - Fifth level § Too often use vague terms: • Understand which antiemetics can prevent chemotherapy-induces nausea and vomiting
Action Verbs Click to edit Master title style § • • Click Defineto edit Master • text styles Perform • Second level Identify • Distinguish - Third Practice level • Describe - Fourth level Recall • Summarize - Fifth Implement level • Classify Articulate • Utilize Recognize Objectives avoid use of vague terms Apply like “know” or “understand”
Objectives Click to edit Master title style § Click to which chemotherapeutic agents Identify edit Master text styles pose the largest risk for nausea and • Second level vomiting - Third level § Classify antiemetics by mechanism of - Fourth level action - Fifth level § Select optimal antiemetic regimen to prevent nausea and vomiting for common clinical scenarios
Teaching Methods Click to edit Master title style § Clicksize does not fit all styles One to edit Master text § • Second levelof learners you will find a In any group - Third level variety of learning styles • • • - Fourth level Some learn by sight - Fifth level Some learn by hearing Some prefer a combo Some learn alone and others in groups We all learn by doing
Teaching Methods Click to edit Master title style § Need to select methods after considering Click to edit Master text styles your learning objectives • Second level • What methods are most likely to facilitate - Third level meeting of the learning objectives? - Fourth level § Other considerations: - Fifth learners • Number oflevel • Amount of time • Available resources (or ability to develop new ones) • Adult learning principles
Teaching Methods Click to edit Master title style § Click to edit Master texttalk) Didactic (lecture, chalk styles § • Second level learning Problem-based - Third level § Electronic modules, webinar, podcast - Fourth level § Bedside/Rounds-based - Fifth level § Simulation
Evaluation of Outcomes Click to edit Master title style § Click should Master text styles of the Plan to edit be made at the start process • Second level - Third missed step § Often a level - Fourth level • Rush to get started - Fifth level • Uncertain of methods
Evaluation of Outcomes Click to edit Master title style § Click to edit Master text styles Satisfaction § • Second level Feasibility - Third level § Did we meet our objectives - Fourth level • Evaluate learners - Fifth level - Knowledge, skills, values/attitudes, behavior • Determine whose perspective to measure - Learner, patient, instructor • Consider repeating needs assessment
Educational Master Process Click to edit. Planning title style § Click to edit Master text styles State desired outcome (goals) • Second level - Third level Measure whether - Fourth level objectives were met - Fifth level Needs assessment Develop learning objectives Conduct activity Decide on teaching methods
Click to edit Master title style § Click to edit Master text styles • Second level Questions? - Third level [email protected] harvard. edu - Fourth level - Fifth level