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Educational Methodology Click to edit Master title style § Click to edit Master text 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 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 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 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 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 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 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 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 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 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, 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 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 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 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 § 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 § 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 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 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 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 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 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. 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 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 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 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 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 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 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 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 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 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 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 • 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 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 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 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 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 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 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 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 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 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 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 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) 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 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 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 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 • 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