Transcript Click to edit Master title style - The American Society of Pediatric

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, EdM
Dana-Farber/Boston Children’s Center for Cancer and Blood
Outline:
Guidelines
Click to ABP
edit Content
Master title
style
 Educational
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Theory text styles
Second level
 •Feedback
and Evaluation
- Third level
 Teaching
Methods
- Fourth level
 Educational Planning
- Fifth level
Educational
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Master title style
 Adult
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learning
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principles
text styles
• Second
Self directed
level learning
- Third
levellearning environment
 The
optimal
- Fourth your
level learners
 Motivating
- Fifth level
 Reflective practice (Kolb’s cycle)
 The hidden curriculum
Why
Learning
Principles?
ClickConsider
to edit Adult
Master
title style
 Consideration
adult learning
principles will help optimize
Click to editofMaster
text styles
your time spent on teaching
•• Second
level and effectiveness
Increases efficiency
• Facilitates
achievement of learning objectives
- Third level
• Improves learners’ experience
- Fourth level
 ABP also
thinks
this is important!!
- Fifth
level
Adult
Principles
Click Learning
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title style
 Malcolm
Knowles
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Master text styles
 •1980
text:level
Modern Practice of Adult Education
Second
 Androgogy
- Third level
• Art- Fourth
and practice
level of teaching adult learners
• Distinct
- Fifthfrom
levellearning in childhood
- Pedagogy
Knowles M. Modern Practice of Adult Education: From pedagogy to androgogy. The Adult Education Company, New York: 1980; 390 pages.
Androgogy
vs. Pedagogy
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to edit Master
title style
 •Click
to edit Master text• styles
Pedagogy
Androgogy
Formal level
• –Second
– Learners are dependent
- Third
level by teacher
and directed
– -Evaluation
is external
Fourth level
(teachers, tests)
- Fifth level
– Learners extrinsically
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
Environment
ClickLearning
to edit Master
title style
 Must
Click to
allow
editfor
Master
self-direction
text styles
Second
level are autonomous and goal •Adult
learners
- Third level
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
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title style
 Click
to edit
Master must
text styles
Adult
learners
be free to set their
• own
Second
level
learning
goals
level
•- Third
At the
start 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
must
assume
Click tolearners
edit Master
text
styles responsibility
for their own learning
• Second level
• Presentations
Third level
• -Group
leadership
- Rounds
- Fourth level
- Family
- Fifth and
levelteam meetings
• Patient “ownership”
- Daily management
- Approach to complex care
• Individual literature review and critical thinking
The
Environment
Click Learning
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title style
 Click
to edit Master
text styles
Teachers
as facilitators,
set the right tone
adults
• for
Second
levelto learn
•- Third
Demonstrate
respect for learners
level
• Solicit learners’ perspectives
- Fourth level
- Needs assessment must be part of the routine
- Fifththem
levelto learning opportunities that reflect
• Bring
their interests and meet their needs
• Show learners’ that the experience will help
them attain learning goals
- Be explicit
Click
to editEnvironment
Master title style
The Learning
Get toto
know
yourMaster
learner, shows
partnership
that adult learners
 Click
edit
text
styles
crave
• • Second
levelwant to feel like equals with their instructors
Adult learners
- Third level
 Three questions
Fourth
level
• -What
are you
hoping to learn?
• Where
will level
your future career steps likely take you?
- Fifth
• 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 Master
Relevanttitle style
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 Focus
Click toonedit
what
Master
motivates
text styles
your learner
Second
levellesson to learner’s goals
 •Relate
each
- Third
 How
will level
your lessons be used to solve actual
- Fourth level
challenges?
- Fifth level
• Case-based
learning
• Simulation
• Learning at the bedside and during rounds
ClickIndividualized
to edit Master
title style
Learning
Plan (ILP)
 Click to edit Master text styles
Put forth
• •Second
levelby the ACGME and the Pediatric
- Resident
Third levelReview Committee
A requirement
-–Fourth
level for pediatric training programs
• Trainees
must update their ILP and review
- Fifth level
with mentor regularly
• Self-directed, goal oriented, establishes
relevance, fosters effective environment
Cycle
of Experiential
ClickKolb
to edit
Master
title styleLearning
 Click to edit Master text
styles
Concrete
• Second level
- Third level
- Fourth level
Experimentation
Reflection
- Fifth level
Experience
Reflection
Reflection
Abstract
Conceptualization
David A. Kolb. Experiential Learning: Experience as the source of learning and development (1984)
Steps
in edit
Reflective
Click to
MasterPractice
title style
 Concrete
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•


text
styles
The learner, after hearing your instruction on this procedure, gets directly involved with the
• activity
Second level
Reflection
Third
level
• -Thinks
critically
about the experience…what went well? At what point did I run into
difficulty?
- Fourth level
Abstract conceptualization
• Tries -to link
your message
Fifth
level from teaching with what was just experienced
 Experimentation
•
Improve performance now with better understanding of your lessons
Missed
Click toSteps
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 Optimal
requires
 Click
to editlearning
Master text
stylestime for all four
steps
• Second level
- Rushed
Third levellearners often skip reflection and
abstract
conceptualization
- Fourth level
 Oscillation
- Fifth levelbetween experience and
experimentation is far less effective
Concrete
Experience
Experimentation
Reflection
Elements
of Reflection
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Master title style
 Based
the worktext
of John
Dewey
Click largely
to editonMaster
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 dolevel
it differently next time
- Fifth
• 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
Click toCurriculum
edit Master title style
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Master text
styles since 1960’s
 Concept
in education
literature
Second
level introduced hidden curriculum to
 •Fred
Hafferty
- Third education
level
medical
community 20 years ago
- Fourth level
• Applicable
concept for medicine
Fifth
level
 Must-be
acknowledged
• Powerful influence o behavior and attitudes of
learners
Hidden
Click toCurriculum
edit Master title style
 Teaching
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thatMaster
is inconsistent
text styleswith and may
the formal curriculum
•contradict
Second level
- Third level between what is taught formally
 Discordance
and- what
implied informally
Fourthislevel
- Fifth
level for learners and has negative
 Creates
tension
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
Click toCurriculum
edit Master title style
 Unwritten
Click to edit Master text styles
 Exists in everyday experience of learners
•• Second
level elevator
Heard in cafeteria,
• -Seen
in behavior
Third
level of role models
• Implied by tacit attitudes of beliefs that are infused into the culture
- Fourth level
 We are all part of it, yet many are unaware
- notice
Fifth level
 Trainees
hidden curriculum
• Influences them as they socialize into medicine
• Take on professional role
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
Feedback
andMaster
Evaluation
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title style
 Approach
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feedback
text styles
Second level
 •Formative
and summative feedback
- Third
level from evaluation
 How
it differs
- Fourth level
 Competencies and milestones
- Fifth level
Approach
to Feedback
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Master title style
 Skills
giving
andMaster
receiving feedback
are essential for adult learning
Clickin to
edit
text styles

•
Determines whether learning goals are being met
•
•
•
- Fear the recipient may react poorly
Limited observations
Faculty buy-in
Result….trainee dissatisfaction!
• Second level
Numerous barriers exist
- Third level
• Not enough time
• Lack
of comfort level
- Fourth
- Inadequate knowledge and skills
- Fifth level
- Difficult conversation
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Types
Feedback
Master title style
• Click
to
edit
Master
text
styles
Formative
• Summative
•– Second
Informal level
Third level
– -Halfway
point
- Fourthopportunity
level for
– Provides
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
 Feedback
Click to editworks
Master
better
textwhen
styleslearners already
whatlevel
is expected of them
•know
Second
- Third
 Chat
withlevel
your learners in advance
- Fourth
 Identify
theirlevel
goals and clarify your expectations
- Fifth level
for them
 Know the goals and objectives of the learning
experience
Guidelines
forMaster
Feedback
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title style
 Plan
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to edit Master text styles
••
•
•
•
Prepare
yourself and the receiver
Second level
Choose
time and place
- Third level
Receiver
has
chance
to
reflect
on
own
performance
- Fourth level
Establish learning goals
- Fifth level
- 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
forMaster
Feedback
Click to edit
title style
 Note
Click what
to editheMaster
or shetext
hasstyles
done well
Secondareas
level for improvement
 •Identify
- 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
forMaster
Feedback
Click to edit
title style
 Leave
Click totime
editfor
Master
discussion
text styles
• Second
Assess receiver's
level
understanding
- State
Third level
in your own words….
• Agree
- Fourth
upon
level
plan for improvement
level on your own performance
 Solicit- Fifth
feedback
 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 to
edit Master
style
Feedback
andtitle
Assessment
 Click to edit Master text styles
• Second level
- Third level
- Fourth level
- Fifth level
Duffy et al. Academic Medicine 2004;79: 495-507
Assessment
Click to edit Master title style
 Systematic
Click to editcollection
Master text
of styles
data about performance
Second level of outcomes or skills
 •Measurement
- Third
level
 Often
written/form-based
- Fourth level
 Decision about assessment instrument to use
level needs to be measured
based- Fifth
on what
Selecting
Instruments
Click to edit
Master title style
 What
of performance
do you
want to measure?
Clickarea
to edit
Master text
styles
• Task
•• Second
level
Competency
Thirdscope
level
• -Define
as narrow or broad
 Who-isFourth
the ideal
observer?
level
 When -and
where
Fifth
levelwill the measurement occur?
 Which instrument or form best meets your needs?
• Validation
• Refine as needed
• Pilot
Evaluation
Click to edit Master title style
 Patient
Click care:
to edit
•
•
•
•
•

Master
text
styles
Rotation-specific faculty evaluations that parallel the goals for the rotation
history
and physical examination
• Observed
Second
level
Critical incidents (an event/outcome that was particularly good or bad)
-Procedure
Thirdlogslevel
Case logs
- Fourth level
Medical Knowledge:
• Rotation
specific level
faculty evaluations that parallel the goals for the rotation
- Fifth
•
•
•
•
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
and Improvement:
Click to editLearning
Master
text styles
• Focused practice improvement
•• Summary
Secondstatement
levelof intervention and outcome, reflective statement of change in
practice
Third
level
• -Critical
incidents
• Conference attendance log

- Fourth level
Interpersonal and Communication Skills:
- Fifth
• Rotation
specificlevel
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 level
Second
Direct observation
-Patient/Parent
Third level
surveys
Self-assessment
or Peer-assessment
- Fourth level
 Systems-based Practice:
•
- Fifth level
Documentation of a systems error with strategies to positively impact the system
and eliminate the error
The
Projecttitle style
ClickMilestone
to edit Master
 Spearheaded
Click to edit Master
by ACGME
text styles
in partnership with
•member
Secondboards
level of ABMS
- Third level
 Charge:
- Fourth
• Refine
thelevel
competencies in the context of the
specialty
- Fifth level
• Set performance standards for GME
• Identify or develop tools for assessment of
performance
Pediatrics
Milestone
Click to edit
Master Project
title style
 Adds
Click to
critical
edit Master
competencies
text styles
not explicit in
•original
SecondACGME
level competencies (N=51)
- Third level
 Describes
each competency in terms of
behaviors
- Fourthalong
level a developmental continuum
from -novice
to master
Fifth level
 This hierarchy of behaviors are known as
“milestones”
The
Milestones
ClickPediatric
to edit Master
title style
 4-5
Clickmilestones
to edit Master
or performance
text styles levels for each
•competency
Second level
- Third
level provides specific behavioral
 Each
milestone
expectations
that form the substrate of
- Fourth level
formative
- Fifthfeedback
level
 The series of milestones for each competency
serve as a learning roadmap
Educational
Click to editPlanning
Master title style
 Determine
Click to editthe
Master
desired
textoutcome,
styles goals
Second
level
 •Needs
assessment
- Third level
 Learning
objectives
- Fourth level
 Teaching methods
- Fifth level
 Evaluation of outcomes
Determine
theMaster
Desiredtitle
Outcome
Click to edit
style
 Look
Click to
at edit
the big
Master
picture
text styles
Second
level
 •What
is the
problem you want to solve through
- Third
level
your
teaching?
- Fourth
level what the ideal would be
 Define
for yourself
- Fifth
level
 Desired
outcomes
are known as goals
• Ensure that each patient receiving chemotherapy receives
adequate prophylactic medications to minimize
chemotherapy-induced nausea and vomiting
Needs
Click toAssessment
edit Master title style



Essential
first Master
step, tootext
oftenstyles
missed
Click to edit
the gap between the ideal and the actual
•Document
Second level
Collect
data
from all stakeholders to define
- Third
level
educational
- Fourth needs
level
•
•
•
•
Learners
- Fifth level
Teachers, educators, professional societies (eg: ASPHO, ABP)
Patients
Nursing
 What kind of barriers exist? Where are the gaps?
Learning
Objectives
Click to edit
Master title style
 Learning
Click to edit
objectives
Master text
are astyles
written plan for
•meeting
Secondthose
level needs, achieving desired
outcome
- Third level
 By the
end level
of this session, learners will be able
- Fourth
to… - Fifth level
 Too often use vague terms:
• Understand which antiemetics can prevent
chemotherapy-induces nausea and vomiting
Click toVerbs
Action
edit Master title style
• Click
Defineto edit Master text •styles
Perform
•
•
•
•
•
•
•
•Identify
Second level
- Third level
Practice
- Fourth level
Recall
- Fifth level
Implement
Articulate
Recognize
Apply
•
•
•
•
•
Distinguish
Describe
Summarize
Classify
Utilize
Objectives avoid use of vague
terms
like “know” or “understand”
Objectives
Click to edit Master title style
 Identify
Click to which
edit Master
chemotherapeutic
text styles agents pose
largestlevel
risk for nausea and vomiting
•theSecond
- Third antiemetics
level
 Classify
by mechanism of action
- Fourth
levelantiemetic regimen to prevent
 Select
optimal
- Fifth
nausea
andlevel
vomiting for common clinical
scenarios
Teaching
Methods
Click to edit
Master title style
 One
Clicksize
to edit
does
Master
not fittext
all styles
levelof learners you will find a variety of
 •In Second
any group
- Third level
learning
styles
•
•
•
•
•
- Fourth
Some
learnlevel
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
methods
after
considering your
Click to
to select
edit Master
text
styles
•learning
Secondobjectives
level
• What methods are most likely to facilitate meeting of the
- Third level
learning objectives?
Fourth
level
 Other considerations:
- Fifth
• Number
of level
learners
• Amount of time
• Available resources (or ability to develop new ones)
• Adult learning principles
Teaching
Methods
Click to edit
Master title style
 Didactic
Click to edit
(lecture,
Master
chalk
texttalk)
styles
Second level learning
 •Problem-based
- Third level
 Electronic
modules, webinar, podcast
- Fourth level
 Bedside/Rounds-based
- Fifth level
 Simulation
Evaluation
of Master
Outcomes
Click to edit
title style
 Plan
Click should
to edit Master
be made
text
at styles
the start of the process
Second
level step
 •Often
a missed
Thirdtolevel
• -Rush
get started
- Fourth level
• Uncertain
of methods
- Fifth level
Evaluation
of Master
Outcomes
Click to edit
title style
 Satisfaction
Click to edit Master text styles
Second level
 •Feasibility
level our objectives
 Did- Third
we meet
- Fourthlearners
level
• Evaluate
- Fifth levelskills, values/attitudes, behavior
- Knowledge,
• Determine whose perspective to measure
- Learner, patient, instructor
• Consider repeating needs assessment
Educational
Process
Click to editPlanning
Master title
style
 Click to edit Master text styles
• Second level
- Third level
Measure whether
- Fourthwere
level
objectives
met
- Fifth level
State desired
outcome (goals)
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]
- Fourth level
- Fifth level