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Issue 03 OCT 2013

Electronic Newsletter for for Faculty Instructional Development

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

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this issue
Cover: Promoting EBMD P.1

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tion

Inside Scoop: Promoting EBDM P.2

romoting evidence-based decision making (EBDM) in medical educa-

Event: The next FID Series seminar P.3 Using smart technology P.3 Save the date: Upcoming events P.8

Karen Spear Ellinwood, PhD, JD, EdS

As a lawyer, the concept of evidence-based decision making resonates with me. Make decisions based on evidence. Make sure the evidence is reliable and credible. Ask yourself: Does it stand up to scrutiny? This is a prudent process for any professional in the position to make decisions that will affect their careers and the people who depend upon them whether we call them clients or patients. To engage in evidence-based decision making, however, you have to move away from rote learning and reflect on process and procedural knowledge as well as content knowledge (Schn, 1983; Santasier & Plack, 2004). Such reflection requires critical engagement, an examination of bias and assumptions, and an open mind that considers multiple perspectives before ruling anything

Try the EBDM Search tools online at the AHSL website!

in or out. Investigating facts and assessing their

reasoning at each step of a structured problem solving process in case-based instruction. The ultimate goal is for such a habit to become part of students professional medical practice. The concept of evidence-based decision making (EBDM) embodies reflective and critical engagement, and applies to teaching as well as to learning and professional practice (Keim, et al., 2008). In

earn more about online tools for enhancing learner engagement inside!

relevance and materiality or centrality to the case and how much weight to attribute to particular facts is at the heart of both legal and medical practice. In the September issue of Med/Ed eNews, I addressed how the UA COM is attempting to cultivate in students such a habit of critical, reflective engagement by requiring students to articulate their

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Inside Scoop | Evidence-based Decision Making

The AHSL EBDM tools are located on the AHSL website cine and Public Health, and has published scholand aim to assist the practicing clinician, researcher arly articles on evidence based decision making or student in finding the best evidence to answer clini- as well as sharing a collaborative model used for

SUBMISSION GUIDELINES
Med Ed eNews has 1,859 reads through Scribd.com, our publishing host!, in addition to the UA COM faculty readers. If you would like to submit a piece, please follow these guidelines: 1) 1000 words maximum; 2) topic addresses issues relevant to teaching, assessment or technology use in classroom or clinical settings; 3) include references to scholarly works on (medical) education. SUBMIT

cal questions, (website). At present, there is a tool for developing the EBM web-based tools for the UA searches in medicine at large and others for: College of Medicine. Relevant Publications Keim SM, Howse D, Bracke P, Mendoza K. Promoting evidence based medicine in preclinical medical students via a federated literature search tool. Med Teach. 2008;30(9-10):880-4. PubMed PMID: 18821125; access via EBSCO. Bracke PJ, Howse DK, Keim SM. Evidence-based

Emergency Medicine, Medical Imaging, Pediatrics, and Surgery/Critical Care.

In addition, AHSLs website hosts an EBDM glossary defining key concepts involved in conducting and re-

porting research, such as, central tendency, categorical Medicine Search: a customizable federated data, and normal distribution. These and other glossary entries are accompanied by links to video shorts explaining and illustrating the concepts. Sam Keim, MD, is the Department Chair of Emergency Medicine and a Professor of the UA Colleges of Medisearch engine. J Med Libr Assoc. 2008 Apr;96 (2):108-13. PubMed PMID: 18379665. Howse DK, Bracke PJ, Keim SM. Technology mediator: a new role for the reference librarian? Biomed Digit Libr. 2006 Oct 13;3:10. PubMed PMID: 17040566. Additional resources for teaching EBDM
thas go gram o r P AE t The R t star a grea o t f f evelten o ents d m t r a 5 dep ors with educat s a s t n reside oping . mming progra re >>> ut mo Find o

SE! ct OM Conta up in& gro e n r o e-on ent fo For on al developm l a u ion individ struct t s or n ptors e e c m e t r depar ing p d lu c y, in facult ! idents s re! & re ut mo d Fin o

Dobbie A, Tysinger JW. Evidence-based strategies that help office-based teachers give effective feedback. Fam Med 2005;37(9):617-9. Heneghan, C., & Badenoch, D. (2006). Evidencebased medicine toolkit (2nd ed.). Malden, MA: Blackwell. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123 (3):A12A13. Rosenberg W, Donald A. (1995). Evidence-based medicine: an approach to clinical problemsolving. BMJ. 1995;310:1122-1126. Rucker L, Morrison E. The EBM Rx: an initial experience with an evidence-based learning prescription. Acad Med. 2000;75 (5):527528. Sharon E. Straus, W. Scott Richardson, Paul Glasziou, and R. Brian Haynes. Evidence-based medicine: How to practice and teach EBM (3rd ed). Edinburgh: Churchill Livingstone, 2005.

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

M e d E d / e N e w s [2]

C R
Learn more:

Teaching with Technology

BI Facilitator esources
There are a variety of

Using smart technology to promote reflection and flip the classroom (or any learning situation)
Karen Spear Ellinwood, PhD, JD, EdS

resources online for facilitators of case -based instruction (CBI), including links to short videos demonstrating ThinkShare Pro (formerly ThinkSpace), a facilitator guide to the developmental curriculum for CBI in the first two years of the undergraduate curriculum, and examples of student work using the eTools ThinkShare (Formerly GroupShare) and ThinkShare Pro.

Students enjoy interacting with peers and instructors during class sessions (Ferreri & OConnor, 2013). Beyond the enjoyment however, is learning. [S]ocial interactions play a fundamental role in the process of cognitive development (Conole 2013, 65; also Moll, 2013). An educator has many tasks but one primary role: to create zones of proximal development (ZPD) in moving learners toward their more distal goals. The concept of the ZPD is defined by the difference between what a learner can do without help and what they can do with help from others or through the use of artifactstools and other resources (id.). The key to creating zones of proximal development is to understand learners funds of knowledge, that is, what they comfortably understand and can perform without assistance, and what the next probable achievement ought to be in their development (Moll, 2013). The educator's objective in every learning situation, then, is to provide strategic guidance to help learners navigate these zones, to ensure that the immediate learning objectives are proximal, and not distal or beyond their reach. (Moll, 2013; Spear-Ellinwood, 2011). Technology can serve this purpose by actively engaging learners in applying the concepts we aim to convey.

Web-based tools for teaching & learning

Using different types of gadgets and

technology in lectures has the potential to improve student engagement and interest, particularly if they are able to provide feedback to students at the same time (Jain & Farley, 2012, 429). There are easy-to-use, free audience response software and other apps that enable instructors to find out what students are thinking in real time and offer immediate, constructive feedback. To use these effectively, we must be strategic about how we use these tools. What does it mean to use technology strategically? Technology is not a panacea, and ought to be used in conjunction with educational strategies. For example, audience response software can be used during lecture time to ask students questions about the material and check for understanding. This is a minimalist usage of such technology. However, if instructors combine audience response software with educational strategies such as inquirebased learning, think-pair-share or other small group learning formats, they impose a greater demand on learners to articulate their reasoning in a way others can understand, discern

A structured approach to medical

problem-solving

Reflective Teaching/Learning CBI eTools

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[Continued from page 3| Teaching with Technology] the differences and similarities in their thinking process and ideas vis a vis other learners, and work together to reconcile a group response to questions. In addition, the questions themselves, should be effective aimed at promoting discussion and debate, and not simply designed to obtain yes/no responses. There are many technologies, free and otherwise, that we can use to implement inquiry -based learning. Poll Everywhere and Socrative are two. AHSC has a Questions can be posed using an easy -to-learn webbased software called Poll Everywhere. Poll Everywhere, for example, facilitates active participation by asking learners questions to check for understanding, challenge learners to think more deeply about the topics presented, or assess whether they have achieved the learning objectives of the session. Poll Everywhere allows three types of questions: multiple choice, yes/no, and open -ended. The AHSC subscription available to all faculty affiliated with any of the AHSC colleges, makes a fourth type available: the discourse question. Participants can submit their responses and then rank all responses submitted. This sort of engagement helps to stimulate higher order thinking and foster discussion as well as interaction among learners. But where can you learn to use these technologies? Faculty affiliated with any of the colleges in the Arizona Health Science Center (AHSC) have instructional support to learn new technologies for teaching in classrooms or clinical settings. The Teaching with Technology (TWT) Workshop series is an opportunity for all teaching faculty, including , residents, clinical and basic science faculty, and community-based preceptors to learn the basics and get hands-on guided experience with various applications. The first workshop (October 9, 2013) provided an overview of the basic features and uses of Poll Everywhere, an audience response software available for free online. Faculty can sign up with Mr. Griffith to take advantage of the AHSC BioCommunications subscription for Poll Everywhere that enables faculty to use it with up to 250 participants in a single session. The Teaching with Technology (TWT) workshop series will present six workshops during the year, one every 2 months. Mr. Griffith will conduct the workshops, and Karen Spear Ellinwood, PhD, Associate Specialist for faculty instructional development in the Office of Medical Student Education (OMSE), will help facilitate sessions. These workshops will not be recorded, however, Mr. Griffith will create resource guides to capture the essentials of each application to remind those who attended and introduce those who cannot attend to the purpose, uses, and basics of each app covered (e.g., view Doceri materials, 2012). In December, the TWT Series will provide AHSC faculty with an opportunity to experiment with Doceri. Doceri is a smart app for mobile devices, such as iPhone and iPad, designed to facilitate the flipped classroom but it can also be used as a remote control for presentations. Last year, TWT Series presented both functions of Doceri in one session, but realized it was not within anyones zone of proximal development to cover so much at once. This year, the TWT Series is presenting the Doceri app in two parts.
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P
error.

receptor esources
There are a variety of

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

Although the 2012-13 AMES\OMSE Faculty Instructional Development (FID) Series has come to a close, you may access recordings of all 13 seminars onlinesimply Click&Go! - Use your UA NetID to access the videos!

Check out our Faculty Instructional Development Calendar online!

AMES/OMSE FID Series #4

Developing Educational Strategies

Gail Pritchard, PhD

Lu Martinez, PhD

Dr. Pritchard and Dr. Martinez will provide an overview of effective strategies for teaching in the classroom and clinical settings, and offer practical guidance on how to implement such activities.

Date: October 29, 2013 Time: 12:00 pm1:30 pm Location: COM-3230 Refreshments will be served.

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[Continued from page 1|EBDM]

medicine, physicians must determine the best course of action in each case. To do so, they look to scientific and clinical research on point. But wading through the mass of articles, books and encyclopedic documents is time-consuming. For medical students, learning how to locate scholarly resources to guide their medical problem-solving and learning how to weigh that evidence and apply it to a set of facts presents a formidable challenge. In truth, learning how to weigh evidence is a lifelong process. Whether in support of case-based or other learning, undergraduate medical students often defer

to Uptodate, while others begin their searches or problem solving with Google search. Some might prefer starting with Google Scholar, a preferable resource because it crawls only scholarly databases. Still others go directly to PubMed or Cochrane (The Cochrane Library). Given these multiple possible starting points and the varying credibility of source materials, Dr. Keim, Nicole Capdarest-Arest, MA, AHSL Emerging Technologies Librarian, and others, developed a set of EBM search tools to assist faculty, researchers and students to provide strategic guidance for learning how to locate and weigh the credibility of scholarly research. The AHSL EBM Search tools articulate a structure for ranking the relative credibility of particular kinds of resources using an algorithm depicted by the Evidence Pyramid (Figure 1, based on Oxfords model). The Pyramid stratifies the quality by the type of research conducted. A linked chart provides detailed explanations for each stratum. Systematic reviews, for example, with a higher degree of homogeneity, that is, studies free of worrisome variations, occupy the highest level. While based in experience or scholarship, textbooks are often published without critical peer review or appraisal, and, therefore, appear at the lowest stratum. Case studies in medicine have value but are not ranked as highly as observational studies for their lack of statistical generalizability to larger populations; the Pyramid also differentiates case studies by the degree of control appliedthe greater the control, the higher the ranking. The EBM Glossary serves as a strategic guide for learners and educators alike, providing videos explaining key concepts such as statistical or other research methodologies to improve understanding and application of research. Thus, EBM Search Tools seek to educate students, instructors and professionals on how to evaluate scholarly evidence and to promote reflection on the reliability and quality of such evidence in the decision making process applied to simulated or actual cases. Figure 2 (at p. 5) offers an example of search results using the General EBM search tool, inputting the keywords case based instruction and evidence based decision making. While the Cochrane and ACP Journal Club results were not what I was looking for, the PubMed Systematic Reviews identified several relevant peer-reviewed publications addressing how to teach evidence-based decision making in case-based and small group learning contexts. An important caveat for using any search toolwhether its Google, PubMed or EBM Search Tools, is that the search tool you use is only as good as the queries you write. While this may seem obvious, learning how to construct an effective search query is a skill to be developed, not one that occurs naturally in students or practitioners. Exploring a topic to become familiar with relevant terminology and definitions or to un identify the gaps in medical knowledge is the key to planning a more focused search (Spear -Ellinwood, 2011). Thus, as educators it is important to include deliberate instruction and continuing guidance to students on how to frame their queries. Formulating an effective query requires reflection on what you know, what you need to know, and how to identify the right keywords that will capture this gap. In his presentation in the AMES/OMSE FID Series (October 18, 2013), Dr. Keim presented the 4 Asthe basic comFigure 2. Example of General EBM Tool search results. Figure 1. Evidence Pyramid; source: AHSL website; Pyramid adapted from the following table from the Oxford Centre for Evidence-based Medicine Levels of Evidence.

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[Continued from page 5|EBDM] ponents of the EBDM process: 1) Ask; 2) Acquire; 3) Appraise; and 4) Apply. These are defined as follows: 1) Ask appropriate questions; 2) acquire appropriate evidence, 3) appraise evidence found, and 4) apply information obtained to narrowing the diagnosis or developing an appropriate plan of care (see, Keim, et al. 008, 880). Dr. Keim explained, however, that two additional steps properly frame this process. First, there is a preparatory stepto recognize the knowledge gap. Thus, students first must identify what is known about the case, what they know in terms of applicable medical knowledge, and what they need to know or discover in order to resolve the case. Following engagement in the 4 As inquiry process, students (and practitioners) should debrief, that is, evaluate change in practice. This expanded EBDM approach recognizes the importance of reflecting before, during and after case resolution, a process of critical and reflective lifelong, professional learning process suggested by Schn (1983) and taken up by many others (e.g., Plack & Santasier, 2004). Dr. Keims (2008) research shows that 88% of first-year student participants from the class of 2010 (n=69) used AHSLs EBM Search Tools to gather knowledge for solving medical cases in CBI at least half the time. 55% reported using it always or almost always. Very few experienced problems using the tools (13.5%). Today, the UA COMs structured approach to CBI as medical problem-solving exemplifies the essential components of EBDM. As explained in our September issue, students are asked to apply a structured approach to problem-solving in CBI, involving 5 discrete steps: 1) define the problem (problem-posing); 2) formulate hypotheses and articulate rationales therefor; 3) strategize for how to assess the patient; 4) narrow diagnoses after considering all relevant information; and 5) reflect once the case is resolved (see Figure 3). Students must weigh the relative applicability and reliability of all types of evidence, including physical examinations, lab tests, imaging and patient histories, and consult one another asynchronously before meeting in the facilitated session, during the session, and have an opportunity to consider peer reflections once the case is resolved. Students are expected, as well, to search, review and cite credible scholarly sources to support their reasoning. The EBM Search Tools offer instructive resources to teach students how to engage in that process. CBI seems an ideal educational context in which students may explore how to use EBM search tools. The UA COM has three key threads in undergraduate medical education: evidence in medicine,
Figure 3. Problem-solving structure for CBI.

health in society, and individual health. The Thread Director for evidence in medicine, Richard Amini, MD, will collaborate with the CBI Team to explore how to make stronger connections

between EBDM and activities in CBI. The OMSE RAE Program will consult with Dr. Keim to explore how we can help residents as educators build on student experience wtih EBDM and medical problem-solving in CBI and assist them in transition to supervised clinical practice in clerkships and selectives. Community based preceptors are an integral part of strengthening these connections as they supervise students in medical practice in local communities where students face a wide variety of patients and medical problems in diverse social contexts. If you would like to know more about EBDM or how to teach students to engage in EBMD during preclinical or clinical years, please contact us. References Keim SM, Howse D, Bracke P, Mendoza K. Promoting evidence based medicine in preclinical medical students via a federated literature search tool. Med Teach. 2008;30(9-10):880-4. PubMed PMID: 18821125; access via EBSCO. Plack, M.M. & Santasier, L.G. (2004). Reflective Practice: A Model for Facilitating Critical Thinking Skills Within an Integrative Case Study Classroom Experience. Journal of Physical Therapy Education, 18(1). Schn, D. (1983). The reflective practitioner: How professionals think in action. NY:Basic Books. [Access at Google Books] Spear-Ellinwood, K.C. (2011). Re-Conceptualizing the Organizing Circumstance of Learning. Dissertation. [Access at UA Campus Repository]. View Video recording of Dr. Keims presentation in the AMES/OMSE FID Series, October 18, 2013. M e d E d / e N e w s [6]

[Continued from page 4|Teaching with Technology]

The next session on December 10, 2013 (8:-0010:00 am, College of Medicine, Room 3116) will address how to use Doceri to control your presentation and free you to walk the lecture hall aisles and engage your students. In January, TWT Series will present Doceri Part 2: Creating presentations for the flipped classroom. The Medical Education Journal Club addressed the flipped classroom in its September meeting (click the Download icon file below to view references from that event). Flipping the classroom calls on learners to be more active in preparing for sessions and increases their accountability (Ferreri & OConnor, 2013) by asking learners to review a short video that captures the essential concepts to be conveyed in the lecture. These short videos can assist learners in understanding required readings and prepare for discussion. Thus, flipping the classroom enacts the reflective engagement pedagogy promoted by Donald Schn (1983), and many others in medical education (e.g., Plack & Santasier, 2005). The idea is to cultivate the learners habit to reflect on concepts before, during and after instructor-directed engagement. As a result, learners more actively participate in their own education (Jain & Farley, 2012), as was shown in UA COM Professor Friedman's Teaching Scholars medical education research project in 2013 (view the poster, Friedman, 2013). Using technology to combine the concept of the flipped classroom with inquiry -based learning through the use of audience response software, such as Poll Everywhere, capitalizes on the anticipated outcomes of both approaches. The UA Arizona Health Sciences Center Office of BioCommunications has experience and expertise in various educational technologies. The Associate Director, Mike Griffith, MS, has demonstrated his eagerness in bringing our instructors into the 21st century in the classroom and at the bedside and will work with faculty one-on-one. Associate Specialist Karen Spear Ellinwood, PhD, JD, EdS, has experience in using and helping to develop learning technologies and is available to assist you in learning how to adapt these technologies to classroom or clinical situations in which you teach. References References and other resources on inquiry-based learning, flipping the classroom and pedagogical concepts mentioned in this article are available by clicking the icon at right.

The Office of Resident Development

Gail Pritchard, PhD
The Office of Resident and Fellow Developments mission is to provide educational support in a structured environment for helping Residents and Fellows achieve their educational goals. The ORD provides individual support for developing:

A curriculum vitae and cover letter An appropriate study schedule for STEP 3, in-Service exams, and specialty boards Communication skillsi.e. Giving/receiving feedback, developing presentation skills Projectsi.e. Efficiently reading and reviewing research articles; synthesizing literature into comprehensive

Gail Pritchard, PhD

Senior Interim Learning Specialist
Offices of Medical Student Education and Graduate Medical Education

reviews; effective preparation for group presentations Strategies for learning content material related to exams Strategies for test-taking The ORD also provides department level support by conducting workshops for residents and fellows that focus on developing learning strategies, test-taking strategies, and organization and time management strategies, and enhancing presentation skills, such as in learning strategies fro improving how to present Grand Rounds. Please contact Dr. Pritchard for more information or to schedule an appointment.

[520.626.2390]

M e d E d / e N e w s [7]

Save the date!

Date/Time
29 October 2013 8:3010:00 am [COM-3230] 15 November 2013 11:30am1:00 pm [COM-3230] 9 December 2013 8:3010:00 am 10 December 2013 [COM3116]

Presentation Title

Presenters

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

FID Series Developing effective educa- Gail Pritchard, PhD tional strategies Lupita Martinez, PhD FID Series Writing effective multiple choice, single best answer exam questions Chris Cunniff, MD Jack Nolte, PhD

FID SeriesSmart apps for clinical medi- Kevin Moynahan, MD cine Mike Griffith, MS TWT SeriesDoceri presentation tool Mike Griffith, MS

RAE
Ask about the RAE program for residents as educators!

Director, Faculty Instructional Development Chris Cunniff, MD Office of Medical Student Education (Comstock House) Em. ccunniff@peds.arizona.edu Ph. 520.626.5173

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

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

rontiers in Biomedical Research Date: Wednesday, October 30, 2013 Time: 1:00 - 3:30 pm Where: AHSC Plaza Description: Faculty, Graduate Students, Postdoctoral fellows, Medical residents and fellows present posters of basic and clinical science research projects, showcasing campus-wide research activities in AHSC and help promote collaborations. Information derived from: Sangita Pawar, PhD, MBA Executive Director Research Affairs COM Research Office

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

MedEd eNews Volume 02 Issue 03 October 2013

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