Medical Education - Recently Updated Pages

The Networked Student

DeirdreB — Fri, 25 Dec 2009 15:36:42 CST

Three ways that schools deal with innovative technologies.

they condemn them (see your local AUP),
they co-opt them to support tried and true methods and curriculum, and, finally,
they marginalize them, creating all of those “tinkering on the edges” initiatives to keep the reform minded happy.

Rethinking Education in the Age of Technology

Workbook

Leadership of Integrated Teams in Virtual Environments
Geographically dispersed integrated project teams collaborating in virtual environments face many challenges in successfully completing projects, particularly if the teams are non-homogeneous.

Medical Networking Sites

Hospitals that use Social Networking Sites

Medical people on twitter

Asklepios The Canadian Medical Association site.

Doc2doc BMJ's approach to connecting doctors worldwide.

DoctorsHangout is an exclusive next generation social networking service for Medical Students, Residents and Doctors.

QuizMD - the open collection of practice exam questions created by and for medical students. Test yourself on what your colleagues deem important, and learn by creating questions to test others. Focus your valuable study time on what really matters: clinical decision making.

DrKtgoes2medschool a video blogger about her med school experience

Within3 is the private professional networking site exclusively for health and life science practitioners to find, connect and collaborate with the right colleague, right now.

New Media Medicine is an online Social Network of over 42,000 doctors, medical students and pre-med students. It's like Facebook for medics!

Ozmosis a new community, currently in private beta, created by physicians for physicians. Members have to be verified during the registration process

Sermo, the fastest - growing community created by physicians, for physicians. Here, physicians aggregate observations from their daily practice and then - rapidly and in large numbers - challenge or corroborate each others opinions, accelerating the emergence of trends and new insights on medications, devices and treatments. You can then apply the collective knowledge to achieve better outcomes for your patients. Caution: This company releases data to pharma companies.

Medical Education Evolution is one is my personal favourite because it's small, very international and about my favourite topic - medical education.

Changemakers is collaborating with the Pioneer Portfolio of the Robert Wood Johnson Foundation to launch a global search for “nudges” – innovative little pushes — that help people make better decisions regarding their own health and the health of others.

Second Life

Second Life needs to be downloaded to your computer. Do not teleport without a basic orientation or your experience will be meaningless!

Webcina Second Life Guide

Second Life Glossary

Second Life Health wiki lists various sites including patient support sites.

Blogs with information about Second Life Medicine

Health Info Island - Funded by the Greater Midwest Region of the National Network/National Library of Medicine (GMR NN/NLM) through a grant written by Lori Bell, of the Alliance Library System, Illinois, librarians at Health Info Island in Second Life explore the provision of consumer health information services in a virtual environment. The island is home to a consumer health library and a medical library, as well as virtual outposts or displays run by the National Library of Medicine's Special Information Services, contractors for the National Institutes of Health (NIH), and our newest building, the Accessibility Center. This center houses another GMR NN/NLM funded project with the aim of encouraging awareness of vision, mobility, learning, and other disabilities. Teleport

Anne Myers Medical Clinic one of the first medical resources in Second Life. Teleport

The Second Health Project was unusual in that it was not explicitly focused on building a presence in the virtual world of Second Life, but rather on using that world to tell a visual story about a unique vision for the near-term future in real life. Along the way, this remarkable effort pushed the limits of avatar creation, animations, machinima, clothing design, modeling — and even traditional building. Teleport

Second Health from Imperial College A health system centred on each patient’s specific ne eds? Join us in the 3D virtual World of Second Life to explore, discuss and shape a shared vision of the future. The Faculty of Medicine at Imperial College London has developed a Virtual Hospital in Second Life that aims to design game-based learning activities for the delivery of virtual patients that can drive experiential, diagnostic, and role-play learning activities supporting patients’ diagnosis, investigation and treatment. Teleport

Monash has purchased a closed-access island (not available to the public) in Second Life, a virtual world, available to staff and students at participating universities. The island has been christened Pharmatopia, and as the name suggests, aims to develop a pharmacy education ‘oasis’.

The Birth Unit what we would like the students to do in the birth unit that meets the learning objectives: Video

demonstrate an understanding of the role of the midwife in the normal childbirth process;
demonstrate effective evidence based, midwifery practice guided by a sound knowledge base.

Teleport

Play2Train is a virtual training space in Second Life designed to support Strategic National Stockpile (SNS), Simple Triage Rapid Transportation (START), Risk Communication and Incident Command System (ICS) Training.

Digi S Lab Biomedicine Research Labs is the island created by Digi S Lab in Second Life to recreate a real bio lab environment

Second Nature These islands are now part of the Elucian Islands archipelago, Nature Publishing Group and Macmillan Publishers's expanded home in the virtual world of Second Life. The islands are home to exhibitions, ongoing projects, regular events on a wide range of topics and state-of-the-art buildings dedicated to the communication of new ideas Teleport

Second Life sites without websites

See Science Rolls List

Genome Island, created by Max Chatnoir and offering a rich virtual environment for teaching and learning about genetic science. Teleport

Heart Murmur Sim auscultation simulation with heart sounds and learning outcomes assessment.

Palomar West Hospital Teleport

Postpartum Hemorrhage site from University of Auckland Teleport

University of Saskatchewan site Teleport

Virtual Hallucination UC Davis site is designed to give participants a virtual experience of schizophrenia. Teleport

Illness Patterns

DeirdreB — Fri, 25 Dec 2009 13:30:42 CST

"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken

"The idea that experts recognize features and patterns that are not noticed by novices is potentially important for improving instruction…One dimension of acquiring greater competence appears to be the increased ability to segment the perceptual field (learning how to see). Research on expertise suggests the importance of providing students with learning experiences that specifically enhance their abilities to recognize meaningful patterns of information.” - How People Learn: Brain, Mind, Experience, and School

One of the primary differences between novice and expert physicians is the number of illness scripts experts have developed over the years. These patterns are similar to algorithms, but more individualized to the expert's experience and personal style. The more experienced the expert, the more shortcuts will be included in the individual's patterns because of automaticity.

Newly graduated doctors have spent most of their time in medical school giving the correct answer to questions, they are very good at "right answers" but this skill can present problems in the clinical setting because this desire to be right frequently leads to premature closure of the differential. You can assist learners in a clinical setting to develop their own differential patterns by asking them to graph common illnesses as they progress through their training and by sharing your differential thinking with residents and interns. Illness scripts have the added advantage of forcing the student to think in terms of a broader differential without the power struggle of arguing about a whether a particular diagnosis is correct.

These graphs can be kept in a binder and added to as the learner increases their knowledge. The final graph will be useful for studying for final exams. Both text-based and visual representations are acceptable depending on the student's personal learning preference. See a list of online tools and the NHS Map of Medicine for examples. For people who like a more concrete approach, check out Google Squared.

Caution: Remember this is not your illness script; it is the student's. It will not contain all the knowledge in your brain, nor will it look like what you draw on the board. This is also a developmental tool which will improve over time and experience.

Example of a text based script	Example of a visual script from Visual Mnemonics

To view other examples, go to MedMaps, a great resources for examples of medical mindmapping.	Here is an example of a simple visual image that might be used by a student to remember basic information about diabetes. As the student increases their knowledge, they would add more information and the image will become more complex. This image is also an example of automaticity because the same image represents key phrases that an expert would use to recall complex knowledge.
Another example of a text based script from Allergy Notes	Cardiovascular disease examples Acute Coronary Syndromes pdf Acute Myocardial Infarction – Complications pdf Acute Pulmonary Oedema pdf Acute Right Ventricular Failure pdf Air Embolism pdf Aortic Dissection pdf Australian Resuscitation Council Guidelines – 2006 changes pdf Blood Supply of the Heart pdf Cardiac Physiology pdf Cardiogenic Pulmonary Oedema pdf Conduction Disturbances pdf Deep Vein Thrombosis pdf Endocarditis pdf Fat Embolism pdf Heart Transplant pdf Indications for Adult Cardiac Surgery pdf Levosimendin pdf Mechanisms of Arrhythmia pdf Myocarditits pdf Pericarditis pdf Peripheral Arterial Disease Emergencies pdf Pulmonary Embolism pdf Pulmonary Hypertension pdf Shock pdf Sudden Cardiac Death pdf Supraventicular Arrhythmias pdf Treatment of Severe Heart Failure pdf Troponin in Critical Illness pdf Valvular Disease Emergencies pdf Wide Complex Arrhythmias pdf Wolff-Parkinson-White Syndrome pdf More examples at http://lifeinthefastlane.com/exams/jficm-fellowship/icu-mind-maps

For More Information:
Examples of Scripts from a medical resident

http://journals.lww.com/academicmedicine/Fulltext/2008/07000/A_Conceptual_Framework_for_the_Use_of_Illness.9.aspx
http://www.ncbi.nlm.nih.gov/pubmed/12028392
http://www.ingentaconnect.com/content/bsc/meded/2007/00000041/00000012/art00009;jsessionid=8sr1nf5kr4brc.alexandra?format=print
http://www.fammed.ouhsc.edu/robhamm/OKJDM2000/Hamm/sld001.htm
http://casemed.case.edu/curricularaffairs/scholars/2002-03Archives/scholars0203/PLtoILLgroups.pdf
http://content.nejm.org/cgi/content/full/355/21/2217
http://www.saem.org/download/kuhn.pdf http://www.cogs.susx.ac.uk/users/bend/doh/reporthtmlnode5.html
http://www.informaworld.com/smpp/content~content=a783763088~db=all

http://en.wikipedia.org/wiki/User:Madhero88/MindMaps

Argument Mapping Tutorial

Mind Maps: Immunomodulators for allergic disorders
Mindmaps - Asthma

Life is Full of Tough Choices: Mindmap or Concept Map?

Concept maps or mind maps? the choice

Online Mapping tools
Exploratree this free tool has a variety of online thinking graphs such as identifying supporting evidence and exploring ideas from different perspectives.
MedMaps is a free tool for creating and sharing illness scripts based on a signs and symptoms, characteristics, differential, complications, management formula.

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Thinking like a Physician

DeirdreB — Fri, 25 Dec 2009 10:27:40 CST

Many of the daily problems of practice act as opportunities for learning;

spending time to reflect on these moments can lead to informed and intentional changes to practice.

Regehr and Mylopoulos, 2008

The good physician treats the disease; the great physician treats the patient who has the disease.

Sir William Osler

A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves.

Herbie Hancock

Underlying all of the following techniques is the need to actively engage student's minds, hearts and bodies in the learning process. The most useful clinical teaching techniques in medicine that help students develop their clinical reasoning skills are:

Using Questions to Stimulate Thinking Picking questions that match the level of thinking you expect from students and residents is an important skill for medical faculty. Discovery Based Learning is a Socratic technique of using questions to help students make connections/learn patterns.

Teaching Issues of Diversity When Diagnosing and Treating Patients - A Podcast.

Bedside Teaching This module covers several aspects of hospital-based teaching.And another that uses BEDSIDE as a Mnemonic.

Intentional Role Modeling Demonstrating how you think about a patient issue, helps students understand the process.

SNAPPS SNAPPS is a case presentation method that, when taught to students and junior residents, helps them be more self directed. Adding the NHS Evidence Search tool makes this more interesting.

Precepting Using Microskills Also known as the 1 minute preceptor, this technique is very useful for evaluating how students are making decisions about a diagnosis. For a shorter version or to watch a video of this technique, go to Practical Prof.

Chart Stimulated Recall This is a technique primarily for use with senior residents who work fairly independently, but may also be used to teach charting skills with junior residents.

Clinical Decision Analysis is the application of explicit, quantitative methods to analyze decisions under conditions of uncertainty. Decision analysis allows clinicians to compare the expected consequences of pursuing different strategies.

Illness Scripts Expert physicians have thousands of illness patterns stored in their memory. This technique will help students and residents develop their own patterns.

Ambulatory Teaching of Clerks/Jursi's - a presentation by Dr. Gill White. A podcast is available here.

Preparing Clinical Vignettes The American College of Physicians preparation checklist

MicroteachingA quick technique for teaching in a classroom type situation

Feedback We usually think of feedback as an end result of teaching, but it can also be used as part of the learning process.

Teaching Clinical Observation Skills

How To Help Students See When Their Knowledge is Superficial or Incomplete

Narrative Medicine
Developing narrative competence in medical students In this educational case study from BMJ Learning, L. Younie describes how one student used words and painting to produce a creative interpretation and representation of an encounter with a patient.
Stories we hear and stories we tell: analyzing talk in clinical practice BMJ Article
An extraordinary moment CFP Article

Other Resources

Critical Thinking Video

The top 5 OSCE medical student mistakes for Clinical History and Examination

CanMeds START

The Health Advocate Role: A Practical Plan for Teaching and Assessment from CanMeds
.
Confidentiality A BMJ learning Module

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Active Engagement

DeirdreB — Tue, 22 Dec 2009 14:46:11 CST

Even when, to both teachers and students, lecturing appears to be working, (students intently listening, nodding heads, taking notes), what’s going on in the minds of students probably looks a lot like what would be going on on the boat full of my friends – distraction, lack of interest, and only a vague recollection of what was said. Even though it can appear that lecture-based, PowerPoint-driven learning is effective, it rarely is, and is almost never as effective a use of time as the learning-by-doing approach that could be done in its stead.

- Roger Schank

Ideal teachers are those who use themselves as bridges over which they invite their students to cross,
then having facilitated their crossing, joyfully collapse, encouraging them to create bridges of their own.

- Nikos Kazantzakis

Students need to be actively involved mentally and/or physically in learning in order to move through the Learning Cycle. Out of every 100 items in a passive lecture, students will remember approximately 10. If you took the same amount of time to actively involve students, you might only cover 75 items, but students would remember approximately 15, also those 15 items are more likely to be linked storage that can be retrieved more effectively in the future. Listen to a podcast about this topic.

Think about the goal of teaching; is the goal for you to transmit information or is the goal students remembering/understanding information? If you believe it is transmission, how do you know that what you say is learned?

The following slide show contains examples of active engagement in large medical classrooms. Click on individual images for an explanation of which technique is being used.

Self Directed Learning

DeirdreB — Tue, 22 Dec 2009 14:38:04 CST

"Education would be so much more effective if its purpose were to ensure that by the time they leave school every boy and girl should know how much they don't know, and be imbued with a lifelong desire to know it."

-- Sir William Haley

Medicine requires a constant interest in keeping up to date with new methods, research and technology, so students need to develop skills in reflecting on what they need to learn and where to look for information.

Before beginning, you might want to read:

What is Critical Appraisal? - Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context.
What is Evidence Based Medicine Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.
Evidence Based Medicine: what it is and what it isn't- an editorial from the British Medical Journal
Using Wikis and Peer Evaluation to Teach Medical Students How to Find and Assess Evidence Based Resources: A Pilot Study .

cc licensed flickr photo shared by Will Lion

If you only have time to check one website, then check out PeRSSonalized Medicine, one of the most brilliant attempts at medical aggregating I've seen to date.

What Are Your Patients Reading?

Here are some resources that will help with that process

Librarian Recommendations

The National Library for Health's Clinical Knowledge Summaries are a reliable source of evidence-based information and practical ‘know how’ about the common conditions managed in primary and first-contact care.

Emedicine from WebMD has 65,000 articles searchable by specialty and topic.

DynaMed is a medical information database with nearly 3,000 clinical topic summaries. Designed for use at the point-of-care, providing best available evidence and updated daily.

First Consult is an authoritative evidence-based and continuously updated clinical information resource for healthcare professionals. Designed for use at point of care, it provides instant, user-friendly access to the latest information on evaluation, diagnosis, clinical management, prognosis, and prevention.

health-evidence.ca aims to support evidence-informed decision making in public health by providing current research evidence in a searchable online registry. Findings of a research project funded by the Canadian Institutes of Health Research, demonstrated a need for a reliable source of review evidence that public health practitioners and decision-makers could easily access and employ.

The Journal of the International Association of Medical Science Educators (JIAMSE) is the redesigned, peer-reviewed publication of the International Association of Medical Science Educators and represents a natural evolution from the former Basic Science Educator.

MEDLINE is the National Library of Medicine's premier bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.

MedlinePlus will direct you to information to help answer patient's health questions. MedlinePlus brings together authoritative information from NLM, the National Institutes of Health (NIH), and other government agencies and health-related organizations.

PubMed, available via the NCBI Entrez retrieval system, was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM), located at the U.S. National Institutes of Health (NIH).

UpToDate, which is available through the Web, desktop, and PDA, combines the best evidence with the experience of expert physicians around the world. Preferred in a study of Australian doctors.

Medical Education Resources

Association of American Medical Colleges (AAMC) developed and launched MedEdPORTAL as a free publishing venue and dissemination portal to support educators and learners as they create and use on-line teaching materials, assessment tools and faculty development resources.

British Medical Journal Learning offers a variety of learning modules including one on Confidentiality and another on Consent.

Epocretes Online organizes practical, peer-reviewed content with a unique patient-centered approach, providing you with answers, not more questions. Famous for drug information on your PDA.

Essential Evidence

The Health Education Assets Library (HEAL) is a digital library that provides freely accessible digital teaching resources of the highest quality that meet the needs of today's health sciences educators and learners.

Human Embryology Animations The animations on this site from the Indiana University were developed so students could better understand the complex processes that must occur in embryologic development.

Journal of Medical Internet Research sponsor of the yearly Medicine 2.0 conference in Toronto.

MedicalStudent.com: A digital library of authoritative medical information for the medical student and all students of medicine

*** The goal of The Medpedia Project is to collaboratively build the living encyclopedia of health, medicine, and the body, only MD's and PhD's are allowed to edit the entries.

MedTing where you can customize cases and resources for use by your university.

Meducation is a site that provide videos, podcasts, powerpoints, revision notes, exam questions and more, all targeted at medical education. All the content is user submitted and we have a thriving community.

PocketSnips from Northern Ontario School of Medicine provides high-quality educational materials that will benefit a variety of learners and be accessible to Personal Digital Assistants (PDAs). Specifically targeted are the learning needs of medical students and residents, nursing students, and other allied health professionals.

Podmedics.com is a new website, and podcast developer, run by a group of junior doctors and medical students. All our podcasts are aimed specifically at medical students, and outline key principles and concepts.

Swansea Radiology This site aims to provide easy access to a radiology resource which includes a ‘case of the week’, tutorials for medical students, a film library and mock exam cases for radiology registrars.

Interactive Clinical Pharmacology has been designed to increase understanding of important and sometimes difficult concepts and principles in Clinical Pharmacology. It is not intended to be comprehensive for all aspects of Clinical Pharmacology teaching.

University of Maryland Medical Centre videos on numerous medical topics from robotic laparoscopy to patient success stories.

Other Sources

*** recommended, other sites may not be familiar to me. Please write a review in the discussion area.

AskDrWiki.com originally from the Cleveland Clinic, where you can publish your review articles, clinical notes, pearls, and medical images on the site. Using a wiki anyone with a medical background can contribute or edit medical articles.

The Australian e-Health Research Centre, a joint venture between CSIRO and the Queensland Government, is a leading national research facility in ICT for healthcare innovations.

***British Medical Journal Learning offers several options for self study including regularly emailed articles. You do need a subscription to the magazine.

Cases Journal is a rapidly peer-reviewed, open access journal publishing case reports from any area of healthcare

*** Clinical Cases and Images, another website from the Cleveland Clinic, this site has cases and procedure guides.

The Creative MD is a showcase of artwork by medical students, physicians and surgeons around the world because its not just about facts.

***DiagnosisPro - Covering over 15,000 disease manifestations such as symptoms, labs, ECG, X-ray, CT-Scan, MRI, Ultrasound, pathology, microbiology results and more.

The Doctor’s Channel is a Web site that allows doctors to learn from each other at their convenience. The time-saving site includes short one- to two-minute streaming video clips designed to get to the point, with insights and opinions from experts in 35 different specialties, as well as community and lifestyle features that help doctors stay on top of the latest news, ideas and information.

The eHealth International Journal provides a peer-reviewed vehicle for timely publication of scientific research on the application of information technology in medicine, medical care delivery, and public health.

EKG/ECG Reading and Interpretation is an educational web site by Dr. Dale Dubin (Dale Dubin, M.D.), which includes important EKG (ECG) information about EKG tracings, 12 lead EKG's, and cardiac monitors.

eMedTV offers over 100 health channels, each serving as a portal to an extensive library of medical information. Our articles explore subjects ranging from symptoms and diseases to tests and procedures to drugs and supplements. Each topic contains a series of articles carefully designed to answer your questions and provide detailed health information. Links to related articles are found on each page, streamlining your search for the exact medical information you need.

e-meducation Teaching Cases from the AIBS institute in Greece

Free Medical Lectures -videos

Global RPH is a guide to drug therapy for clinicians.

Every 24 hours, MDLinx scans 1200 leading journals across 30 medical specialties and professions and summarizes and filters the articles so you'll see just what is important in your areas of interest.

MedTing where you can customize cases and resources for use by your university.

The Medi-Vision™ Film Series aims to teach good clinical practice through expert case demonstrations on film; second to patient-side experience, we think this is the best way to become a better doctor. We keep the focus of our DVDs on observation, interaction and assessment skills and especially on history-taking, physical signs and the appropriate use of tests. They have some excellent examination DVDs for sale.

POM1 from the University of Virginia has links to instructional modules and videos demonstrating physical exam techniques.

*** The Rx for Change database summarizes current research evidence about the effects of strategies to improve drug prescribing practice and drug use. This database houses summaries of key findings from systematic reviews that evaluate the effects of strategies targeting professionals, the organization of health care, and consumers.

*** Top Medical Podcasts: Medicine and Health Audio and Videos - multi-discipline, multi site list.

*** TripAnswers is a collection of interactive clinical Q&As from around the World. Check out his tagcloud of Clinical Uncertainty. Answers is part of the larger Trip Database, which allows health professionals to easily find the highest-quality material available on the web - to help support evidence based practice. There are 90,000 images at the site.

QuizMD has 1000 questions thanks to all of its hardworking contributors.

UK Ehealth site

UpToDate, which is available through the Web, desktop, and PDA, combines the best evidence with the experience of expert physicians around the world. Whenever you have a clinical question, you can tap into the collective wisdom and experience of our faculty of more than 4,000 leading clinicians.

VideoMD was created by physicians, for physicians and their patients. Our mission is to strengthen the relationship between doctors and their patients. Using contemporary technology to help physicians fully educate patients on their specific healthcare concerns, the bond between doctor and patient will be changed forever.

Virtual Mentors is the American Medical Association's online ethics journal. The journal is open-access and advertisement-free—we strongly believe that ethics education for physicians and physicians-to-be is in the public's interest and should be made available without charge. Founded in 1999, Virtual Mentor (VM) explores the ethical issues and challenges that students, residents, and other physicians are likely to confront in their training and daily practice. For this reason, the journal is a valuable teaching resource for medical educators at all levels as well as for doctors and doctors-to-be. Each monthly issue of VM contains original articles and commentary on a given theme-e.g., access to care; quality-of-life considerations in clinical decision making, public roles of physicians, ethical issues in endocrinology, conflict of values in the clinic.

WebMed Technology are very proud to introduce these videos as an aid to anyone that may need to refresh their knowledge in these particular areas. Procedural videos include Chest Tube Insertion and Lumbar Punctures.

Wellcome Library Collections of books, manuscripts, archives, films and pictures on the history of medicine from the earliest times to the present day.

wePapers is a free social knowledge sharing web application which allows college & university students and lecturers to share their papers, notes and other materials, ask each-other questions and more. It is in 12 languages and hopes to be the world's largest study group.

Discipline Specific

Anatomy Lab Zoom, dissect rotate on your iPhone

American Family Physician, the refereed magazine of The American Academy of Family Physicians is one of the largest American medical organizations, representing more than 94,000 family physicians, family medicine residents, and medical students.

Canadian Family Physician (CFP) is a peer reviewed medical journal dedicated to serving Canadian family physicians and advancing the specialty of family medicine worldwide.

Family Medicine Digital Resource Library contains user-posted conference presentations and handouts, and shared curricular materials such as PowerPoint lectures, learning modules, syllabi, digital images, video and audio recordings, recommended Web sites and more.

Talking With Your Older Patient: A Clinician’s Handbook Learning effective communication techniques—and using them—may help you build more satisfying relationships with older patients and become even more skilled at managing their care.

DermAtlas 11, 000 images

Dermatology Atlas Loyola University Dermatology Medical Education Website

Dermis images

Beautiful Cervix source for images of the cervix throughout the monthly cycle.

Clinical Guidelines for Obstetrical Providers from the Harvard Medical insurance providers.

Global Library of Women's Health A major not-for-profit initiative to provide medical professionals worldwide with free and universal access to a vast and constantly updated, peer-reviewed resource of clinical information and guidance. Most of the chapters listed in the main contents on this site were originally published in the 6-volume textbook, Obstetrics and Gynecology, edited by Professor John Sciarra in 2004.

Mnemonics in Obstetrics & Gynaecology Primarily for MRCOG exam.

Pathology Library This popular web resource includes over 1900 images along with text, tutorials, laboratory exercises, and examination items for self-assessment that demonstrate gross and microscopic pathological findings associated with human disease conditions.

PEIR (Pathology Education Instructional Resource) has a large image bank and is a resource developed under the supervision of Dr. Peter Anderson of the University of Alabama at Birmingham.

PediatricEducation.org is a Pediatric Digital Library and Learning Collaboratory intended to serve as a source of continuing pediatric education. It is edited by two faculty at the University of Iowa.

PedsCases from the University of Alberta is a comprehensive database of pediatric cases and pediatric questions. With the aid of staff pediatricians, this site will serve as a tool to assess your knowledge in multi-step clinical scenarios and various recall questions.

Interactive Clinical Pharmacology The site has been designed to increase understanding of important and sometimes difficult concepts and principles in Clinical Pharmacology. It is not intended to be comprehensive for all aspects of Clinical Pharmacology teaching. It has been developed using Macromedia Flash to enable user interaction.

ARRS GoldMiner® provides instant access to 234,187 radiological images published in 262 selected peer-reviewed journals. You can search by findings, anatomy, imaging technique, and patient age and sex.

Welcome to Radiopaedia.org, a collaborative radiology resource.

List of radiology resources

Radiology wiki The free medical imaging resource created by the radiology community.

ORLive a large collection of surgery videos and other resources.

SurgyTec describes themselves as your online community for surgical and invasive procedures.

Wikisurgery is collaboratively building the most comprehensive and trusted free surgical encyclopaedia. With over 1,300 articles for surgeons and patients, including news, articles, operation scripts, biographies and images.

Top 50 Surgery Blogs

Wikiecho is a project to create a free, up-to-date and reliable online resource covering the rapidly advancing field of echocardiography .

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Early Clinical Contact Projects

DeirdreB — Thu, 17 Dec 2009 12:08:01 CST

There is no abstract available for this page revision.

Hidden Curriculum

DeirdreB — Mon, 14 Dec 2009 17:07:55 CST

Within every learning encounter, there is an explicit curriculum that students are marked on and an implicit curriculum that students are never told about directly, although they may find themselves judged in other ways because of it. Frequently this hidden curriculum revolves around how the instructor expects students to behave or think.

Unintentional Role Modelling
Students closely watch us for cues about both our professional and personal preferences. Sometimes faculty role model behaviours they would never want students to emulate such as mistreatment of staff, prejudice against or neglect of certain types of patients, backstabbing of colleagues or disrespect for certain types of students.

Intentional Role Modelling
It is very important that you think about how you are going to role model how medical faculty think through problems and behave professionally.

Positive Feedback
If you want students to develop the habits of heart and mind of physicians, you need to let them know when they are performing well and give them opportunities to change their behaviour or correct mistakes. Listen to a podcast about the hidden curriculum.

For further reading:

The hidden curriculum in undergraduate medical education

Rewriting the hidden curriculum: Keeping empathy alive

Uncovering the Hidden Medical Curriculum through a Pedagogy of Discomfort

Study - The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School
In addition, modern medical education promotes physicians' emotional detachment, affective distance, and clinical neutrality as emphasized through a focus on the science of medicine and a benign neglect of the art of patient care.

Cultivating Empathy for the Mentally Ill Using Simulated Auditory Hallucinations These results suggest that empathy may increase when students are given a brief glimpse into the mind of a mentally ill patient by listening to simulated auditory hallucinations. Specific interventions to increase empathy for the mentally ill can lead to a better understanding of how empathy can improve patient care, enhance the doctor-patient relationship, and direct future educational strategies.

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Feedback

DeirdreB — Mon, 14 Dec 2009 15:51:38 CST

"The single biggest problem in communication is the illusion that it has taken place." George Bernard Shaw. Under Construction

T imely
H elpful
A ppropriate
N ever labelling, demoralizing, shouted
C ollaborative and culturally sensitive
S pecific

Watch a great video from the University of Wisconsin.

Resources

Why Rewards and Punishment Don't Increase Learning
Encouragement: Giving “Heart” to Our Learners in a Competency-based Education Model. Retrieved Feb., 2009

Feedback: An Educational Monograph For Community-Based Teachers. Retrieved Dec., 2008

How To Deliver Constructive Feedback in an Interculturally Sensitive Manner. Retrieved Dec., 2008
Feedback to Promote Student Learning Retrieved Apr., 2009

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Acting Like a Physician

DeirdreB — Wed, 09 Dec 2009 13:06:52 CST

Doctors lack confidence in their procedural skills after completing the current NHS postgraduate training curriculum. A survey of 181 doctors, published in the open access journal
BMC Medical Education, has shown that
from ten of the procedures
medics are officially required to be competent at,
most are only confident of their ability to perform five.

Graeme Baldwin

The following are used to teach learners the habits and behaviours of physicians in your specialty:

5 Step Approach to Teaching Patient-Centered Skills/Procedures

Video Library of Clinical Communication Skills University of Texas, M.D.Anderson Cancer Centre's videos of doctor-patient communication skills.

Teaching procedures and skills with Mannequins

Just Like the First Time

Physical Exam Module from the University of Virginia

Intentional Role Modeling (Observation and Shadowing by learners)

Clinical Supervision (Observation, supervision and assessment of learners)

Teaching in the Operating Room (Under construction)

Teamwork
This is linked to the BMJ module Team working: a user's guide

Feedback
We usually think of feedback as an end result of teaching, but it can also be used as part of the learning process.

Assessing Communication Skills in Residency from CanMeds

An evidence-based approach to getting dressed How resident clothing affects patients, colleagues, success

Resources:

Maintaining Competence in the Field: Learning About Practice, Through Practice, in Practice This paper explores a likely source for the learning that allows practitioners to engage in their own continuing professional development: the process of learning from their personal experiences of solving problems in their daily practice.

Online learning in clinical skills: the Belfast experience Students supplement their training by using the online facilities in a blended approach. At the tap of a key, students have the opportunity to access a diverse range of learning materials. Not only can clinical teachers give feedback, they can also contribute to the resource, for others to share. The online facility helps us to strengthen links and relationships with our NHS teaching colleagues.

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What Are Your Patients Reading

DeirdreB — Thu, 03 Dec 2009 09:37:34 CST

Higher Order Thinking

DeirdreB — Thu, 19 Nov 2009 16:05:40 CST

Goal of Learning: "2. Thinking activities that construe, modify and use this knowledge to interpret situations in that domain."

"It's possible to go to the best schools in the world, and emerge incapable of thought" - Jamie Mackenzie

"If it were not for the great variability among individuals, medicine might as well be a science and not an art."
Sir William Osler, 1892

Just because they remember, doesn't mean they understand.

Read Why students think they understand when they don't.

Read What Are the Seven Reading Comprehension Strategies?

In ideal cases, the two elements of learning (1. Remembering and 2. Higher Order Thinking) occur in the same setting and students use knowledge stored in memory as a foundation for higher order thinking (critical thinking, problem solving and creative thinking.) Higher order thinking is a key requirement for Backward Thinking, one of the clinical reasoning processes.

The best ways to teach students to think more deeply about a topic are:

1. Ask higher order, open ended questions

2. Assist students to create their own pattern knowledge about how content relates to other content instead of memorizing your patterns

3. Make your thinking explicit by demonstrating how you would think through a difficult case (Intentional Role Modeling)

4. Use techniques such as group problem solving, structured controversy, case-based reasoning (integrated case learning), precepting using microskills, chart stimulated recall and discovery-based learning

5. Shake them up (cognitive dissonance).

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The Medical Education Moderator

DeirdreB — Tue, 17 Nov 2009 10:28:06 CST

Welcome!

I am Deirdre Bonnycastle, the clinical teaching development coordinator at the College of Medicine, University of Saskatchewan. I have been using computers in my teaching for 30 years and am a strong advocate of "Just in Time" resources, so I created this site. I am hoping it will be an "Everything you want to know about teaching in a medical school" resource with contributions from all over the world. Please feel free to send me messages or critique the site using the discussion board.

Using Questions to Stimulate Thinking

DeirdreB — Sat, 14 Nov 2009 12:26:52 CST

Most of the clinical teaching methods suggested require fairly sophisticated questioning techniques. Good questions actively engage the students brain, increase attention and are an important method for helping students recall, and reorganize information. To ease students into this technique, you might start by saying " The first question I would ask myself is ...", thereby, intentionally role modeling your thinking process.

The following table will help you select question stems according to the level of objective you wish to achieve. The further down the list, the more complex the level of thinking required. To watch a video about questioning techniques in medicine, see The Practical Prof.

To read an example of using questions, see Discovery Based Learning.

Level of Objective	Question Stem
Organizing Arranging Information	What conclusions have you reached about...? In your own words...? How else might you...? Show how...? How would you compare ... to ...? Why did .... cause...?
Applying Demonstrating prior knowledge within a new situation	What evidence is there that ...? In what ways might ...? Give some instances of ...? What would result if ...? Compare...? Contrast...? Where else might you use...?
Analysing Examining parts and relationships	What are the functions of...? What is the motive of ...? How would you classify..? What justifies...? What inference are you making about..? What assumptions are you making? How is this different from...?
Integrating Connecting and combining information	How many ways can you think of to...? What would the result be if...? What treatment plan would you suggest? What would you do if...? What if...?
Evaluating Assessing quality or reasonableness	Should ____ be permitted to...? Evaluate whether you would do ... or ...? Was it right or wrong for ...? Explain? What is the most important ...? Why? Which of the following...? How effective was...? Which of the following...?
Generating Producing new information, meaning, ideas	If you had been ..., what would you have done differently? How many ways can you think of to...? What would happen if...? How would you improve...? What changes would you make ...? How does .... see this problem?

Question Do Nots

Questions at this level are about helping learners to improve clinical reasoning skills, not about assessing who is the best resident.

Don't ask people to read your mind.
Don't ask a junior student to answer after a senior resident has been incorrect.
Don't ask impossible questions in front of the patient because you want to show learners how little they know.
Don't use questions to humiliate anyone including patients and house staff; students will avoid answering questions or develop bullying techniques themselves.
Don't use questions to reward your favourite student; it destroys teamwork and encourages destructive competition.
Don't ask questions to show how intelligent you are.

Resources
Teaching on the run tips 7: effective use of questions

Thinker's keys

The thinker's keys are a range of question starters developed by Tony Ryan in 1990. They are designed to engage and motivate students in divergent thinking activities and provide a framework for teachers when developing units of work. The thinkers keys include:

the reverse – name 10 things you cannot eat
the what if? – what if the sun stopped shining?
the alphabet – compile a list of words on a topic from A to Z
the BAR – make an item bigger, add something to it, replace something on it
the combination – list the attributes of two dissimilar objects. Combine all the attributes to make a single object
the disadvantages – choose an item and list all of its disadvantages
the different uses – find 10 uses for empty plastic yoghurt containers
the prediction – predict what children will be like in 10 years
the picture – draw a simple diagram and students work out how to link it to the topic
the ridiculous – make a ridiculous comment that would be impossible to implement and then attempt to substantiate it.

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Objectives

DeirdreB — Wed, 07 Oct 2009 11:01:05 CDT

Given that learning is the central purpose of teaching, student-centered objectives are the foundation of educational planning because of the following:

You use the objectives to plan the learning activities students will engage in to facilitate their learning.
The objectives tell you how the student should be assessed.
Students use objectives to plan how and what they will study.

Review
How do Outcomes/Competencies Become Objectives?

Writing Objectives
In order to be useful, objectives need to meet the following criteria:

Student Centered

Measurable

Achievable

Relevant

Timely

They must be STUDENT-CENTERED. The objectives must express what the student will be able to do once the instruction is concluded (Students will be able to identify symptoms of endocarditis.), not what the instructor will do or hopes to do (I will talk about endocarditis.), and not what the student will do to learn the material (Students will complete a case report on endocarditis.)

Objectives need to be plainly MEASURABLE in some written, oral, OSCE, or direct format. If they are not measurable, there will usually be widespread disagreement about whether the student has achieved the objective. That is why you never use the verb understand or know; they can never be measured because they can’t be directly observed. They are thinking processes, not actions and can only be judged based on assumptions about what is going on in the student’s head.

The learning expected of the student must also be ACHIEVABLE under the constraints of time and place. There are few things more frustrating and demotivating than an objective that student cannot possibly meet.

The objectives need also be RELEVANT; they must pertain to the course and the overall goals of the students and the program.

The objectives need to be TIMELY; in other words they need to fit with the flow of content for that semester. Pre-requisites should have been taught recently and classes attended later need to reinforce the material.

Answering the following questions will help you to write objectives:

What do I expect the student to be able to do as a result of my instruction?
How will the student demonstrate that he/she has learned?

Examples of medical objectives: (Notice the highlighted verb that states what the student will be able to do)

Upon completion of this unit, the student will be able to describe the mechanisms of action, the pharmacological effects, the therapeutic actions, and the adverse effects of lithium.
Provided with the necessary equipment, the student will be able to intubate a patient with minimum discomfort to the patient.

Resources

For more information about writing objectives, see http://www.medicine.usask.ca/cbf/JITR/Cycles/objectives or the TIPS manual.

For a great image of how online tools support different levels of objectives, see Visual Bloom's or Digital Bloom's Taxonom y.

To see a unique tool for linking objectives and content see the Differentiator.

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Remembering

DeirdreB — Fri, 02 Oct 2009 14:47:21 CDT

The Knowledge that Represents Phenomena in the Subject Domain

Just because you told them, doesn't mean they remember

"Never memorize anything that you can look up." - Einstein

Learning medicine requires the memorization of a tremendous amount of facts, theories, skills, etc. Remembering is a key requirement for the most common type of clinical reasoning, Forward Thinking.

It’s only when your memory is engaged in the learning process that your brain is really challenged - Dr. Michael Merzenich

So let's examine how memory works. We remember because of the way information is stored and because of the way it is accessed. We need to help students store information, so it can be accessed in the long term.

Watch the TED Talk by Tom Wujec about how the brain works.

Passive vs Active Learning
Ask yourself, "What is the goal of teaching?" Studies have shown that students who passively sit and listen to lectures remember about 10% at the end of the lecture, whereas students who are actively engaged mentally and physically will remember about 40%. So if they passively listen to you lecturing about 100 items, they will remember 10. If you engage them with 50 things, they will remember 20. Yes, you taught less but they remembered more.

Recognition vs Knowing
Recognition is not understanding; it is the first step on the journey. In the Cycle of Learning, recognizing that you have heard this before is part of the transition between Unconscious and Conscious Incompetence. This is one of the issues with multiple choice questions; students use their recognition of words to make decisions that they really don't understand.

The Content Jungle
Listen to a podcast about this important concept.

Working Memory
In order to store information in long term memory, the student has to actively manipulate it in working memory in some way. In order to manipulate it, they have to be paying attention. The human attention span lasts about 15 minutes and that decreases if students are fatigued, hungry or distracted with personal issues. Think of your voice as a hypnotic agent, the students look like they are paying attention but they won't remember the experience. As a teacher, you need to do something every 15 minutes to refocus attention:

Pausing allows students to reflect and move what they have been hearing from working into short term memory
Asking for questions refocuses attention even if no one responds
Changing topics
Changing focus by introducing a case, telling a story, making them laugh
Involving the students in a short activity such as a quiz, demonstration or game.

Working memory has a limited capacity, so divide your content into chunks of about 7 or fewer items. Allow students to process the 7 items by actively engaging them through questions, group activities, memory devices (see linked storage below). Then you can present 7 more items.

Random Storage:
Many students make the mistake of memorizing what they need to know as discreet facts. They stuff as much information into their memory as they can. They use techniques such as cue cards to remember long enough to write an exam; then cram in more discreet information. I call this bulimic learning because, although they are stuffing themselves, they lack real knowledge.

Most of this information will be lost over the long term because the student doesn't remember where they stored it.

Linked Storage (Long Term Storage):
Information that is linked to something else is easier to memorize and easier to retrieve later because the links connect memories together. If you remember one link, it will be easier to retrieve other links. The most common links are:

Relevance to the daily activity of physicians. See Illness Scripts for an example of making this link.
Patterns such as numbers, mnemonics, songs, more songs, algorithms and humour that assist in serial recall
Closed questions that link previously learned material to new material
Images that hold a symbolic or emotional meaning for the learner
Questions used as advanced organizers for focusing attention during pre-reading that assist in cued recall.

This illustration is based on my 50 year old memory of learning the Great Lakes in Grade 3:

Huron,
Ontario,
Michigan,
Erie,
Superior.
I would not have remembered them this long without this device.

Spacing Effect
Storage needs to be reinforced over time, so it's important to reinforce links between previously learned and new material as well as reviewing the material. PowerPoint Games and student response clickers can be used for this type of activity. Application exercises (working through real or virtual cases, especially in peer groups) are the best ways of reviewing and reinforcing previously learned material. Other ideas for using remembered information to complete more complex thinking tasks are available here. Anki is a website based on this concept that helps students set-up flashcards where content is reviewed at set intervals.

image from www.wired.com/medtech/health/ma gazine/16-05/ff_wozniak?cu...
based on the work of Piotr Wozniak

Something to Think About

Now, information becomes obsolete quickly—and because it’s always retrievable at the click of a mouse, a well-educated person is not necessarily one who stores great amounts of knowledge, but rather one who knows where to find what he needs when he needs it.- Don Tapscott in Growing Up Digital

Resources

Why One Way Of Learning Is Better Than Another A new study from the Montreal Neurological Institute and Hospital (The Neuro) of McGill University reveals that different patterns of training and learning lead to different types of memory formation. The significance of the study, published in the Journal of Neuroscience, is that it identifies the molecular differences between spaced training (distributed over time) and massed training (at very short intervals), shedding light on brain function and guiding learning and training principles.

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Deliberately Practicing

DeirdreB — Mon, 21 Sep 2009 17:08:53 CDT

Physicians who deliberately practice the art and skill of medicine are more likely to achieve excellence.

Guest et al concluded that teaching deliberate practice means providing learners with opportunities to:

1. Address problems in medicine at the upper level of their ability

Suggestions:
• Take an educational history
• Plan appropriate challenging patients at least once a week
• Suggest an independent learning project of interest to the student

2. Develop a livelong habit of self monitoring (seek out blind spots)

Suggestions:
Assist students to identify their strengths
Provide students with opportunities to identify and correct mistakes in a safe environment
Reflective Learning
Significant Event Audit http://www.projects.ex.ac.uk/sigevent/
One Minute Preceptor http://www.practicalprof.ab.ca/teaching_nuts_bolts/one_minute_preceptor.html

3. Repeat tasks to improve performance

Suggestions:
• Guide through multiple cases
• Skills and knowledge increase with repetition to the point where you are unconsciously competent (automatic)
• Key is timely feedback to prevent mistakes that might result in becoming unconsciously incompetent.

Here are some articles about deliberate practice:

The Role of Deliberate Practice in the Acquisition of Expert Performance
The definitive article from K.A. Ericsson who initially proposed the concept although not specifically medical

The Effects of Deliberate Practice in Undergraduate Medical Education
The present study investigated the relationship between several aspects of deliberate practice and study achievements among undergraduate medical students

The Rigorous Application of Deliberate Practice Methods in Skills Courses
Prepared for: UCLA/IALS Sixth International Clinical Conference Enriching Clinical Education

Clinical Skills Training – practice makes perfect Research in instructional science demonstrates that the acquisition and maintenance of skills expertise in clinical medicine depend upon the learner’s engagement in deliberate practice of desired educational outcomes

The Lifelong Challenge of Expertise
The development and maintenance of expertise requires extensive time dedicated specifically to the improvement of skills, an activity termed deliberate practise

Developing Clinical Reasoning: The role of deliberate practice, reflection and analogical mapping
Research indicated that practice, reflection, and cognitive processes are necessary for effective clinical reasoning ability but do not adequately answer the question of how they are related

The Structure of Reflective Practice in Medicine The capability to reflect consciously upon one’s professional practice is generally considered important for the development of expertise and, hence, for education

Deliberate Practice and CPD in Psychiatry
This editorial outlines the philosophy of deliberate practice and potential difficulties in making use of it in psychiatry

Mastery Learning Of Advanced Cardiac Life Support Skills
Our objective was to use a medical simulator to assess PGY-2 medical residents' baseline proficiency in six ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards

Mastery Learning of Thoracentesis Skills
Our aim was to use a thoracentesis simulation to assess graduating residents' proficiency in thoracentesis procedural skills and to evaluate the impact of an educational intervention on skill development to mastery standards.

Reflection, perception and the acquisition of wisdom Medical Education 2008

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Clinical Assessment

DeirdreB — Mon, 21 Sep 2009 14:45:21 CDT

The following are some popular clinical assessment techniques that you might like to know more about. Because assessment strategies vary from dept. to dept., please refer to your home institute for guidance on which method is most relevant to your situation.

The ACGME Outcomes Project

Direct Observation Field Notes

Continuity-Structured Clinical Observations (CSCO):The continuity-structured clinical observation tool was developed and used to conduct a multiple-observer evaluation to assess residents in the core competency areas of patient care, interpersonal and communication skills, and professionalism Part 1 and Part 2. Read more here.

The RIME method was developed by Dr Pangaro and compares students on a Reporter, Interpreter, Manager and Educator continuum.

Use of assessment to reinforce patient safety as a habit This paper focuses on the constructive use of assessment to embed a pervasive and proactive culture of patient safety into practice, starting with the trainee and extending out into the practice years. This strategy is based on the adage that "assessment drives curriculum" and proposes a series of new assessment tools to be added to all phases of the training-practice continuum.

Doctors' perceptions of why 360-degree feedback does (not) work: a qualitative study

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Intentional Role Modelling

DeirdreB — Mon, 21 Sep 2009 13:42:09 CDT

Setting an example is not the main means of influencing another, it is the only means. -Albert Einstein The authority of those who teach is often an obstacle to those who want to learn. -Cicero

Setting an example is not the main means of influencing another, it is the only means. -Albert Einstein

The authority of those who teach is often an obstacle to those who want to learn. -Cicero

There are three key roles of clinical teachers:

Intentionally Role Modeling
Teaching students to think and act like physicians
Supervising student development in a safe working environment.

This section of the website will examine Intentional Role Modeling.

" Role modelling is a powerful teaching tool for passing on the knowledge, skills, and values of the medical profession, but its net effect on the behaviour of students is often negative rather than positive. By analyzing their own performance as role models, individuals can improve their personal performance." from Role modelling—making the most of a powerful teaching strategy by Sylvia R Cruess, professor of medicine, Richard L Cruess, professor of surgery, Yvonne Steinert, professor of family medicine

In order for role modelling to be effective, you have to make it intentional by consciously modelling how you think and act as a physician. This modelling allows the implicit to become explicit. So what does this mean?

_______________________________________________________________________________________________________________________________

Unintentional Role Modeling
Students closely watch us for cues about both our professional and personal preferences. Sometimes faculty role model behaviours they would never want students to emulate such as mistreatment of staff, prejudice against or neglect of certain types of patients, backstabbing of colleagues or disrespect for certain types of students. Sometimes faculty model very good behaviour unconsciously and through reflection can make that role modelling intentional.

A. Hidden Curriculum
Studies have shown that students arrive in medicine wanting to help patients, but by the time they reach residency, they have developed negative attitudes towards certain types of patients (gender, religion, race, drug & alcohol abusers, chronic illness, elderly etc.) because of unconscious messages they are receiving from attendings, other health care professionals and other students that certain patients are less deserving of care.

"Another woman with mysterious abdominal pain!" This was said to a male resident by the attending male physician. A week later after the resident had left, "the mystery" resulted in the patient's IUD perforating her uterus. The resident only heard that women frequently have mysterious abdominal pain; the physician probably was completely unaware of the message the student left with.

B. Automaticity
Practicing physicians move through their day without thinking about why or how they do what they do because they work primarily in a state of unconscious competency. This state is necessary for carrying out your day-to-day tasks but can confuse students who see you jumping from point A-F. You may have trouble explaining to them how you concluded F from A, because it was so spontaneous (based on previous learning).

_______________________________________________________________________________________________________________________________

Making the IMPLICIT (Unconscious) EXPLICIT (Conscious)

The picture on the right comes from the article mentioned above by Cruess and Steinert.

Before the student arrives

Pick two or three things you do very well and break these procedures/techniques down into steps that the student needs to know in order to replicate what you do.
Create two or three illness scripts for the most common issues students will see in your clinic.
List 5-10 attitudes that you think exemplify great physicians and think about how you are going to role model those attitudes while students are in your clinic. Pick some that relate to patients, some that relate to staff, some to other areas of you life.

While the student is in your care

Encourage the student to ask questions about why you made the decisions you made.
Pick one or two difficult cases a week and walk the student through how you made the decision you made; even if it seems obvious to you that A=F, it may not be as obvious to the student. Avoid asking students to read your mind.
Share your illness scripts with students before asking them to create their own.
Guard the appropriateness of your behaviour to patients and staff even when the day is trying.
Talk to students about working with patients whose values, behaviours, and illnesses can create issues for the physician. Try and reflect the guidelines of the profession even if they aren't your own (save those discussions for colleagues).
Demonstrate and encourage Deliberate Practice by giving students multiple opportunities to apply what you are teaching them with patients.

-excerpted from The Medical Education Blog

_____________________________________________________________________________________________________________________________

Implicit and Explicit Knowledge Definition
	Implicit knowledge (U)	Explicit knowledge (E)

Example	The implicit knowledge used to recognize the face of a specific person.	The explicit knowledge (e.g., textual descriptions) that would allow to recognize faces of people (including a specific person).
Complexity, Context retention	Rich, grounded in reality. High retention of context in form of salient features.	Lean, more abstract, symbolic. Variable amount of context retention.
Acquisition	Detection, learning of correlations and regularities of environment.	Explicitation of one's implicit knowledge. Explicit acquisition of knowledge (e.g., through reading).
Representation	Unstructured, present implicitly in data recordings of the environment (e.g., image of a person).	Varies from less structured (e.g., natural language) to very structured (e.g., formal descriptions).
Transferability	Transferable only in implicit form through the data recordings (i.e., representations) of the environment.	Transferable through languages (natural or formal) and communication (e.g., verbal).
Applicability	Very well applicable to specific problem instances.	Applicable to both, specific and more generic problems.
Processing mechanisms	Pattern recognition, feature selection, associative memory.	Reasoning.

-excerpted from Pantazi et al. BMC Medical Informatics and Decision Making 2004 4:19 doi:10.1186/1472-6947-4-19

References
Role modelling—making the most of a powerful teaching strategy

An Intentional Modeling Process to Teach Professional Behavior: Students' Clinical Observations of Preceptors

Pathways to “Involved Professionalism”: Making Processes of Professional Acculturation Intentional and Transparent

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Clinical Teaching Techniques

DeirdreB — Fri, 18 Sep 2009 11:39:49 CDT

" Better outcomes are associated with workplace-based training and a course which provides repeated episodes of training spaced out over a period of weeks/months with the facility for practice of the skill. These findings are important as many current clinical skills training courses do not use the techniques associated with better outcomes."

Byrne, Pugsley and Hashem, 2008

There are six major tasks required of clinical teachers:

1. Preparing your work environment

2. Orienting the learner

3. Facilitating learners developing the thinking skills of physicians

4. Facilitating learners ability to act like physicians

5. Assessing learners progress in becoming physicians

6. Assessing your effectiveness as a clinical teacher.

"We must acknowledge again that the most important, indeed, the only, thing we have to offer our students is ourselves. Everything else they can read in a book or discover independently, usually with a better understanding than our efforts can convey." Tosteson DC. Learning in Medicine. N Engl J Med. 1979:301(13):6904

Another important area to consider is Teaching International Medical Graduates. Read about Family Medicine residency in Portugal.

When you have finished this module, please take the quiz at the end and receive a certificate of completion.

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How do medical students learn?

DeirdreB — Mon, 14 Sep 2009 17:40:30 CDT

Learning depends on the transformation of information into knowledge

- F. Papa

Goal of Learning

Learning is viewed here as developing a way of thinking and acting that is characteristic of an expert community. Such a way of thinking consists of two important elements:

the knowledge that represents phenomena in the subject domain
the thinking activities that construe, modify and use this knowledge to interpret situations in that domain and to act in them.

Billet, 1996

Situated learning: bridging sociocultural and cognitive theorizing

Learning and Instruction, 6

How Do You Know If Learning Has Occurred?
Learning has occurred when there is a permanent change in the learner's behaviour. This changed behaviour can then be assessed if necessary, for academic standards.

For people interested in Instructional Design, here is information about the common theories.

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