Medical Education - Recently Updated Pages

Songs

DeirdreB — Thu, 09 May 2013 19:36:47 CDT

I love the idea of using songs to begin or end a class and there are some great resources out there. Some of these songs have risky language so listen to them before playing to a class that is particularly true of Amateur Transplants and Monty Python songs..

Basic Science
Aortic Valve -animation and song
BioChemist Songbook This songbook presents information on biochemical pathways set to well-known songs, providing students with an easy way to remember often complicated information. The songs should also serve as end-of-term review material.
BioRap (DNA Replication and Protein Synthesis with a Beat)
Brainstem -pinky and the brain
Circulatory Rap - basic but fun rap
Circulatory System -animation and song
Dem Bones from most of our childhoods
ECG Dance Learn cardiac electrophysiology with the Mad Professor although some prefer the silent version!
Elements Song Tom Lehner's song includes an animation
Essential Amino Acid Metabolism Rap -a med student created song
Glucose Song - set to Sugar, Sugar music, so its pretty easy to remember
The Gram Positive Bacteria Song sung to the tune of the William Tell Overture by Dr. Taylor Williams.
Songs of Anatomy and Physiology (Study Materials) - a series of 14 songs to help students remember some key ideas.
Whoomp there it is the joy of restarting a heart.

Clinical
Anaesthetists Hymn -The Laryngospasms or Amateur Transplants version
Don't Smoke Your Life Away including some graphic pictures
Babychild Great song by Ross Martin MD about delivering a baby in difficult circumstances that you will never see again
Baby Poo - Arrogant Worms
Between music and medicine: Robert Gupta gives a moving TedTalk of society’s marginalized and the power of music therapy, which can succeed where conventional medicine fails.
Breathe -The Laryngospasms
Brian's Balls (yep, its about orchidectomy, and curling) - Arrogant Worms
Breakfast at Glenfield - The Educational Music Video about ACUTE ASTHMA MANAGEMENT
Bringing Patients Back - ER from a community hospital
Call Day DRZMD rap about being on call
Clouds - A 17 year olds musical response to receiving a terminal cancer diagnosis.
Colorectal Surgeon by Bowser and Blue
Colon is a mighty big river sing the blues while showing the process of a colonoscopy
daVinci Robot Surgery by Methodist Hospital and da Vinci Robotic Hysterectomy
Diagnosis Wenckebach from the University of Alberta
Eternal Clerking - Amateur Transplants version of taking a history
Everything Comes Down to Poo - Stool sample song from Scrubs
Fix me up - a song created by two live long friends as a response to one of them being diagnosed with terminal cancer
Give me my DaM Data a music video by Dr. Ross Martin about patients rights to their medical information based on a famous speech by EPatient Dave
Hard Doc's Life (Hospitalist Anthem) ZDogg's Anthem to GP's
Heimlich Maneuver- Arrogant Worms
Hernia Belt - Arrogant Worms
Horrible Medical History - Robert Knox singing about his relationship with Burke and Hare
Irritable Bowel Syndrome - Arrogant Worms
I don't want no cornbread, meat and black molasses a song about medical experiments on prisoners.
Immunize - ZDogg's ode to the need to immunize kids

I Pulled My Groin - Arrogant Worms
Manhood in the Mirror - Testicular Cancer Self Exam

Medical Love Song -VD ballad from Monty Python - not for faint of heart
MMR vaccine - Amateur Transplants
Medical Terminology Concerto - Amateur Transplants
One Grain More The Les Misérables food allergy parody that will knock your hypoallergenic socks off!
Paracetamoxyfrusebendroneomycin - Amateur Transplants song about drug advertisements
Pink Glove Dance a great collaboration by an entire hospital for breast cancer awareness (Providence St. Vincent Hospital)
Please don't bury me - John Prine cover
Prescription Drug Song - Arrogant Worms
Rights and Responsibilities of child patients music video from Children's Hospital, London Health Sciences Centre.
Safe Sex Rap -ZDog MD channel on UTube
Sam the Guy from Quincy - Arrogant Worms Pathology
The Smokey Gray Carcinogen Blues lyrics by Dr. Ross Martin about a baby trapped in a smoke filled womb are horrifying
Some Studies That I Like to Quote A song about Evidence Based Medicine

Trichinosis by Arrogant Worms
Unbreakable by Panah A wonderful upbeat song from a wheelchair user

Ulcer Rap -ZDog MD channel on UTube
Vaccine song -Ted Willmore
Waking Up Is Hard To Do -The Laryngospasms
Yellow -Jaundice by Amateur Transplants

Management
Electronic Health Records (EHR) and Patient Centered Care
Give me My DaM Data Based on a presentation by EPatient Dave
My Boss is Ceo about the frustration of people complaining in the ER
SVH a great tongue in cheek look at patient satisfaction

Medical Student Life
210 Scalpel - for me this song by Ross Martin MD resonates with how difficult it can be to reflect on and change yourself
Always Look on the Bright Side of Life -Monty Python
Bad Project - a parody of Lady Gaga about bad research projects
Big Words a reflection on graduating into the real world after Academia by Ross Martin MD.
Careless Surgeon - Amateur Transplants take on explaining medical error
Chemical Bond "It isn't love that we’re feeling – it's really just a chemical bond" by Ross Martin MD
Do What I Say - a satire on medical school done by Mathew Morrey when he was a medical student
Medical version of “Glow” music video made by graduating medical students of the University of Tromsø, Norway. Mix of English and Norwegian lyrics.
Finals Fantasy - Amateur Transplants version of the stress of exams
Glad You Came Welcome to new med students
Gunnin' And I Know It Parody of Sexy and I know it from Ohio Med School
Hallelujah - K.D. Laing version for bad days
Ice, Ice, Baby Rap about how to pass the CSA
I'm alive not medical but joyful, upbeat song about being alive.
I'm at a Code Dalhousie Med School
Lonely Lab of Broken Hearts Arrogant Worms
Lose Yourself Eminem for tough days
Med Life Crisis Video about medschool stress
Med School the Musical -a satire on medical school done by Mathew Morrey when he was a medical student
Medical School Gunner
Queens student promo to encourage more people to come to Queens
Real Med Students of Genius -a collection of satires on med students
Rolling in the Deep Med School Parody - Waiting for the Beep from University of Manitoba
Scrubs - Like a Surgeon Remix of the Al Yankovic song with scenes from Scrubs
Somebody That I Used to Know (Med School Style)
Study maybe a med school parody on "Call me maybe"
Waiting for the Beep - Rolling in the Deep Med School Parody
What good am I? A great song about self reflection by 70 year old Tom Jones

Collections
HealthRock - a series of songs that can be purchased
Med School Rock - a series of songs that can be purchased on ITunes
In the Hospital Album available from Peter Alsop site
And if you want to try singing The Biochemist's Song Book is available.
Humour Break at the Medical and Allied Health Library
Dr. Ross Martin has a large selection here and here and join his The American College of Medical Informatimusicology, a nonpartisan institution, though we remain shameless promoters of music with a medical message

University of Saskatchewan - I have the Amateur Transplant CD if you would like to borrow it DeirdreB.
Set to music of Sugar, sugar

Steps in Learning Clinical Thinking

DeirdreB — Mon, 06 May 2013 16:04:17 CDT

80% of medical errors are diagnostic thinking errors -25-Year summary of US malpractice claims

Medicine is learned by the bedside and not in the classroom. Let not your concepts of the manifestations of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first. No two eyes see the same thing. No two mirrors give forth the same reflection. Let your word be your slave and not your master.

- William Osler

Clinical Thinking Defined

i. Focused History, Examination and Investigations

Some medical schools teach this, some don’t; even if taught some students are weaker in this area than others, so always start a rotation with assessing this step. Observe and talk about how different conditions and diseases reveal themselves through good questions followed by physical examination and relevant investigations. Talk about the problem with the18 seconds before a patient is interrupted by the doctor. Talk about the use of Subjective/Objective questions. Talk about how different specialties approach this task differently. Your automaticity in this area means a patient is in your office 5 min. and 8 times out of 10, you know the diagnosis. Your student is not at that level and if you push them too quickly to emulate your skill, they will make diagnostic errors, and they will cover up those errors. Avoid encouraging the development of this habit by giving them reasonable time to develop this ability.

ii. Differential Diagnosis

Medical students have been rewarded for twenty some years for quickly coming up with the correct, memorized answer. Now you are going to ask them to stop doing that and learn to problem solve. Some of them will probably feel awkward, reluctant and embarrassed because they will be using a type of thinking they probably have very little experience with. Again, hold your automaticity in check and force yourself to go over the differential with the student by using techniques like Illness Scripts or SNAPPS until the student does a differential easily. Talk to them at this stage about how cognitive errors impact on developing the differential and help them learn to identify when they are making this type of error. Help them understand why medical error is the 7th leading cause of death in Canada.

iii. Patient Management

Clerks can in many cases be trusted with simple management plans such as stitching simple cuts, ordering standard tests and giving shots. As their diagnostic skills improve in resident years, your trust in their management skills will also improve and your teaching strategy can change to Chart Simulated Recall, then 1 Minute Preceptor for the most independent students.

Clinical Thinking Teaching Techniques

Think of these techniques as a continuum, as students develop increasing independence, your interactions with them change. If they begin a rotation at a higher level, use a higher level technique.

1. Illness Scripts

2. Teaching Differential Diagnosis from Clinical Reasoning, a guide for improving teaching and practice

Differential Diagnosis is a process that must be taught. It is not an intellectual skill that people are born with. Medical schools may or may not have taught students this skill in their undergraduate training, and they certainly haven’t learned how to do a differential in your specialty, so always start by assuming the Clerks or Resident doesn’t know how to do this.

What is the process?
These six steps are the most important procedures the clerk/resident needs to develop. It is well worth your time near the beginning of a rotation to teach this process.

1. Presenting Complaint Allow the patient/family to provide details about why they are here
2. Consider three or more Hypotheses Combine presenting complaint with basic demographics (age, gender etc.)
What are the key presentations of each hypotheses (Illness script)?
How does the hypotheses match/not match the presenting symptoms?
3. History Taking Ask questions that inform your knowledge of the differential
How does new information fit your hypotheses
Re-prioritise your hypotheses
4. Refine the Differential Primary hypotheses and differential
5. Physical Examination Determine what findings are expected based on differential and look for them
Refine the differential further based on exam
6. Relevant Investigations Will the investigation confirm or alter your hypotheses. If not reconsider doing the investigation

Demonstrate and deconstruct
Initially, you will be acting as a deliberate role model/medical expert moving the student from unconscious incompetence to conscious incompetence by walking the student through each step as you perform it. If time with the patient is limited, do the deconstruction in a later debriefing session.
Ask your students to take notes using the 6 steps in the table above as a guideline. Some key points to emphasize with the student are:
use key words from the presenting complaint to develop 3 hypotheses (most acute, most common, most chronic?)
use the hypotheses to ask questions in the directed history
use the information obtained to refine the differential
review the relevant anatomy/physiology to inform the physical exam
use the results to determine further investigations required.

Comprehension
Next, you will be acting as a coach, moving the student from conscious incompetence to conscious competence. Demonstrate the process again without explanation, but have your student take notes about how they would approach each step in the diagnostic thinking process. Go over their notes with them.

Performance
In the final step, you act as a clinical supervisor giving students direct feedback on their diagnostic thinking. The combination of practice and feedback moves the student towards unconscious competence. Very few students truly reach the unconscious competence stage except for the most common diseases and conditions during their post graduate training.

1. Presenting Complaint	Allow the patient/family to provide details about why they are here
2. Consider three or more Hypotheses	Combine presenting complaint with basic demographics (age, gender etc.) What are the key presentations of each hypotheses (Illness script)? How does the hypotheses match/not match the presenting symptoms?
3. History Taking	Ask questions that inform your knowledge of the differential How does new information fit your hypotheses Re-prioritise your hypotheses
4. Refine the Differential	Primary hypotheses and differential
5. Physical Examination	Determine what findings are expected based on differential and look for them Refine the differential further based on exam
6. Relevant Investigations	Will the investigation confirm or alter your hypotheses. If not reconsider doing the investigation

3. SNAPPS -primarily used with Clerks

4. Chart Simulated Recall (CSR) -primarily used with Residents

5. One Minute Preceptor -primarily used with Residents

Other ideas and techniques for clinical teaching

Clinical Teaching Techniques

DeirdreB — Mon, 06 May 2013 16:02:20 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.

Proceed to Classroom Teaching or How Do Medical Students Learn?
or choose a section from the left hand menu

Thinking like a Physician

DeirdreB — Mon, 06 May 2013 15:28:33 CDT

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

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

Education is not the learning of facts, but the training of the mind to think.

Albert Einstein

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.

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

Return to Clinical Teaching
Proceed to Acting Like a Physician
or use the left hand menu to make another selection

Remembering

DeirdreB — Sun, 28 Apr 2013 18:57:18 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. Dr. Robert Bjork has a video Spacing improves long-term retention on this topic.

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.

Return to How Do Medical Students Learn?
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Discipline Specific Resources

DeirdreB — Tue, 02 Apr 2013 17:18:08 CDT

Anatomy

Abdominal Anatomy Podcasts Colo-rectal cancer site but has general anatomy as well

Acland’s Video Atlas is a virtual anatomy lab at your fingertips.

Anatomy Atlases list of various anatomy resources

Anatomy Arcade makes basic human anatomy come ALIVE through awesome free flash games and interactives. It's perfect for the novice teenager in the classroom, right through to students and professionals of health care looking for a fun way to revise.

Anatomy Clipart This selection offers over 2860 black & white 19th century illustrations of human anatomy images, separated into all major systems.

Anatomy Lab Zoom, dissect rotate on your iPhone

Anatomy TV animations

Bassett Collection of Stereoscopic Images of Human Anatomy

Brain Info

Cells Alive represents 30 years of capturing film and computer-enhanced images of living cells and organisms for education and medical research.

DirectAnatomy.com comes with an interactive interface that comes with four angles of view allowing you to browse through more than 1,200 annotated anatomy images.

eSkeletons provides an interactive environment in which to examine and learn about skeletal anatomy.

Eye Simulator Eye Movement Simulator, the Pupil Response Simulator, and Patient Cases.

Human Body Parts Quiz Smithsonian Museum

Human Body & Mind BBC presentation on how the mind works

Inner Body Each topic has animations, 100’s of graphics, and thousands of descriptive links.

Instant Anatomy a website with illustrations of the Human Body to aid the learning of Human Anatomy with diagrams, podcasts and revision questions

Lumen Dissector online, interactive dissection site

MEDtropolis Virtual Body: Built for kids but could also be used as a refresher for med students.

Neuronotes Various resources including an interactive neuroanatomy atlas featuring a selected list of the most clinically relevant neuroanatomical structures with descriptions of their functions. University of Toronto site.

NIGMS Image Gallery a searchable database of photos, illustrations, and videos. Permission is granted to use these images for educational, news media, or research purposes, provided the source for each image is credited.

Nucleic acids and chromatin online module from the UK Open University.

Pocket Body "for the iPad is a robust, flexible and useful tool for studying and reviewing musculoskeletal anatomy. Any student that is taking a human anatomy course and owns an iPad should seriously consider owning this app." First peer reviewed app.

Skeleton Typogram the human skeleton in an easily digestible format.

Think Anatomy a collection of the best anatomy resources

Visible Human

Anaesthesia

Practice Guidelines for Chronic Pain Management: An Updated Report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.

PeRSSonnalized Anaesthesia an aggregator of the top resources

Cardiology

GPlectures - a series of videos from UK

Pocket Heart redefines what engaging medical education content truly is. Our award-winning realtime beating 3D heart app, with its elegant design, contains quizes, clinical cases and over 20,000 words of learning material.

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

Dermatology
DermAtlas 11, 000 images

Dermatology Atlas Loyola University Dermatology Medical Education Website

Dermis images

PeRSSonalized Dermatology an aggregator of the top resources

Emergency Medicine
Emergency Medicine and Web2.0 an aggregator of the top resources in this discipline

EMCrit Blog and Podcasts bring Upstairs Care, Downstairs-–that is to bring ICU level care to the ED, so our patients can receive optimum treatment the moment they roll through the door.

Life in the Fast Lane is a Medical Blog and website dedicated to providing online emergency medicine and critical care insights and education for everyone, everywhere... usually with a healthy dose of good humour, and always with endless enthusiasm.

Resus.ME exists to help you keep up to date in all aspects of life-saving medicine, from acute medicine and paediatrics, to emergency and critical care medicine, and even pre-hospital care!

Self Care Guidelines

Family Medicine

Aboriginal Healing Foundation Research Reports

Adolescent Reproductive Health

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.

British Medical Journal Channel Videos produced by the British Medical Journal UTube channel.

CATIE: Canadian Aids Treatment Information Exchange

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

Canadian Virtual Health Library -under construction but potentially useful

Cancer and Web 2.0 An aggregate of resources

Complete History and Physical an online module from University of Virginia

Crohn's disease and Web 2.0

The Curricula Organizer for Reproductive Health Education (CORE) is a collection of peer-reviewed, evidence-based teaching materials. It is an open access tool that anyone can use at any time free of charge.

Detroit Medical Centre List of videos produced by the Detroit Medical Centre

Diagnosis 101 Welch Allyn's site demonstrates the ins and outs of basic diagnostic procedures including ophthalmoscopy, otsoscopy, blood pressure measurement and auscultation in a fun, interactive environment.

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.

Ganfyd is a collaborative medical reference by medical professionals and invited non-medical experts. Check out their survival guides for new physicians.

Geriatrics Simulations GeriaSims from the University of Iowa are interactive "virtual patient" simulations on issues encountered in the care of older adults. Each simulation takes approximately 1 hour to complete, depending on your level of content knowledge.

The Lupus Initiative, a national education program designed to reduce health disparities experienced by patients with lupus.

Mayo Clinic Channel List of videos produced by the Mayo Clinic

MedCalc is a free medical calculator that gives you easy access to complicated medical formulas, scores, scales and classifications. Each formula has been individually designed and optimized for the small iPhone screen.

Medscape CME provides weekly cases by Email and telephone links.

Palliative Care resources

Patient Decision Aids These patient decision aids (PDAs) have been developed to help support difficult decisions in which patients need to consider benefits versus risks. Decision aids prepare patients for decision-making by increasing their knowledge about expected outcomes and personal values.

Practice Guidelines for Chronic Pain Management: An Updated Report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine.

PreOP Patient Education a site for patients about what to expect during common surgeries that might also be useful for JURSI'S

Proficient Procedures 15 minute videos of basic procedures.

A Practical Guide to Sexual Assault A BMJ Learning module

Social and Medical Advocacy with Transgender People and Loved Ones a collaborative publication from Vancouver Coastal Health, Transcend Transgender Support & Education Society, and the Canadian Rainbow Health Coalition.

Sexual health: erectile dysfunction in primary care A BMJ Learning Module

Sexual Health Aggregator

Society of Rural Physicians of Canada (SRPC) is the national voice of Canadian rural physicians. Founded in 1992, the SRPC’s mission is to provide leadership for rural physicians and to promote sustainable conditions and equitable health care for rural communities.

Stories from the Saskatoon Health Region Live Well™ with Chronic Conditions Program for Aboriginal people

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.

Women's Health Journal Written specifically for GPs, practice care nurses and other healthcare professionals with a special interest in women’s health in the UK.

Geriatrics
Geriatrics Simulations GeriaSims from the University of Iowa are interactive "virtual patient" simulations on issues encountered in the care of older adults. Each simulation takes approximately 1 hour to complete, depending on your level of content knowledge.

PeRSSonalized Geriatrics an aggregator of the top resources

Nephrology
Nephrology On-Demand Powered by the Division of Nephrology and Hypertension at East Carolina University, this website is a 100% evidence-based Nephrology teaching instrument. It is programmed and maintained solely by the faculty members of ECU-Brody School of Medicine, but is intended for all those who want to learn Nephrology.

Neurology

Brain Info searchable database from University of Washington

GPlectures - a video series from England

Neuro Localizer app helps doctors identify location of nerve lesions based on signs & symptoms (Free)

Neurology 2.0 an aggregator of the top resources

NeuroLogic Examination Videos

Pocket Brain "redefines what engaging medical education content truly is. Our award-winning brain app, with its elegant design in eight layers of 3D neuro-anatomy, cross sections, nerve pathway animations and clinical case studies"

OBGYN

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

The Curricula Organizer for Reproductive Health Education (CORE) is a collection of peer-reviewed, evidence-based teaching materials. It is an open access tool that anyone can use at any time free of charge.

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

da Vinci Robot Hysterectomy Complete hysterectomy set to classical music

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.

Obstetrics and Gynaecology 2.0 Obstetrics and Gynecology is a medical field which is really rich in online content and also in websites containing false information. We created this package to help you find relevant resources.

PeRSSonalized OB/Gyn PeRSSonalized Medicine is a free, easy-to-use aggregator of quality medical information that lets you select your favourite resources and read the latest news and articles about a medical specialty or a medical condition in one personalized place.

Sperm Video: Great short video set to the music of my first my last my everything.

Pathology

Pathology 2.0 an aggregator of the top resources

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.

Pathology Review Games a series of games for reviewing pathology basics.

Pathology Student - Making pathology fun and easy.

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.

Pediatrics

HopeLab is a nonprofit organization that combines rigorous research with innovative solutions to improve the health and quality of life of young people with chronic illness. We work closely with young people with chronic illness to understand their needs and to incorporate their critical and ongoing input into product development. We are committed to the scientific study of our interventions through formative research and outcome studies to ensure that these products and/or approaches are effective.

Medical Games List of games for kids, many of which were developed to help kids cope with illness.

PeRSSonalized Neonatology and Perinatology an aggregator of the top resources

PeRSSonalized Pediatrics an aggregator of the top resources

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.

Pediatrics and Web 2.0 Social media resources for pediatricians

Spotting the Sick Kid This is a new interactive tool commissioned by the US Department of Health to support health professionals in the assessment of the acutely sick child.

Psychiatry

Autism Wiki developed for people with autism to share their experience, it would also provide information for med students

Depression Interviews interviewed 38 people about their experiences of this condition.

Experiences of Psychosis interviewed 34 people (31 people with direct experience and three carers) about their experiences

Psychiatry 2.0 an aggregator of the top resources

Pharmacology
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.

Radiology

Radiology 2.0 an aggregator of the top resources

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

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.

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

Rheumatology

Rheumatology 2.0 an aggregator of the top resources

Surgery
ONSurg resources for Med students, residents and surgeons

Surgery 101 A series of podcasts available on ITunes from U. of Alberta

Surgery 2.0 an aggregator of the top resources

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

PreOP Patient Education a site for patients about what to expect during common surgeries that might also be useful for JURSI'S

Case Based Teaching

DeirdreB — Mon, 11 Feb 2013 18:17:52 CST

There is no abstract available for this page revision.

Teaching in the Operating Room

Sean_Polreis — Fri, 18 Jan 2013 12:54:54 CST

Educational Principle

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 B.I.D Method

Briefing
This is a short (2- to 3-minute) interaction at the scrub sink. The purpose of the interaction is to assess the needs of the learner, to cause the learner to assess her own learning needs, and to jointly establish learning objectives to guide both learner and teacher. Ideally, the learner establishes her own objectives for the operation. The teaching surgeon/preceptor assists by prompting and guiding the formulation of the objective. Having learners involved in setting the objectives allows them to begin the process of deliberately identifying areas in which practice is needed, and deliberately reviewing past experiences to formulate needs to be addressed in the current operation. This process allows learners to integrate the experience into their semantic networks, making it more likely that the information can be retrieved later. The attending surgeon/preceptor starts the conversation with a brief question about goals for the operation or previous experiences. Learning objectives can follow from this brief needs assessment.

Intraoperative Teaching
The objectives set in the briefing focus the intraoperative teaching. Although other standard forms of intraoperative communication will still be present (i.e., the attending physician will still coach and guide the learner through the operation), the focus of most of the didactic talk will be on the one or two learning objectives set for this operation. This ensures that the teaching is not simply a nonspecific flow of talk, but instead, discussion focused on mutually shared learning goals. Irby argued that, over time, medical teachers develop teaching scripts. The preceptor can still use teaching scripts, but those scripts are manifest in the briefing session and in the intraoperative teaching and are based on mutually developed learning objectives.

Debriefing
After the operation is finished, ideally during the closing, the preceptor and the learner debrief about the encounter. The debriefing consists of four elements:

reflection
rules
reinforcement
correction.

Because the debriefing is focused specifically on the intraoperative teaching, which is focused on objectives set at the beginning of the encounter, it is short. In our example, debriefing the learner during the closing took less than 5 minutes. Debriefing begins with the attending physician asking the learner to reflect on his or her performance and attainment of stated objective. This allows the preceptor to understand the perspective of the learner, and to diagnose any problems the learner is having with his perception of the encounter. Most importantly it requires the learner to assemble his own thoughts about what was learned during the encounter.

Excerpted from The Briefing, Intraoperative Teaching, Debriefing Model for Teaching in the Operating Room Nicole K Roberts, PhD, Reed GWilliams, PhD, Michael J Kim, MD, Gary L Dunnington, MD, FACS Journal of the American College of Surgeons

Resources

OR Live online surgical webcasts

In Surgery, simulation can help:

increase patient safety by facilitating surgical proficiency and certification;

delivering economic benefits for surgical skills centers by delivering cost-effective solutions that increase the speed of learning;

Accelerate the pace of adoption of new procedures and devices.

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population Introduction of the WHO Surgical Safety Checklist into operating rooms in eight diverse hospitals was associated with marked improvements in surgical outcomes.

Review of comparative studies of clinical skills training: 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.

Computers and Virtual Reality for Surgical Education in the 21st Century Computer-based training in technical skills has the potential to solve many of the educational, economic, ethical, and patient safety issues related to learning to perform operations. Although full virtual-reality systems are still in development, there has been early progress that should encourage surgeons to incorporate computer simulation into the surgical curriculum.

The effects of practice and instruction on speed and accuracy during resident acquisition of simulated laparoscopic skills. Practice, with or without dynamic instruction, results in significant improvement in the speed of performance of simulated laparoscopic surgical skills. The addition of dynamic instruction to simulator-based practice improves the quality and consistency of resident acquisition of laparoscopic surgical skills.

Efforts to enhance OR teaching
Effective Or Teaching Skills

Explains reasons behind decisions
Answers questions clearly
Involves learners (pathology)
Provides feedback without belittling

Evaluation of the operating room as a surgical teaching venue.The purpose of this study was to examine the educational activities that occur during the operating-room experience. Technical training in the procedure being done was the primary educational activity, but there were long periods when no form of education was taking place. The operating room provides the teacher and learner with uninterrupted time together, and this time can and should be used for clinical teaching and learning.

Evaluation of a Preoperative Checklist and Team Briefing Among Surgeons, Nurses, and Anesthesiologists to Reduce Failures in Communication One hundred seventy-two procedures were observed (86 preintervention, 86 postintervention). The mean number of communication failures per procedure declined from 3.95 before the intervention to 1.31 after the intervention. Thirty-four percent of briefings demonstrated utility, including identification of problems, resolution of critical knowledge gaps, decision-making, and follow-up actions.

Full scale computer simulators in anesthesia training and evaluation. As technology acquires an increasingly important role in medical education, full scale computer simulators represent an exciting potential in anesthesia. However, the full potential and role of simulators in anesthesia is still in development and will require a dovetailing of clinical theory and practice with current research in medical education.

A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre.

Practice based learning and improvement Objectives: At the end of the workshop participants were able to: 1) List the components of the competency of practice based learning & improvement 2) Describe methods of teaching the competency 3) Discuss evaluation tools for this competency and implementation into residency programs

Resident Teaching Versus the Operating Room Schedule: An Independent Observer-Based Study of 1558 Cases. Anesthesia teaching increased the time to surgical incision by an average of 4.5 minutes. This finding, similar to previous reports in educational settings such as surgery and ambulatory care, also demonstrates that intraoperative anesthesia teaching does increase the time required for a physician encounter. Although our results indicate that teaching occurred in the majority of cases, the issue of decreased teaching when attending anesthesiologists were directing care in more than one OR is very worrisome, as this coverage ratio will become more prevalent in the future. In an environment of cost-containment and need for increasing efficiency in ORs, data from this investigation suggest the need for innovative teaching techniques coupled with computer simulation to supplement anesthesia resident teaching in the future.

Teaching Surgical Skills — Changes in the Wind: Sheer volume of exposure, rather than specifically designed curricula, is the hallmark of current surgical training. But as opportunities for learning through work with "real" patients have diminished, interest in laboratories with formal curricula, specifically designed to teach surgical skills, has increased dramatically. In this new model of surgical education, basic surgical skills are learned and practiced on models and simulators, with the aim of better preparing trainees for the operating room experience.

The 10-year experience with a psychomotor skills laboratory at the Department of Surgery of the Université de Montréal is reported.

Virtual reality training improves operating room performance: results of a randomized, double-blinded study. The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

Stress and Burnout Among SurgeonsTraining for and practicing surgery are stressful endeavors. Studies involving national samples of surgeons from surgical subspecialty societies and graduates of surgical training programs suggest that burnout rates among surgeons range from 30% to 38%.

Active Engagement

DeirdreB — Fri, 18 Jan 2013 11:45:01 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

How do you get classes even large classes working together? Watch the video.

- Dr. Richard Felder, Engineering

University of Saskatchewan Definition
"Active Learning (AL) is an approach to teaching that incorporates one or more of the five elements of talking and listening, reading, writing, reflecting and creating into the engagement by learners in relevant and authentic tasks in a supportive environment. Compared to a traditional approach of passive information transmission, AL produces better learning, including concept formation; increased motivation; discovery of misconceptions; and the acquisition of knowledge, critical thinking, attitudes and values, and interpersonal skills. Case discussions are one example of active learning approaches. Therefore, the College of Medicine will incorporate into all course, programs, and individual teaching session opportunities for students to engage in AL. This does not mean that all teaching and learning will be given in small groups. AL can take place within the traditional large or a small group setting for short or long periods of time."

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?

For ideas about Assessment, see Terms of Engagement a Framework for Assessing Different Modes of Student Interaction and Assessment.

The following slide show contains examples of active engagement in large medical classrooms.

Illness Patterns

DeirdreB — Sun, 07 Oct 2012 12:46:54 CDT

"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	More mindmap examples at http://lifeinthefastlane.com/exams/jficm-fellowship/icu-mind-maps NHS Map of Medicine Healthguides shows you the ideal, evidence-based patient journey for common and important conditions. It is a high-level overview that can be shared by patients and healthcare providers.

For More Information:

How to make mindmaps video

Med Quarterly examples

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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How do students become self-directed learners?

DeirdreB — Wed, 05 Sep 2012 12:15:01 CDT

Use the objectives listed below, to guide your thinking as you read the resources for this workshop.

Objectives

Explain the role of self-directed learning in development of expertise and vice-versa
Explain how self-reflection contributes to self-directed learning and vice versa
Discuss at least two strategies you can use to help improve students’ self-directed learning skills

Prereading
Chapter 7 pgs 188-224
Read Personal Learning Environments and the revolution of Vygotsky’s Zone of Proximal Development
Scan Self Directed Learning for ideas.

Think About
How might working in a peer learning environment improve self directed learning? How might it hinder it? How might you use tools such as Diigo, Scoopit or a wiki such as this site to encourage peer learning environments.

Self Directed Learning

DeirdreB — Wed, 05 Sep 2012 12:01:32 CDT

Half of what you'll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half—so the most important thing to learn is how to learn on your own. Dr. Dave Sackett: “Father of EBM”

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

The integration of e-learning into medical education can catalyze the shift toward applying adult learning theory,
where educators will no longer serve mainly as the distributors of content,
but will become more involved as facilitators of learning and assessors of competency.

-The Impact of E-Learning in Medical Education

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

Medical Education Resources

Other Important Sources of Medical Information

Discipline Specific Resources

Return to Classroom Teaching Techniques
or CASE Curriculum Model
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What kinds of practice and feedback enhance learning?

DeirdreB — Thu, 30 Aug 2012 10:54:48 CDT

Use the objectives listed below, to guide your thinking as you read the resources for this workshop.

Objectives

Discuss the role of feedback in improving practice
Identify at least two strategies for improving feedback in your teaching situations

Prereading
Chapter 5 pgs. 121-152

Pgs. 231-243, 251-259

Classroom Faculty: Look at this Rubric Template. How does giving students standards ahead of time, help with the learning process? How does giving students an opportunity to see other students' work, help students learn? Look at Assessment for ideas.

Clinical Faculty: Read Giving Feedback and Direct Observation Field Notes.

Think About
Take a look at CenterClass, how might tools like this change the way we think about feedback. If you are a clicker user, how has that changed your thinking about feedback.

Assessment

DeirdreB — Thu, 30 Aug 2012 10:52:08 CDT

One of the best ways to function as ally or coach is to role--play the enemy in a supportive setting. For example, one can give practice tests where the grade doesn't count, or give feedback on papers which the student can revise before they count for credit. This gets us out of the typically counterproductive situation where much of our commentary on papers and exams is really justification for the grade---or is seen that way. Our attempt to help is experienced by students as a slap on the wrist by an adversary for what they have done wrong. No wonder students so often fail to heed or learn from our commentary. But when we comment on practice tests or revisable papers we are not saying "Here's why you got this grade." We are saying, "Here's how you can get a better grade." - Peter Elbow in Embracing Contraries

Not just to prove but to improve - NG Patil, AMEE2012 Conference

Assessment is the third step in the planning process for classroom teaching. Listen to a podcast about the Pass/Fail Grading System. Watch Final's Fantasy, a humourous song on the stress of medical school exams.

Linking Objective, Learning Activity and Assessment

Classification	Instructional Objectives The learner will be able to:	Learning Activities/ Teaching Method	Assessment Methods
Remembering Recalling specific information	Recognise List Define Describe Identify Retrieve Name Locate/Find	Graphic Organizers Mnemonics Crosswords Puzzles Jeopardy or other games Note Taking Drill and Practice Flash Cards	Simple Multiple Choice (MCQ) True/False Fill in the blank Label Diagram Clicker Quiz
Explaining Explaining ideas or concepts	Interpret Summarise Infer Paraphrase/Restate Classify Explain Attribute Discuss Translate into simpler language	Concept mapping Short Case Cooperative Task Write, Pair, Share Role Play Matching Games Group Discussion Patient/Family explanation Structured Controversy	Short Case Presentation Short Answer Questions Blog/Journal Graphing Matching Short Presentation Poster Session MCQ with vignettes Patient/Family Feedback Simple Case Studies
Applying Using information in another familiar situation	Implement Carry out Use Execute Operate Take Perform Demonstrate Illustrate Practice Perform Manage	Simulation Lab Discussion Rounds Cases Standardized Patients Virtual Patients Chart Review 5 Step Procedure Teaching Field Trips Demonstrations Projects Role Play Communicate with patients and families	Demonstration Case Study SOAP 360 Assessment Patient/family Assessment Direct Observation Mini CEX OSCE MCQ with vignettes ITER Exercises
Analyzing Breaking information into parts to explore understandings and relationships	Analyse Compare Contrast Organize Deconstruct Outline Structure Integrate Calculate Debate Deconstruct Differentiate Distinguish between Inspect Infer	Collaborative Tasks PBL Spreadsheets Research Project 5 Minute Preceptor Writing a Wiki Reflection Problem Solving Open Ended Questions Complex Case Study Concept mapping Opinion Polling	Survey Report Paper + Analysis Rubric Project Report Group Presentation Grand Rounds Create a Mind Map Reflective Writing Problem Identification Extended Matching MCQ Complex Case Studies
Synthesizing Integrating information from multiple systems into a holistic understanding	Arrange Collect Compose Formulate Organize Manage Plan Prepare Propose	Group Tasks Self Directed Learning Integrated Case Studies Interprofessional PBL	Integrated Case Studies Paper + Integration Rubric Research Report Group PBL reports
Evaluating Judging the value of ideas, materials and methods by developing and applying standards and criteria	Appraise Assess Check Hypothesize Critique Judge Test Detect Experiment Monitor Value Measure Select Revise	PBL Complex Case Study Research Project Discussion Critical Thinking Exercises Critiquing Exercises Feedback Error Identification Reflection Critique Peer Review	Peer Review Create Rubrics Comparison Report Criteria Selection Tasks Error Identification Project Report Rubric
Creating Putting together ideas or elements to develop an original idea or engage in creative thinking	Design Construct Plan Produce Invent Devise Make Build Set Up	Produce a Video, Art, Animation, Photograph, Roleplay, Concert, Game, Practice Guidelines Build a Model, Simulation Publish a Blog, Journal Article, Poster Session Produce Patient Guides, Health Presentations for Community	Final Product Rubric Peer Review Expert Review Creativity Rubric

-Based on the work of Andrew Church

Resources
SOAP Assessment 2 3 4 at the U. of Washington
Osce's Guide
Undergraduate Medicine: Good Written Assessment Practice by Andrea Owen, Project Manager of UMAP, University of Manchester

Deliberately Practicing

DeirdreB — Wed, 08 Aug 2012 12:40:28 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
Reflection and reflective practice in health professions education
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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How do students develop mastery?

DeirdreB — Wed, 08 Aug 2012 12:38:35 CDT

Use the objectives listed below, to guide your thinking as you read the resources for this workshop.

Objectives

Explain the learning cycle and the implications for teaching
Discuss teaching strategies that:

improve student’s ability to participate in Deliberate Practice
engage students in authentic Deliberate Practice

Prereading

Chapter 4 pgs 91-120
Learning Cycle
Deliberate Practice

Think About
How does Deliberately Practicing Teaching improve your mastery?

Rewards and Punishment

DeirdreB — Thu, 02 Aug 2012 18:07:13 CDT

"...the anxiety children feel at constantly being tested, their fear of failure, punishment, and disgrace,
severely reduces their ability both to perceive and to remember, and drives them away
from the material being studied into strategies for fooling teachers

into thinking they know what they really don't know."

- John Holt

Punishment

research has shown it doesn't increase learning over time
- punishment becomes associated with learning, so simplistically you avoid punishment by avoiding learning
increases dependency or rebellion
- when you can't avoid punishment learning, you watch your teacher very carefully and conform to what they want or you do the opposite and constantly challenge the teacher in order to defeat them. These behaviours can become habitual even when the threat is removed.
decreases self-directed learning
- in both of the above situations, the desire to learn is motivated by fear not intrinsic curiosity or desire to improve patient care; remove the fear, remove the motivation to learn
embeds deeply in person and is difficult to shake
- years later, the punished sometimes becomes the perpetual victim or the punisher even when they say they would never do this to others (like abused children and spouses)
- years later, the punished continues to avoid learning, a dangerous habit for a practicing physician
- years later, the emotional scars linger even in wonderful, productive physicians

Rewards

useful with animals and very young children
- children need dependency to feel safe and to learn to behave in socially accepted ways
builds dependency on reward/reward giver
- the learner can spend a lot of time and energy concentrating on what will please the instructor instead of reflecting on what they personally need to learn next
decreases self directed learning
- once again intrinsic desire to learn is lost when you need an external reward or punishment in order to motivate yourself to learn
increases competition
- rewards only work when they are perceived to be in short supply. If a group of individuals want a limited number of rewards (marks, placements, attention), then someone is going to do whatever they can to win.
decreases effective team work
- medical students have been competing successfully all their school lives and this competition decreases their ability to be team players. Competitive people prefer to work alone, be in charge or continue the competition into the workplace. The more competition is expressed in passive/aggressive behaviour, the less effective the medical team becomes at problem solving and planning.

References

A jury yesterday awarded $1.6 million to a female neurosurgeon at Brigham and Women's Hospital, finding that she was subject to a hostile work environment and that, when she complained, the hospital retaliated against her.

Dan Pink lecture on the surprising science of motivation at TED or this animated video if you want a quick overview.

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How does the way students organize knowledge affect their learning?

DeirdreB — Fri, 20 Jul 2012 14:24:58 CDT

Use the objectives listed below, to guide your thinking as you read the resources for this workshop.

Objectives

Describe
1. the difference between how novices and experts organize knowledge
2. the implications for teaching
Discuss the implications for instruction of differences in how people approach a learning task
Identify at least two methods you could use to help your students use different forms of pattern making to organize their knowledge.

Prereading
Chapter 2 pgs 40-65
Watch Book Report and think about how each character approached their learning task
Remembering
Illness Patterns
Watch a video about how a student uses an iPad to organize his learning.
Classroom Faculty read Case-based medical informatics
Clinical Faculty read Making the IMPLICIT (Unconscious) EXPLICIT (Conscious)

Think About

How does this quote from Dr. David Lewis "The eyes don't see what the brain does not know" apply to learning your discipline?
Take a look at how Manchester Medical School students use iPads and think about how technology is changing the way students organize knowledge.

Scan the Active Learning page for ideas that might help students organize knowledge more effectively.

How does student’s prior knowledge affect their learning?

DeirdreB — Tue, 17 Jul 2012 13:36:29 CDT

Use the objectives listed below, to guide your thinking as you read the resources for this workshop.

Objectives

Explain the importance (centrality) of prior learning to current and future learning
Choose at least two methods you could use to help students remediate gaps in prior knowledge
Choose at least two methods you could use to help students activate prior learning to build new knowledge.

Prereading
Chapter 1 pgs 10-39 and pgs 225-230

Think About
Classroom teachers, how might the use of clickers help activate student's prior learning?

If you are involved in clinical education, take a look at Orientation to Clinical Experience as a tool for accessing student's prior learning.

What factors motivate students to learn?

DeirdreB — Tue, 17 Jul 2012 11:52:22 CDT

Use the objectives listed below, to guide your thinking as you read the resources for this workshop.

Objectives

Discuss the issues with reward and punishment being used as motivators
Discuss at least two strategies you could use to increase your students’ motivation.

Prereading
Chapter 3 pgs 66-90
Reward and Punishment
Watch the Ted Talk on the Science of Motivation

Think About
Scan the Active Engagement resources for ideas about motivation

Medical Education - Recently Updated Pages

Songs

Steps in Learning Clinical Thinking

Clinical Teaching Techniques

Thinking like a Physician

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:

Other Resources

Remembering

The Knowledge that Represents Phenomena in the Subject Domain

Something to Think About

Discipline Specific Resources

Case Based Teaching

Teaching in the Operating Room

Educational Principle

The B.I.D Method

Resources

Active Engagement

Illness Patterns

How do students become self-directed learners?

Self Directed Learning

Here are some resources that will help with that process

Librarian Recommendations

Medical Education Resources

Other Important Sources of Medical Information

Discipline Specific Resources

What kinds of practice and feedback enhance learning?

Assessment

Classification

Instructional Objectives

Learning Activities/ Teaching Method

Assessment Methods

Deliberately Practicing

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

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

3. Repeat tasks to improve performance

How do students develop mastery?

Rewards and Punishment

Punishment

Rewards

References

How does the way students organize knowledge affect their learning?

Think About

How does student’s prior knowledge affect their learning?

What factors motivate students to learn?