Jack Bookman

Do pediatric residents prefer interactive learning? Educational challenges in the duty hours era

Background: The volume of information that physicians must learn is increasing; yet, trainee educational time is limited. Many experts propose using trainees’ learning preferences to guide teaching. However, data regarding predominant learning preferences within pediatrics are limited. Aim: Identify predominant learning preferences among pediatric residents in a Residency Training Program. Methods: The Visual–Aural–Read/Write–Kinesthetic (VARK) questionnaire and Kolb Learning Style Inventory (LSI) were administered anonymously to 50 pediatric residents. Results: Learning style assessments were completed by 50 pediatric residents. Residents were significantly more likely to be accommodating on the Kolb LSI, which is consistent with an interactive learning preference (p < 0.01); 30% demonstrated a multimodal preference on the Kolb LSI (Figure 1). VARK assessments demonstrated that 45 (90%) respondents were kinesthetic, which is also consistent with a significant preference for interactive learning (p < 0.01). Forty (80%) were found to be multimodal on the VARK (Figure 1). There was no association between learning preference and the residents’ anticipated career choice or level of training. Conclusions: The predominant learning preferences among a cohort of pediatric residents from a single training program were consistent with a preference for interactive learning, suggesting that some trainees may benefit from supplementation of educational curricula with additional interactive experiences. Continued investigation is needed in this area to assess the effectiveness of adapting teaching techniques to individual learning preferences.

Milestone-Based Assessments Are Superior to Likert-Type Assessments in Illustrating Trainee Progression

BACKGROUND The Pediatrics Milestone Project uses behavioral anchors, narrative descriptions of observable behaviors, to describe learner progression through the Accreditation Council for Graduate Medical Education competencies. Starting June 2014, pediatrics programs were required to submit milestone reports for their trainees semiannually. Likert-type scale assessment tools were not designed to inform milestone reporting, creating a challenge for Clinical Competency Committees. OBJECTIVE To determine if milestone-based assessments better stratify trainees by training level compared to Likert-type assessments. METHODS We compared assessment results for 3 subcompetencies after changing from a 5-point Likert scale to milestone-based behavioral anchors in July 2013. Program leadership evaluated the new system by (1) comparing PGY-1 mean scores on Likert-type versus milestone-based assessments; and (2) comparing mean scores on the Likert-type versus milestone-based assessments across PGY levels. RESULTS Mean scores for PGY-1 residents were significantly higher on the prior years Likert-type assessments than milestone-based assessments for all 3 subcompetencies (P < .01). Stratification by PGY level was not observed with Likert-type assessments (eg, interpersonal and communication skills 1 [ICS1] mean score for PGY-1, 3.99 versus PGY-3, 3.98; P  =  .98). In contrast, milestone-based assessments demonstrated stratification by PGY level (eg, the ICS1 mean score was 3.06 for PGY-1, 3.83 for PGY-2, and 3.99 for PGY-3; P < .01 for PGY-1 versus PGY-3). Significantly different means by trainee level were noted across 21 subcompetencies on milestone-based assessments (P < .01 for PGY-1 versus PGY-3). CONCLUSIONS Initial results indicate milestone-based assessments stratify trainee performance by level better than Likert-type assessments. Average PGY-level scores from milestone-based assessments may ultimately provide guidance for determining whether trainees are progressing at the expected pace.

SEVEN YEARS OF PROJECT CALC AT DUKE UNIVERSITY APPROACHING STEADY STATE

ABSTRACT Duke University was the site of one of the first large scale calculus reform projects funded by the National Science Foundation (NSF) in the post-Tulane conference era. In the seven years during which Project CALC has first taught, it has undergone numerous revisions. In this paper, we will discuss these revisions and the reasons behind them. In particular, we will describe the changes we have made over the last seven years in the: mathematical content; text; software and hardware; emphasis on computational skill; amount and nature of student writing; amount and nature of student homework; and grading, testing and assessment of student learning. The reasons for these changes include: examination of the results of our formal evaluation; the attitudes of students; and the attitudes of faculty. *Parts of this paper were presented at the Joint AMS/MAA Meetings on 11 January 1996.

An Expert Novice Study of Metacognitive Behavior in Four Types of Mathematics Problems.

ABSTRACT The purpose of this study was to examine the differences between the metacognitive behaviors exhibited by experts and novices. Of particular interest was the degree to which subjects managed or controlled their behavior and the extent to which solutions, particularly by experts, were schema driven. Nine novices (college freshman) and six experts (first and second year graduate students in mathematics) were asked to think aloud while solving four mathematics problems: (1) a routine problem; (2) a problem with more than one obvious path; (3) a nonroutine problem that involved the use of the skills used in the routine problem; and (4) a problem with insufficient or contradictory information. The verbal protocols provide evidence that: experts in this study possessed and used schemas to solve problems but schema use did not fully or adequately characterize expertise; of the two aspects of metacognition - beliefs about cognition and control of cognition - beliefs played a more important role than cont...

Using an Innovative Curriculum Evaluation Tool to Inform Program Improvement: The Clinical Skills Fair

BACKGROUND Program evaluation is important for assessing the effectiveness of the residency curriculum. Limited resources are available, however, and curriculum evaluation processes must be sustainable and well integrated into program improvement efforts. INTERVENTION We describe the pediatric Clinical Skills Fair, an innovative method for evaluating the effectiveness of residency curriculum through assessment of trainees in 2 domains: medical knowledge/patient care and procedure. Each year from 2008 to 2011, interns completed the Clinical Skills Fair as rising interns in postgraduate year (PGY)-1 (R1s) and again at the end of the year, as rising residents in PGY-2 (R2s). Trainees completed the Clinical Skills Fair at the beginning and end of the intern year for each cohort to assess how well the curriculum prepared them to meet the intern goals and objectives. RESULTS Participants were 48 R1s and 47 R2s. In the medical knowledge/patient care domain, intern scores improved from 48% to 65% correct (P < .001). Significant improvement was demonstrated in the following subdomains: jaundice (41% to 65% correct; P < .001), fever (67% to 94% correct; P < .001), and asthma (43% to 62% correct; P  =  .002). No significant change was noted within the arrhythmia subdomain. There was significant improvement in the procedure domain for all interns (χ(2)  =  32.82, P < .001). CONCLUSIONS The Clinical Skills Fair is a readily implemented and sustainable method for our residency program curriculum assessment. Its feasibility may allow other programs to assess their curriculum and track the impact of programmatic changes; it may be particularly useful for program evaluation committees.