Lindsay Davidson

A 3-year experience implementing blended TBL: active instructional methods can shift student attitudes to learning.

Medical educators have been encouraged to adopt active instructional strategies that require learners to engage in and direct their own learning. These innovations may be seen as disruptive and face early challenges due to student resistance. We report 3 years of experience implementing a blend of team-based learning (TBL) and online learning modules in an undergraduate medical course. Three sequential cohorts of first year medical students were surveyed exploring how they valued different instructional methods during a period of evolving curricular design. In addition to a demonstrated increase in acceptance of new teaching methods, there was a shift in student perceptions of the relative merits of didactic, online and TBL teaching. Medical students’ appreciations of different instructional methods are influenced by the maturity of instructional design. Educational change is best viewed through a longer term lens, acknowledging the necessity for teachers to develop experience in implementing new methods in the context of their institution.

Is a mandatory general surgery rotation necessary in the surgical clerkship

BACKGROUND Changes in the spectrum of general surgery and the delivery of surgical care have placed the requirement for a mandatory general surgery rotation in the surgical clerkship in question. METHODS We tested the hypothesis that equal mastery of surgical clerkship objectives can be obtained in a clerkship with and without general surgery. Students chose any two surgical rotations and were assessed by written examination, objective structured clinical examination (OSCE), ward evaluations, self-assessment objectives questionnaire, and satisfaction survey. RESULTS Data for 54 students showed no differences in scores between groups on any parameter. No specific concerns related to the absence of general surgery were identified. CONCLUSIONS Effective undergraduate surgical education can be offered in many specialty settings. Removal of the requirement for general surgery in clerkship may lead to a more effective use of all educational opportunities. A careful analysis of local programs and facilities is necessary before suggesting this change to other institutions.

Enriching the clerkship curriculum with blended e-learning.

Context and setting The pre-clinical years of undergraduate medical education have recently witnessed a shift away from the traditional, lecture-based model of teaching towards new instructional methods designed to encourage student-centred learning. Blended e-learning, which combines online self-study modules with face-to-face teaching, can be used to achieve this goal. Although the use of blended e-learning in the pre-clinical years has been described in the literature, there have been few reports about this method of instruction at the clinical clerkship level. Why the idea was necessary Prior to this project, formal clinical clerkship teaching at our university involved didactic weekly seminars presented by faculty members. Rising enrolment without any increase in the number of teachers led us to investigate novel methods of content delivery. The purpose of this project, therefore, was to improve teaching for clinical clerks at our institution while maximising the quality of the time spent with teaching faculty. What was done A web-based module was created to complement the material covered in the existing clinical clerkship seminar ‘Acute Hand Injuries’. The objectives for the module were developed with reference to national specialty society objectives as well as those published by the Medical Council of Canada. The module was presented as a series of authentic clinical cases and included self-assessment questions with embedded feedback. Given the solid theoretical foundation provided by completion of the new module, the existing 60-minute didactic seminar was modified into a 30-minute session that focused on the consolidation of knowledge through a review of relevant cases. The effectiveness of this blended e-learning model was compared with that of our traditional approach. One group of clinical clerks attended the traditional, expert-led seminar and another completed the new case-based, online module and then attended the shorter session with the same expert, who facilitated discussion and answered questions. Both groups then completed a content-based quiz and participated in focus groups designed to better understand the students’ reactions to their learning experience. Evaluation of results and impact Although the number of students was too small for statistical significance, the group that completed the online module scored 1.15 marks (out of 10) more on the content-based quiz than the group that attended the didactic seminar. During the focus group sessions, it became clear that students who had completed the module and subsequent follow-up session felt more engaged during the seminar and were more confident about applying their knowledge to cases. Other benefits included consistency of instruction and flexibility of use. It was concluded that this blended e-learning approach should be implemented in clerkship teaching as it enriches the student learning experience by increasing student engagement and encouraging active learning. At present, three modules have been completed and are in use; two others are in development. We anticipate that blended e-learning with the use of online modules will become a central part of our clinical clerkship curriculum. These resources will be shared with other institutions by means of submission to digital repositories.

Teaching about child abuse with a mock trial

ahead of sessions and completed a short pre-test quiz on the article prior to class. An online critical assessment worksheet (CAW) was used by each TBL group to facilitate in-class group exercises that were specific to the following article types: cohort study; case–control study; diagnostic testing; randomised controlled trial, and meta-analysis. Learners worked through exercises in TBL groups for 30 minutes using the CAW to introduce specific aspects of study types. The course instructor used the remainder of the time to reinforce specific content (calculation of odds ratios, risk ratios and numbers needed to treat; randomisation; blinding, etc.) according to session objectives. This format was followed for five of eight sessions. The remaining three sessions involved searching the literature to address a focused clinical question. Medical librarians presented strategies for forming clinical questions using the PICO (Patient problem, Intervention, Comparison, Outcome) framework and for searching online databases. Each TBL group then selected a clinical question from a pre-formulated list created by the course director. Groups were tasked to use strategies demonstrated by the librarians to identify the article that best addressed the selected clinical question. In the last session, the TBL groups critically appraised the journal articles they had identified as an in-class final, leveraging the skills learned earlier in the course. Evaluation of results and impact Of all respondents, 81.3% agreed that the CAW was a useful selfdirected tool for appraising journal articles. Learners reported a 17.5% (95% confidence interval [CI] 9.6– 25.3%) increase in perceived ability to search the literature. Throughout this EBM course, the practice of turning to the literature in situations of clinical uncertainty was emphasised and modelled. The learners practised the same behaviour and 70% of learners agreed or strongly agreed that these EBM skills would be helpful in the future (using a Likert scale of 1–5, where 1 = strongly disagree and 5 = strongly agree; mean score: 3.86, 95% CI 3.65–4.06). Our next step, in partnership with the internal medicine clerkship, is to eschew standard student topic presentations and adopt a focused clinical question approach. Thus, an examination of whether one imaging modality (ultrasound) is superior to another (computed tomography) in acute pancreatitis will replace a 5-minute review on pancreatitis. We plan to disseminate this approach to all other clerkships so that the desired behaviours of literaturesearching and critical appraisal introduced in the EBM course are reinforced throughout Years 3 and 4, providing the foundation for solid lifelong learning behaviour’s.

Virtual Patient Stories as a Facilitator of IPE: A Pilot Study

Learning Together With Cases (LTWC) was a pilot project designed to create a series of stand-alone, media rich online modules. We describe how interprofessional groups of pre-licensure students from medicine, nursing and occupational therapy used one case, including the social networking capabilities, to achieve a rich interprofessional community of learning.