Lise McCoy

Developing Technology-Enhanced Active Learning for Medical Education: Challenges, Solutions, and Future Directions

Growing up in an era of video games and Web-based applications has primed current medical students to expect rapid, interactive feedback. To address this need, the A.T. Still University-School of Osteopathic Medicine in Arizona (Mesa) has developed and integrated a variety of approaches using technology-enhanced active learning for medical education (TEAL-MEd) into its curriculum. Over the course of 3 years (2010-2013), the authors facilitated more than 80 implementations of games and virtual patient simulations into the education of 550 osteopathic medical students. The authors report on 4 key aspects of the TEAL-MEd initiative, including purpose, portfolio of tools, progress to date regarding challenges and solutions, and future directions. Lessons learned may be of benefit to medical educators at academic and clinical training sites who wish to implement TEAL-MEd activities.

What millennial medical students say about flipped learning

Flipped instruction is gaining popularity in medical schools, but there are unanswered questions such as the optimum amount of the curriculum to flip and whether flipped sessions should be mandatory. We were in a unique position to evaluate feedback from first-year medical students who had experienced both flipped and lecture-based courses during their first semester of medical school. A key finding was that the students preferred a variety of different learning formats over an “all or nothing” learning format. Learning format preferences did not necessarily align with perceptions of which format led to better course exam performance. Nearly 70% of respondents wanted to make their own decisions regarding attendance. Candid responses to open-ended survey prompts reflected millennial preferences for choice, flexibility, efficiency, and the ability to control the pace of their learning, providing insight to guide curricular improvements.

Student Assessment of an Innovative Approach to Medical Education

BackgroundInductive reasoning via the Clinical Presentation (CP) Model is an innovative approach to medical education delivery. Moving the locus of training from the medical school campus to a community health center (CHC) or CHC-affiliated site for the second, third, and fourth year is equally innovative.MethodsWe investigated student impressions of the CP Curriculum, inductive reasoning process and the early contextual learning experience. An electronic survey of 10 questions was sent to 194 third and fourth year SOMA students. Of the 194 registered students, 146 (75.3%) responded.ResultsGreater than 80% of all respondents rated their experience at the contextual learning campuses as having a positive impact on their ability to perform in their clerkship years. The majority of students (60.3%) rated their level of understanding of the CP Model highly as well as their understanding of how to actually use the CP Model to arrive at a diagnosis (50.7%). Respondents rated their perceptions of their understanding of inductive vs. deductive reasoning with less confidence (39.0%).ConclusionsOverall, student assessment of the CP Curriculum and early clinical experiences was positive. Third year students rated the CP Model higher than their fourth year counterparts as a positive method to organize and learn medical knowledge. The majority of students reported some degree of adjustment period regarding communicating the CP Model to their trainers.

Evaluating medical student engagement during virtual patient simulations: a sequential, mixed methods study

BackgroundStudent engagement is an important domain for medical education, however, it is difficult to quantify. The goal of this study was to investigate the utility of virtual patient simulations (VPS) for increasing medical student engagement. Our aims were specifically to investigate how and to what extent the VPS foster student engagement. This study took place at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA), in the USA.MethodsFirst year medical students (n = 108) worked in teams to complete a series of four in-class virtual patient case studies. Student engagement was measured, defined as flow, interest, and relevance. These dimensions were measured using four data collection instruments: researcher observations, classroom photographs, tutor feedback, and an electronic exit survey. Qualitative data were analyzed using a grounded theory approach.ResultsTriangulation of findings between the four data sources indicate that VPS foster engagement in three facets:1)Flow. In general, students enjoyed the activities, and were absorbed in the task at hand.2)Interest. Students demonstrated interest in the activities, as evidenced by enjoyment, active discussion, and humor. Students remarked upon elements that caused cognitive dissonance: excessive text and classroom noise generated by multi-media and peer conversations.3)Relevance. VPS were relevant, in terms of situational clinical practice, exam preparation, and obtaining concrete feedback on clinical decisions.ConclusionsResearchers successfully introduced a new learning platform into the medical school curriculum. The data collected during this study were also used to improve new learning modules and techniques associated with implementing them in the classroom. Results of this study assert that virtual patient simulations foster engagement in terms of flow, relevance, and interest.

Faculty Assessment of an Innovative Approach to Medical Education

BackgroundThe Clinical Presentation (CP) Model and inductive reasoning process is an innovative approach to undergraduate medical education delivery used at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA). Embedding cohorts of students into community campus settings during the second, third and fourth year is equally as innovative and a unique model for training future physicians that fosters contextual learning.MethodsWe investigated faculty impressions of the CP Curriculum (CPC), inductive reasoning process and the early contextual learning experience. Electronic surveys were sent to 36 Mesa campus faculty and 23 Regional Directors of Medical Education (RDME) at each of the 11 National Association of Community Health Centers (NACHC) affiliated Community Health Campuses (CHC’s) in nine states.1 A total of 40 respondents (68%) completed the survey.ResultsSeventy percent of faculty respondents indicated that they “Completely Understand or “Understand Very Well” the CP Model as a teaching tool. Ninety-five percent of respondents stated they understand the application of “inductive vs. deductive” processes as they apply to medicine, and 88% expressed that they understood at least “Somewhat” how to use the CP Model to arrive at a diagnosis in “real life”. More than half (53%) indicated that placing the medical student in the contextual learning campus beginning in year 2 is the “right idea that is implemented at the right time”.ConclusionsSince about half of faculty surveyed indicated that they understand the inductive reasoning aspect of the CP Model very well or well, additional faculty development training is warranted. In the classroom, 70% reported including clinical presentation schemes 80–100% of the time during instruction. Clinical faculty were statistically significantly more likely to indicate that placing the medical students in the community health clinic settings at the beginning of their second year is the right idea at the right time.

Teaching Medical Students About Health Systems Science and Osteopathic Principles and Practice Using a Virtual World: The Envision Community Health Center

Medical education technology initiatives can be used to prepare osteopathic medical students for modern primary care practice and to provide students with training to serve vulnerable populations. Over academic years 2014 through 2017, the authors designed and implemented 26 case studies using patient simulations through a virtual community health center (CHC). First-year students, who were preparing for clinical training in CHCs, and second-year students, who were training in CHCs, completed the simulation case studies, gaining practice in clinical reasoning, Health Systems Science, and applied osteopathic principles and practice. This article explains the project, illustrates an alignment with Health Systems Science and osteopathic competencies, and highlights findings from previous research studies.

Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach:

Background: Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. Methods: Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. Results: Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. Conclusions: The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction.

Gaming science innovations to integrate health systems science into medical education and practice

Health systems science (HSS) is an emerging discipline addressing multiple, complex, interdependent variables that affect providers’ abilities to deliver patient care and influence population health. New perspectives and innovations are required as physician leaders and medical educators strive to accelerate changes in medical education and practice to meet the needs of evolving populations and systems. The purpose of this paper is to introduce gaming science as a lens to magnify HSS integration opportunities in the scope of medical education and practice. Evidence supports gaming science innovations as effective teaching and learning tools to promote learner engagement in scientific and systems thinking for decision making in complex scenarios. Valuable insights and lessons gained through the history of war games have resulted in strategic thinking to minimize risk and save lives. In health care, where decisions can affect patient and population outcomes, gaming science innovations have the potential to provide safe learning environments to practice crucial decision-making skills. Research of gaming science limitations, gaps, and strategies to maximize innovations to further advance HSS in medical education and practice is required. Gaming science holds promise to equip health care teams with HSS knowledge and skills required for transformative practice. The ultimate goals are to empower providers to work in complex systems to improve patient and population health outcomes and experiences, and to reduce costs and improve care team well-being.