CEEP Journal - Part 1: Student becomes Teacher. Coming July 1.

One of the major objectives for this CEEP selective is to develop an appreciation for and to gain insights towards medical education. Personally, some of the themes that I wish to explore include curriculum design, effective teaching strategies, the concept of self-directed ‘adult’ learning, and adapting education in the face ever-evolving technology. For me, the subject at hand is an interesting one because as a medical student, I’ve spent the last 4 years being the recipient and now byproduct of just this, “world-recognized” medical education at the University of Toronto - and haven’t really put much thought into the work, design, research, and effort that has afforded me this doctor title.

In a few months, my cohort and I will transition from being medical students to ‘resident physicians’ and will suddenly no longer be the most junior members on a team. Moreover, for the first time, we will have a role to teach, to mentor, and to lead medical students just as the many exemplar residents did before us. And as we progress through our medical careers, the duty and responsibility to pass our knowledge down allows the cycle of medical learning to come full circle - from student to teacher to student again. But how do we do this? What strategies and techniques were effective in my own learning? Which lecturers had the most affinity? Which sessions had lasting impressions or motivated me to study further? And ultimately, which areas of medical education most benefited my performance? How do we quantify this? How will it change with time, and how robust are we to adapt?

These are some of the questions I hope to answer for myself and to apply to my own education and teaching career going forward. Stay tuned! - AC

Today I am reflecting upon a concept proposed by Cate in the article “What happens to the student?” I was particularly intrigued by the argument that it is impossible to measure the effectiveness of medical education strictly by evaluating student performance on tests. The main reason for this, as discussed in the article, is based upon the students’ ability to compensate for poor medical education, simply by increasing the time spent studying and learning outside of the classroom. Conversely, exemplary medical education may result in less time spent studying for an exam. The end result is similar student performance on tests and exams, despite possible discrepancy in educational quality. While I had never actually given any direct thought to this theory, I absolutely subscribe to its fundamental philosophy, based upon my experience with undergraduate medical education.

I would argue that the impact of this phenomenon might even be underestimated in this article. While based only on my own anecdotal evidence, it seems as though compensation is compounded through repetition. After hearing from upper year students about a particularly difficult exam, my fellow peers and myself would make sure to spend extra time and effort in preparation for said exam. Of course, this means that attempting to infer the quality of medical education based on the results of this exam would be even more misleading than before.

Given these insights, Cate proposes that perhaps we should be investigating how the student behaves after medical education, in preparation for exams and clinical encounters, as a better predictor of the effectiveness of medical education. While this seems like a reasonable solution, it may be hard to collect this type of data, and relies heavily on self-reporting measures, which are not always accurate. It is possible that further work in this field would elucidate superior methods for collecting this data and evaluating the effectiveness of medical education as a whole.

-AS

Thinking about curriculum development and assessment

My colleague and I reflected on our site visit to Bitove Academy and shared our experience and feedback with Dr. Panisko. The conversation allowed me to reflect more on the process of curriculum design and development. We visited Bitove Academy with the intention of learning more about the program and services they offer, and whether medical students would benefit from a site visit. Medical education frequently undergoes changes that are aimed to meet the evolving needs of learners as well as the healthcare system. With change, new experiences and learning opportunities are added, while existing ones are modified or removed from the curriculum. I have been reflecting on the limited time that exists in the curriculum and the importance of ensuring that each activity has a purpose and achieves certain learning objectives.

I also began to think critically about assessment in medical education. We frequently design and implement novel ideas into the curriculum, but we must also be cognization of the evaluation process. At the same time, my opinion is also not to create additional assignments and projects for the sake of evaluation. Rather, the assessment process should match the complexity and duration of the experience. Kirkpatrick's Four-Level Training Evaluation Model outlines evaluation of reaction, learning, behaviour and results, and Bloom’s Taxonomy outlines remembering, understanding, applying, analyzing, evaluating and creating. It would be valuable to evaluate students at as many levels as possible to determine true impact and significance of novel activities or experiences.

I am curious to learn more about curriculum design and development, as well as program evaluation. I have a strong interest in medical education and hope to be a part of developing and refining curricula as part of my residency training and future career.

- Usman T.

Blog #6 – March 15, 2017

Teaching is not an easy task. Teaching in medicine can be even more challenging as the topics are often complex and difficult to communicate when time is a limitation. Though we are not formally trained to teach as physicians, we spend a decent portion of our time teaching especially in academic hospitals. Some of us eventually identify as being a clinician teacher as we utilize and adopt different strategies during our training based on mentors who we think are good teachers. As a resident, I think we will be put in a unique position as we would still be learning content ourselves, but we would also have trainees who are more junior in their training that we can relate to. In that sense, we could model how we deliver information and be mindful or cognizant of where their level of understanding might be as well.

In this CEEP selective, we were given the task of delivering a 30-minute presentation to our peers who our also fourth year medical students. While deciding on a topic to cover, I wanted to choose one that would be relevant for my colleagues as I knew they were heading into specialties like neurology, radiology, and internal medicine. And yet, I also wanted to choose a topic that I was passionate about as I strongly believe that teaching is an effective way to learn. Throughout this process of creating a presentation, I found myself looking up concepts I was unfamiliar, thinking of different ways to communicate the same idea, and practising how I would deliver the content over a set time period. In doing so, I found myself filling my own knowledge gaps, verbalizing content in different ways, and ultimately synthesizing information differently than I would when I am studying for an exam. Furthermore, while I was delivering the presentation, I was also asked questions I had not considered and it got me to start thinking of how I could fill that knowledge gap (e.g. via conducting a literature search) or even how I could answer those questions in a research setting. I think there are many benefits for the learner when they teach others. This concept of ‘learning by teaching’ is certainly not a new one in medical education and I am glad to have had the opportunity to personally experience and reflect on this model. My hope is that with more practice in teaching I will become more comfortable with creating these presentations efficiently and will have a better understanding of how to deliver such content to different audience members. I have seen expert clinician teachers teach a complex concept and could engage different levels of learners by tailoring the types of questions they were asking.

1. - CY

Blog #5 -  March 14, 2017

As part of the CEEP curriculum, my colleague and I were asked to make a site visit to the Bitove academy, an initiative that uses art, social activities, and exercise programs to keep adults with mild to moderate dementia engaged. We were given the assignment of determine whether the site was a worthwhile experience for medical students to be involved with and decide to what degree our level of involvement should be. This involved creating learning objectives and describing potential ways students could be evaluated if this were integrated into our curriculum.

I thought this activity was an effective exercise and gave us some insight of what it might take to design curricula. Entering our debrief session with Dr. DP having been given time to reflect on our visit was useful. It gave me the opportunity to organize my thoughts, but more importantly, gain insight from an expert who has had experience with curriculum design. I learned that part of this process involves conducting different types of needs assessment and that we should ultimately be considering how much this activity would enhance our learning as a medical student. During our discussion I found myself admitting that while a visit to the Bitove Academy would be beneficial with more structure and organization, extending the experience may not add value as I did find myself losing engagement towards the end of my visit. I appreciated how open and receptive Dr. DP was to our feedback and liked how thought-provoking the questions were.

Together, we also discussed how this experience could be explored further and expanded by our peers. As one of the first students to engage in this activity, I think it is certainly worthwhile especially for students who have a strong interest in medical education. The skills that we learned from this small assignment will hopefully be useful for when we (one day) become educators who are involved in making similar decisions about curriculum design.

- CY 

Teaching our colleagues

Today I had an opportunity to teach a few of my peers who are also on Selective in GIM this block. The teaching exercise was open-ended and allowed us to develop our own approach. Rather than delve into one topic, I decided to review a couple of cases in cardiology, gastroenterology, endocrinology and medical imaging in the format of Jeopardy. The cases were designed to have an overview and review of some important concepts, with an additional objective of serving as introductory preparation for our upcoming Medical Council of Canada Qualifying Examination (MCCQE)! Given the timing of this teaching exercise, I felt this would be the most effective way to engage the other clerks and deliver a session that would be valuable to them.

This exercise allowed me to reflect on my own teaching objectives, while being cognizant of the learners’ priorities and goals. It also required me to develop a creative way to present and discuss the cases. Jeopardy was an interactive method as the learners had an opportunity to select the ‘category’ (topic) of the question and difficulty level. Each learner took a turn selecting a topic and question they’d like to approach. This resulted in greater engagement and fun while learning. For the more challenging questions, the entire group discussed their thought process and consequently engaged in collaborative learning.

As I move forward in my career, I am enthusiastic about engaging in more teaching activities with my peers as well as with medical students. I enjoy teaching, particularly in small groups where the learning experience can be engaging and interactive. I hope to be able to incorporate teaching as a part of my career in the future, by teaching residents and medical students in my specialty.

- Usman T.