Ome Newsletter, Fall 2008 (12!04!08)

Office of Medical Education Newsletter Tulane University School of Medicine Office of Medical Education 1430 Tulane Avenue, SL-6 New Orleans, LA 70112 The OME newsletter provides on-going professional development to faculty, residents, Tel 504-988-6600 preceptors, and others with direct responsibility for medical student education in the areas of: Fax 504-988-6601 [email protected] • Methods of pedagogy www.som.tulane.edu/ome • Communication and assessment • Development and implementation of educational objectives • Educational Technology • Competency-based Evaluation MISSION

Fall 2008

Volume 2, Issue 2

WE CONTRIBUTE

The ultimate goal of this resource is to enhance the teaching and evaluation skills of medical educators at Tulane University School of Medicine.

TO THE MEDICAL

(Read more on page 12, under Call for Submissions.)

STUDENTS’ EDUCATION BY PROVIDING FACULTY DEVELOPMENT,

Upcoming Events: You are cordially invited to join us for:

EDUCATIONAL SUPPORT AND SERVICES TO FACULTY AND STUDENTS.

Education Excellence Week January 12-16, 2009 Read more on page 13.

Career Day March 7, 2009 See page 13.

In this issue… Competencies……….....2 Evidence Based Med….4 RIME/TBL ………….... 4 Welcome………….…….7 UME-GME ………….…8 Lagniappe ……………..8 OME Updates ………...9 Call for Submissions…12 Upcoming Events ..…..13

IAMSE Webinar Series Spring 2009 Begins March 4, See page 13.

Education Day May 7, 2009 Effective In-Training Feedback Call for submissions, See page 13.

OME Newsletter, Fall 2008

Guest Commentary: Assessment of Competencies James M. Shumway, PhD Associate Dean for Medical Education Professor
of
Internal Medicine
and
Pediatrics
 West Virginia University School of Medicine

Dr. Shumway received his doctorate in medical education from the University of North Carolina at Chapel Hill in 1981. His expertise is in curriculum development and student assessment with academic interests focusing on competence (or outcomes) based medical education. He is Associate Dean for Medical Education, Director of the Office of Medical Education at the West Virginia University (WVU) School of Medicine, and is a tenured Professor of Internal Medicine and Pediatrics. He has been a Liaison Committee for Medical Education (LCME) team member for over 15 years, and was recently appointed an institutional review team secretary for the LCME. He regularly facilitates problem based learning groups and believes that education is not about teaching, but about helping students learn.

Competencies in Medical Education: Some Thoughts about the Importance of Outcomes-Based Assessment1 Assessment plays a major role in the process of medical education, in the lives of medical students, and in society by certifying competent physicians who can take care of the public. The very foundation of medical curricula is built around assessment milestones for students. For example, in the United States medical students must pass a series of steps towards licensure before graduating from medical school. It is assessment and evaluation that often drives the curricula of medical schools, and students measure their progress through the curriculum by the 1

This short piece has been abstracted from a longer article published in 2003 (Shumway JM and Harden RM. AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician. Medical Teacher, Vol. 25, No. 6, 2003, pp. 569-584).

2 examinations they have passed. Assessment becomes a motivating force for them to learn. Society has the right to know that physicians who graduate from medical school and subsequent residency training programs are competent and can practice their profession in a compassionate and skilful manner. It is the responsibility of the medical school to demonstrate that such competence has been achieved, and the responsibility of accreditation agencies to certify that the educational programs in medical schools can do what they promise. Assessment is of fundamental importance because it is central to public accountability. All North-American medical education programs are required to have their program based on the educational outcomes that students are expected to achieve. Some programs call these competencies and others call them educational outcomes. In either case, competencies or outcomes are a broad description of what the student should be able to demonstrate in terms of knowledge, skills, and attitudes upon graduation. In educational terms, outcomes or competencies are the broad areas to which course-specific educational objectives are expected to contribute. Perhaps the best example of a competency or outcome model in the United States is the that of the six core competencies established by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties (ABMS): 1) patient care, 2) medical knowledge, 3) practice-based learning and improvement, 4) interpersonal and communication skills, 5) professionalism, and 6) systems-based practice. While competence in these six core areas is required for post-medical school residency training programs, the six core competencies are also being adopted by many medical schools. The Liaison Committee for Medical Education (LCME) is the accrediting agency for North American medical schools (USA and Canada). Medical schools in North America have traditionally been accredited on the quality of the elements that make up the student educational program (e.g. faculty, research, facilities, courses and clerkships). There are essentially four questions asked during accreditation: 1) What are the goals?; 2) What did students actually learn?; 3) What is the evidence?; 4) What needs to be changed? The LCME has instituted standards focusing on the assessment of outcomes. In outcomes-based assessment the educational

OME Newsletter, Fall 2008

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program goals or learning outcomes are defined and their accomplishment is assessed. North American medical education institutions are now required to document educational outcomes in light of their institutional purposes and missions. Assessment is an intrinsic component of outcome-based education. Outcome-based education and performance assessment are closely related paradigms. Outcomebased education involves an educational approach in which the decisions about the curriculum and evaluation are driven by the learning outcomes that students should achieve. In this approach, the product (student learning outcomes) defines the process (instructional methods and learning opportunities). This is distinctively different from earlier educational approaches that relied on inputs. These approaches, having defined the educational program, accepted whatever outcomes resulted from the process. The assumption was that a ‘better’ process would result in ‘better’ outcomes. In outcome-based education, agreement on predetermined student learning outcomes defines the processes used to achieve them. In 1990 Dr. George Miller proposed a pyramid of learning with increasing professional authenticity, starting with the learner’s cognition and moving towards a focus on the learner’s behavior. Dr. Cees Van der Vleuten linked a hierarchy of assessment approaches of increasing authenticity with the Miller Pyramid. This model is useful with regard to assessment in so far as different assessment instruments are appropriate at each level of the pyramid. The figure below shows the Learning Assessment pyramid with the purposes of assessment (on the left) and each of the four levels matched with one or more assessment approaches (on the right). Written assessment is the predominant instrument at the ‘know’ and ‘know how’ levels, clinical assessment and the Objective Structured Clinical Exam (OSCE) at the ‘shows how’ level and observation, portfolios and logbooks at the ‘does’ level. The development in medical education institutions of appropriate approaches to assessment, underpinned by a related philosophy, has lagged behind developments that have occurred in other aspects of the curriculum. The implications of this may be serious. Implementation of a new curriculum without changes in the approach to assessment may result in little or no change at all. More attention must be paid to assessment. Faculty and staff at each institution should spend time developing a cohesive assessment philosophy and engaging in a faculty and staff development program. Engagement with the assessment process and ensuring that students achieve the required

learning outcomes is one of the important roles of a medical teacher. It is unlikely that one assessment instrument can address all of the learning outcomes. In general, what is required is a focus on the construction of assessment blueprints to adequately sample the learning outcomes to be assessed. It is necessary to choose assessment approaches that will do the job. New assessment instruments have been developed and introduced, and can be used to assess the range of learning outcomes. More traditional instruments such as multiple-choice questions (MCQs) that have been used for decades have dominated the assessment process. We are likely to see in the future a move away from selected-response questions as in MCQs to constructed-response questions. There will also be a move to the assessment of learning outcomes which are not currently being tested. Institutions need a basic package of assessment methods that will get the job done. The basic assessment package should consist of some sort of written assessment, for example, constructed response questions, and/or extended-matching items. The toolkit should also include a performance assessment such as the OSCE. Finally some measure of the students over time to assess other outcomes such as critical thinking and self-assessment is necessary. Portfolios can be used for this purpose. Portfolios are a collection of material made by a professional that documents the learner’s achievements and includes a reflection by the learner on those achievements. This basic package is not meant to be exhaustive; indeed institutions are encouraged to develop additional assessment strategies that meet the unique and

OME Newsletter, Fall 2008 particular needs of their own settings. What is needed is a move to assess what learners do in practice and how they apply their knowledge of basic and clinical sciences to the care of patients. While many schools have moved to the assessment of competence in stimulated situations, only a few have placed a major emphasis on the assessment of performance in clinical practice through direct observational approaches or through the use of indirect measures such as portfolios. Qualitative assessment approaches have also been underused in medical education. Qualitative assessment has been associated wrongly with subjective assessment. Evidence based literature exists that outlines the principles of good qualitative assessment. Qualitative assessment methods provide the assessor with a sense of the environment and conditions in which the learning and its practice take place. It allows the assessor to better understand not just what students know or do not know, but what they do with that knowledge in the real settings that require the application of the learner’s knowledge, skills and attitudes. In response to increasing public demands for a greater measure of accountability for the physicians we educate, rapid progress needs to be made in designing competency- or outcomes-based curricula and assessing students in increasingly realistic ways to show they can practice medicine. We need an understanding of the assessment process and knowledge of the tools available and how they can be used to assess the full range of learning outcomes. The assessment of learning outcomes needs to be applied across the different phases of medical education from undergraduate medical education to postgraduate education to continuing professional development (CME). We need more studies of how professional competence is measured and how those measurement data are applied so that desired changes in behavior are achieved. We have an opportunity to work across the medical education continuum to significantly improve what we do educationally, to have an impact on the future of the practice of medicine, and to guarantee to the public the competence of our physician workforce.

Evidence Based Medicine . . . Introduction & Seminar Opportunity Pamela Wiseman, MD Assistant Professor of Family & Community Medicine Tulane University School of Medicine

4 Evidence-based Medicine is defined as the “Conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. (Sackett, DL, et al. Evidence-based medicine: What it is and what it isn’t, BMJ 1996). We use EBM skills everyday during patient care when we ask questions and find answers, when we evaluate new medical literature, and even when we decide which journal articles to read. These skills are useful for the medical school environment during morning report, patient rounds, Grand Rounds, and Journal Club. EMB skills are useful for students, residents, and faculty alike. It is especially important that faculty model and teach EBM to residents and students. EBM stresses to the trainee the importance of the evaluation of evidence from the medical literature and cautions against the use of intuition, unsystematic clinical experience, and untested pathophysiologic reasoning as sufficient for medical decision making. (Chessare, JB. Pediatrics, 1998, 101.) The basic steps in practicing evidence-based medicine are: 1) Formulate a clear clinical question from a patient’s problem. 2) Search the literature for relevant clinical articles. 3) Evaluate the evidence for validity and usefulness. 4) Implement useful findings in clinical practice. There are also several categories of Evidence-Based Medicine skills which can be discussed with learners: Information Mastery is how to efficiently and effectively find and incorporate new medical information into your practice. This approach focuses on information likely to change your current practice. As educators, we often assume that our learners know how to search for medical information and where the valid sources are. Unfortunately, often this is not the case. Critical Appraisal is how to read and interpret journal articles. This is the typical focus of most journal clubs and was the first focus of EvidenceBased Medicine when the landmark series, “The User’s Guide to the Medical Literature,” was published by JAMA in 1993. The User’s Guide series described how to approach different kinds of articles about therapy, prognosis, prevention, diagnostics tests, harm, etc., and apply the findings to

OME Newsletter, Fall 2008 clinical practice. Critical Appraisal skills are necessary but not sufficient for the skilled clinician. Point of Care Questions/Answers are also called “Just in Time” learning, because it enables clinicians/learners to answer questions in time to affect their treatment of a patient. This approach starts with the ability to formulate appropriate patient-oriented questions which can be answered efficiently. The PICO format (patient/intervention/control/outcome) is practiced to give the learner the ability to generate appropriate clinical questions. Clinical Questions structured in this format are considered answerable, searchable, and even researchable. Many resources are popping up to help clinicians efficiently access point of care information. PIER, DynaMed, and UpToDate are a few that are available through our own Rudolph Matas Library Website. Many of these resources are available in versions that can be placed on a handheld device for portable use. The goal is to be able to answer a question at the “point of care” while in the room with the patient and in 90 seconds or less. While points of care resources are very useful and also very popular, it behooves us to understand the place of these resources in the evidence hierarchy. It is essential that we are familiar with Level of Evidence Criteria and Strength of Recommendation Taxonomy so that we can judge the validity of these resources and be confident that they use a systematic approach to reporting findings. Only then can we be sure that we are getting the current best evidence to answer our questions. If you are interested in practicing or teaching evidence-based medicine, then prepare to attend a series of workshops sponsored by the Office of Medical Education on EBM. The first with be on “Teaching Information Mastery,” to be given in January given by Dr. Pamela Wiseman of the Department of Family and Community Medicine.

EBM Library Resources and Services Philip Walker Reference Librarian Library Services, Rudolph Matas Library Tulane University School of Medicine

The amount of biomedical information is staggering and may be impossible to navigate without adequate skills or

5 assistance. The Reference Librarians at the Matas Library can perform a variety of functions regarding the EBM resources available within the library. First and foremost, we can direct you towards those EBM resources that already have Systematic Reviews compiled for you, such as the Cochrane Database of Systematic Reviews, ACP Journal Club, or PubMed’s Clinical Queries. Secondly, there are several Point-of-Care resources available through our website with explanations of the evidence used in their conclusions, such as UpToDate and STAT!Ref. Lastly, if the EBM search is unsuccessful, we can recommend databases, search terms, and strategies that will enable you to build your own evidence. Feel free to contact us for individual assistance or to schedule a workshop for students, residents, faculty, or staff at [email protected] or 504-988-5155.

Team Based Learning (TBL) Comes to Tulane Marc J. Kahn, MD Professor of Medicine Hematology/Medical Oncology Senior Associate Dean for Admissions and Student Affairs Medical Director, Tulane Physician's Organization Tulane University School of Medicine

The second year class had their first TBL exercise as part of the Mechanisms of Disease course. The Mechanisms of Disease course is run alongside the second year Pharmacology course and Physical Diagnosis. The Hematology and Neoplasia Block is approximately 30 hours of time including traditional lectures, review sessions, case-based discussions, self-directed learning exercises, and cases from the American Society of Hematology (www.hematology.org).

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A newly-constructed TBL was administered to students following lectures and discussion of basic coagulation, hypercoagulability, bleeding disorders, and anticoagulation. Students were divided into TBL groups of six or seven students in the cafeteria. As is typical with TBL exercises, students were asked to read the three articles prior to class. Students were then administered an Individual Readiness Assessment Test (IRAT) and then completed the IRAT as a team with a scratch off card. Teams were then administered a Group Assessment Exercise (GAE) composed of “harder” questions that the students answered as a group. Students were encouraged to use the internet, textbooks, and articles for all group exercises. The GAE was resolved with a show of cards indicating the group answers. Discussion followed. Attendance was mandatory for this session. Grading was based on individual and team effort and was factored into the “professionalism” component of the course grade. Grade breakdown was as follows: First individual test (IRAT) 10 points, first group test (GRAT1) 10 points, second group test (GAE) 6 points, and participation 10 points. The session was moderated by Dr. Kahn, a hematologist who was also the course director for the block. The session was completed in two and one-half hours, and ran very smoothly. Student feedback was uniformly positive. As expected, group performance was significantly better than individual performance.




On October 22, 2008, Dr. Krane provided a highly novel Grand Rounds session in which he “taught” the basics of both RIME and TBL--without lecturing. Dr. Krane’s program entitled, Are You an Adult Learner?, introduced the principles and practice of the RIME evaluation rubric for providing structured, objective feedback (RIME stands for: Reporter, Interpreter, Manager, Educator). Using Team Based Learning (TBL) as the instructional vehicle for the RIME principles, Dr. Krane engaged those present in co-operatively creating their own learning experience. This technique resulted in a very lively event--with animated interaction between faculty, residents, and students.


 


Nutrition &Team Based Learning Theresa Dise, MD Professor of Pediatrics Director, Foundations in Medicine Program Tulane University School of Medicine Reported by Deborah Larimer (OME staff)




RIME &Team Based Learning Kevin Krane, MD Vice Dean for Academic Affairs Tulane University School of Medicine Reported by Deborah Larimer (OME staff)

Dr. Terry Dise introduced Team-Based Learning in her nutrition course for first year students beginning in Fall 2008. She reports that both she and the students are finding this technique enjoyable and productive. Students work in groups of 4-5 to read articles and answer questions. Students currently taking the course stated that, while they sometimes find the effort to be challenging, they generally enjoy the collegiality and relaxed atmosphere of the small group work. Using this instructional approach, Dr. Dise has found that students become much more engaged and active learners than in a traditional lecture setting. As an independent observer, I also noticed a heightened level of excitement and engagement as

OME Newsletter, Fall 2008 students worked together to find the best answers for the questions that were posed about specific cases scenarios.

Dr Dise has found that the students don't seem to mind staying later for a class when they are engaged in the discussions. While the TBL approach holds much promise for improved learning outcomes such as effective teaming in health care provision and enhanced experiences for patients, the process of learning to use this tool effectively (both for faculty and students) remains a challenge. Following this initial trial of TBL in her nutrition course, Dr. Dise has decided to revise some instructional procedures for the next block. In spite of the need for ongoing adaptation to meet the needs of the students, Dr. Dise’s experience with TBL has encouraged her to continue its use in the classroom.

MOD &Team Based Learning Ross Klingsberg, MD Associate Professor of Pulmonary Diseases and Internal Medicine Tulane University School of Medicine Reported by Deborah Larimer (OME staff)

Dr. Ross Klingsberg is currently giving TBL a try in his Fall 2008 Mechanisms of Disease/pulmonology course. He reports that the course has gone well overall using this approach, and has been especially productive in getting students to work together. Some concerns that Dr. Klingsberg has identified include: the TBL case-testing format requires additional time for completion due to the complexity of the cases; development of time-management skills is especially important for students when using this learning method (and in medical practice as well); and it would be helpful to have a multi-disciplinary team review the test cases and questions to make sure that they accurately reflect the course objectives. Dr. Klingsberg suggested that, “The time allowed for the IRAT [Individual Readiness Assessment Test] should reflect the length and complexity of the questions. I think it may be acceptable to simply ask the students if they are all finished and give a five minute warning.” He also noted that his experience with TBL in the classroom was

7 consistent with the information communicated in the initial TBL workshops. Dr. Klingsberg felt it was beneficial to give students the learning objectives in advance, so that they could orient their efforts toward achieving the course objectives efficiently. He concluded that TBL was particularly useful for helping students develop the interactive approach to health care that they will need in future practice settings; and commented, “I think the student feedback will be the most valuable guide to how well it went over.”

What Else is New? Kevin Krane, MD Vice Dean for Academic Affairs Tulane University School of Medicine

Plans are actively underway for the next large learning facility on the 2nd floor of the Murphy Building. This facility will be large enough for 180 learners and will provide an ideal setting for TeamBased Learning as well as traditional lectures, and small group teaching. The room will be enhanced with a new sound system and multiple large projection screens. The room can also be sub-divided for smaller groups of learners. Scheduled to open in early 2009, this new facility will be an exciting educational space for the newest generation of learners.

Welcome to . . . Mr. Neville Prendergast, newly appointed director of the Rudolph Matas Library, who will begin his tenure on January 9, 2009. Prendergast comes to Tulane from the
Becker Medical Library

at Washington University School of Medicine in St. Louis, where he was Associate Director for Health Information Resources. He has been a fellow in the Association of Research Libraries Leadership Medical Informatics and Career Development Program, and in the NLM/Association of Academic Health Sciences Libraries Leadership Institute.

James R. Korndorffer, Jr., MD (Surgery) has been appointed director of the new Simulation

OME Newsletter, Fall 2008 Center located on the third floor of the Murphy Exploration Building, at 131 South Robertson St. Jennifer Calzada oversees the day-to-day operations of the center, which is currently under construction and expected to open towards the end of January, 2009. An educational consulting team composed of clinical, basic science, nursing faculty and administrators has been meeting to align center development with the needs of the students and departments. As a member of this group, Dr. Annie Daniel has requested that all departments share with our office the goals, objectives and assessment methods for their simulation modules—so that these can be included in the curriculum mapping process currently underway.

Fostering the UME-GME Connection with Tara Benjamin, MD Resident, Tulane Medical Center Currently a second year OB/GYN resident at Tulane Medical Center, Dr. Benjamin struggled with learning disabilities & depression during her undergraduate medical education at Harvard. Academically successful prior to medical school, Benjamin graduated first in her high school class of 400; and magna cum laude from Xavier University with honors in biology, chemistry and English. When she began failing tests and required four attempts to pass USMLE Step 1, she knew she needed to find help. Harvard provided tutoring, learning specialists, counseling, and a strong support network that combined with Benjamin’s personal drive and a lot of hard work to help her complete her medical training. As part of her commitment to her chosen profession, Benjamin now wants to help medical students who may be experiencing similar difficulties. Dr. Benjamin is available as a peer tutor through the PAL program. She will also make a presentation during Education Week in January, and is currently designing Academic Support Workshops on preparing for the USMLE, study skills and test-taking skills that work. Benjamin is highly motivated to help her future colleagues succeed, and to improve the teaching and learning processes at Tulane SOM. She states, “We can be the Harvard of the South.” Dr. Benjamin plans to offer academic support workshops

8 at 6:30 pm on the first Tuesday of each month, beginning January 6, 2009. For information on the PAL program, connecting with a peer tutor, study skill workshops, etc., please contact: Kornelija Juskaite: 988-6600; [email protected] or Tara Benjamin, MD: [email protected]

LAGNIAPPE: In the News . . . from a Times Picayune editorial: “Not so young at heart” Thursday, November 13, 2008

Cardiologist, Dr. Geetha Raghuveer of Kansas City, Mo., studied childhood obesity in 70 boys and girls. Her results showed fatty buildup in neck arteries that was comparable to that of 45-year-olds. All of the children in the study had high cholesterol, and about 60% of them were obese.

Did You Know? DID YOU KNOW that . . . according to the CDC,

21% of Americans over the age of 20 have cholesterol levels greater than 240 mg/dL? . . . almost 30% of Louisiana’s population, and 37 % of New Orleans’ population, is clinically obese? . . . 27.9% of New Orleanians live in poverty? DID YOU KNOW that world-wide, HIV treatment is available to only about 31% of HIV-positive people? In the US, HIV is the major cause of death among black women aged 25-34; and the second leading cause of death in black men aged 35-44? The HIV infection rate in Washington, DC is equivalent to that in South Africa. (CNN.com) DID YOU KNOW that Tulane is the oldest continually functioning school of medicine west of the Appalachian Mountains? It the second-oldest medical school in the Deep South and the 15th oldest medical school in the United States. Originally called the Medical College of Louisiana, Tulane was founded in 1834 and chartered in 1835. Initially, classes were held in a church, in private homes, and in the charity hospital. (Wallace Tomlinson, MD)

OME Newsletter, Fall 2008

Research Anyone? During his Grand Rounds lecture on December 1, 2008, Gary Clark, MD, a candidate for the new Chair of Neurology, stated that there have as yet “been no population studies to indicate the frequency of brain development abnormalities.” Frequency estimates will be important in future neurological research. Anyone willing to take up the gauntlet?

OME UPDATES Director’s Update from the desk of . . . Annie Daniel, PhD In an Era of Change… As I reflect on my tenure at Tulane University School of Medicine, I recall what the Office of Medical Education (OME) looked like when I arrived two years ago. The OME was in a temporary space in the Office of Student Affairs and Admissions. Dr. Kahn and the staff there were so gracious as the current OME home in the SOM was being restored after the flooding. At that time, the OME was staffed with two other people besides myself (Kornelija Juskaite, the program manager and Tripp Frasch, the educational technologist), to whom I am very grateful for supporting me during my time of transition. Over the past two years, the OME has changed and evolved into a place that offers support and services in multiple areas to the SOM’s faculty, students, and administration. The OME has grown from a staff of three to a staff of seven. We are now able to offer support and services in the following areas: • Consultation on Teaching • Curriculum Development • Evaluation of Medical Student Performance • Program Evaluation • Medical Education Research • Publication of Scholarship in Medical Education • Proposals for Medical Education Grants • Evidence Based Medicine • Faculty and Student Professional Development • Educational Technology • Academic Counseling for Students

9 Recently, the OME started the Medical Education Research Group and the Journal Club. These two programs will allow faculty to enhance their skills and knowledge in medical education research. In addition, the Research Group will encourage, assist in developing, and support faculty and students in medical education research. The Medical Education Journal Club seeks to help individuals to critically evaluate current literature and assess the possibility of changes that may occur in medical education and medical education research, while increasing their knowledge base in medical education. The OME has several on-going faculty and student development activities throughout the academic year. These include: • Teaching Excellence Series • Faculty Professional Development Series • Education Day • Education Excellence Week • Careers in Medicine – Support • Mini Grants for Medical Education Research • Faculty Newsletter • Student Newsletter It is my long-term goal, as the Director of OME, to be as supportive as possible to faculty, students, and administration. All of the OME-sponsored activities and events are developed with one purpose in mind, to help ensure that medical students ultimately become highly qualified, patient-centered physicians.

Instructional Technology Update from the desk of . . . Jeanne Samuel, MEd “People rarely go to lectures to learn facts. They go to be inspired, to discover what’s new in the field, and to be challenged to think differently. The success of a lecture should therefore surely be measured not by how much more people’s knowledge has grown but by how much their framing of the topic (and extent to which they care about it) has shifted2.”

2

Greenhaigh, T. (2008, May 31). Campaign for real lectures. Outside the Box.British Medical Journal. Volume 336. Retrieved September 25, 2008 from the BMJ.com website http://www.bmj.com/cgi/content/extract/336/7655/1252-a

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On December 10th, at noon, I plan to present the topic Does PowerPoint Make Us Stupid? There has been much written about the evils of PowerPoint. “Audience boredom is usually a content failure, not a decoration failure,” states Edward Tufte3, Yale University Professor Emeritus. Tufte said that PowerPoint’s cognitive style teaches children how to “formulate client pitches and infomercials” rather than “writing a report using sentences.” He further complains that it “trivializes content.” Clive Thompson wrote a New York Times article4 summarizing Tufte’s work and adding, “Perhaps PowerPoint is uniquely suited to our modern age of obfuscation -- where manipulating facts is as important as presenting them clearly. If you have nothing to say, maybe you need just the right tool to help you not say it.” In 1999, Google’s Peter Norvig5 reduced Lincoln’s Gettysburg Address to six slides using the Auto Content wizard. There is even a YouTube comedy sketch about common PowerPoint presentation mistakes by Don McMillan titled, Life after Death by PowerPoint6.

student motivation and attendance, handout format, and student performance. During my December presentation, I plan to share at least three alternative formats for creating engaging PowerPoint presentations. I will leave plenty of time for any topic discussion and questions relating to technology and education. Future topics may include how to de-bloat your slide decks and PDF files, playing multimedia files from within slideware media, product comparisons for examware, and online course development. Please contact me anytime if you have questions or need education-related technology support – Jeanne, [email protected].

Early research about information recall and multimedia left educators with the posit that students who view multimedia presentations will better remember what was presented than they will after text-only presentations. Some even go as far as to state that multimedia is an example of active learning, and more is better. The problem with a one-size-fits-all pedagogical assumption is that it is incomplete. For instance, many studies indicate that students benefit from multimedia when it is relevant. Irrelevant content on the screen can negatively impact learning. Multiple Intelligence and personality type learning theorists suggest that individuals will benefit most from presentations favoring their learning style preference. For instance, visual learners will learn best when images accompany text. Others, such as Daniel Willingham7, state that if an image is the best representation for a concept, everyone will benefit from the visual representation, not just visual learners.

Data Exploration

Just as one-size-fits-all assumptions are incomplete, so are generalizations about the faults of educational method. For example, critics of PowerPoint as a lecture medium also have studied lecturer presentation skills, 3 4

http://www.wired.com/wired/archive/11.09/ppt2.html

http://query.nytimes.com/gst/fullpage.html?res=9C00EEDF163CF937 A25751C1A9659C8B63 5 http://norvig.com/Gettysburg/ 6 http://www.youtube.com/watch?v=cagxPlVqrtM 7 http://www.aft.org/pubsreports/american_educator/issues/summer2005/cogsci.htm

Assessment/Evaluation Update from the desk of . . . Jennifer Gibson, PhD

This information is intended to provide a guide to data exploration, the first step in data analysis. Data exploration allows the researcher to screen and check assumptions about the data collected. When using parametric tests, tests based upon the parameters of the population, four assumptions must be met for results to be deemed interpretable. They are: normally distributed data, homogeneity of variance, interval data, and independence. Normality: This assumption presumes that the data in your sample are derived from a normally distributed population. To check for normality, begin by plotting a histogram. This will give you a graphical representation of the data so you can determine if the scores form a bell-shaped curve. You can also detect obvious outliers (scores very different from the rest). If outliers are detected, use a boxplot to reveal the case of data that is producing the outlier. You can then check the raw data to determine if an error was made in data entry or if the result is a true outlier. If the result is a true outlier, you can remove the case or replace the score. If the distribution remains deviant, consider transforming the scores. While a histogram may give you a visual representation of your distribution, it does not tell

OME Newsletter, Fall 2008 you whether your distribution is close enough to normality to be useful. The Kolmogorov-Smirnov and Shapiro-Wilks tests are objective tests that can help make that determination. If these tests are significant, (p < .05), then your data set is considered non-normal and data transformation should be considered. There is, however, a limitation to these statistics. When your sample size is large, these tests may produce significant results even when there is only a small deviation from normality. Therefore, use these tests as a guide, but also plot your data so an informed decision can be made regarding violation of this assumption. Homogeneity of Variance: This assumption implies that the variance of your dependent variable is similar or stable across all levels of your independent variable. In order to test this assumption, use Levene’s test. If Levene’s test is significant, you can assume that there is not homogeneity of variance but rather heterogeneity of variance. Again, however, like the Kolmogorov-Smirnov and Shapiro-Wilks tests, this test may be overly sensitive when working with a large sample. To overcome this shortcoming, use the variance ratio. Divide the smallest variance of the group by the largest variance of the group. If the result is less than 2, it is safe to assume that you have not violated the homogeneity of variance assumption. Interval Data: Data measured should be at the interval level. Interval level data have order and equal intervals but not a true zero point. Independence: This assumption implies that the data from different subjects in the sample are independent of one another. The behavior of one subject does not affect or influence the behavior of another subject.

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Introducing . . . OME’s newest staff member, Instructional Specialist, Deborah Larimer, EdD Hello! I’m excited to be working at Tulane University School of Medicine--where cordiality, courtesy, and a profound commitment to excellence seem to be the norm. Just about everyone I’ve encountered (from passersby on the street to janitorial staff to dean) has been genuinely friendly and welcoming. I am also excited by the degree of collegiality, sincere humanitarian motivation, and desire to improve the educational process and product that I’ve observed since arriving. I have to admit to a bit of culture-shock, as well as climate-shock. Believe it or not, Jazz is an “endangered species” in my previous home state; and winter temperatures are frequently in the ‘teens from November through March, with snowfall that turns cars--and sometimes even houses--into white boulders. My experience in academic medicine includes educational research and support services, research in rural health and health promotion, and serving as LCME coordinator for West Virginia University SOM in 2006-2007. Research interests include: the impact of a spiritual focus in education on the optimization of learning and professional behavior; dispositional optimism and a language of encouragement as health promotion and problem solving tools.

In summary, it is important to examine your data prior to running the main statistical analysis. Begin with graphical representations of the data to determine whether outliers, or data-entry errors, exist. If none exists and the data remain non-normal, consider transforming the data. Run statistical procedures such as KolmogorovSmirnov and Shapiro-Wilks to test for normality, and Levene’s statistic to test for homogeneity of variance. Ultimately, if you fail to meet the assumptions outlined above, consider using non-parametric tests for data analysis.

As my third month at Tulane begins, I look forward to your continued help to become a full-fledged, contributing member of the Tulane community. At this point, my broad goal is to facilitate ongoing improvements in teaching, learning, professional and curricular development. Toward that end, I will begin compiling online training modules that you can access at your convenience, making it easier for busy faculty, residents and students to expand /update their knowledge and skills. To identify areas of future emphasis, I will review the recently completed Faculty Needs Assessment.

NOTE: The information provided in the above article was extracted from, Field, A. (2005). Discovering Statistics Using SPSS, 2nd ed. Thousand Oaks, CA: Sage Publications Inc.

OME’s director, Dr. Annie Daniel, has decided to institute a Medical Education Fellowship Program

OME Newsletter, Fall 2008 that will result in certification as a medical educator. Together, we will work with on that initiative and on mapping the SOM’s curriculum. I am also pursuing funding for a grant-writing workshop to help you with your research efforts. Over the long term, your individual instructional and professional development needs--and your unique expertise--will guide the development of my goals and objectives, and will help direct the course of my research and service endeavors.

Call for Submissions OME Newsletter The Office of Medical Education Newsletter is published twice a year as an Adobe Acrobat file delivered by email and posted on the OME website: http://www.som.tulane.edu/ome/ The OME newsletter: •

•

•

provides general information on events, support services and activities sponsored by the Office of Medical Education features short articles summarizing research on current issues, concerns, and innovations in medical education offers guest commentaries on relevant topics in medical education

http://www.som.tulane.edu/ome/

12 The editor welcomes short articles from the faculty that introduce or inform others about a unique teaching strategy or method currently being used for teaching. Submissions may include:  Announcements  Short medical education articles (up to 500 words)  Teaching Strategies and Tips  Descriptions of research in progress  Reviews of research  Book reviews  Letters to the editor or faculty  Events of interest  Research ideas for collaboration  Publication notices and requests Materials/manuscripts should be submitted in Microsoft Word (hard copy or email) to: Annie J. Daniel, Ph.D., OME Newsletter Editor Office of Medical Education 1430 Tulane Avenue, SL-6 Suite 1730 New Orleans, LA 70112 Tel: 504-988-6600 Fax: 504-988-6601 [email protected] www.som.tulane.edu/ome

OME Newsletter, Fall 2008

Mark your calendar for these important Upcoming

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Events:

• Education Excellence Week – January 12-16, 2009 Speakers include: Dr. Jeff Wiese on biostatistics Dr. John Pelley on developing professional skills Dr. Donald Melnick (NBME president) on USMLE changes

• Career Day –March 7, 2009 •

Education Day - May 7, 2009 Key-note Speaker: Patricia O’Sullivan, EdD, Associate Director for Educational Research in the Office of Medical Education, University of California, San Francisco Events include: Teaching Scholar Award Ceremony Lunch Oral Presentations Posters

Call for Submissions: deadline - 4:00 pm, January 16, 2009

Professional Development Meetings . . . • Research Group - 3rd Tuesday of each month (4:00pm) • Journal Club - 4th Monday of each month (4:00 pm) • IAMSE “Webinars”- Spring 2009 Sessions begin Wednesday, March 4, 11:00 am OME conference room, Suite 1730, 1430 Tulane Ave.

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You are cordially invited to attend a series of interactive lectures. The objectives of this professional development series are to improve your teaching skills, your ability to give effective feedback, and to design effective assessments.

THE OFFICE OF MEDICAL EDUCATION PRESENTS

IAMSE
Webinar
 Series,
 Spring
 2009
 
 International
Association
of
Medical
 Science
Educators 
 Featuring

Selected National and International Experts

Session I: Defining a Path for Professionalism in the Curriculum Wednesda y, March 4 at 11: 00 a.m. , 1 430 Tulane Ave , Suite 1730 & Addition al sessions will follow monthly on t opics to be determined.

To reserve your space for the first seminar, please contact Kornelija Juskaite in the Office of M edical Education

RSVP: ome@ tulane.edu

OME Newsletter, Fall 2008

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Our Staff… Annie J. Daniel, PhD Director Phone: (504) 988-6600 Fax: (504) 988-6601 Email: [email protected]

Office of Medical Education 1430 Tulane Avenue, SL-6 Suite 1730 New Orleans, LA 70112 Tel 504-988-6600 fax 504-988-6601 [email protected] www.som.tulane.edu/ome

Byron E. Crawford, MD Professor of Pathology Associate Director Phone: (504) 988-6603 Email: [email protected] Kornelija Juskaite, MA Program Manager Phone: (504) 988-8896 Email: [email protected] Jennifer Gibson PhD Assessment/Evaluation Specialist Phone: (504) 988-6600 Email: [email protected] Jeanne Samuel, MEd Instructional Technologist Phone: (504) 988-6600 Email: [email protected] Deborah Larimer, EdD Instructional Specialist Phone: (504) 988-6600 Email: [email protected]

Our Office is available to support faculty in educating and assisting students to ensure their academic success and their development of professional competencies. The Office of Medical Education’s missions align with and support TUSOM’s institutional goals. OME Missions: • • • • • • • • • • •

Consultation on Teaching Curriculum Development Evaluation of Medical Student Performance Program Evaluation Medical Education Research Publication of Scholarship in Medical Education Proposals for Medical Education Grants Evidence Based Medicine Faculty Development Educational Technology Academic Counseling for Students and Residents