Inquiry E-folio – My personal journey through ETEC 533

E-folio Analysis

As I read through my e-folio, one quote from John Dewey came to mind:

“If we teach today’s students as we taught yesterday’s, we robe them of tomorrow.”

When I started my ETEC 533 journey, I seemed to have been quite disgruntled at the current state of education technology use in the medical school classroom. This was further highlighted in my interview with Dr C, which confirmed that technology was mostly being used to disseminate information that was previously presented by other means. It is a very knowledge-centered, teacher-focused method of teaching. As Cristina Leo pointed out in her Unpacking assumptions post “[digital] technology goes beyond the replacement of an ‘old’ way of doing something, but rather is innovative and modifies and redefines the original task.” This notion was echoed by many of my peers in this class. As I read through the many interviews from module A, I found the contrast between what was happening with education technology in medical school classrooms compared to the many examples of effective use of education technology in K-12 classrooms striking. Reflecting on my blogs entries, I notice that this contrast had me running to excuses for why my colleagues and I have failed to use education technology effectively in our classrooms. For example, I noted that we had many barriers, such as large classroom sizes, lack of training and lack of time. These barriers were my assumptions and it was almost as if I was waiting for a top down restructuring of medical education to make this situation better. What I now realize is that effective use of technology is not up to the faculty. Training can be facilitated by the University, but at the end of the day it is up to me to analyze my teaching environment, students, learning goals and outcomes. I have a responsibility to my students as an educator and it is up to me to rethink my use of technology.

In module B, we started off by learning about Pedagogical content knowledge (PCK) and Technological pedagogical content knowledge (TPCK). TPCK “emphasizes the connections, interactions, affordances and constraints between and among content, pedagogy, and technology” (Mishra & Koehler, p. 1025). This framework clearly defined my knowledge gap as an educator in the 21st century. Though it is always a work in progress, I was pretty confident with my PCK. What needed work was my Technological content knowledge (TCK) and Technological pedagogical knowledge (TPK). This allowed me to focus the remainder of my time in this course to begin filling my TPCK knowledge gap.

As I worked through Module B, I became familiar with different types of technology enhanced learning experiences (TELEs) that were used in STEM classrooms, as well as their underlying frameworks. All four were routed in constructivism, and all of them emphasized the importance of collaboration. In terms of technology, all methods used it as a way to present information to students, and each one allowed the students to interact with it in meaningful ways. Each TELE differed in the way and degree to which scaffolding was provided. On reflection, I think each one of these TELEs could have a place in medical education. The choice is TELE is dependent on the student’s level of knowledge, learning goals, cognitive and social affordances of each. I would also need to explore and test the use of these TELE in specific medical contexts. In my brief exploration of each, I believe I have increased my TPK though there is a long way to go. As Gary Ma pointed out in his Module B Synthesis post, “learning how to use these different tools to teach effectively is quite a monumental task”. But again, I must remind myself that the size of the task should not deter me from the task itself. For “[if] we teach today’s students as we were taught yesterday, we rob them of tomorrow” (John Dewey)

As pointed out earlier, all methods emphasized the importance of collaboration. Collaboration enables students to engage in discussions with others, which in turn can facilitate reflection (Edelson, 2001). This reflection is a key component of learning and improving understanding (Linn, Clark, & Slotta, 2003). In pre-clerkship medical education, which is mainly done in the lecture theatre, the majority of student time is spent individually. I observe many students passively listening to lectures as they look at the PowerPoint material on their personal laptops. Some are even doing other things during lecture time, such as browsing through Facebook. The readings, activities and discussion during Module B has really inspired me to change this, at least in the lectures that I participate in. I am hopeful that with this new found knowledge and enthusiasm, I will be able to make such changes, even with the constraints of the physical space (lecture theatre) and the overwhelming number of students. These changes could be as simple as posing a question to generate discussion in the middle of the lesson and encouraging the students to talk to their neighbour student. I think the trick to these questions would be to make them challenging enough to generate discussion but not too challenging that the students disengage as was pointed out by Linn, Clark and Slotta (2003) in their design of WISE.

Another theme that was emphasized in the TELEs was the role of the teacher as a facilitator. This is in direct contrast to many medical school lectures where the teacher is the disseminator of knowledge. Khan (2010), in her research on T-GEM found that the teacher viewed their role as a guide in inquiry. Similarly, CGTV (1990) saw the role of the teacher as a mediator of discussions and a guide to discovery. This again highlights the change that is needed in medical education. In order to “foster deep and robust conceptual understanding that students can draw on to create explanations, make predictions and argue from evidence” (Edelson, 2001, p. 355), they cannot be passive listeners in lectures. They need to engage in inquiry and experience the process of questioning, evidence-gathering, and analysis that echoes the scientific method. I was really inspired by the modelling of the scientific method in many articles that we read and would like to strive to achieve that in my classrooms. In order to achieve this type of active learning, I need to restructure the lessons I teach and change my role as a teacher to that of a facilitator, who guides students in their learning and assist in generating meaningful discussion and collaboration.

Making the concepts accessible was another theme that drew my attention. This was emphasized in all the TELEs that we studied. Knowledge can be viewed as tools, and “when people learn about a tool they learn what it is and when and how to use it. When people learn new information in the context of meaningful activities, they are more likely to perceive the new information as a tool rather than as an arbitrary set of procedures or facts” (CGTV, 1990, p. 3). Looking back at the many lectures in medical school that I observed, students were given decontextualized facts that they were then expected to draw upon when they encountered patients in the following years. We were providing students with inert knowledge, which is knowledge that can be recalled when explicitly asked to do so but is not used spontaneously in problem solving even though it is relevant (The Cognition And Technology Group At Vanderbilt, 1990). Though medical education has tried to compensate for this by adding problem based learning to their curriculum, the vast majority of “knowledge” is obtained in the inert, passive form through a lecture format. It is not enough for our doctors to be able to recall the pathognomonic physical signs of systemic lupus erythematosus. We need them to be able to see a patient, use their knowledge to ask all the pertinent questions, examine them, order the appropriate investigations, and manage them accordingly, all the while remembering that each patient is an individual and their values and beliefs need to be considered during the entire process. We are doing the doctors of tomorrow a disservice by continuing to teach them the way we were taught. We need to situate their learning in applicable contexts that are accessible in order to achieve a deeper level of understanding that goes beyond inert knowledge.

In Module C, we explored emerging genres of teaching, learning and digital technologies. Some of these genres are older ideas that are being elevated by advancements in digital technologies, such as augmented reality, virtual reality, and mobile devices. What stood out to me during this module was the sheer volume of these education technologies that I was unaware of. As I explored each one, it led me to look for similar technologies used in medical education. Though the volume is much smaller than that found for K-12 education and the vast majority is not free, it is growing. I am excited to explore more of these technologies, analyze their cognitive and social affordances for learning medicine, and integrate some of them into an active learning environment.

Embodiment, which is the physical dimension of cognition, and embeddedness, which is the interdependence of cognition and the environment, were new terms that I had not encountered until Module C (Winn, 2003). Winn (2003) goes on to explain that our sensory experience of the world is limited by our physiology. For example, we cannot see beyond certain wavelengths or hear sounds below or above certain frequencies. This is where artificial environments that create metaphorical representations can be useful to bring students concepts and principles that “normally lie outside the reach of direct experience” (p. 8). I believe this is particularly applicable when learning medicine. We examine patients and observe their signs and symptoms within our physiological constraints, but we must understand their condition, investigations, and treatments at microscopic and molecular levels. With information visualization, simulation and modeling technologies, these metaphorical representations are not only achievable but can be created to be dynamic and interactive. When metaphorical representations are depicted in a text book, they are two dimensional and static. In the context of diffusion and osmosis, it was found that students often fail to grasp many concepts such as the dynamic nature of this process (Friedrichsen & Pallant, 2007). However, when using a program such as Molecular Workbench, students showed a significant increase in their understanding of a variety of concepts and were able to easily transfer their new understandings to novel situations. I believe a similar level of understanding could be achieved by medical students if given the opportunity to interact with such representations.

I started this course as a disgruntled frustrated medical educator, but I feel as though I have completed my journey with a sense of hope. Reflecting back on this course, I have come to the realization that the only true barrier to effective use of education technology in the classroom was me. I used class size, lack of time, and lack of faculty driven guidance and assistance as excuses for my TPCK gap. Through this course, I feel that my eyes have been opened to the potential of various education technologies and TELEs. That being said, I also recognize that these technologies are tools and certain tools are applicable in certain situations and their usefulness can vary based on the user. As an educator, my role is to explore these technologies, analyze their affordances and use them in situations where it will benefit my students’ construction of knowledge. In addition, I need to see myself as a facilitator, and allow my students the freedom to explore, inquire, and challenge themselves while working together to problem solve and construct knowledge. I know that this will not be an overnight project, but I hope to continually make small changes and gradually achieve the type of active TELE that has been exemplified in this course.

References

Edelson, D. C. (2001). Learning‐for‐use: A framework for the design of technology‐supported inquiry activities. Journal of Research in Science Teaching, 38(3), 355–385. http://doi.org/10.1002/1098-2736(200103)38:3<355::AID-TEA1010>3.0.CO;2-M

Friedrichsen, P. M., & Pallant, A. (2007). French fries, dialysis tubing & computer models: teaching diffusion & osmosis through inquiry & modeling. The American Biology Teacher. http://doi.org/10.1662/0002-7685(2007)69[22:FFDTCM]2.0.CO;2

Khan, S. (2010). New Pedagogies on Teaching Science with Computer Simulations. J Sci Educ Technol, 20(3), 215–232. http://doi.org/10.1007/s10956-010-9247-2

Linn, M. C., Clark, D., & Slotta, J. D. (2003). WISE design for knowledge integration. Science Education, 87(4), 517–538. http://doi.org/10.1002/sce.10086

Mishra, P., & Koehler, M. J. (2006). Technological pedagogical content knowledge: A framework for teacher knowledge. Teachers College Record, 108(6), 1017–1054.

The Cognition And Technology Group At Vanderbilt. (1990). Anchored Instruction and Its Relationship to Situated Cognition. Educational Researcher, 19(6), 2–10. http://doi.org/10.3102/0013189X019006002

Winn, W. (2003). Learning in artificial environments: Embodiment, embeddedness and dynamic adaptation. Technology.

Molecular Workbench – a successful lesson on diffusion and osmosis

For this weeks lesson, I decided to take a look at Molecular Workbench. Molecular workbench is a open-source software that allows students to run simulations of scientific phenomena at the macro scale level all the way down to the subatomic scale. It is also a modelling tool that allows users to design their own simulations and experiments and create simulation based curriculum materials.

For this week’s reading, I chose to read the article by Friedrichsen and Pallant (2007). This article describes a series of lessons on diffusion and osmosis. They use the 5E instructional model, which consists of the following 5 phases: engagement, exploration, explanation, elaboration and evaluation. Molecular workbench was used in the explanation phase. The lesson started with student making predictions on what would happen to a skinned potato if it was submerged in three different environments; water, 0.9% NaCl solution, and 10% NaCl. During the exploration phase, the student made observations on what happened to the potatoes. Then they are given a chance to come up with an experiment that could help explain the observed phenomenon. This is done in small groups and the group decides on the experimental method based on the supplies that are available (which includes dialysis tubing, a semi-permeable membrane). In the explanation phase, the students try to make sense of the data collected during the exploration phase. Molecular workbench is used at this stage to help students develop molecular-level explanations for their findings.

Molecular workbench allows students to visualize phenomena that cannot be seen by the naked eye. Unlike static images, students can see the constant motion of molecules as well as their interactions, which results in diffusion and osmosis. The interactive nature of Molecular workbench also allows students to manipulate variables and see the outcome, which is helpful in understanding the interplay between the molecules and the environment. These cognitive affordances of the program aid in developing an understanding of these complex phenomena. In addition, during this lesson, Molecular workbench is a group activity, which allows students to not only interact with the program but interact with one another to discuss observations, and make sense of the changes that occur when they manipulate certain parameters. This discourse is important in developing understanding.

Molecular workbench activity was followed by reflection and revision of their original explanations of the potato experiment to include molecular and cellular level representations. What I really liked about this lessons was that it models the way the scientific community acts. Instead of the teacher critiquing each group’s explanation, a peer review process was performed, and students were given opportunities to clarify or revise explanations based on feedback from their peers. Finally in the elaboration phase, students are asked to apply their knowledge of osmosis to new contexts to strengthen their conceptual understanding.

I believe this is a very successful lesson on diffusion and osmosis. As noted by Srinivasan et al. (2006), many novices view software simulation as “fake”, and strongly value “real” experiences over such simulations. In this lesson of diffusion and osmosis, the authors introduced the topic using something that was very relatable to students, presented them with an opportunity to participate in a “real” experience through a hands-on experiment, but also tied this to phenomena at the cellular level using software simulation. I think this is a great example of how information visualization software can be used successfully in eduction. Visualization software is great, but unless these visualizations are tied to something students can relate to, it may be just as abstract to students as the concepts that it is trying to demonstrate.

References

Srinivasan, S., Pérez, L. C., Palmer, R. D., Brooks, D. W., Wilson, K., & Fowler, D. (2006). Reality versus Simulation. J Sci Educ Technol, 15(2), 137–141. http://doi.org/10.1007/s10956-006-9007-5

Role playing and it’s potential use in math and science classrooms

In social studies classrooms, role playing activities would generally involve students assuming the role of an important figure in history or representing a group of people. The purpose of role play would be to understand different perspectives of those adopted characters and develop a deeper understanding of history or human societies in general. I speculate that the reason role playing activities are not promoted in math and science classrooms is because a concept in math or science does not directly translate into a character or role as easily as it does in social studies. However, this is not to say that role playing does not have a place in math and science classroom.

According to Winn (2003), “cognition is embodied in physical activity, … this activity is embedded in a learning environment, and … learning is the result of adaptation of the learner to environment and the environment to the learner” (p. 1). When considering this definition of cognition, role playing seems to be a great tool for learning. This is because role-playing involves the use of one’s body to act out a role and interact with the environment (which may involve a made up scenario and other students acting out other roles). An effective use of role playing in learning geometry was demonstrated by Duatepe-Paksu and Ubuz (2009). In their study, they took a group of seventh grade students and taught geometry through drama based instruction, which included role-playing and compared these students to another group of seventh graders taught traditionally with the use of a textbook, worksheets and teacher directed instruction. All geometrical concepts covered between the two different instructional methods were the same. To learn about circles and their properties, the drama based instruction group was told that they were scouts going to a campsite. They walked in line, singing until the instructor told them that they had reached their campsite and were asked to stand so that everyone could see one another and then were told to position themselves to get heat equally around a fire pit. Through this role playing exercise, the students learned about what defined a circle, the properties of a circle, and objects in day to day life that were circles. The study showed that drama-based instruction had significant effects on students’ achievement, retention, thinking and attitudes compared to traditional teaching methods. Drama based instruction made learning easier and students understood concepts better because they were given the opportunity to contextualize geometric concepts and problems, role play and collaborate in the learning environment.

As demonstrated in the above example, we as teachers need to take math and science concepts and contextualize them for students, so that they can relate to these concepts and they are no longer abstract. I believe role playing is a great way to achieve this goal.

References

Duatepe-Paksu A, Ubuz B. (2009) Effects of drama-based geometry instruction on student achievement, attitudes, and thinking levels. The Journal of Educational Research. 102(4):272-286. doi:10.3200/JOER.102.4.272-286.

Winn, W. (2003). Learning in artificial environments: Embodiment, embeddedness, and dynamic adaptation. Technology, Instruction, Cognition and Learning, 1(1), 87-114.

A comparison of 4 TELEs

I decided to summarize the 4 TELEs in table format. This is what I came up with:

Below is a link to a PDF in case the above does not read well.
Module B synthesis

Synthesis

All methods noted in the table are based on constructivist learning theories. All methods aim to achieve a deeper understanding of complex phenomena or concept in math and/or science. I found that the use of technology for presentation of information was the same in each TELE, however, the degree to which technology was used for other things differed. For example, in the Jasper series (Anchored instruction), technology use was limited to presentation of information, whereas in WISE (SKI), MyWorld (LfU), and Chemland (T-GEM), it was also used for data evaluation, visualization of ideas and collaboration. The TELEs also differed in the degree of guidance or scaffolding that was provided as well as the provider of that scaffolding. For Jasper, the purpose was for generative learning, and thus minimal scaffolding would be provided (though this can be adjusted dependent on the preference of the teacher and experience of the students). In contrast, with MyWorld, the teacher provides guidance at each step and also provides explanations of relationships that were uncovered by students during the knowledge construction observation stage. In Jasper, MyWorld, and Chemland scaffolding was provided by the teacher. However in the WISE projects, much of the scaffolding was provided by technology in combination with the teacher particularly for those groups that were struggling.

Continue reading “A comparison of 4 TELEs”

T-GEM for cardiovascular physiology

A commonly cited conceptual challenge in medical education is cardiovascular physiology. This seems to be a consistent finding at different educational levels (Mikkila-Erdmann, 2012). If applying the T-GEM model (Khan, 2010)to teaching this, I would organize it as follows:

I would provide some background content information, such as the definition of cardiac output, mean arterial pressure, heart rate, and systemic vascular resistance (total peripheral resistance)
Have the students pair up and access the following simulator: https://ilearn.med.monash.edu.au/physiology/Cardiovascular/index.html
- on the Home tab, have the students look at the relationship between cardiac output, mean arterial pressure, and heart rate
- have students generate a relationship between the above variables (by seeing what happens to these variables during different activities)
Based on this relationship, have students predict what will happen to these variables with postural change
Have students run the postural change simulation and evaluate the relationship
Have students review their initial predictions and compare to the relationship that was observed through the simulation.
- ask students to modify their initial predictions/relationships based on new data.

I think this method will offer students a chance to challenge their conceptual models by simulation and make modifications as needed. In trying to find software for TGEM in the medical context, I ran into a significant challenge. This is because a lot of medical simulations were for clinical skills or other technical skills improvement, and not for the purposes of understanding certain phenomena. But I do think this is a great way to learn and really understand concepts in a deeper more meaningful way (compared to the superficial rote memorization that is still common in medical education). I hope that simulations that examine concepts in my field become more readily available as time goes on.

References

Khan S. New Pedagogies on Teaching Science with Computer Simulations. J Sci Educ Technol. 2010;20(3):215-232. doi:10.1007/s10956-010-9247-2.

Mikkilä-Erdmann M, Södervik I, Vilppu H, Kääpä P, Olkinuora E. First-year medical students’ conceptual understanding of and resistance to conceptual change concerning the central cardiovascular system. Instr Sci. 2012;40(5):745-754. doi:10.1007/s11251-012-9212-y.

LfU – an application for pelvic anatomy?

According to Edelson (2001), LfU is based on 4 theories of learning, which are:
1) learning takes place through construction and modification of knowledge structures
2) knowledge construction is a goal-directed process, guided by a combination of conscious and unconscious understanding of goals
3) circumstances in which knowledge is constructed and subsequently used determine its accessibility for future use
4) knowledge must be constructed in a form that supports use before it is applied.

These principles underlie the LfU model, which is a three-step process involving
1) motivation
2) knowledge construction
3) knowledge refinement

In terms of technology, it plays many important roles within the LfU model. For example, it can play a role in eliciting curiosity (motivation), help students interactive with phenomena not possible in the real world which aids with knowledge construction and refinement.

So how would I apply it to a topic that I teach? The one thing that comes to mind is pelvic anatomy. Students tend to struggle with pelvic anatomy because it is quite complex and has multiple layers to it. I would start off by presenting students with a case of a patient who underwent surgery and shortly thereafter developed leg weakness and pain (this is actually one of the patient that presented to me early in my career). I would then have the students come up with theories based on their current knowledge level, regarding the cause of this pain/leg weakness. This is to draw their attention to their current level of knowledge and to have them recognize their limitations and thus increase motivation to learn. This would also create a context in their memory for integrating new knowledge (Edelson, 2001). Then I would use AnatomyTV, which is an interactive 3D anatomy resource (available through UBC at http://resources.library.ubc.ca/page.php?id=888) as my software of choice. This interactive resource that allows students to manipulate the body in 3D (select 3D Atlas —> Pelvis, then click female pelvis and perineum ~ tumble under 3D views from menu on the left to try it out!), which is really helpful, as most textbooks only present the learner with the upright position of the human body. This is not practical because in most gynecologic clinical practices, we examine patients and operate on them in the supine position, and thus knowledge of anatomy in this position is much more applicable. This program also allows the user to strip away all layers of the body and add them one by one, which allows students to understand how each layer relates to the other. I would also have student work in small group to promote interaction and discussion as this also aids in knowledge construction and refinement. Finally, I would have the students reflect on their initial theories, make any changes they feel are needed and present it as a group to the class and further apply their new knowledge to come up with a management plan for the patient. In this way, I believe I have applied the LfU principles to this topic.

References
1. Edelson DC. Learning‐for‐use: A framework for the design of technology‐supported inquiry activities. Journal of Research in Science Teaching. 2001;38(3):355-385. doi:10.1002/1098-2736

WISE projects

This week, I read a lot about WISE (Web-based Inquiry Science Environment) projects. The project’s creation was motivated by a state and national call for inquiry learning, which the creators found was minimal in the science class room. WISE is based on a knowledge integration framework. Their research indicated that students try to make sense of complex phenomena, but were unable to interconnect these ideas or apply them to new problems or phenomena (Slotta & Linn, 2009). The knowledge integration framework emerged to make sense of ideas that students bring to class with them, make learning of science more efficient (through an inquiry method), and help connect existing ideas with new ideas.

According to Linn, Clark and Slotta (2003), there are 4 tenants of knowledge integration framework:

Make learning accessible
Make thinking visible
Learn from others
Promote autonomy

Each WISE project is created with these tenants in mind. It also follows a general instructional pattern as follows:

elicit repertoire of student ideas
add promising normative ideas to the mix
support process of combining, sorting, organizing, creating and reflecting to improve student understanding

So far in this course, we have been introduced to the Jasper series as well as WISE projects. I believe the main difference between the two is the degree of guidance or scaffolding that is provided. In the Jasper series, a more generative process is desired. Whereas the WISE projects have inquiry maps which provide students with a guide during their inquiry process. I think both approaches are valuable, and one will appeal to some students more than others, and this distinction is based on personal preference, degree of autonomy and level of knowledge. Both strategies are highly adaptable, and the Jasper series could be used in a more guided process, just as the WISE projects can be adapted to provided less guidance.

In terms of how I would use wise, I think it is very similar to case based learning at our institution. I think I would be able to create a WISE project using some of the case based learning integrated with some lecture material to provide normative information. The customization I would perform is only to the inquiry map. As mentioned by Linn, Clark and Slotta (2003), if the inquiry steps are too precise, students fail to engage, but if too broad, students may be easily distracted and not motivated to complete the project. Based on the type of learners I have, I think I can make the inquiry steps a little broader.

References

Linn MC, Clark D, Slotta JD. WISE design for knowledge integration. Science Education. 2003;87(4):517-538. doi:10.1002/sce.10086.

Slotta JD, Linn MC. WISE Science: Inquiry and the Internet in the Science Classroom. Teachers College Press. 2009.

Jasper, anchored instruction and PBL

The theoretical framework that underpins the Jasper series is anchored instruction. Anchored instruction is instruction that is “situated in engaging, problem-rich environments that allow sustained exploration by students and teachers” (Cognition and Technology Group at Vanderbilt, 1992). The Jasper series is a video based instruction format that presents students with a complex problem, which requires many subproblems to be generated and solved for the main complex problem to be addressed. It uses an engaging narrative with embedded data to present the students with all the information they may require to engage with the complex problem. This instructional approach promotes several teaching and learning activities that are central to constructivism. This includes generative learning, collaboration, active learning and engagement, and construction of knowledge.

Certainly the Jasper series could be presented without the use of technology. However technology does enhance the teaching and learning activities mentioned above. For example, the use of video could make the material more engaging due to the increased realism afforded by the video format (though it is a little dated now). This notion is supported by several papers, as highlighted by Taylor and Parsons (2011) in their review of the literature on student engagement. It can also be helpful for those students with learning challenges where an audio only narrative or reading only narrative would present a significant barrier.

Medical education has certainly moved in this direction. During the first two years, we have increased exposure of students to real clinical environments where they would learn though clinical encounters in a situated learning environment. In addition to this, their didactic lectures are taught along side problem-based learning activities, which is essentially anchored instruction. Our school currently does not use a video format, but a written digital document is provided to students in small groups, which gives students a clinical scenario. They then discuss the case to figure out what is going on with the patient. In all groups, the members decide on what further knowledge is needed in order to move forward with the case scenario. During this discussion portion, they are not allowed to use any resources other than their own ideas and experiences, which promotes discussion, collaboration and reflection. Once they have established learning objectives for the group, the first session ends and they have 1-2 days to research their learning objectives (either collaboratively or individually, depending on the group). They then reconvene and discuss the learning objectives before more of the clinical scenario is revealed. Typically, each case is discussed over 2-3 group sessions.

I think that in our problem-based learning groups, technology can be used to enhance collaboration and generative learning. For example, concepts maps may be useful to organize the group’s thoughts in a visual manner, adding to collaboration and generation of ideas. The use of something like Google Docs which affords collaboration asynchronously could also be helpful in collaboration outside of the group meetings. A video format could also be helpful to refine students’ observational skills as this is a critical part of the medical assessment, and again help to create an authentic/realistic environment.

References
Cognition, Vanderbilt TGA. The Jasper experiment: An exploration of issues in learning and instructional design. ETR&D. 1992;40(1):65-80. doi:10.1007/BF02296707.

Taylor, L. & Parsons, J. (2011). Improving Student Engagement. Current Issues in Education,14(1). Retrieved from http://cie.asu.edu/

Impressions of the Jasper series

The Jasper series is an instructional tool for mathematics. It presents mathematical problems in a narrative format on video. All of the values and information needed to solve the challenge is presented within the narrative of the video. Some information is presented within the verbal conversations between characters where as others are just visually shown. In addition, there are follow up videos that present “analog” problems, where one parameter is changed and the student is asked to solve a problem. There are also extension videos, which takes a real life scenario (such as a past event) and ties it into the complex problem that was initially presented, asking the students a challenging question.

My initial impression of the series was that, contrary to my impression from the readings, the initial challenge is not generative. The students are presented with the challenge at the very end of the series. However, there are many subproblems that need to be generated to solve the challenge/question that it poses. There is also some scaffolding built in within the series. The series has many similarities with problem based learning that we do in medicine. It makes me wonder whether our problem based learning could also be presented in a similar format to make it more interesting and engaging. Also, this is in video format, which could make finding the specific information needed to solve the problem cumbersome. Would this be any easier in another format? If everyone had access to this video on their own personal devices, would it decrease the collaboration that occurs?

PCK/TPACK and TVT

PCK/TPACK were definitely new terms for me. Though my idea of a “good” teacher was one who had both content knowledge and pedagogical knowledge specific to that content, I had never heard of it being described in such a concise manner. Looking at the many physicians that teach, particularly at the clinical level, they are definitely content experts with little or no pedagogical knowledge. Somehow it is presumed that having the content knowledge gives you the ability to teach medicine, which is far from the truth, and I have personally been on the receiving end of this. For example, experienced physicians are able to accomplish tasks in an “unconscious competent” manner. Looking at the diagram below, novice students and residents start at the “unconscious incompetent” stage of this cycle.

They observe an expert accomplish something (such as suturing) and because the expert made it look so easy, presume that it can easily be accomplished. When they are given the opportunity to do the task themselves, they move into the “conscious incompetent” stage, where they begin to understand that it isn’t as easy as it looks and there are a lot of steps that they had not considered upon observation. With repeat practice, reflection, and learning with guidance, they enter the “conscious competent” stage, where they still have to think about each step but can complete the task competently. Clinical teachers facilitate their learners through this cycle, but because many of them are doing tasks in the “unconscious competent” state, sometimes they are unable to identify some of the steps that are automatic for them, and thus are missing the pedagogical knowledge component.

A common procedure that I perform that is difficult to learn is insertion of a device called a TVT. This device is used for the treatment of stress incontinence. It is difficult to learn because it is a relatively blind procedure, with a high bladder injury rate (which increases learner anxiety!) When teaching this procedure, I often break it down into several steps for my residents:
1) Observation – I will have them observe the procedure as I perform it. I will deliberately take my time performing each step, and explain each step as well as the rationale behind my movements.
2) Then I take them over to a pelvic model for simulation (after the observation). Again, I repeat the procedure, performing each step slowly and with explanation. I will also have them slide their hands over mine to feel where I am in relation to the anatomy (because most of it is done blindly).
3) Next, I have the learner verbally repeat the steps while visualizing
4) Then I have them perform the steps, verbalizing each step as perform it (on the model simulator).
5) I will have them repeat this on the model a few times until they are comfortable
6) At the next OR, if this procedure comes up, I will have them verbalized the steps with visualization prior to the case.
7) Finally, I will have them perform the case, while verbalizing each step, and provide guidance as needed. At this point, I gauge their level of comfort and competence and adjust my guidance as needed.

Over the last couple of years that I have been teaching this, I have modified the steps based on the areas that my learners seem to struggle the most. These areas are broken down into smaller steps, with simple instructions so the procedure is easier to understand and perform.