Tools For Medical Apprentice Learners - Moving Towards Mastery


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Talk given at IAMSE 2013 meeting in St. Andrews

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Tools For Medical Apprentice Learners - Moving Towards Mastery

  1. 1. Tools For Medical Apprentice Learners
Moving Towards Mastery"Donna M. DAlessandro, M.D."University of Iowa College of Medicine / University of Iowa Childrens Hospital""""
  2. 2. Disclosures"•  Nothing to disclose"
  3. 3. The Learning Continuum"Data -> Information -> Knowledge - > Wisdom / Mastery"[acquired + organized] [reflected] [shared] "Personal learning environment -> Social learning network"[focus on individual] [focus on group]"
  4. 4. Learning Portfolio"•  A digital archive of your medicaleducational life = learning diary"•  Entries aggregate over time into a physicianspersonal learning experience = knowledgemanagement system "•  Educational construct"•  Adult learning theory = Learning situated inpractice"•  Schons theory of clinical problem solving /model of reflective practice / learning cycle"
  5. 5. Philosophy
Why Create a Learning Portfolio?""An unexamined life is not worth living" - Socrates"•  You create the data and information in the learningportfolio but it is by reflecting upon it that youbecome knowledgeable. Reflection is personal."•  Through the practice of sharing knowledge withothers, you develop wisdom and move towardsmastery"•  Share in different settings - teacher to learner, peer topeer in small or large groups"•  Use the wisdom to affect change - for an individualpatient, groups of patients, communities, societyat large"•  Reflection in action"
  6. 6. Educational Social Network =Community of Practice""Communities of practice are groups of people who share a concern, aset of problems, or a passion about a topic, and who deepen theirunderstanding of this area by interacting on an ongoing basis." "- Wenger E. et. al. Cultivating Communities of Practice: A Guide to Managing Knowledge"•  Educational construct = Interdependent Learning Theory"•  Teaching each other = collaborative learning = sharing the wisdom"•  Can be easily done by sharing learning portfolios on educational social networks"
  7. 7. Tools For Sharing
Web 2.0 Landscape"•  Web 2.0 = Read / Write Web"•  Weapons of Mass Collaboration"•  Blogs / Micro-blogs, photo / video-sharing, wikis, socialbookmarking, social networking"•  Self organizing systems = grassroots organization"•  Promotes micro-learning"•  Soul of Web 2.0 is sharing / connecting / iteration / openness "- Mark Pesce"•  Tools that support the 4 Cs for 21st Century"•  Critical thinking"•  Communication"•  Collaboration"•  Creativity"
  8. 8. Example of My Learning Portfolio -"•  A pediatricians clinical experiencescoupled with reflection"•  5 elements for each case"•  Evaluation shows unstructured curriculumunfolding in practice over 5 years (234 cases)"•  Covers 100% of age ranges (n=9)"•  100% of specialties (n=42)"•  98% of symptoms (n=127)"•  55% of diseases (n=707 [50-60% are pediatric])"•  90% of topics in 3 national pediatric curricula"•  20 hours of CME / year"•  "My reading is now focused on my patients""- DAlessandro DM, DAlessandro MP. Formative Evaluation of aPediatric Digital Librarys Educational Content and Comparison toNational Curricular Standards. Medical Teacher. 2008;30(9-10) 880-6."•  Learner taking control of and assumingresponsibility for their own learning bytying their learning to practice + receivingCME + MOC for it"•  Learning portfolio documents what youhave learned"•  Assessment by examination documents whatyou dont know"
  9. 9. Example of Sharing Learning Portfolios
Pediatric Commons --"•  A community of pediatric learning,teaching, sharing + collaboration"•  Goal - build a pediatric learning communityaround content, conversations and connectionsfor the purpose of improving childrens health"•  Place to come learn pediatrics every day"•  Enter cases into your learning portfolio"•  Store your experience, reflection, knowledge,wisdom"•  Participate in your community of practice"•  Contribute content, Engage in conversations,Make connections"•  Enables peer-to-peer and master-to-apprenticeteaching"
  10. 10. Pediatric Commons
Learning Portfolio - Educational Social Network"•  For each case: Question ~ Story ~ Answer ~ Impact on Practice ~ Resources Used"•  Permissions ~ Tag Cloud (discipline, anatomy, disease, institution, level)"
  11. 11. Integration Into The Educational Social Workflow
Web site / Blog vs. Ning Network vs. Facebook page vs. Twitter"Members: " 1 700 3,300 " " 216 Followers"Subscribers: 200 RSS/Email "19 RSS " " 3,300 " " 216 Followers"Visitors/month: 31,000 " 600 1,800 (Reach) " " N/A"Pages/month: 41,000 1,500 Unknown " " " N/A"Cases/month: " 4 " 5 " " " 5 " " " 4"Comments/case: 0 0-1 0-1 0 Comments/Retweets"
  12. 12. Other Educational Social Networks"Members: " "14,000 " "170,000 " " "130,000 " ""Subscribers: "14,000 " "N/A " " "N/A"Visitors/month: "Unknown " "Unknown " " "Unknown"Pages/month: "N/A " "Unknown " " "Unknown"Cases/month: "1 " "8 " " "30 ""Comments/case: "5-30 " "5-10 " " "5-50"Mescape and Sermo are anonymous + have low signal to noise ratio ~ Sermo business model unsavory"
  13. 13. Other Educational Social Networks"Members: " "Potentially 60,000 members of AAP, true number unknown"Subscribers: "N/A"Visitors/month: "Unknown"Pages/month: "Unknown"Cases/month: "12"Comments/case: "0"
  14. 14. So What? Does This Work?
Educational Effectiveness of Educational Social Networks / Social Learning"•  Types of evaluation / assessment "•  Formative vs. Summative"•  Proposition: The house believes that social networking technologies will bringlarge [positive] changes to educational methods, in and out of the classroom."•  Assessment for learning (formative assessment)"•  Learning in the classroom built around peer support, self-assessment + questioning, peerassessment -- all coupled with learning logs - with teacher as a guide = Learning in a socialnetwork"- Ewan Mcintosh, The Economist Debate Series: Education - Social Networking, The Economist, January 2008""Firm evidence shows that formative assessment is an essential component ofclassroom work and that its development can raise standards ofachievement…"""- Paul Black and Dylan Wiliam, Inside the Black Box: Raising Standards Through Classroom Assessment, Phi Delta Kappan, November 1998""Teachers found that the motivation and attitudes of their students improved, andthe students achieved higher scores on externally set tests and examinations"""- Paul Black, Working Inside the Black Box: Assessment for Learning in the Classroom, Phi Delta Kappan Sept 2004"…So formative assessment improves summative assessment…"
  15. 15. Educational Effectiveness of EducationalSocial Networks / Communities of Practice""Physicians interact with peers and mentorsto frame issues, brainstorm, validate andshare information, make decisions, andcreate management protocols, all of whichcontribute to learning in practice. It is likelythat working together in this way creates thebest environment for learning that enhancesprofessional practice and professionaljudgment."""- Parboosingh JT. Physician Communities of Practice: Where Learning and Practice areInseparable. Journal of Continuing Education in the Health Professions. 2002. 22, pp.230-230"•  Sharing among health care providers is thebest environment to move towards mastery"
  16. 16. State of the Art in EducationalSocial Network Evaluation"•  14 studies"•  11/14 studies for medical students only"•  2/14 combination of medical students + others"•  Only 1/14 for practicing physicians""Interventions using social media tools wereassociated with improved knowledge (e.g.exam scores), attitudes (e.g. empathy), andskills (e.g. reflective writing).""Cheston CC, Flickinger TE, Chisolm MS. SocialMedia Use in Medical Education: A SystematicReview. Acad Med 2013: 88:1-9."
  17. 17. Future of Educational Social Networks"•  Plethora of research opportunities usingeducational social networks"•  Need more about students, but have very littlefor other health professionals"•  Opportunities to transfer knowledge fromone field to another"•  Gifted and talented (G/T) research shows peerinteraction markedly facilitates growth of G/Tstudents"•  What would happen if G/T research was appliedto health care professionals using educationalsocial networks?"
  18. 18. Future of Educational Social Networks"•  Education across the continuum"•  Document ones developmental progress of movingfrom apprentice towards mastery within a profession"•  Document continuous professional development acrossprofessional lifetime"•  Interprofessional education"•  Health care professionals are providing more team-based care. Why shouldnt they learn in teams too?"•  Among health care professionals in initial training and inpractice to facilitate patient care"•  Among health care professionals and scientists to facilitateresearch"
  19. 19. The Learning Continuum"Data -> Information -> Knowledge - > Wisdom / Mastery"[acquired + organized] [reflected] [shared] "Personal learning environment -> Social learning network"[focus on individual] [focus on group]"
  20. 20. Conclusion"•  Components of future of medical education"•  Situate learning in practice"•  Document learning in practice with individual learning portfolios "•  Participate in educational social network by aggregating learning portfolios"•  Interface via mobile phone"•  Sum total is your personal learning environment + social learning network"•  Goal is to create an environment which allows"•  Personal learning + reflection "•  Master-to apprentice and Peer-to peer teaching"•  Conversations about art and science of medicine"•  This is how to create and preserve a lifelong passion for medicine"•  This is how to create medical learning machines who strive for and achieveexcellence in practice and pursue mastery of medicine over a lifetime"
  21. 21. For An In-Depth Discussion…"•  Workshop Monday at 5:00 pm at Location"•  Learning Portfolios and Educational Social Networks - Tools For MedicalApprentice Learners"•  Questions"•  1. Learning portfolios "•  What should they contain and what is the best way to implement them? "•  2. Educational social networks "•  Which tools are the most powerful and most useful for creating them and should you creatededicated educational social networks or use pre-existing ones? "•  3. Your data and information "•  How do you maintain control of it, keep it secure, keep it backed up, ensure itsinteroperability, and migrate it to future hardware and software platforms? "•  4. Professionalism "•  How do learners respect confidentiality and utilize educational social networks in aprofessional manner?"•  This talk available at"•"