Application of ISD(Instructional System Design)in Healthcare ProfessionalEducationTakahiro Matsumoto, M.D., Ph.D.Assistant...
Overview• Instructor Training in Clinical Medicine  – Utilization of ADDIE Model• Application of PDS in M&M Conference  – ...
Contribution to Society               as an Anesthesiologist• My Question:  – As an Anesthesiologist, how can I contribute...
How to become an ICLS Instructor   (ICLS: Immediate Cardiopulmonary Life Support, in Japan)• Criteria for Instructor   1. ...
How to become an AHA Instructor• AHA Core Instructor Course  – Eligibility: AHA BLS/ACLS/PALS Diploma  – Textbook: AHA Cor...
AHA Core Instructor Course   (AHA: American Heart Association)      • A prerequisite for AHA Instructor        Candidates ...
ibstpi Instructor Competency            • ibstpi:The International Board of              Standards for Training,          ...
ibstpi Instructor CompetencyProfessional Foundations1. Communicate effectively.2. Update and improve one’s professional kn...
Also Available in Japanese Translation               • Matsumoto T, Application Of                 Instructor Competency I...
ADDIE Model                           A         D            D             I          E• The five letters denote the phase...
Ibstpi Instructor Competency and ID                                                                        A            D ...
Instruction: Is It An Art or Science? Science of Medical Care⇒ Nursing, Medicine, Basic Science Standards of Medical Care⇒...
What Are The Teaching Resources For             Instructors?                       The strongest is their own past        ...
Healthcare Professional Education Based   On ISD & Instructor Competency           Good Healthcare ProvidersClinical Pract...
Proposed Facilitator Course In    Healthcare Professional Education• Basic Course  – Goal: Educate Instructors with Basic ...
Summary 1• ibstpi Instructor Competency  – An International Standard of Instructor• Faculty Development Based on ISD  – Ap...
APPLICATION OF ISD IN M&M CONFERENCE(PDS: PERFORMANCE DEVELOPMENT SYSTEM)  28 December 2011   ISD for learning of health p...
Malfunctioning M&M Conference• What M&M should be:  – Peer reviews of complications occurring during the    care of patien...
Creating a Paradigm Shift in M&M• M&M needs to change because:   – You learn less in punitive environment   – Discouraging...
(http://isd-resource-space.wikispaces.com/file/view/How+to+Link+HRD+to+Organizational+Needs.pdf)
PDS-Based M&M: Case 1• Present the case• Find out the international guidelines and/or  organizational rules related to thi...
PDS-Based M&M: Case 2• Cause Analysis (What’s missing?)  – Skills & knowledge: e.g. ability to detect volume    depletion ...
PDS: Solutions Linked to CausesPossible Causes - Lack of:                           Possible Solutions – Look at:• Skills ...
Summary 2• Malfunctioning M&M Conferences  – Punitive, discouraging meeting  – Blaming one another  – Negative effect on c...
APPLICATION OF ISD INHEALTHCARE STUDENT LECTURE 28 December 2011   ISD for learning of health professionals   25
Reality Check #1:      Goal Settings for Med Students• Ideal  –   Become a clinician who honors scientific evidence  –   B...
Reality Check #2:       Issues in Med School Lecture• Dysfunctional Lecture  – Lacking Syllabus. Non-functional if any.  –...
Improving Med School Didactics with ISD• Application of ADDIE Model  – A: Creative lecture content  – D & D: Utilization o...
Two Weeks Prior to the Class• Anesthesia Chair put me in charge of the keynote  lecture of Anesthesiology for Med Students...
Anesthesia-Related Goals for             Med Students• Passing the Exams  – OSCE, Graduation Exam, Board Exam• Achieve the...
Topic Examples Related to             “Passing the Exams”• Select questions from past Board Exams• Explain Anesthesia-rela...
Topic Examples Related to              “Pathophysiology”• What does Blood Pressure implies? How low can  it be?• Pathophys...
Mobile Based Voting System “ShuKeitai”• Developed by Kimura  Inormation Technology  – http://www.k-    idea.jp/company/syu...
Vote Result 1                   learning                    science     issues              patient safety                ...
Vote Result 2                  pain management       red blood cell transfusion                              infusion  iss...
Lecture Planning Based on Vote Result• Main Topics  – Pathophysiology and treatment of Brady- &    tachycardia  – Past boa...
Mishaps on the Day of Lecture• Underestimated the attendance  – About 70 students showed up instead of usual less    than ...
Post-lecture Feedback• Aim  – Assess the achievement level after the lecture     • Had the students answer the past Board ...
Post-lecture Feedback 1• Q. What was most impressive about this  lecture?  – Lecture was not one-way               8.51%  ...
Post-lecture Feedback 2• Q. What needs to be improved about this  lecture?  – Could not learn much                        ...
Post-lecture Feedback 3• Q. How do you feel now after taking this  lecture?  – Bored                                  1.72...
Summary: Lecture Designing• Preparation  – E-mail the lecture topics  – Students vote for topics via Mobile Based Voting  ...
Provide the Opportunity for                 Voluntarily Studying• Set up “Clinically Oriented Physiology” study  group• Sc...
Testimony from a med student after “Clinically       Oriented Physiology” study meeting• I have been skipping most of the ...
The Effect of Mobile Device Voting System• What I found in this lecture  – Motivates the students     • 70% of the student...
Function of Face-to-Face-Style Lecture• Functions confirmed with this lecture  – Functionality to achieve information and ...
Caveat• Need to take into account that not all students  have web access on cell phones  – Make announcements or send docu...
Summary 3• Classroom Response System will change the  lecture style   – Pre-lecture: Vote for lecture topics, post quiz   ...
Take Home Messages• Application of ISD to Healthcare Provider  Education  – ADDIE Model for faculty development  – PDS for...
AcknowledgementThis presentation was originally created inJapanese. It was translated into English by:David R. Okano, M.D....
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English_version_Application of isd_in_classroom_sea_eng_16_dec2011

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translated version of the same title in Japanese. An anesthesiologist's experience in the application of instructional system design (ISD) for health professional education.
This was presented at Software Engineers Association, in Tokyo, on16 Dec 2011.

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  1. 1. Application of ISD(Instructional System Design)in Healthcare ProfessionalEducationTakahiro Matsumoto, M.D., Ph.D.Assistant ProfessorDepartment of AnesthesiologyJikei Universitytakahiro_matsumoto@jikei.ac.jp
  2. 2. Overview• Instructor Training in Clinical Medicine – Utilization of ADDIE Model• Application of PDS in M&M Conference – PDS: Performance Development System• Utilization of ISD in Healthcare Student Lecture – Applying Keller’s ARCS Model 28 December 2011 ISD for learning of health professionals 2
  3. 3. Contribution to Society as an Anesthesiologist• My Question: – As an Anesthesiologist, how can I contribute to the society by not just being confined in OR?• My Plan: – Establish In-Hospital Code Response System – Set up scheduled CPR (cardiopulmonary resuscitation) training courses• Impression: – Instructor Training was critical in CPR course 28 December 2011 ISD for learning of health professionals 3
  4. 4. How to become an ICLS Instructor (ICLS: Immediate Cardiopulmonary Life Support, in Japan)• Criteria for Instructor 1. Finish ICLS Course → 5 Assistant Instructor Experience 2. Finish ICLS Course → 2 Assistant Instructor Experience + Instructor Training Workshop• Remarks 1. Become Assistant Instructor upon finishing ICLS Course • Pick what you can do among various Instructor tasks (a good example of Legitimate Peripheral Participation?) 2. Instructor Training Workshop is NOT a must • You can become an Instructor with Assistant Instructor Experience only 28 December 2011 ISD for learning of health professionals 4
  5. 5. How to become an AHA Instructor• AHA Core Instructor Course – Eligibility: AHA BLS/ACLS/PALS Diploma – Textbook: AHA Core Instructor Course Textbook• AHA Instructor Course – Eligibility: AHA Core Instructor Course Diploma – Textbook: AHA BLS/ACLS/PALS Instructor Kit• Note – All Instructors MUST have finished Core Instructor Course 28 December 2011 ISD for learning of health professionals 5
  6. 6. AHA Core Instructor Course (AHA: American Heart Association) • A prerequisite for AHA Instructor Candidates – Self-directed learning via DVD – Interactive online learning program • Outstanding Learning Program! – Must have been written by a Didactics pro • Back Cover of The Textbook Says: – “Core content is based on … core instructor competencies identified by the International Board of Standards for Training, Performance and Instruction (ibstpi)” ISD for learning of health professionals 6
  7. 7. ibstpi Instructor Competency • ibstpi:The International Board of Standards for Training, Performance and Instruction – Development of standards in the areas of training, performance and instruction – Composed of professionals in ISD (Instructional System Design) ibstpi • 18 Competencies – 5 Domains – 98 Performance Statements ISD for learning of health professionals 7
  8. 8. ibstpi Instructor CompetencyProfessional Foundations1. Communicate effectively.2. Update and improve one’s professional knowledge and skills.3. Comply with established ethical and legal standards.4. Establish and maintain professional credibility.Planning and Preparation5. Plan instructional methods and materials6. Prepare for instruction.Instructional Methods and Strategies 7. Stimulate and sustain learner motivation and engagement. 8. Demonstrate effective presentation skills. 9. Demonstrate effective facilitation skills. 10. Demonstrate effective questioning skills. 11. Provide clarification and feedback. 12. Promote retention of knowledge and skills. 13. Promote transfer of knowledge and skills. 14. Use media and technology to enhance learning and performance.Assessment and Evaluation15. Assess learning and performance.16. Evaluate instructional effectiveness.Management17. Manage an environment that fosters learning and performance.18. Manage the instructional process through the appropriate use of technology. ISD for learning of health professionals 8
  9. 9. Also Available in Japanese Translation • Matsumoto T, Application Of Instructor Competency In Education For Health Professionals, JJHPD, 1; 41-52, 2011. • Matsumoto T, Japanese Translation of Ibstpi Instructor Competency Chapter 4, JJHPD, 1; 53-62, 2011. ISD for learning of health professionals 9
  10. 10. ADDIE Model A D D I E• The five letters denote the phases which represent dynamic, flexible guidelines for building effective training and performance support tools. – Analysis : – Design : – Development: – Implement: – Evaluation: ( http://en.wikipedia.org/wiki/ADDIE_Model ) 28 December 2011 ISD for learning of health professionals 10
  11. 11. Ibstpi Instructor Competency and ID A D D I E Professional Foundations 1. Communicate effectively. I 2. Update and improve one’s professional knowledge and skills. 3. Comply with established ethical and legal standards. 4. Establish and maintain professional credibility. Planning and Preparation D D Practicing ID in 5. Plan instructional methods and materials 6. Prepare for instruction.I Instructional Methods and Strategies 7. Stimulate and sustain learner motivation and engagement. 8. Demonstrate effective presentation skills. 9. Demonstrate effective facilitation skills. InstructorA 10. Demonstrate effective questioning skills. 11. Provide clarification and feedback. 12. Promote retention of knowledge and skills. Competency 13. Promote transfer of knowledge and skills. 14. Use media and technology to enhance learning and performance. Assessment and Evaluation 15. Assess learning and performance. E 16. Evaluate instructional effectiveness. Management 17. Manage an environment that fosters learning and performance. 18. Manage the instructional process through the appropriate use of technology. 28 December 2011 ISD for learning of health professionals 11
  12. 12. Instruction: Is It An Art or Science? Science of Medical Care⇒ Nursing, Medicine, Basic Science Standards of Medical Care⇒ Guidelines Bringing the Art of Medicine into Science Bringing the Art of Instruction into ScienceStandards of Instruction⇒ Instructor CompetencyScience of Instruction⇒ ISD (Instructional System Design) 28 December 2011 ISD for learning of health professionals 12
  13. 13. What Are The Teaching Resources For Instructors? The strongest is their own past experiences as learners (e.g. mimicking the way you have been taught) The second strongest is the knowledge about teaching came from reflecting on their own teaching experiences (Irby, DM, Academic Medicine 68 ;10:760-3, 1993) Application of Teaching Science is in GrowingDemand Among Healthcare Provider Education 28 December 2011 ISD for learning of health professionals 13
  14. 14. Healthcare Professional Education Based On ISD & Instructor Competency Good Healthcare ProvidersClinical Practice Adhering to Instructor Competency Understanding & Practicing of ISD during Students 28 December 2011 ISD for learning of health professionals 14
  15. 15. Proposed Facilitator Course In Healthcare Professional Education• Basic Course – Goal: Educate Instructors with Basic Skills of Healthcare Professional Education – Contents: • ibstpi Instructor Competency 1, 7, 11, etc• Advanced course – Goal: Educate Facilitators and Managers of Healthcare Professional Education – Contents: • ibstpi Instructor Competency 1, 9, 10, 15, 16, etc 28 December 2011 ISD for learning of health professionals 15
  16. 16. Summary 1• ibstpi Instructor Competency – An International Standard of Instructor• Faculty Development Based on ISD – Application of ibstpi Instructor Competency 28 December 2011 ISD for learning of health professionals 16
  17. 17. APPLICATION OF ISD IN M&M CONFERENCE(PDS: PERFORMANCE DEVELOPMENT SYSTEM) 28 December 2011 ISD for learning of health professionals 17
  18. 18. Malfunctioning M&M Conference• What M&M should be: – Peer reviews of complications occurring during the care of patients – Constructive learning to modify behavior and judgment• What M&M in Japan is: – Usually “Punitive” and discouraging environment – Often ends up blaming other parties • May cause someone to leave the practice – Same ol’ conclusion “Study hard, practice hard!” 28 December 2011 ISD for learning of health professionals 18
  19. 19. Creating a Paradigm Shift in M&M• M&M needs to change because: – You learn less in punitive environment – Discouraging environment creates poor teamwork – Performance will not improve solely by training• Can we change M&M into an effective and attractive opportunity to learn?• Let’s apply ISD to M&M – PDS (by John Keller) can be a powerful tool • PDS: Performance Development System – Article: HOW TO LINK ISD and HRD TO ORGANIZATIONAL NEEDS – http://isd-resource-space.wikispaces.com/file/view/How+to+Link+HRD+to+Organizational+Needs.pdf 28 December 2011 ISD for learning of health professionals 19
  20. 20. (http://isd-resource-space.wikispaces.com/file/view/How+to+Link+HRD+to+Organizational+Needs.pdf)
  21. 21. PDS-Based M&M: Case 1• Present the case• Find out the international guidelines and/or organizational rules related to this case• Describe the “gap” between ideal performance and real world medicine – e.g. One week longer hospital stay than guidelines – Important to extract good performances as well 28 December 2011 ISD for learning of health professionals 21
  22. 22. PDS-Based M&M: Case 2• Cause Analysis (What’s missing?) – Skills & knowledge: e.g. ability to detect volume depletion – Environment: – Motives and Expectations: – Incentives and Rewards:• Seek Solutions for Individual Cause 28 December 2011 ISD for learning of health professionals 22
  23. 23. PDS: Solutions Linked to CausesPossible Causes - Lack of: Possible Solutions – Look at:• Skills / Knowledge • Training – formal or OJT, Job aids• Environmental Constraints • Work redesign• Appropriate Incentives • Recognition for excellence, Promotion based on performance• Individual Motivation • Confidence building (http://isd-resource-space.wikispaces.com/file/view/How+to+Link+HRD+to+Organizational+Needs.pdf) 28 December 2011 ISD for learning of health professionals 23
  24. 24. Summary 2• Malfunctioning M&M Conferences – Punitive, discouraging meeting – Blaming one another – Negative effect on camaraderie and facilitate quitters• Applying PDS to M&M – Will enable systematic approach to the problems that cannot be solved by training 28 December 2011 ISD for learning of health professionals 24
  25. 25. APPLICATION OF ISD INHEALTHCARE STUDENT LECTURE 28 December 2011 ISD for learning of health professionals 25
  26. 26. Reality Check #1: Goal Settings for Med Students• Ideal – Become a clinician who honors scientific evidence – Become a clinician who cares about patient safety – Become a medical science researcher – Become a medical officer in the government• Reality – Must pass the medical board exam • Some med schools have reverted back to classic lecture style after their pass rates dropped • Governmental aid to the med school will be cut if pass rates drop 28 December 2011 ISD for learning of health professionals 26
  27. 27. Reality Check #2: Issues in Med School Lecture• Dysfunctional Lecture – Lacking Syllabus. Non-functional if any. – Poor Attendance • Napping, yaking in classroom • Many students feel attendance is irrelevant to passing the board exam – Multiple issues on faculties • Same ol’ classic lecture • PBL (Problem Based)• Med school didactics need a drastic change 28 December 2011 ISD for learning of health professionals 27
  28. 28. Improving Med School Didactics with ISD• Application of ADDIE Model – A: Creative lecture content – D & D: Utilization of Classroom Response System and Mobile Based Voting System – I: Avoid “lecturing” in the classroom – E: Achievement evaluation and feedback via Mobile Based Voting System after the class• Confirmation of Kirkpatrick Level 3 – Establish study groups which can be attended voluntarily 28 December 2011 ISD for learning of health professionals 28
  29. 29. Two Weeks Prior to the Class• Anesthesia Chair put me in charge of the keynote lecture of Anesthesiology for Med Students• I analyzed the specific function of this lecture: – Introduction to Anesthesia and related medical fields – Impact on students & residents till they graduate• Getting prepared – E-mail the lecture topics to students – Have students vote on their interested topics via Mobile Based Voting System 28 December 2011 ISD for learning of health professionals 29
  30. 30. Anesthesia-Related Goals for Med Students• Passing the Exams – OSCE, Graduation Exam, Board Exam• Achieve the Basis for Medical Professional – Understand Pathophysiology – Learn Basic Technical Skills – Care Patient Safety – Be a Scientist – CME 28 December 2011 ISD for learning of health professionals 30
  31. 31. Topic Examples Related to “Passing the Exams”• Select questions from past Board Exams• Explain Anesthesia-related questions 28 December 2011 ISD for learning of health professionals 31
  32. 32. Topic Examples Related to “Pathophysiology”• What does Blood Pressure implies? How low can it be?• Pathophysiology and treatment of tachy- & bradycardia• How much oxygen does your patient need?• Where do you start reading the ABG?• Basics of selecting IV fluids• Basics of pain management• When do you start giving red cells? 28 December 2011 ISD for learning of health professionals 32
  33. 33. Mobile Based Voting System “ShuKeitai”• Developed by Kimura Inormation Technology – http://www.k- idea.jp/company/syuukeitai. html• Post the website and QR code – http://mana.3esys.jp/tju/1/ 28 December 2011 ISD for learning of health professionals 33
  34. 34. Vote Result 1 learning science issues patient safety physiology examination 0 20 40 60 vote• Physiology and Exam Topics were popular. 28 December 2011 ISD for learning of health professionals 34
  35. 35. Vote Result 2 pain management red blood cell transfusion infusion issues blood gas analysis oxygen needs bradycardia & tachycardia blood pressure 0 10 20 30 40 50 vote• Brady- & tachycardia, pain management were popular among pathophysiology topics. – Decided to defer pain management to other lecture opportunity. 28 December 2011 ISD for learning of health professionals 35
  36. 36. Lecture Planning Based on Vote Result• Main Topics – Pathophysiology and treatment of Brady- & tachycardia – Past board exam questions – Why do you learn? – Significance of Learning• Lecture Style – Small-Group Discussion • Avoid one-way talking as much as possible – Use Classroom Response System 28 December 2011 ISD for learning of health professionals 36
  37. 37. Mishaps on the Day of Lecture• Underestimated the attendance – About 70 students showed up instead of usual less than 20 – Only 20 sets of 3e-analyzers available – could not utilize • http://www.k-idea.jp/3e/analyzer/index.html• Bad reception for mobile device in the classroom – Could not use “ShuKeitai”• Detected one sleepyhead 28 December 2011 ISD for learning of health professionals 37
  38. 38. Post-lecture Feedback• Aim – Assess the achievement level after the lecture • Had the students answer the past Board Exam questions – Get the opinion about the lecture• Number of Responds: 30 – Actual number of respond unknown due to dropped data calls 28 December 2011 ISD for learning of health professionals 38
  39. 39. Post-lecture Feedback 1• Q. What was most impressive about this lecture? – Lecture was not one-way 8.51% – Lecture made us think 40.43% – Significance of physiology 23.40% – Significance of Patient Safety 7.45% – Dangerousness of focusing on just passing the board exam 20.21% 28 December 2011 ISD for learning of health professionals 39
  40. 40. Post-lecture Feedback 2• Q. What needs to be improved about this lecture? – Could not learn much 12.50% – Inadequate lecture resource 10.71% – Could not understand well 3.57% – Felt too lengthy 1.79% – Nothing to improve 71.43% 28 December 2011 ISD for learning of health professionals 40
  41. 41. Post-lecture Feedback 3• Q. How do you feel now after taking this lecture? – Bored 1.72% – No change 17.24% – Want to learn more 60.34% – Want other teachers do similar lecture style 20.69% 28 December 2011 ISD for learning of health professionals 41
  42. 42. Summary: Lecture Designing• Preparation – E-mail the lecture topics – Students vote for topics via Mobile Based Voting System (MBVS)• In-Class – Lecture on topics based on Voting result – Stress on small-group discussion• Post-lecture – Achievement confirmation via MBVS – Feedback via MBVS 28 December 2011 ISD for learning of health professionals 42
  43. 43. Provide the Opportunity for Voluntarily Studying• Set up “Clinically Oriented Physiology” study group• Schedule – Once a week, starting 7pm, lasts about 90 min – No set day of the week – Announce the meeting by mailing list – Textbook: “Principles of Physiology for Anaesthetists, 2nd ed”• Accomplished 1st and 2nd meeting so far – Dec 1st and 12th , 7pm till past 8pm – 20 people attended (mostly pre-clinical med students) 28 December 2011 ISD for learning of health professionals 43
  44. 44. Testimony from a med student after “Clinically Oriented Physiology” study meeting• I have been skipping most of the classes recently because I was so disappointed with the studying style that puts stress on memorizing stuff…• But now I am wondering how exciting it could be to connect my knowledge of physiology to clinical medicine.• I believe I can start learning real medicine by attending your study group. 28 December 2011 ISD for learning of health professionals 44
  45. 45. The Effect of Mobile Device Voting System• What I found in this lecture – Motivates the students • 70% of the students voted to pick the lecture topic – Able to Confirm Achievement • Can ask to vote for understanding during class • Can perform post-lecture quiz (test)• Future – Possibility of “Ubiquitous Style” Lecture • Enables to attend the class without physically being there 28 December 2011 ISD for learning of health professionals 45
  46. 46. Function of Face-to-Face-Style Lecture• Functions confirmed with this lecture – Functionality to achieve information and knowledge will actually decline • What students want is the information you can ONLY achieve through lecture – Most important: Function to AWAKEN the desire to study • Students started to attend voluntary study group• Future Plan • Team-Based Learning • Workshops 28 December 2011 ISD for learning of health professionals 46
  47. 47. Caveat• Need to take into account that not all students have web access on cell phones – Make announcements or send documents via e- mail 28 December 2011 ISD for learning of health professionals 47
  48. 48. Summary 3• Classroom Response System will change the lecture style – Pre-lecture: Vote for lecture topics, post quiz – In-class: Acknowledge students’ reaction and achievement (unsuccessful this time) – Post-lecture: Acknowledge the desire to learn• Construct an effective and attractive learning environment – Function of the lecture is to awaken the desire to learn and facilitate team-based learning • Not so effective in transmitting information to students 28 December 2011 ISD for learning of health professionals 48
  49. 49. Take Home Messages• Application of ISD to Healthcare Provider Education – ADDIE Model for faculty development – PDS for M&M Conference – Keller’s ARCS Model to motivate students in the classroom• Systematic approach such as ISD is required in Healthcare Provider Education 28 December 2011 ISD for learning of health professionals 49
  50. 50. AcknowledgementThis presentation was originally created inJapanese. It was translated into English by:David R. Okano, M.D., Ph.D.Assistant Professor of Clinical Anesthesia 28 December 2011 ISD for learning of health professionals 50

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