Connecting Pediatric Learning To Clinical Practice


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Talk given at Pediatric Grand Rounds at Children's Memorial Hospital on November 4, 2011

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Connecting Pediatric Learning To Clinical Practice

  1. 1. Connecting Pediatric Learning 
 To Clinical Practice:
 "A Radiologists Vision For The Future of Pediatric Education Michael P. DAlessandro, M.D. " " University of Iowa College of Medicine / University of Iowa Childrens Hospital" " "
  2. 2. Our Vision"•  Educational Informatics Laboratorys vision since 1989" •  To improve patients care, outcomes and lives;" •  By changing physicians knowledge, attitudes, and behaviors;" •  Through the creation and evaluation of tools, techniques, and procedures that shift learning from the classroom and lecture hall to the point-of-care"•  Strong record of innovation in medical education" •  Resulting in grants, peer-reviewed publications, awards" •  Currently serve 2 million learners / year ~ highest impact factors on Internet"
  3. 3. Experience With Research Collaboratories / 
 " Learning Portfolios / Communities of PracticeCurrent research is focused on empowering physicians through learning tools that enhance learning at the point-of-care and documenting and preserving this learning to create a personalized learning environment / knowledge management / e-memory system for every physician"
  4. 4. Introduction"•  A few definitions first…"
  5. 5. Personal Learning Environment "•  System that help learners take control of and manage their own learning including providing support for learners to" •  Set their own learning goals" •  Manage their own learning - both content and process " •  Communicate with others in the process of learning "•  Learner-centric ~ "This is what I will learn today""•  Decentralized ~ RSS is glue that holds it together"
  6. 6. E-Memory System"•  A digital archive of your life " •  "Lifelogging""•  Made possible / inevitable by" •  Most memories are digital" •  Near-infinite space to store them" •  Ever-improving technology to recall them"•  Captures, stores, organizes and makes retrievable your experience + reflected wisdom"•  You become the librarian, archivist, cartographer and curator of your life "
  7. 7. Learning Portfolio"•  A digital archive of your medical educational life = learning diary" •  Document + store your clinical questions + answers which aggregate into a physicians personal learning experience"•  For each case" •  Question ~ Story ~ Answer ~ Impact on Practice ~ Resources Used"•  Educational construct" •  Adult learning theory = Learning situated in practice" •  Schons theory of clinical problem solving / model of reflective practice / learning cycle" •  Case-Based Learning" •  Constructionism ~ Learning by doing / Learning artifacts"
  8. 8. How the Medical Apprentice Learns"•  Diagnosis" •  Clinical skills related to experience" •  When seeing a new case you pattern match "illness scripts" to diagnose" •  Case-based reasoning / Storytelling" •  Expert is the person who can best capture, organize, and retrieve their experience (cases)"•  Treatment" •  Work up driven by medical knowledge"- Schmidt HG, Norman GR, Boshuizen HPA. A Cognitive Perspective on Medical " Expertise: Theory and Implications. Acad Med 1990 Oct;65(10):611-21.
  9. 9. Community of Practice""Communities of practice are groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their understanding 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" •  Facilitates assessment by critique"
  10. 10. Back To The Future""In what my be called the natural method of teaching, the student begins with the patient, continues with the patient, and ends his studies with the patient using books and lectures as tools, as means to an end." " " " " " "- Sir William Osler"Personal Learning" "To teach is to model and to demonstrate" "To learn is to practice and reflect" " " " " "- Stephen Downes"
  11. 11. Future of Medical Education"•  CME traditionally disconnected from clinical practice, found to be completely ineffective" •  Long held dream of the few was to connect CME to clinical practice - but technically difficult" •  Advent of Internet, which can bring library to POC, makes dream reality"•  Connecting education to practice is best way to change physicians knowledge / attitudes / behaviors and improve patients care / outcomes / lives" •  ACCME, CME as a Bridge to Quality, 2006" •  Josiah Macy Foundation, Continuing Education in the Health Professions, 2008" •  IOM, Redesigning Continuing Education in the Health Professions, 2009" •  Molly Cooke, David M. Irby, Bridget C. OBrien. Educating Physicians: A Call For Reform of Medical School and Residency, Jossey-Bass, 2010"•  Most physicians do not know how to connect their learning to their practice" •  Unaware of recent advances in E-memory systems"•  Purpose of this talk is to show you how to connect your learning to your practice and receive CME for it using a personal learning environment, learning portfolio and community of practice"
  12. 12. Digital Natives - Mark Prensky
 " Medical Student of Today Is As Old As The Web Born 1990 = 1 Web site ~ 1992 = 10 Web sites ~ 2011 = > 1 billion Web sites"Will receive less and less of their training in hospital ~ From 100-> 80-> 56 hour work weeks"Preferred learning environment Web 2.0 ~ Read/Write Web ~ Weapons of mass collaboration"
  13. 13. Methods"•  My personal learning environment"
  14. 14. Web 2.0 Landscape "•  Web 2.0 = Read / Write Web" •  Weapons of Mass Collaboration" •  Blogs / Micro-blogs, photo / video-sharing, wikis, social bookmarking, social networking" •  Self organizing systems ~ Micro-learning" •  Soul is sharing / connecting / iteration / openness " - Mark Pesce"•  Tools that support 4 Cs for 21st Century" •  Critical thinking" •  Communication" •  Collaboration" •  Creativity"
  15. 15. Your Interface To The Cloud
 Mobile Phone + Web Browser + App Store" Android Blackberry iPhone Windows Phone""It is now clear that the long process of connecting everyone on Earth to a global telecommunications network, which began with the invention of the telegraph in 1791, is on the verge of being completed."" - Tom Standage, Finishing the Job (Special report on telecoms in emerging markets), The Economist, September 24, 2009"
  16. 16. Seeking Answers / Decision Support
 Specialty-Specific Search Engines""Difference between Radiology Search Engine + StatDX for Decision Support" "StatDX helps you quickly find an answer" "Radiology search engine helps you learn and remember the answer, especially when coupled with learning portfolio ~ Allows you to receive CME for the answer"
  17. 17. Documenting Learning
 Learning Portfolio"PACS -> USB Excel iPhoto iPod / Lecture Flickr "•  Why?" •  For Yourself - Passion + Reflection! " "An unexamined life is not worth living" - Socrates" •  For Point-of-Care CME - questions are starting point for further learning" •  For sharing with trainees and peers" •  Individuals face to face" •  Groups in conferences and lectures" •  World on Internet"•  Created + archived on PC ~ Shared on the Cloud"
  18. 18. Receiving CME + MOC 
 " For Point of Care Learning - Up to 20 hours / yeariPOC (free) for MOC Part 1 ~ 20 Learning Plans over 5 years each with PREP question (cost) due to ABP for MOC Part 2 ~ Vision is for Learning Plans to be connected to Communities of Practice" ."
  19. 19. Sharing + Teaching
 Community of Practice""Learning portfolio can be shared with your community of practice for collaborative learning"
  20. 20. Pediatric Commons
Learning Portfolio - Teaching File - Community of Practice "•  For each case: Question ~ Story ~ Answer ~ Impact on Practice ~ Resources Used"•  Permissions ~ Tag Cloud (discipline, anatomy, disease, institution, level)"•  Aggregated learning portfolios ~ Public Forums"
  21. 21. An Invitation to the Future of Pediatric Education
 Pediatric Commons -- "•  A community of pediatric learning, teaching, sharing + collaboration" •  Goal - build a pediatric learning community around content, conversations and connections for 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" •  MyTeachingFile ~ MyKnowledgeManagementSystem ~ E-memory system " •  Participate in your community of practice" •  Contribute content, Engage in conversations, Make connections" •  Experience your personal learning environment" •  Helps learners take control of + manage their own learning" •  Enables peer-to-peer and master-to-apprentice teaching" •  Fulfills part of the requirement for Maintenance of Certification" •  Tieing your learning to your practice and awarding you CME ""
  22. 22. Learning
 Podcasts + Video + RSS"" " " " " " Activity stream / News wire"
  23. 23. Learning
 eBooks + eJournals + Slide Sharing"iPad (ePubs + PDFs + PPTs)"
  24. 24. Joining The Pediatric Cloud
 " Social Networking + Microblogging (= Activity streams / News wires)"Connections to professional identity (CV) Connections to news " Connections to friends + personal / professional interests
  25. 25. Results"
  26. 26. " Evaluation of a Learning Portfolio•  A pediatricians clinical experiences coupled with reflection" •  5 elements for each case" •  Evaluation shows unstructured curriculum unfolding 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 a Pediatric Digital Librarys Educational Content and Comparison to National Curricular Standards. Medical Teacher. 2008;30(9-10) 880-6. "•  Learner taking control of and assuming responsibility for their own learning by tying their learning to practice + receiving CME for it"•  Learning portfolio documents what you have learned" •  Assessment by examination documents what you dont know"
  27. 27. My Personal Learning Environment Results" Tabbed browsing " Mashups -•  This is a way to enjoy rather than endure your 10,000 hour voyage towards expertise"•  My learning has never been so focused, so relevant, so interesting, so meaningful, so enjoyable"•  I have finally become a learning machine, passionately pursuing mastery of medicine"
  28. 28. Educational Effectiveness of Social Networks Social Learning"•  Types of evaluation / assessment " •  Formative / critique (CQI) vs. Summative / examination"•  Proposition: The house believes that social networking technologies will bring large [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, peer assessment -- all coupled with learning logs - with teacher as a guide = Learning in a social network" - Ewan Mcintosh, The Economist Debate Series: Education - Social Networking, The Economist, January 2008""Firm evidence shows that formative assessment is an essential component of classroom work and that its development can raise standards of achievement…"" "- 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, and the 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 assessment by critique improves assessment by examination…"
  29. 29. Educational Effectiveness of Communities of Practice""Physicians interact with peers and mentors to frame issues, brainstorm, validate and share information, make decisions, and create management protocols, all of which contribute to learning in practice. It is likely that working together in this way creates the best environment for learning that enhances professional practice and professional judgment."" "- Parboosingh JT. Physician Communities of Practice: Where Learning and Practice are Inseparable. Journal of Continuing Education in the Health Professions. 2002. 22, pp. 230-230"
  30. 30. Integration Into The Social Workflow
Web site vs. Ning Network vs. Facebook page"Members: 1 600 2,100"Visitors/month: 24,000 1,000 1,000"Pages/month: 33,000 2,000 15,000"Comments/case: 0 1 1 . " Cataract Surgery Facebook page has 9,0000 members and 5-30 comments/case "Medscape Connect / Sermo - Anonymous, low signal to noise, some curbsides little learning"
  31. 31. Just One More Thing - 
 Regaining Our Seat At The Table"•  We have lost face-to-face touch with our clinical colleagues" •  Slovis TL. The Easier Path - A Blueprint For Failure. Pediatr Radiol. 2007 May;37(5):415-6"•  One way to address this is to attend their conferences" •  Slovis TL. The Path Less Travelled - A Road To Success. Pediatr Radiol. 2007 Jun;37(6):513-4."•  Pediatric Commons is another way to reconnect with our clinical colleagues in order to improve the quality of patient care" •  Build online bridges of collaboration + friendship" •  Take part in their conversations + get into their decision loops" •  Digital natives do this in their personal lives ~ will want to do it in their professional lives""Can we use a system like Pediatric Commons to recreate / reproduce the daily informal clinical interactions + conferences we used to have before PACS?" - Shunsuke Nosaka, M.D. (NCCHD Tokyo)"
  32. 32. Change is Hard…""There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in success, than to take the lead in the introduction of a new order of things… Innovation makes enemies of all those who prospered under the old regime, and only lukewarm support is forthcoming from those who would prosper under the new" " - Niccolo Machiavelli""You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete."" "" " " " "- Buckminster Fuller"
  33. 33. " Conclusion•  Components of future of pediatric education" •  Situate learning in practice with pediatric search engines" •  Document learning in practice with individual learning portfolios " •  Participate in community of practice by aggregating learning portfolios" •  Interface via mobile phone" •  Sum total is your personal learning environment"•  Goal is to create an environment which allows longitudinally over time" •  Personal learning + reflection " •  Master-to apprentice and Peer-to peer teaching" •  …and ultimately - conversations about art and science of pediatrics"•  Tying education to practice is how to create and preserve a lifelong passion for medicine" •  This is how to create medical learning machines who strive for and achieve excellence in practice" •  Philosophically must strive to pursue mastery of medicine, rather than merely recertification"•  Pediatric Commons is small step on long journey towards fulfilling vision of future of pediatric education"
  34. 34. For More Information…"•  About this talk" •"•  About Pediatric Commons" •" •"•  About what we do and why we do it…" •"