Taking evidence seriously: what would happen to our training programmes?

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An AMEE 2013 plenary presentation by Cees van der Vleuten

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Taking evidence seriously: what would happen to our training programmes?

  1. 1. Taking evidence seriously: what would happen to our training programmes? Cees van der Vleuten Maastricht University The Netherlands AMEE Conference 2013, Prague, 28 August 2013
  2. 2. Collegezaal rond 1798
  3. 3. Collegezaal rond 1998
  4. 4. A parallel attitude? Evidence-based Medicine (EBM) Best Evidence Medical Education (BEME)
  5. 5. Instructional formats Lecture Reading Audiovisual presentation Demonstration Group discussion Practice by doing Teach others
  6. 6. The Learning Pyramid Teach others Lecture Discussion group Demonstration Audiovisual Reading Practice by doing 5% 10% 20% 30% 50% 75% 80% Average Retention Rate National Training Laboratories, Bethel, Maine, USA Teachothers Lecture Discussiongroup Demonstration Audiovisual Reading Practicebydoing
  7. 7. Reductionism in education  Illustrations:  Education as a tradition, as a ritual  Focussed on information transmission  Not stimulating motivation, excellence, creativity  Information-poor grade culture  An out-dated learning model (mastery learning)
  8. 8. Solid evidence in education  Processing information leads to more profound learning (elaboration) Levin, J. R. (1988). Elaboration-based learning strategies: Powerful theory=powerful application. Contemporary Educational Psychology, 13(3), 191- 205.
  9. 9. Elaboration  Contingent on the functioning of our cognitive system (short-term, long term memory)  Can be done in many different ways:  Discussing  Explaining others  Schematizing  Apply to (transfer) cases  ………
  10. 10.  Processing information leads to more profound learning (elaboration)  Working in groups (collaborative learning) Solid evidence in education
  11. 11. Collaborative learning  Evidence-based conditions:  Equality in participation  Individual responsibility  Mutual positive interdependence  Simultaneous interaction Johnson, D.W., Johnson, R.T., & Smith, K. (2007). The state of cooperative learning in postsecondary and professional settings. Educ Psychol Rev, 19, 15–29.
  12. 12.  Processing information leads to more profound learning (elaboration)  Working in groups (collaborative learning)  Feedback works Solid evidence in education
  13. 13. Feedback  No learning without feedback!  Contemporary education provides little feedback  Summative information-poor assessment systems  Limited direct observation in work-based learning Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77, 81-112.
  14. 14.  Processing information leads to more profound learning (elaboration)  Working in groups (collaborative learning)  Feedback works  Coaching/mentoring works Solid evidence in education
  15. 15. Coaching/mentoring  Empirical findings:  Increased feedback use (feedback is a dialogue)  Improved professional development  Career preparation and success (incl. higher (clinical) production, higher positions)  Under-used by those who need it most Driessen, E. & Overeem, K. (2013) Mentoring. In: Oxford Handbook of Medical Education.
  16. 16.  Processing information leads to more profound learning (elaboration)  Working in groups (collaborative learning)  Feedback works  Coaching/mentoring works  (Clinical) learner responsibility works Solid evidence in education
  17. 17. Learning in the workplace  Care for patients is powerful way of learning  Increases intrinsic motivation  (Access to) supervision and feedback is essential Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26(2), 247-273. Dornan, T., Boshuizen, H., King, N., & Scherpbier, A. (2007). Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning. Medical education, 41(1), 84-91. Watling, C., Driessen, E., Vleuten, C. P., Vanstone, M., & Lingard, L. (2013). Beyond individualism: professional culture and its influence on feedback. Medical education, 47(6), 585-594.
  18. 18.  Processing information leads to more profound learning (elaboration)  Working in groups (collaborative learning)  Feedback works  Coaching/mentoring works  (Clinical) responsibility works  Attention to „generic‟ skills works Solid evidence in education
  19. 19. Generic skills  Professionalism, communication, teamwork, leadership…….  Activating learning environments lead to superior generic skills  Success and failure on labour market are (strongly) associated with these skills  They require longitudinal attention! Meng, C. . (2006). Discipline-specific or academic ? Acquisition, role and value of higher education competencies. (PhD), PhD Dissertation, Universiteit Maastricht, Maastricht. Schmidt, H.G., & Van der Molen, H.T. (2001). Self-reported competency ratings of graduates of a problem-based medical curriculum. Academic Medicine, 76, 466-468. Papadakis, M. A., Hodgson, C. S., Teherani, A., & Kohatsu, N. D. (2004). Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Academic medicine : journal of the Association of American Medical Colleges, 79(3), 244-249.
  20. 20. So, what should we do in education?  Use elaboration assignments  Use group or teamwork  Provide feedback  Coach and mentor learners  Introduce early (clinical) responsibility  Give ample attention to generic skills
  21. 21. Radical change 1  We “capture” all information transmission through IT use (collaboratively in MedEdWorld?)
  22. 22. Illustration
  23. 23. Radical change 1  We “capture” all information transmission through IT use (collaboratively?)  Education consists of (free to choose) assignments fulfilled in groups  Intensive guidance by teachers  All assessment is formative and informative; summative on longitudinal progression
  24. 24. Radical change 2  Competencies and milestones are leading for all courses and assessment, in longitudinal flexible tracks  Early exposure to patients and health care  Tight regulations, demanding on students, considerable (peer) social control
  25. 25. Conclusions  Education practice and education evidence are not aligned  Effective education focuses on information processing, not on information transfer  Education can be radically different!  Education for the 21st century? Will be different
  26. 26. “Did you ever feel you’re on the verge of an incredible breakthrough?” This Powerpoint can be found at: www.fdg.unimaas.nl/educ/cees/amee

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