Incorporating Mechanism Maps in Teaching A Strategy for Enhancing Critical Thinking

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A teaching hospital of Harvard Medical School. Incorporating Mechanism Maps in Teaching A Strategy for Enhancing Critical Thinking. Jeremy B. Richards, MD, MA Richard M. Schwartzstein, MD Shapiro Institute for Education and Research Beth Israel Deaconess Medical Center - PowerPoint PPT Presentation

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  • Students mechanism maps

  • Students mechanism maps

    A teaching hospital of Harvard Medical School

    SummaryTeaching/learning that emphasizes conceptual framework supports understanding and application of contentInductive reasoning may facilitate adaptive expertiseMechanism maps provide a strategy to reinforce basic concepts and teach students how to work the problem

    A teaching hospital of Harvard Medical School

    Mechanism map examplesTopic- versus case-based concept maps

    A teaching hospital of Harvard Medical School

    Case-based mechanism map76yo woman with ~10 years of steadily worsening dyspnea, who now cannot walk more than half a block on flat ground due to breathlessness. She has smoked 10-20 cigarettes a day for 55 years. Recently, she has developed a productive cough and wheezing. Her exam is notable for a temperature of 98.7, BP 122/84, HR 98, RR 18, O2 sat 90% on room air. Her chest has low-lying diaphragms and is hyperresonant to percussion. She has decreased breath sounds and expiratory wheezes with an increased anteroposterior diameter. Heart sounds are distant. Fingernails are not clubbed or cyanotic. She has a 2+ lower extremity edema.

    A teaching hospital of Harvard Medical School

    Case-based mechanism mapIdentify and highlight core signs and symptomsIdentify pathophysiologic and clinical mechanisms that link these core signs and symptomsBegin to link the core signs and symptoms using pathophysiologic mechanismsUse linking words when neededBe open to opportunities to cross-link concepts or expand the map in new directions

    A teaching hospital of Harvard Medical School

    Case-based mechanism map76yo woman with ~10 years of steadily worsening dyspnea, who now cannot walk more than half a block on flat ground due to breathlessness. She has smoked 10-20 cigarettes a day for 55 years. Recently, she has developed a productive cough and wheezing. Her exam is notable for a temperature of 98.7, BP 122/84, HR 98, RR 18, O2 sat 90% on room air. Her chest has low-lying diaphragms and is hyper-resonant to percussion. She has decreased breath sounds and expiratory wheezes with an increased anteroposterior diameter. Heart sounds are distant. Fingernails are not clubbed or cyanotic. She has a 2+ lower extremity edema.

    A teaching hospital of Harvard Medical School

    Case-based mechanism mapworsening dyspneasmoked cigarettesproductive coughwheezing

    A teaching hospital of Harvard Medical School

    Break-out groupsTime to put theory into practice!Divide into groups of 4-5Each group will spend the next 20 minutes designing a mechanism map based on a case vignetteHighlight pathophysiologic mechanisms as they relate to clinical signs and symptomsDuring the process, keep track of pros and cons of developing a mechanism map

    A teaching hospital of Harvard Medical School

    Break-out groups?Students were assigned to groups of 3 and instructed to produce a consensus concept map in response to questions about microbiologyKinchin I, Hay D. J Adv Nurs 2005;51(2):1837Morse D, Jutras F. CBE Life Sci Educ 2008;7(2):243-53Learning and performance was higher in students in groups with disparate backgrounds and different knowledge bases Peer (and instructor) feedback reinforces learning beyond the act of building a concept map

    A teaching hospital of Harvard Medical School

    Break-out groupsTime to put theory into practice!Divide into groups of 4-5Each group will spend the next 20 minutes designing a mechanism map based on a case vignetteHighlight pathophysiologic mechanisms as they relate to clinical signs and symptomsDuring the process, keep track of pros and cons of developing a mechanism map

    A teaching hospital of Harvard Medical School

    Case vignetteMr. Green, a 47yo attorney and former heavy drinker, presents with a 6 month history of marked fatigue and dyspnea on minimal exertion. He tells you, I feel so tired by lunch time that I have to go home to sleep. He has also had decreased exertion, and has cut his daily 2 mile walk to 1 mile, a half mile, and then stopped walking altogether. He cannot lie flat at night because he awakens 1-2 hours after going to sleep with dramatic shortness of breath. Over the last two weeks he has only been comfortable sleeping upright in a chair.

    A teaching hospital of Harvard Medical School

    Case vignetteMr. Green, a 47yo attorney and former heavy drinker, presents with a 6 month history of marked fatigue and dyspnea on minimal exertion. He tells you, I feel so tired by lunch time that I have to go home to sleep. He has also had decreased exertion, and has cut his daily 2 mile walk to 1 mile, a half mile, and then stopped walking altogether. He cannot lie flat at night because he awakens 1-2 hours after going to sleep with dramatic shortness of breath. Over the last two weeks he has only been comfortable sleeping upright in a chair.

    A teaching hospital of Harvard Medical School

    Physiologic mechanismsConsider using these concepts / mechanisms in your map:PreloadAfterloadSympathetic nervous systemContractilityStroke volumeHeart rate

    Diastolic (volume, pressure)Systolic (volume, pressure)Systemic vascular resistanceOxygen deliveryGas exchangeHypertrophy

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