Chapter 1Dialogue Education:

Active Learning, the Eight Steps of Planning, and the Four I’s

Faculty Development SeriesMadigan Healthcare SystemTacoma, Washington 98431

Dialogue Education: Active Learning and The Eight Steps of Planning

Chapter Contents

Group Leader ChecklistLearner Needs and Resources Assessment (LNRA)

Attendance SheetEvaluation Form

Example Eight StepsHandout

Summary of Supporting References and Resources

Checklist for the Group Leader

Before the Session....

___ 1. Review the suggested eight steps of planning for this presentation.

___ 2. Review the PowerPoint, handouts, and supporting references in this chapter.

___ 3. Duplicate and distribute the LNRA to faculty.

___ 4. Have faculty return the LNRA at least 5 days before the session.

___ 5. Review the faculty LNRA prior to the session.

___ 6. Modify the suggested eight steps and write your plan to fit your needs.

___ 7. Modify the PowerPoint and handout to fit your plan.

___ 8. Duplicate the appropriate number of copies of the attendance roster, faculty evaluation forms, and handouts.

During the Session....

___ 9. Have each participant sign-in using the attendance roster.

___ 10. Distribute the handout(s) to the participants.

___ 11. Conduct the session based on your eight steps of planning.

After the Session....

___ 12. Collect the evaluation forms from the faculty.

___ 13. Keep the attendance roster for the session in your department and provide the appropriate amount of CME to each participant.

___ 14. Reflect on the seminar - How did it go? What was good about it? What could have been better? Is there a better approach to this topic? Were there needs identified during this session that would be the basis for future seminar(s) in your program?

___ 15. Where will your program go from here based on this seminar?

Learner Needs and Resources Assessment

Please complete the following needs assessment for the upcoming seminar on Dialogue Education: Active Learning, Designing a Successful Learning Event as part of your faculty development program.

The seminar will consist of an introduction by your group leader, a short PowerPoint presentation, and a discussion period.

The purpose of this needs assessment is to determine your learning needs and interests, so that the seminar is most useful for you. This needs assessment should also stimulate you to think about active learning before the seminar begins. We need your enthusiastic participation now, and in the seminar. It will be fun, and at the end of it, we'll be asking for your feedback!

Please turn this in to your group leader (______________) no later than (_____________). Your group leader will return this form to you at the beginning of the session. 1. Have you any formal training in characteristics of Dialogue Education/Active Learning? Yes No

2. How much of the content taught in your residency lectures is actually retained by the learners?

5-10% 10-30% 30-50% 50-70% 70-100%

3. Describe the typical format of lectures/learning activities in your department:

4. What active learning activities have you used in your presentations?

5. List three things you would like to learn/take away from this session:

a.

b.

c.

Any other comments / concerns for this presentation:

ATTENDANCE ROSTER – Page____of_____Pages

Department: ____________________ Institution:____________________Title of CME Activity: Faculty Development Series – Dialogue Education: Active Learning, Designing a Successful Learning Event

Course Content: Didactic, and Group Discussion –An Introduction to the Eight Steps of Planning a learning event

Instructor (Group Leader):____________________________

Date:____________ Time: Began___________ Ended________ Total ___________

Name RankCheck One

Department or Mailing AddressStaff

PhysicianResident Physician

Other Professional Discipline

Total Number of Learners Attending This Activity: _________

ATTENDANCE ROSTER – Page____of_____Pages

Department: ____________________ Institution:____________________Title of CME Activity: Faculty Development Series – Dialogue Education: Active Learning, Designing a Successful Learning Event

Course Content: Didactic, and Group Discussion –An Introduction to the 4 I's of Learning Tasks

Instructor (Group Leader):____________________________

Date:____________ Time: Began___________ Ended________ Total ___________

Name RankCheck One

Department or Mailing AddressStaff

PhysicianResident Physician

Other Professional Discipline

Total Number of Learners Attending This Activity: _________

Faculty Development Session Evaluation Form

Date Speaker Topic

Please rate the speaker using the scale below:

Strongly Disagree

Disagree

Somewhat Agree

Agree Strongly Agree

Content was relevant to my needs

The speaker conveyed the subject matter clearly

The speaker used active learning techniques to teach this subject

The speaker gave adequate time for questions

Audiovisual / handout material added to the presentation

Overall, the speaker was effective

List one thing that you learned from this presentation:

Please add your comments/suggestion for improving this session on the back—they are VERY helpful

Faculty Development Session Evaluation Form

Date Speaker Topic

Please rate the speaker using the scale below:

Strongly Disagree

Disagree

Somewhat Agree

Agree Strongly Agree

Content was relevant to my needs

The speaker conveyed the subject matter clearly

The speaker used active learning techniques to teach this subject

The speaker gave adequate time for questions

Audiovisual / handout material added to the presentation

Overall, the speaker was effective

List one thing that you learned from this presentation:

Please add your comments/suggestion for improving this session on the back—they are VERY helpful

Dialogue Education: Active Learning and the Eight Steps of Planning

Example Eight Steps

The eight steps presented below may be used as a guide for your planning.Modify these steps to meet your specific needs.

Who: 20 faculty learners from the Department of Family Medicine

Why: Enhance didactic teaching as part of a required faculty development curriculum. The intent of this chapter is to emphasize that knowledge transfer from traditional lecture-and-listen presentations is very low. Thus, much of the time that we spend in lectures is lost. With ever increasing demands upon our time as clinical teachers and with seemingly ever increasing limitations to resident work hours, we must become more effective and more efficient in knowledge transfer. Only then will our residents/students leave our programs with the knowledge, skills and attitudes needed to successfully care for patients.

When: 0730-0900 on a Wednesday morning, blocked schedule for faculty development

Where: Classroom, individual desks, accessible, AV supported, requires own computer

What: Will explore the eight steps of planning an outstanding learning experience. Informed by the LNRA.

What For: By the end of this session, we will have:

Prioritized the 8 Steps of Planning a Learning Activity Reviewed the 8 Steps Applied the 8 Steps to a future talk Committed ourselves to teaching using active learning techniques

How: General: Active learning: small group activities and discussion, larger group discussion, minimal PowerPoint slides. Room contains individual desk. Will pre-configure desks into larger half-moon shape. Within larger half-moon configuration, will group four desks in smaller half-moon shape for five groups of four learners each. This will facilitate small group activities followed by larger group discussions. The session will take place at 0730, so will provide refreshements.

Grabber: Use the opening slides to get participants thinking about the way we traditioinally teach medical topics

Induction Tasks: 1. Began with LNRA and continued in first activities. Using the first page of the handout, have the group work in pairs to decide on which two of the 8 steps are the most important, in their opinion. Have each pair share their top two with the

group and explain why they choose those two. Allow them to ask any questions about the 8 Steps that came up during this exercise. Use the hyperlinked slide to teach about any of the 8 steps that need clarification.

Input Tasks:1. Use the hyperlinked slide to teach about any of the 8 steps that need clarification.

Implementation Tasks:1. Next, have the participants fill in the eight steps on the worksheet for an upcoming (or recently given) learning event. Have them share their plan with their neighbor. Note: skip step 7 as this will be covered in the next presentation.

2. Ask a few participants to share their 8 Steps with the larger group.Be sure to provide lavish affirmation to all who participate.

. Integration Tasks:Ask the participants to commit to using the 8 Steps as they design future learning

events.

So What:Learning: Learners understand the eight steps and how to apply them to their own teaching.

Transfer: Learners begin using the eight steps of planning for their own presentations.

Impact: Departmental didactic teaching is enhanced, improved learning and success for residents.

Active Learning-Using the 4 I’s to Plan Learning Tasks

Example Eight Steps

The eight steps presented below may be used as a guide for your planning.Modify these steps to meet your specific needs.

Who: 20 faculty learners from the Department of Family Medicine

Why: Enhance didactic teaching as part of a required faculty development curriculum. The intent of this chapter is to emphasize that knowledge transfer from traditional lecture-and-listen presentations is very low. Thus, much of the time that we spend in lectures is lost. With ever increasing demands upon our time as clinical teachers and with seemingly ever increasing limitations to resident work hours, we must become more effective and more efficient in knowledge transfer. Only then will our residents/students leave our programs with the knowledge, skills and attitudes needed to successfully care for patients.

When: 0730-0900 on a Wednesday morning, blocked schedule for faculty development

Where: Classroom, individual desks, accessible, AV supported, requires own computer

What: Will explore the eight steps of planning an outstanding learning experience. Informed by the LNRA.

What For: By the end of this session, we will have:

Reviewed the 4 I’s

Listed learning tasks for each ‘I’

Selected learning tasks for presentation

Committed themselves to using the 4 I’s in preparing learning events in the

future

How: General: Active learning: small group activities and discussion, larger group discussion, minimal PowerPoint slides. Room contains individual desk. Will pre-configure desks into larger half-moon shape. Within larger half-moon configuration, will group four desks in smaller half-moon shape for five groups of four learners each. This will facilitate small group activities followed by larger group discussions. The session will take place at 0730, so will provide refreshements.

Grabber: Show the video clip from Ferris Buler and ask learners to ponder what they see happening

Induction Tasks: 1. Began with LNRA and continued in first activities. In pairs, have the learners discuss the following:

• What did you see happening?• Why was it happening?• When this happens to you as a learner, what do you do?• How can you prevent this from happening when you are teaching?

Input Tasks:1. Use the PowerPoint presentation to teach about the 4 I’s Include the video from Dead Poets Society and ask similar questions of the group as during the inductive task.

2. Using the handout, have the participants familiarize themselves with the definitions of each of the 4 I’s by completing the matching activity. and asking for their questions.

3. Continue with PowerPoint presentation, review an example of the 4 I’s

4. Have the learners brainstorm a variety of learning tasks for each of the 4 I’s and record them on 4 dry erase boards with each board representing a different I. Have the four groups rotate to each of the dry erase boards and add any additional examples of learning tasks they came up with.

Implementation Tasks:1. Have the participants use their handout to record at least one learning activity for each I.

2. Ask a few participants to share their I’s.

Integration Tasks:Ask the participants to commit to using the 4 I s to plan learning tasks for their

next lecture.

So What:Learning: Learners understand the 4 I’s and how to apply them to their own teaching.

Transfer: Learners begin using the 4 I’s for their own presentations.

Impact: Departmental didactic teaching is enhanced, improved learning and success for residents; improved board scores and improved patient care.

The Eight Steps of Planning1 HandoutDesigning a Successful Learning Event

Consider a future learning event you are involved in planning.

1. Who? Consider number and profile of participants. What do they already know? How do they learn best? Do a learning needs assessment.

2. Why? Consider why this course is important, why the participants need to learn the material and what the need is.

3. When? Consider the timing and length of the event.

4. Where? Consider location. How will the location facilitate active learning tasks? What AV equipment will be available? What will I need to bring with me?

5. What? Describe the content of the course; name the subject matter: what knowledge, skills, and attitudes will be taught?

6. What for? The objectives2: What participants will do with what they have learned.

7. How? In what order will you sequence the material? What learning tasks will you have the participants do with the material? What materials will you need to do these learning tasks?

8. So What? How do they know they know?

Learning: New skills, knowledge, attitudes manifested as behaviors

1 Vella, J. (2002). Learning to listen, learning to teach. San Francisco, CA: John Wiley & Sons, Inc.2 Kern, D.E., Bass, E.B., Howard, D.M., Thomas, P.A. (1998). Curriculum development for medical education: a six-step approach. Baltimore, MD: The Johns Hopkins University Press.

Objectives should be:

specific, measurable, and expressed as a

verb.

Format suggestion:Who will do how

much (or how well) of what by when?

Example: Participants will list the 8 steps of planning by the end of

this session.

Transfer: Taking the material learned above into your workplace Impact: Systems changes in your organization due to this training

Active Learning In Action

Directions: Work in pairs to brainstorm your learning tasks for each objective. Some of these will be shared with the large group. Consider how you can apply active learning principles to the

design of the course. Be prepared to discuss your thoughts.

How? Plan the learning tasks for the course.

1. Inductive Tasks – consider open question, grabber, or activity. Draw upon the knowledge, skills and attitudes that the learners bring with them to the learning event.

2. Input Tasks – the presentation of new material that you want the learners to take away with them.

3. Implementation Tasks – learners practice using what was taught during the input phase.

4. Integration Tasks—ways to use the new material taught in clinical practice, a call to action.

Brainstorming about tasks that I could use in my department for other presentations

Inductive -

Input -

Implementation -

Integration -

Call to action

Use the 4 I’s above to plan active learning into your next teaching session.

Be an ambassador for active learning: encourage your staff to do the same.

Active Learning and Effective Presentations

Elements of Active LearningActivity- so our brains can process information by doing something with it

Variety- so the training will appeal to all of our different learning styles

Participation- with others, so that our learning environment feels safe and we can effectively engage with the topic

The 4 I’s

Inductive - connect with what they know:

1. Small group discussion – Have the audience break up into groups of four or five and ask them to discuss a patient they have cared for with your subject condition. What difficulties did they encounter in diagnosis, treatment, compliance, referral or co-morbidities? What rewards? Then each small group should pick one person to describe his or her case to the whole room.

2. Quiz – Either true/false or multiple choice quizzes are a great way to open a talk and review boring basics like epidemiology and pathophysiology without a lecture.

3. Worksheet – A resident at Madigan recently began a talk with handout. It was a blank chart listing eleven different types of transfusion reactions, arranged into two categories of either immune-mediated or non-immune-mediated. Before even beginning to lecture, she asked everyone to rank them in order of severity and then in order of how commonly they occur. Learners then filled out the chart as she described the incidence, pathophysiology, signs and symptoms, diagnosis, and treatment of each transfusion reaction. On the back of the handout was a treatment algorithm for transfusion reactions.

4. Role playing – Utilize the aspiring actors in your department to help you illustrate psychosocial aspects of a condition or demonstrate the difference between a clear and concise history and physical and a disjointed one.

5. Actual patient interview – You need sensitivity, judgment, and a sound relationship to approach a patient with this kind of request. But if you know a patient with interesting physical findings or stigmata of a particular condition it is unfair to keep them to yourself. Many patients are happy to help in the education of physicians, especially if you offer to buy them lunch. A real live patient is invaluable in teaching and puts a human face on a disease.

6. Video clip -- ask the learner what they see happening, why is it happening, when it happens to you, what do you do, how can we prevent this from happening?

7. Audience response system -- Audience response system can be used to gather information about the baseline knowledge level of the participants and can be used along the way to check on knowledge transfer.

Input - learn something new:

1. Videos – There are many excellent medical education videos available for free on the internet.

2. Case-based – Start with a case and develop it using a series of questions such as: What else do you want to know? What is your differential diagnosis? What further studies would you order? What is the etiology of that condition? Teach each topic as you go.

3. Article-based – Distribute the article beforehand and then discuss the article. Alternatively you can go through the article using a worksheet like a Journal Club.

4. Game shows – A game of “Jeopardy!” keeps the audience involved and adds a spirit of competition if you break the audience into groups. One colleague used PowerPoint to design the game “Battleship,” where a correct answer allows the team to choose coordinates to try to find and sink their opponents’ ships. Be sure this is content rich as well as fun as it is easy to have the learning get lost in the fun.

5. Small groups – Provide each small group the resources they need to teach a portion of the subject matter. Give them 15 minutes to learn it and then 10 minutes each to teach it to the larger audience. Initiate a contest after the teaching is over by giving a quiz on the subject material. The small group that teaches their subject the best, wins.

6. Audience choice – Provide a handout of not yet covered material and have the learners fill it out using their own experience and knowledge (A matching worksheet would be a good example). Then provide the answers and ask learners which of the topics they have questions about. Present only the slides that answer their questions.

7. PowerPoint presentation, outlining the new content

8. Reading material, handed out to learners. Each reads and highlights points that speak to him/her. Then each has a turn to present what they highlighted and why. What was missing from the material presented? What did you disagree with?

9. Be an ambassador – Give learners a new identity (each of you is going to be a different type of anemia) and provide them a sheet of paper that describes who they are and what the key characterists are about that type of anemia. These sheets might be on yard around their neck with the type of enemia printed on one side and the information about it on the back.Then ask them to move about the room looking for others who have a different type of anemia. Have them quiz you and you quiz them about that type of anemia. When a pair think they have each other’s anemia mastered, they break up and look for other types of anemia. This continues until each learner has been exposed to every anemia type available. You might follow this with a post-test or jeopardy game with the learners divided into teams. Keep score to see which team gets the most correct.

Implementation - practice what they learned

Integration – take it home and use it

Active Learning Matching Exercise: The 4 I’s

Working with your neighbor, match the ‘I” with the definition:

4 I’s Definition

____ 1. Inductive A. Take it home and use it

____2. Input B. Practice what they learned

____3. Implementation C. Connect with what they already know

____4. Integration D. Learn something new

Supporting References and Resources

1. Problem solving – After a brief “how to” didactic let the learners solve some problems (cases), either individually or in pairs. Start out easy and build up complexity of problems.

2. Medical equipment – Feeling a bulky O2 canister is very enlightening for learners. Looking at the actual O2 generator provides a deeper understanding about the patient with COPD requiring oxygen therapy. During your talk on sleep apnea, bring in a CPAP machine. When discussing low back pain borrow a TENS unit.

3. Hands on – This works well for skills that can be done cheaply on each other such as plaster splints, ultrasounds, or osteopathic manipulation.

4. Simulation – Simulation provides hands-on learning in a controlled atmosphere and doesn’t hurt a patient. A variety of relatively inexpensive simulators are available such as joints for injection, necks for cricothyroidotomy, sternums for intraosseous access, and backs for lumbar puncture.

This cannot be observed during the learning event, of course, but there are ways to encourage this to happen.

1. Ask learners to discuss in pairs, in groups, or just to write down what they are going to do differently later today (or next week) based on what they have learned today.

2. Call or email learners a week or two later to see how they are applying the new information and what questions they have about it.

Active Learning

Just Say No to Death by PowerPoint!

(Or, tips on how to use active learning so that people will actually enjoy and remember your presentation.)

Kelly Latimer, MDLCDR MC USN

Faculty Development FellowMadigan Army Medical Center

We’ve all been there: Noon lecture. Residents and faculty shuffle in, lunches and coffee cups in hand, making small talk. Some poor second-year resident purposefully marches up to the lectern, fires up the projector, and dims the lights. The first slide: “Decontamination of the Oropharynx and Digestive Tract in ICU Patients.” Within four minutes, twenty pairs of eyes have glazed over in unison and twenty brains are switched off, victims of “Death by PowerPoint”.

Can you believe PowerPoint has been brightening lecture halls and meeting rooms for twenty years? PowerPoint was originally designed for businessmen to create a “visual aid” for business presentations. Prior to PowerPoint, one had to laboriously type up legible text and find copy-legible graphics and struggle to coax a fire breathing Xerox machine into producing a readable acetate for the overhead projector, (for those of you old enough to remember what an overhead projector is). Now the presenter could develop and produce the presentation with ease by themselves. Entire graphics departments disappeared overnight, replaced by a laptop computer and a small projector.

Critics say PowerPoint has evolved into a presentation “crutch.” Marshall McLuhan recognized the concept with regards to television in his 1964 book, ‘Understanding Media,’ and coined the aphorism “the medium is the message”. Often a PowerPoint lecture is not a means to an end, but an end unto itself. Yet it is the cornerstone of medical teaching, used in settings that range from residency didactics to national meetings. This is especially ironic, since good studies have proven the average adult retains only 5% of a PowerPoint lecture. In fact, of all the teaching modalities that exist, a PowerPoint lecture by itself is the least effective. (Figure 1) Since resident work hour restrictions already constrain the time available to teach an increasing amount of skills and information, we would be prudent to use our didactic teaching time more efficiently.

Does this mean we should abandon PowerPoint completely? Or, phrased another way, has the quest for world domination by a certain billionaire in Redmond, Washington failed? Hardly! PowerPoint can be a very effective tool when combined with other learning modalities. When properly used it can help focus on the message but not be the message.

The intrepid second-year resident in the opening scenario of this article invested a lot of time preparing his lecture. He had hoped at the very least for his colleagues to stay awake and at best to learn a new skill or concept they could retain and use. To accomplish these goals, he

needed to understand the basics of adult learning theory. Volumes of textbooks and journals abound on this topic; I am barely going to scratch the surface.

With a few notable exceptions medical students, residents, and faculty are adult learners. We can apply four assumptions to our adult learners. (Table 1) First, they are already endowed with a wealth of knowledge, life experiences, and perceptions on most subjects. Even though we may be the “experts,” when teaching adults we are wise to anticipate that our audience will know something on the subject we don’t. Teachers of adults should aim for a dialogue instead of the usual monologue, trying to connect students’ prior experiences to new subject matter. Second, adult learners deserve to be respected as equals by their instructors. While fear has traditionally been a motivating factor on medical rounds, true dialogue only occurs in an atmosphere of safety. Third, adult learners are self-motivated. They want to learn this stuff. That should make our job easy, right? The last and most important assumption about adult learners is they are only motivated as long as the material is practical, relevant, and goal-oriented. They need to know they can use the material in their daily life and they need to be engaged with that material on an emotional and physical as well as an intellectual level. Our learners’ goals depend upon their level of training and range from simply surviving the wards, to passing the boards or earning CME.

Table 1:Characteristics of Adult Learners:Foundation of knowledge and experience Mutual respectSelf-directedRelevancy-orientedPracticalGoal-oriented

To increase the effectiveness of his talk, our second-year resident also needs to understand the basics of active learning, which simply put is learning that occurs at the bottom of the learning pyramid in Figure 1. Active learning involves connecting adults to what they know already, learning something new, and then doing something with that new content. (Table 2) Active learning requires creativity on the part of the instructor, and effort on the part of learners. This extra work is far more fruitful than simply sitting back and passively being told what they need to know.

Table 2:The Sequence of Active Learning1. Inductive – connect to the learner; the “grabber”2. Input – new material that is practical and relevant3. Implementation – practice doing4. Integration – actually using it in real life

We must tailor content to our audience. Obviously a talk aimed at medical students should be different than one for board-certified physicians. Let’s assume for simplicity we are planning to instruct our own family medicine department about a medical topic. Most of us have developed a small library of “canned” PowerPoint talks over the years on a variety of subjects. How can we use this material but break away from the oppressive lecture and move towards dialogue and active learning? If necessary modify your PowerPoint slides to conform to the rules of Table 3. Pay close attention to rule #12. Time should be set aside for active learning tasks. So a 30 minute talk should at most have 20 slides, leaving 10 minutes for your learning tasks.

Table 3:Do’s & Don’ts of PowerPoint 1. Do use an easy to read, constant color scheme 2. Do begin your talk with 2-4 objectives 3. Do end your talk reiterating 2-4 key points 4. Do use pictures whenever possible 5. Do keep font size 32 or bigger 6. Do use spell check 7. Don’t use more than 4-5 lines of text per slide 8. Don’t use animation schemes or fancy transitions 9. Don’t use busy slides10. Don’t read your slides11. Don’t talk too fast12. Don’t have more than 1 slide per minute of talk

I have listed some specific strategies you can use to add active learning to your PowerPoint lectures. This list is not exhaustive. The strategies should be combined and interspersed within the lecture to add variety and keep the audience mentally engaged. Initially, you should follow the tried and true sequence of active learning in Table 2.

A) Inductive - connect with what they know:

1. Small group discussion – Have the audience break up into groups of four or five and ask them to discuss a patient they have cared for with your subject condition. What difficulties did they encounter in diagnosis, treatment, compliance, referral or co-morbidities? What rewards? Then each small group should pick one person to describe his or her case to the whole room.

2. Quiz – Either true/false or multiple choice quizzes are a great way to open a talk and review boring basics like epidemiology and pathophysiology without a lecture.

3. Worksheet – A resident at Madigan recently began a talk with handout. It was a blank chart listing eleven different types of transfusion reactions, arranged into two categories of either immune-mediated or non-immune-mediated. Before even beginning to lecture, she asked everyone to rank them in order of severity and then in order of how commonly they occur. Learners then filled out the chart as she described the incidence, pathophysiology, signs and symptoms, diagnosis, and treatment of each transfusion

reaction. On the back of the handout was a treatment algorithm for transfusion reactions. I suspect many of those residents kept that handout in their lab coat pocket for reference on the wards.

4. Role playing – Utilize the aspiring actors in your department to help you illustrate psychosocial aspects of a condition or demonstrate the difference between a clear and concise history and physical and a disjointed one.

5. Actual patient interview – You need sensitivity, judgment, and a sound relationship to approach a patient with this kind of request. But if you know a patient with interesting physical findings or stigmata of a particular condition it is unfair to keep them to yourself. Many patients are happy to help in the education of physicians, especially if you offer to buy them lunch. A real live patient is invaluable in teaching and puts a human face on a disease.

6. Audience response system can be used to gather information about the baseline knowledge level of the participants and can be used along the way to check on knowledge transfer.

7. Video clip -- ask the learner what they see happening, why is it happening, when it happens to you, what do you do, how can we prevent this from happening?

B) Input - learn something new:

1. Videos – The old adage, “See one, do one, teach one,” is active learning at its best. The New England Journal offers excellent 10-minute downloadable files covering various procedures. These videos discuss contraindications and informed consent as well as technique. Unfortunately you need a subscription to access them. Fortunately there are many excellent medical education videos available for free on the internet.

2. Case-based – Start with a case and develop it using a series of questions such as: What else do you want to know? What is your differential diagnosis? What further studies would you order? What is the etiology of that condition? And so on. The answers are always somewhere in the audience.

3. Article-based – Distribute the article beforehand and then discuss the article. Busy clinicians may not always find the time to read it. Ideally you can jump straight to the implementation phase. Alternatively you can go through the article using a worksheet like a Journal Club.

4. Game shows – A game of “Jeopardy!” keeps the audience involved and adds a spirit of competition if you break the audience into groups. One of my colleagues used PowerPoint to design the game “Battleship,” where a correct answer allows the team to choose coordinates to try to find and sink their opponents’ ships. Be sure this is content rich as well as fun as it is easy to have the learning get lost in the fun.

5. Small groups – Provide each small group the resources they need to teach a portion of the subject matter. Give them 15 minutes to learn it and then 10 minutes each to teach it to the larger audience. Initiate a contest after the teaching is over by giving a quiz on the subject material. The small group that teaches their subject the best, (as measured by the overall score of the entire group on their questions), wins.

6. Audience choice – Provide a handout of not yet covered material and have the learners fill it out using their own experience and knowledge. Then provide the answers and ask learners which of the topics they have questions about. Present only the slides that answer their questions.

7. Reading material, handed out to learners. Each reads and highlights points that speak to him/her. Then each has a turn to present what they highlighted and why. What was missing from the material presented? What did you disagree with?

8. Be an ambassador – Give learners a new identity (each of you is going to be a different type of anemia) and provide them a sheet of paper that describes who they are and what the key characteristics are about that type of anemia. These sheets might be on yard around their neck with the type of anemia printed on one side and the information about it on the back. Then ask them to move about the room looking for others who have a different type of anemia. Have them quiz you and you quiz them about that type of anemia. When a pair think they have each other’s anemia mastered, they break up and look for other types of anemia. This continues until each learner has been exposed to every anemia type available. You might follow this with a post-test or jeopardy game with the learners divided into teams. Keep score to see which team gets the most correct.

9. The pneumonic game – Have teams work as a group to develop a pneumonic device to help them remember key points of the presentation

C) Implementation - practice what they learned:

1. Problem solving – After a brief “how to” didactic let the learners solve some problems, either individually or in pairs. Start out easy and build up complexity of problems. Great examples to use this: reading EKG’s, interpreting PFT’s, calculating acid-base status, explaining patterns of liver enzyme abnormalities.

2. Medical equipment – Feeling a bulky O2 canister is very enlightening for learners. Looking at the actual O2 generator provides a deeper understanding about the patient with COPD requiring oxygen therapy. During your talk on sleep apnea, bring in a CPAP machine. When discussing low back pain borrow a TENS unit. Let students lay hands on these things and try them on for size.

3. Hands on – This works well for skills that can be done cheaply on each other such as plaster splints, ultrasounds, or osteopathic manipulation.

4. Simulation – Simulation provides hands-on learning in a controlled atmosphere and doesn’t hurt a patient. A variety of relatively inexpensive simulators are available such as joints for injection, necks for cricothyroidotomy, sternums for intraosseous access, and backs for lumbar puncture.

5. Gallery Walk—Small groups use the information taught to problem solve, generate ideas, brainstorm on the topic at hand. They record their ideas on butcher block or a dry erase board. Other groups work on a different case, concept or problem and each group rotates to each of the buthcer blocks/boards and adds information. When the time is up, one group describes what is listed on each butcher block/board.

D) Integration – start using the new information in your daily work

This cannot be observed during the learning event, of course, but there are ways to encourage this to happen.

1. Ask learners to discuss in pairs, in groups, or just to write down what they are going to do differently later today (or next week) based on what they have learned today.

2. Call or email learners a week or two later to see how they are applying the new information and what questions they have about it.

Incorporating active learning into your medical lectures may seem awkward at first, but the more you do it the easier it becomes and the more you expect it in your own learning experiences.

Don’t be discouraged. Anyone can be ensnared by PowerPoint’s allure. My ten-year old son and a classmate were assigned to teach their 5th grade colleagues about a particular Indian tribe here in Washington State. He proudly showed me the slides that he and his buddy had so laboriously prepared. They had exploited nearly every annoying feature of PowerPoint, from sounds to animation to gaudy colors and charts. Each slide had a different background and was crammed full of barely readable words of varying fonts, sizes, and colors. I cringed, knowing full well that my fellowship director would have a heyday critiquing it. I attempted some gentle yet constructive criticism to no avail. He considered the effects “cool” and assured me that the other kids and his teacher would as well. I have yet to see his grade from the project.

Figure 1: The Learning Pyramid

Adapted From National Institute for Applied Behavioral Science

The power of active learning

References

Vella, J. (2002). Learning to listen, learning to teach. San Francisco, CA: John Wiley & Sons, Inc.

Vella,J. (2000). Taking Learning to Task. San Francisco, CA: John Wiley & Sons, Inc.

Kern, D.E., Bass, E.B., Howard, D.M., Thomas, P.A. (1998). Curriculum development for medical education: a six-step approach. Baltimore, MD: The Johns Hopkins University Press

Lecture 5%

Reading 10%

Audiovisual 20%

Demonstration 30%

Discussion Group 50%

Practice By Doing 75%

Teaching Others 90%

Average

Learning

Retention

The Learning Pyramid