An interesting article was published in Medical Education which you don’t see too often in journals. It’s a first-person reflective account of Dr. Ronald Harden’s long and internationally well-regarded career in medical education. No p-value. No sample size calculation. His experiences and lessons learned provide great insight. Here’s his advice to current and future educators.
Cognitive Theory of Multimedia Learning
In a nutshell, people learn through two channels — words and images. This dual-channel theory suggests that people process auditory and visual stimuli separately. Each channel requires time to process information before merge into a cohesive cognitive concept.
In 2010, the Carnegie Foundation for the Advancement of Teaching published recommendations for the future reform of medical education. This same Carnegie Foundation had also commissioned and published the landmark 1910 Flexner report 1 on medical education, exactly 100 hears prior.
Here is a summary of the four major recommendations:
Teaching professionalism in a formal curriculum is so much different than demonstrating professionalism in the Emergency Department. So much of what students and residents learn about professionalism are from observed behaviors of the attending physicians — that is, the hidden curriculum.
In a qualitative study assessing medical student reflection essays during an EM clerkship, the authors (my friends Dr. Sally Santen and Dr. Robin Hemphill) found some startling results. The instructions to the medical students were to “think about an aspect of professionalism that has troubled you this month. Write a minimum of one half-page reflection describing what was concerning and how you might handle it.”
At the CDEM meeting during the SAEM national meeting this past week, the keynote speaker (Dr. Charles Hatem from Harvard) mentioned a great editorial article called “Inconvenient Truths About Effective Clinical Teaching.”
Here’s a summary of the opinion article from Lancet:
“To be or not to be?”
What could be more strange on a medical school curriculum than a theater training course? The authors of this study in Medical Humanities innovatively designed a 1-week elective course to help medical students at Mayo Medical School to improve their case presentation skills in partnership with the Guthrie Theater.
In this pilot course, seven medical students (six 1st year students, one 4th year student) participated. The learning objectives were:
- Hear stories: those told by patients, colleagues and in written narratives
- Identify the elements of a narrative, and examine stories for narrative structure
- Share stories: through case presentations, body movement, storytelling and acting
- Present a patient’s story with elements of traditional medical presentation and narrative
Students were evaluated for the following competencies:
- The cognitive capacity and flexibility needed to evaluate and acquire reliable clinical information.
- The ability to actively and generously observe and listen to another.
- An understanding of the components of narrative leading to effective story construction.
- A performance sensibility that ensures the delivery of a good story, otherwise known as stage presence.
- The finesse to communicate empathically with a patient to create an environment in which she or he feels safe, satisfied and heard.
Eleven sessions, over 25 hours, comprised of the following topics:
- Improvisation activities
- Introduction to case presentations
- Body language – contact improvisation
- Performance of story
- Neutral dialogue and elements of a narrative
- Narrative in context – what’s lost, what’s gained?
- Listening with a neutral mask
- Writing and presenting case histories
- The art of personal monologue
- Final presentations with professional critique
Survey responses uniformly found that students valued this creative, non-traditional approach to learning about interpersonal communications and oral presentations. The art of focused storytelling to an audience is exactly what physicians do every day when presenting clinical cases.
Hammer RR, et al. Telling the Patient’s Story: using theatre training to improve case presentation skills. Medical humanities. 2011, 37(1), 18-22. PMID: 21593246
In an interesting survey-based publication by Dr. Tabas (one of my colleagues) that just came out in Archives of Internal Medicine, we learn more about the ins and outs of CME activities. The authors set out to determine the audience members’ opinions about:
- Commercial/ pharmaceutical support and its impact on bias
- Their willingness to pay extra conference registration fees to eliminate outside support