Innovation and the millennial learner

It will come as no surprise that innovation is a topic at The Teaching Course.The faculty behind The Teaching Course are truly first movers and innovative educators so having Christopher Doty kick off the day with the importance of innovation and the millennial learner was very appropriate.Just as day 1 was all about knowing your audience, in education and curriculum development it is all about knowing your learner!And right now, many of us are involved in teaching “the millennial learner”. The characteristics of the millennial learner are:

• Hard working
• WIIFM (What’s In It For Me)
• Want to know what the impact is of the educational options they are exposed to. Answer this for them with relevance and they will engage
• Collaborative – and learn through social interaction (on- and offline)
• Not that good with negative feedback, as in not at all!! They aren’t used to it and it will block their ability to learn

Since millennials have these preferences and prefer social interactions and active learning strategies, please no more lecturing + death by powerpoint. They won’t respond well. Rather, engage your learners with active strategies such as case based learning, flip the classroom, simulation, and other experiential learning methods.In case you want a theoretical educational viewpoint, take a look at connectivism. Connectivism might not qualify as a true theory yet, but it describes very well the learners of today, their preferences in learning and what they expect their educators to know.On a personal note, you can call them millennials, generation why? or just learners. This is not necessarily related to age. Nat May wrote an excellent post about this that I think all educators should read.When designing curricula for these millennials, Christopher gave a concrete example of how basic technology skills will get you far and straight to the hearts of millennials (their hearts, in case you wonder, being their apple devices!)He showed us how he had set up a simple calendar with links to core content and suggested background material embedded in the calendar event – such a simple yet excellent idea, a great take home message and easy to implement even if you are not a millennial yourself.The discussion went on about how “learner centered” approach was important, but maybe not quite easy to figure out and how “flipping the classroom” seemed to be the go-to teaching method for this group of learners. With that though comes new challenges, e.g. difficulty in getting learners to actually read pre-course material.So, what is a learner centered approach?, and should we maybe move all the way to a “learner involved” approach? Maybe it’s time that we as educators adapt to the learners instead of just molding them into our curriculum?On a personal note this is a topic of great interest to me and I know I already referred to it yesterday. If you’re curious on how learners of today can be motivated and facilitated go back to the Day 1 recap and check my smaccDUB talk which has details on education theory and novice learners in it. 

Teaching Evidence Based Medicine

After a group discussion by the participants we moved on to the topic of Evidence Based Medicine. Ken Milne from The Skeptics Guide to Emergency Medicine took the stage to educate us on how to teach evidence based medicine so it doesn’t suck (his words not mine!).With gracious elegance, passion and humor he carried us through the 5 topics of the talk

1. Definition of EBM
2. The Venn diagram
3. The history of EBM
4. The 5 steps to critical appraisal
5. Limitations to EBM

Definition:

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making (shared!) decisions about the care of individual patients.

and is nicely summed up in this Venn diagram made by Salim:The history of evidence based medicine was played out in a beautiful run through history involving the #TTCNYC16 participants and walking us through the story of Alexander Hamilton (to illustrate randomization), Franz Mesmer (who taught us to be aware of being mesmerized and instead make use of blinding) and Marie Antoinette and Louis the XVI as the skeptics.Biases and the power of placebo was demonstrated by a brave (and strong and fit!) participant.Everything was wrapped up asking: What if we didn’t have EBM in EM? Would this be what it would look like in our EDs?

https://youtu.be/O2A33la_Abw

 Then Ken introduced us to 5 steps to critical appraisal:

1. Identify the PICO question
2. Search for the literature
3. Rank the literature in the evidence hierarchy
4. perform critical appraissal
5. And finally ask if it’s a game change and how you can use the findings to change clinical practice.

If you want help on how to search for literature and an illustration of the hierarchy of evidence just follow the links!

Finally, we were reminded of the limitations to EBM

• Some things are self-evident
• If it is harmful- it is unethical so don’t do it! (the parachute trial!)
• Most research findings are wrong!
• Most guidelines lack strong evidence!
• And… we tend to ignore good evidence

The take home message

1. EBM Rocks!
2. It all depends!
3. Be skeptical – even if you learned if from theSGEM!

AND it is possible to teach evidence based medicine so it doesn’t suck!Head over to TheSGEM’s webpage and learn more about critical appraisal and EBM.Meta level feedback for Ken from me: As a lover of EBM and recently having designed a curriculum for teaching medical students evidence based medicine in EM – you absolutely nailed it. It brought tears to my eyes and the applause from the audience makes me confident I was not the only one! 

Curriculum development

After Ken’s inspirational theatrical EBM performance piece, we went on to the curriculum development session.Jeff Riddell introduced to Kern’s six step approach to curriculum design:

• Problem identification
• Targeted needs assessment
• Goals & Objectives
• Educational strategies
• Implementation (resources & barriers)
• Evaluation & Feedback

Then it was time for the workshop part were groups had to design a curriculum in cardiology for residents.Feedback from the group discussion:

• Generating learning goals is difficult.
• Remembering that learners only have a set amount of time available for learning is important – so you can’t cover everything at once.
• Designing curricula that covers the needs of the specialty and the department and at the same time are learner centered is a true challenge filled with individual and organizational barriers.
• Solving all (and more!) of these problems in curriculum design can be facilitated by turning to learning theory.

Read this learning theory 101 publication for inspiration on how to aid learning at your institution. 

Self care

As an extra treat the TTC faculty threw in a bonus post lunch talk by Iain about the well-being of health care professionalsIain shared a strong and effective story of how you need to take care of yourself so you can take care of others. And how taking care of others is also taking care of yourself.We need to monitor our wellbeing. Sometimes we go to work hungry, angry, lonely, and tired! When that happens STOP!Find some coping strategies that can change your mood from angry to happy. For Iain, it’s music; for you, it could be something else. Make sure to eat well and healthy before, during and after shifts. If you’re lonely – find a friend – or be a friend to someone you think seems lonely or sad. Pay attention to sleep! Get enough sleep. On a daily basis….Ask yourself “are you adequately rested and fit to treat patients?” And you, you!, are responsible for helping grow a culture where calling in un-fit is ok.After a very emotion filled and emotion triggering performance we went on to another favorite must-happen topic on #TTCNYC16: 

How about infusing Social Media into your curriculum?

Jeff talked to us about the what, why & how of your learners using #FOAMed as an adjunct or maybe even as a substitute to the established curriculum.

1. What are our learners using

Podcasts, blogs, twitter, youtube, instagram, snapchat, wikipedia, apps, google, up to date, e-learning/books/journals, icloud/ other file sharing software.Podcasting seems to be increasingly popular with about 90% of our learners being particularly fond of this type of outlet.Our learners subscribe to about 2,5 podcasts and prefer a length that is below 30 minutes. When asked if podcasting change their clinical practice, 75% answer yes. Remember they listen to podcasts primarily while driving or exercising and therefore are not able to pay undivided attention.  

2. Why are they using it?

Here are some of the very good reason given by the group of participants to why our learners are engaging in social media:

• to assist diagnosing
• to learn how to perform procedures
• to find treatment options
• to find help with board review / core content
• to keep up with literature, networking, cutting edge ideas and innovation
• to learn radiology.

3. How do they make decisions on what content to consume?

They have seen it in the clinical space (80%), or it’s been pushed to them, and/or they use what faculty or program directors recommend.

A few words of advice for us as educators when we prepare and disseminate content:

They primarily find content on facebook and twitter! Many educators join #FOAMed on twitter – but you should consider making a facebook page or facebook group because that is where they are.When planning content know that their reading patterns are FAST and F-shaped when measured with tracking devices. Plus, they read most of the content on their mobile devices…on the go!The average time spent on a webpage is about 2-3 minutes. Boom! That is the amount of time you have to deliver a message (yep, this post is waaayyy to long, but luckily you are a very intrinsically motivated and interested audience ;-)). Right?To consolidate what they’ve read and listened to, invite learners to interact and engage outside of social media. Have a “what did you learn on SoMe – club” where discussion and reflection are emphasized.After this appraisal of social media in medical education, the next question was 

Is #FOAMed making you stupid?

and Will Sanderson tried to help us answer that question.In short: It just might, if we are not careful.In 2007 when the iPhone was introduced the world changed! We got access to everything, everywhere, anytime.And from then on not having internet would scare the s*** out of us. Ask yourself: Are you addicted to the internet?Ask: Is all that time spent on social media really good for you? Your family? Your relationships? Your patients?Or are those “free” social media apps really weapons of mass distraction?If you don’t pay attention to how you consume social media you might just get stupid from it. Because they will challenge your attention span (damn you, notifications) and ruin your sleep (that blue light!). Furthermore, because you generally spend very short time on each topic they don’t really facilitate deep work and reflection.The message here is not to avoid or stop using social media – it’s about using them wisely.Avoid information overload as with all information channels these days. Turn off notifications when you work and reflect and hang out with your family. Design your learning networks so you receive relevant information (and diverse enough to avoid echo chamber effect). Keep personal accounts separate from learning accounts and use work apps that allow for offline use so you don’t get patient care interrupted by your phone vibrating in your pocket. 

Afternoon sessions

The afternoon had 2 tracks to choose from, track one being “Advanced podcasting” and track two “Advanced curriculum design”.I went for the podcasting section and that was truly an awesome session. I’m not going to blog too much about it here – that would be so wrong. So stay tuned as the scanFOAM team embarks on a new adventure into the world of podcasting and soon will be sharing our very first episode with take home messages from this session.I will say, though, that the workshop was led by an awesome faculty with serious knowledge skills and an impressive passion. They taught us all about the technical details of microphones, editing software and more importantly CONTENT! To learn about podcasting from this amazing crew was truly a very special experience. Thanks for sharing your knowledge, guys!

Best part of learning is being taught by those who r passionate. Insane passion at #TTCNYC16 with @srrezaie @emcrit @docib @Teach_Institute pic.twitter.com/8MTB9VWFIG

— Annahieta Kalantari, DO, FACEP, FACOEP 🇺🇦 (@akkalantari) November 15, 2016

Talking microphone technique with @EMCases during podcasting workshop at #TTCNYC16

Most common mistake: being too far away from the mic. pic.twitter.com/NM0w8zU89i

— Will Sanderson (@_wsand) November 15, 2016

For those of you that want even more on this topic, remember The Podcasting Course in Kentucky in April – I know I need to go home and see if I can figure out leave somehow.Since I didn’t attend the curriculum development session I can only refer to the above description of Jeff’s talk and workshop and to Jordana’s talk described in the Day 1 recap.Twitter to the rescue: Look up #TTCNYC16 – seems like a lot of great content came out from that workshop in people’s tweets:https://twitter.com/Teach_Institute/status/798607152772485120And there you have it – my take of day 2 at TTCNYC16 (well, there was also #FOAMaoke, but some things are just best kept off the internet).Thanks for stopping by. Please share, comment and give feedback. It’s highly appreciated.To figure out where you can go sign up to a Teaching Course event near (or far from!) you, go to the Teaching Institute wepbage for more information.Time to get out of bed and head over to the innovation loft to prepare that day 3 recap for tomorrow!Vb/Sandra