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From didactic to TBL: an exercise in transformation Lindsay Davidson Associate Professor Department of Surgery Queens University

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Presentation on theme: "From didactic to TBL: an exercise in transformation Lindsay Davidson Associate Professor Department of Surgery Queens University"— Presentation transcript:

1 From didactic to TBL: an exercise in transformation Lindsay Davidson Associate Professor Department of Surgery Queens University

2 Plan Introductions The course in question Identify problems Create a solution Sense making Change theory and complexity Wrap up

3 Who I am and what I do

4 Then…….

5 What analogy would you use to describe what implementing educational change feels like?

6 Musculoskeletal course Mandatory component undergraduate M.D. program Multi-departmental composite Relevant anatomy taught in first term

7 4 weeks long in the middle of 4+ month term 18/35 instructional hours/wk available for MSK lectures Shares curricular time with 3 parallel courses administered separately –Clinical Skills –Problem based learning –Medicine in Society Evaluation: all courses participate in MCQ and SA exams at end of term (100% grade) Administrative constraints

8 People 100 first year medical students, second term –The average medical student has >4 years undergraduate experience prior to commencing M.D. –Heterogeneous group 19 different faculty members participate in lectures

9 Botterell B139 the TEMPLE OF KNOWLEDGE

10 The role of the medical school is to produce doctors who have the basic building blocks (pluri-potential students) to allow them to differentiate into mature physicians that can populate multiple professional lines. Medical Education for Tomorrow s Doctor University of California, Davis School of Medicine January, 2003

11 RCPSC CanMEDS roles

12 Typical week in traditional course MondayTuesdayWednesdayThursdayFriday Path:Bone structure (Dr A) Adult fractures (Dr C) Anatomy review: upper limb (Dr F) Shoulder problems (Dr C) Rehabilitation (Dr H) Path: Bone healing (Dr A) Anatomy review: lower limb (Dr F) Osteoporosis (Dr B) Children's fractures (Dr D) Imaging principles (Dr G) Knee problems (Dr C) Other courses Study timeMultiple Trauma (Dr E) Study time LUNCH Other courses

13 Group introductions Who you are What you teach Analogy Share

14 You are now instructional design consultants Given what you know about the course… Are there problems with existing format? Make a list using the flip chart As a group, pick the top 2 things you want to change Be prepared to share

15 Problems that I identified Information overload –Absence of key themes/concepts Poor connections between sessions –Many faculty involved in course –Unrelated horizontal course components Disconnect between published objectives/classroom content –Sample of class surveyed every lecture

16 Problems that I identified Evaluation –No formative evaluation High-stakes, multiple choice and short answer end-of- phase exams –Little opportunity to demonstrate analytic processes Poor long-term retention of course concepts –Surface vs. deep learning

17 What does research tell us about how to encourage students to adopt a deep approach to learning? Ensure that the students' workload is manageable, Design out information overload, Ensure that the students have a clear understanding of what is required of them, Ensure that the assessment regime rewards critical thinking and risk taking, Require active participation, Ensure that students have as much choice as possible, Bolster self-esteem.

18 Recognizing concerns with the traditional model of instruction, which of the following would be your priority to change in order to facilitate increased deep learning: A.Revision of objectives, development of themes B.Faculty development – classroom techniques C.Faculty development – pedagogical concepts D.Introduction of pedagogical concepts to students E.Introduction of different learning opportunities F.Alteration of grading scheme G.Other

19 Recognizing concerns with the traditional model of instruction, which of the following would be your priority to change in order to facilitate increased deep learning: A.Revision of objectives, development of themes B.Faculty development – classroom techniques C.Faculty development – pedagogical concepts D.Introduction of pedagogical concepts to students E.Introduction of different learning opportunities F.Alteration of grading scheme G.Other

20 Blended Learning courses that combine face-to- face classroom instruction with online learning and reduced classroom contact hours (reduced seat time) Dziuban, C. D., Hartman, J. L., Moskal, P. D. (2004). Blended Learning. Educause Research Bulletin, 7, 2-12.

21 Receiving information and ideas. Active learning model Passive Learning Active learning Experience Reflective dialogue with: DoingObserving Self Others

22 pre-TBL initiatives (2003-4) Schedule similar but less teachers Learning goals inventory pre-course Classroom activities introduced in sessions I taught –Lecture bingo –Muddy points –Role playing Online activities –Self-study –Quizzes Evaluation –Group and individual projects - 10% grade –Final exam - 90%

23 Externally imposed change Course moved from Feb to April by Phase director MSK now last course before final examination period

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27 Pre-TBL: course evaluation Self-directed learning close to exams problematic Inadequate feedback from online quizzes Anatomy difficult to remember by end of winter term (was taught in fall term) Some sessions: excessive detail

28 Once a learner has made a practice of searching the universe of ideas for a good answer, they must then contend with constant change. Advanced learners must become aware of changes and learn to adapt to them as they occur. These students are connected to professionals, and professional situations as often as possible with the understanding that they will be making a transition. Anticipation of this transition is often a strong motivator. Ralph Larmann, Teaching Portfolio

29 Presented by the UG Dean at Education Journal Club

30 Group task Develop a new schedule for the sample week using TBL principles Consider the problems that you identified previously as you generate your solution Share

31 Year 1: TBL Course divided into four thematic units Use of WebCT to present preparatory material including graded (low stakes) quizzes Introduction of RATs and structured classroom group activities in existing lecture hall)

32 Year 1: TBL 30.9% instructional hours set aside for individual study Course moved to start of term

33 Year 1: TBL - program evaluation strategy Comment cards CTL observational study (2 TL, 2 lecture) Classroom engagement survey after TL sesion End-of-course survey CTL focus groups

34 My impressions after year 1 TBL Students better prepared in class –Less need to define terms, explain simple concepts available in references More classroom discussion, questions Classroom cramped, hard to move around Although RATs and Team Exercises encouraged studying students seemed frustrated by them and complained that their time would be better used in lecture

35 My impressions after year 1 TBL Peer evaluation created a significant amount of anxiety and (even) hostility

36 My impressions after year 1 TBL Some student responded very positively in person – s –Spontaneous conversations after class

37 Student feedback year 1 I did more reading and understood the subject I enjoyed the mixture of didactic and self-directed learning

38 My impressions after year 1 TBL There was a vocal group of students who actively resisted the new methods Peer evaluation created a significant amount of anxiety and (even) hostility

39 Student feedback year 1 I think that the majority of the class came to this school because they WANT a didactic style of learning. I am one of these individuals. I feel that organized lectures are best. I cannot foresee why prospective students would want to come to a medical school that has such poor instruction.

40 Student feedback year 1 Never before have I been so utterly bewildered as to what was happening in school. The group work.. was not helpful in any respect. The time wasted in these exercises could have been used much more effectively with lectures or with self-directed learning. Constructive criticism and comments pertaining to the inefficacy of the course directors approach have been repeatedly ignored and dismissed…..she is clearly deluded. I am extremely disappointed in the caliber of coordination thus far. When potential students ask me about the weaknesses of the medical program in the future, the course coordinator of the MSK block will be the first and only failing I would bring to their attention.

41 Faculty responses to student comments Juvenile Spoiled brats The changes took guts

42 Resisters - Hargreaves and Fullan (1998) May have good ideas You ignore them at your peril if they stay around for implementation In other words… there are good technical and political reasons for taking resisters more seriously Annoyance is often a signal of opportunity

43 Understanding why most attempts at educational reform fail goes far beyond the identification of specific technical problems … (E)ducational change fails partly because of the assumptions of planners, and partly because solving substantial problems is an inherently complex business. Michael Fullan (2001), Understanding Educational Change, p.96

44 What went wrong?

45 Keys to team-based learning Groups must be properly formed and managed –Instructor forms groups; by experience not grade Students must be accountable for their individual and group work –Individual: Readiness assurance process –Group: Peer assessment

46 Keys to team-based learning Assignments must promote both learning and team development: –promote discussion, give and take. Students must get timely and prompt feedback Reward for success: somehow it must matter that team performs well

47 Things that I think contributed to poor result: Poor classroom for TBL My learning curve –Open book RATs –Inexperience with developing team exercises –Suspicious of using MCQ format –More than mini-lectures to debrief Combination with other modalities –Online modules, quizzes –Group, individual project

48 What is the most important next step in planning year 2? A. Resume traditional course format B. Increase faculty development C. Find a different classroom D. Revise RATs and application exercises E. Revise course evaluation structure

49 Year 2: TBL Class sessions moved to hospital gymnasium I attended TBL conference –TBL implementation corrected –Better cases/exercises developed –Learned technique for making groups New website for content delivery –Financial support from administration to hire assistant to transform lecture content into online resource to be used as background –Limited capability for interactivity

50 Year 2: TBL Introductory session to course with practice RAT Pre-course survey of student impressions of group work Improved linkages with horizontal courses –Joint sessions with Epidemiology and Geriatrics –No PBL for first two weeks Coursework = 50% grade Alteration in peer evaluation strategy

51 Feedback year 2 Team learning was great. The team learning was excellent and well prepared/organized. I hope the other blocks incorporate this learning style. I really liked the group learning method (I am dreading returning to lectures next week!). The team learning was extremely helpful and the quizzes also improved my understanding on the topics.

52 Feedback year 2 I really enjoyed the team learning format – it is helpful to work through problems and test our knowledge. In general I loved this block. Im biased because I enjoy group learning, but I think it was good for everyone, even if they dont appreciate it yet. I think that many people that make it into medical school are trained book learners + they take offense when people challenge their set style.

53 Feedback year 2 I didnt like the group work at the beginning, but I learned to like it during the course. I do still prefer lectures, and I feel that I still learn best this way.

54 Feedback year 2 Students hated the gym Students reacted negatively to course website which was not in sync with the schools main online portal

55 The following is offered as a position statement form the Aesculapian Society (AS) on the matter of TBL and its implementation in the MSK course of the Queens undergraduate medical curriculum. There are numerous implementation-based and logistical concerns that must be addressed before the AS can support further application of TBL throughout the Queens undergraduate medical curriculum. Christopher Barnes, VP, Academic Affairs, Aesculapian Society May 10, 2006

56 Typical week - year 3 TBL

57 Year 3: TBL

58 What analogy would you propose to describe what implementing educational change feels like as a teacher?

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62 Change is a leaders friend, but it has a split personality: its nonlinear messiness gets us into trouble. But the experience of this messiness is necessary in order to discover the hidden benefits - creative ideas and novel solutions are often generated when the status quo is disrupted. Michael Fullan (2001), Leading in a Culture of Change, p. 107.

63 Course development A. Revision of objectives, development of themes B. Introduction of different learning opportunities C. Alteration of grading scheme

64 Course development A. Revision of objectives, development of themes B. Introduction of different learning opportunities C. Alteration of grading scheme D. Faculty development – classroom techniques E. Faculty engagement – pedagogical concepts F. Introduction of pedagogical concepts to students

65 Course development A. Revision of objectives, development of themes B. Introduction of different learning opportunities C. Alteration of grading scheme D. Faculty development – classroom techniques E. Faculty engagement – pedagogical concepts F. Introduction of pedagogical concepts to students G. Appropriate classroom H. Sufficient independent work time I. Integration of horizontal components

66 Course development A. Revision of objectives, development of themes B. Introduction of different learning opportunities C. Alteration of grading scheme D. Faculty development – classroom techniques E. Faculty engagement – pedagogical concepts F. Introduction of pedagogical concepts to students G. Appropriate classroom H. Sufficient independent work time I. Integration of horizontal components J. Ongoing course evaluation K. Reflection on the process

67 Understanding the Change Process The goal is not to innovate the most It is not enough to have the best ideas Appreciate the implementation dip Redefine resistance Reculturing is the name of the game Never a checklist, always complexity Michael Fullan (2001), Leading in a Culture of Change, p. 34.

68 Fullans framework for leading complex change Moral purpose –acting with the intention of making a positive difference Understanding change –Respect complexity Relationship building –Diverse people/groups Knowledge creation + sharing –turning information into knowledge is a social process Coherence making Leading in a culture of change (2001, p. 4)

69 Thank you


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