in large group settings sarah williams, md james n. lau, md medical education scholars program
TRANSCRIPT
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in Large Group Settings Sarah Williams, MDJames N. Lau, MD
Medical Education Scholars Program
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Also thanks to:
Lauren Anderson Iman Ghaderi Abbas Hyderi Kathryn Roth
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Goals & Objectives
By the end of this workshop participants will be able to: – Describe the effectiveness of active learning in a
large group setting – Appraise different methods of active learning – Discuss facilitators and barriers to implementing
active learning in a large group setting
Means: Active Participation!
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Kolb’s Learning Cycle
Image Adapted From: http://www.ldu.leeds.ac.uk/ldu/sddu_multimedia/kolb/static_version.php
Concrete Experience [having an
experience]
Reflective Observation [reflecting on experience]
Abstract Conceptualization [learning from the
experience]
Active Experimentation [trying out what
you have learned]
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Evidence: So What, Who Cares?• Prince et al, 2004– Meta-analysis – Data showed significant gains in measured
performance (effect sizes 0.31-0.54)– Scores up to twice as high– Improvement in both simple & complex concepts
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More Evidence• Also large gains in deeper measures– Improved academic performance (0.51-0.64)– Improved perceptions of social support (0.54-
0.70)– Improved retention (0.46)– Improved attitudes (0.55)
Prince et al, 2004
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Why Does It Work?• Attention span– Attention span ~15 minutes• 70% retained from first 10 minutes of a lecture• 20% retention from last 10 minutes
• Enhances student involvement – Significant indicator of future success
• Allows correction of misconceptions
Hartley & Davies, 1978
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All are mechanisms that increase engagement both with the content and with colleagues
IT WORKS!
Cooperative Learning
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Cooperative Learning Examples
Think-pair-share
Think-write-share
Buzz groups
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Cooperative Learning Examples
Pros: short time commitment; engages group…
???
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Team Based Learning (TBL):/www.utexas.edu/academic/ctl/largeclasses/ - tbl
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TBL Section: LayoutGroup Formation
I-RAT
T-RAT
Group Application Exercise
Debrief
Image Taken From :http://foodedlearningcommunity.blogspot.com/2010/07/team-based-learning.html
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TBL – Paradigm
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TBL: DebriefPurpose of IRAT/TRAT?
Purpose of Group Application?
Is TBL learner-centered?
Image Taken From: http://learnification.wordpress.com/2011/03/23/two-stage-group-quizzes-part-1-what-how-and-why/
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A Case-based, Peer-Led Demonstration
Just-in-Time Teaching (JiTT)
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JiTT: Review Online Assignments
3 methods to treat hyperthyroidism Medication to control secretion Radioactive iodine ablation Surgical removal of half or total
thyroid gland
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JiTT: Review Online Assignments
Considerations for surgery:Medications ineffectiveNon-compliance with medicationsPatient choice
i.e. avoid radioactive iodineVery large nodule/glandRisk for thyroid cancerCompressive symptoms
difficulty swallowing, breathing
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JiTT: Review Online Assignments
Areas of difficulty/confusion:
Most interesting aspect of reading:
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54 year old woman with weight loss, palpitations, mild difficulty with swallowing
Her blood tests reveal the following:TSH <0.04 (normal 0.35-5.5 uIU/mol)FT4 1.52 (normal 0.7-1.80 ng/dL)
FT3 0.8 (normal 0.2-0.5 ng/mL)
In-Class Application
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Ultrasound: Right Thyroid Nodule with hypervascularity
Nuclear Medicine Thyroid Scan: Increased uptake in right-sided nodule, suppression in the remainder of the gland
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CASE SUMMARY
54 year old female
Symptoms: Hyperthyroidism, Mild Compressive symptoms
Blood tests: Hyperthyroid
Ultrasound: 3cm nodule in Right lobe with increased vascularity
Thyroid Scan: Hyperfunctioning nodule in right lobe
Fine Needle Biopsy: Intermediate risk for thyroid cancer (~15%); but no clinical risk factors for thyroid cancer
INDIVIDUAL RESPONSE
What is the appropriate management?
A. Right hemithyroidectomy
B. Total thyroidectomy
C. I131 radioactive iodine ablation
D. Thyroid suppression medication
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Individual Response
What is the appropriate management?
A. Right hemithyroidectomy
B. Total thyroidectomy
C. I131 radioactive iodine ablation
D. Thyroid suppression therapy
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CASE SUMMARY
54 year old female
Symptoms: Hyperthyroidism, Mild Compressive symptoms
Blood tests: Hyperthyroid
Ultrasound: 3cm nodule in Right lobe with increased vascularity
Thyroid Scan: Hyperfunctioning nodule in right lobe
Fine Needle Biopsy: Intermediate risk for thyroid cancer (~15%); but no clinical risk factors for thyroid cancer
GROUP RESPONSE
What is the appropriate management?
A. Right hemithyroidectomy
B. Total thyroidectomy
C. I131 radioactive iodine ablation
D. Thyroid suppression medication
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Group Response
What is the appropriate management?
A. Right hemithyroidectomy
B. Total thyroidectomy
C. I131 radioactive iodine ablation
D. Thyroid suppression therapy
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Just-in-Time Teaching (JiTT)
A teaching and learning strategy based on the interaction between web-based study assignments and an active learner classroom
Structures students’ reading before class
Provides feedback so the instructor can tailor the PI questions to target student difficulties
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JiTT: Process
Topic 1: Reading
Assignment
On-line assignmen
t
Review Feedback
Address difficulties in class
Repeat with next
topic
2 conceptual questions
Online assignment In class Application
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JiTT: Just-In-Time Teaching Benefits:
Maximize efficacy of classroom session so faculty and learners interact
Structure out of class time for maximum learning benefit
Create and sustain peer interaction
Novak & Middendorf, 2004
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Peer Instruction (PI)Interactive teaching technique
Gives real-time feedback
Promotes classroom interaction to engage students and address difficult aspects of the material
Allows students to learn from each other
Students need to come to class with some basic understanding of the material
Crouch & Mazur, 2001; Mazur & Watkins, 2009
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Peer Instruction (PI)
Pre-Reading• In order
to free up time during class, learners are assigned readings to complete prior to class
Mini-Present-ation• A
lecture is divided into short “mini-presentations”
• Each is focused on a central concept
Individual Test (Concept Test)• Multiple
choice question
• Addresses difficult material
• Individual commits to a answer
Small Groups• Learners
break into small groups and discuss their answers
• Trying to convince others that they are correct
Individual Re-Test • Learner
s answer the same question again [often chang-ing their answer]
Lecturer Goes Over “Correct” Answer(s)• Imme-
diate feed-back is given
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Peer Instruction Types of Questions: • General theory • Apply concepts in different
contexts• Demonstrate how different
concepts are related
Notes about the Questions: • There does not need to be a “right” answer• All answers must be plausible • Make sure it is not too easy- must require higher order
thinking
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Gallery Walk
Gallery Walk is a discussion technique that gets students out of their chairs and into a mode of active engagement
-Mark Francek
https://sites.google.com/a/mst.edu/certi/flc-active-learning/gallerywalks
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Process
Before Class
-Create questions-Break learners into groups (3-6) -Write questions on large pieces of paper and spread around room
Setting Expectations
-Give clear directions -Colored markers -Learners assign roles
During Class
-Assign beginning station to each team -Groups rotate to each station -Instructor as facilitator
Synthesis
-Each group summarizes and synthesizes material -Oral presentations
Francek 2006
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ModificationsGallery Run
Questions usually have concrete answers
Don’t need as much discussion
Don’t need to spend as much time at each station
Computer Tour Learners looking at
visuals rather than answering a question
Francek 2006
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Assessing a Gallery Walk Different ways to use formative and/or
summative assessment
Can assess:Teamwork [peer evaluation]Oral presentations [rubric]Overall participation [yes/no]
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ExamplesLearners write a pro and con about the
following controversial topic: Supplemental Nutrition Assistance Program (SNAP) cannot be used to purchase “empty calories”, e.g., chips, cookies, colas
Prepare a list of criteria for reducing the risk of heat related illness for inner city elderly. Prioritize the list and justify your rating
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Benefits Teamwork:
Work in teams to synthesize information written from different groups/points of view
Flexible method: Can change time allotted, types of questions, amount
of questions
Promotes use of higher order thinking:Analysis, synthesis and evaluation
Encourages alternate approaches to problem solving
Gauge student misconception
Francek 2006
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Kolb’s Learning Cycle
Image Adapted From: http://www.ldu.leeds.ac.uk/ldu/sddu_multimedia/kolb/static_version.php
Concrete Experience [having an experience]
Reflective Observation [reflecting on experience]
Abstract Conceptualization [learning
from the experience]
Active Experimentation [trying
out what you have learned]
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Supporting Evidence• The following are
summaries of some important studies that confirm the efficacy of active learning strategies– Resources for you to use
with your colleagues and administrators
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TBL Impacts on Performance• 178 students achieved 5.9% (>1 SD) higher
mean scores of pathology content with TBL strategy
– Students in the lowest quartile of the class benefited most (7.9% higher, SD 6.0)
–However, highest quartile group also showed sig gains (3.8%, SD 5.4)
Koles et al, 2010
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TBL Impacts on Performance
• Over 20 years, over 99.5% of the teams have outperformed their best team member with an average of nearly 14%
• The worst team typically outperforms the best individual student in the class
Michaelsen et al, 1989
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Improved Retention: PairsStudy: • 45 minute lecture broken up three times with 2
minute breaks• Students paused to clarify their notes during the
breaks
• Control: standard lecture
Conclusions:• Tested short term retention with free-recall exercise
immediately after: 108 vs. 80 correct facts
• 1.5 weeks later: long term retention: MCQ test: 89.4 vs. 80.9; 80.4 vs. 72.6 (72 students total)
Ruhl et al, 1987
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Enhanced SynthesisStudy: • 256 first year med students learning physiology• 50 minute class divided into 3-4 sections, with short
presentations of 12-20 minutes
– 1 MCQ given on subject just presented • Simple recall & complex reasoning
– 1 minute to think/record first answer– 1 minute to discuss and possibly correct
Conclusions:• Percent of correct answers improved for both recall and
intellectual questions after discussion• Enhanced level of understanding/synthesis
Rao & DiCarlo, 2000
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Deeper UnderstandingStudy: • Over 6000 students in intro physics courses
Conclusions: • Sig improved performance found with higher
interactive-engagement methods• Test scores measuring conceptual
understanding: approximately twice as high than in traditional courses – 2 SD above that of traditional courses
Hake, 1998
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