Risk-taking on electives

Malawi2008-174-300x225
A study in Medical Education (link to full text, UoE) reports on a post-elective survey in 335 students (85% response rate), median age 24, 70% female. Medical students comprised 135 of 185 healthcare students analysed as a group. No surprises that 50% had some kind of illness while away, 2% were admitted to hospital. The roads were more dangerous, 10% experienced theft, and they reported averagely good/poor concordance with malaria prophylaxis, which most seemed to be prepared for.

Four experienced blood exposure, including one in India and one in Ethiopia.  None had taken HIV post-exposure drugs with them.
20% had a new sexual partner while away, more commonly with a national of the country they were visiting than with a fellow traveller.  A minority had taken condoms.  Although 65% of the total student group consistently practised safe sex, this was the case with only 42% in the healthcare student group, but the numbers are getting small at this point.

What is needed?  Good advice, sensible behaviour, condoms, and for many low-resource countries an HIV post-exposure kit would be very wise.

Limitations:  Small numbers. Swedish.
There’s lots of scope to broaden this research.

Reference
Angelin M, B Evengard, H Palmgren. 2015.  Illness and risk behaviour in health care students studying abroad. Medical Education 49: 684-91 (link to full text, UoE)

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The lecture: why does it survive?

Edinburgh Anatomy Theatre

The Edinburgh Anatomy Lecture Theatre of 1888

The epitaph of the lecture has been written many times – for example, see our previous post.  It is truly remarkable that it has survived the arrival of so many competitors.  This has included the arrival of books, then the advent of cheap publishing and the money to pay for it in the 19th century.  In the 20th century it survived film and television, and in the 21st century so far it appears to be barely touched by the the Internet.  Although this last is scarcely 20 years old, and there’s plenty of opportunity yet.  However much of the educational content on YouTube, TED talks, in the new concept of Massive Online Courses, and in implementations of the Flipped Classroom is in fact short lectures.

701px-Anatomical_theatre_Leiden

The Anatomy Theatre at Leiden, early 17th century (Wikimedia Commons)

The lecture has been criticised as

  • Not good for learning.  Too much too fast, little knowledge retained
  • One-time, one-place – inefficient and repetitive for teachers
  • Some students don’t attend
  • Some lectures aren’t very good

So why does it survive?  It does have some key assets

  • You get to see the teacher, and the teacher gets to see you.  Both parties like that.
  • Sometimes they have something memorable to say or show
  • Lecturers often set the exams, so you learn what they are likely to ask
  • They make you think about a topic for at least an hour
  • They’re cheap and they’re the norm.  There’s nothing simpler than picking up your slides and going to lecture to room of 300 people for an hour.  Compare that with 30 x tutorials of 10.

Recording them online takes longer.

 

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When should lectures be compulsory?

"Lectures were once useful; but now, when all can read and books are so numerous, lectures are unnecessary" Samuel Johnson, c. 1780

“Lectures were once useful; but now, when all can read and books are so numerous, lectures are unnecessary” Samuel Johnson, c. 1780

We’re revisiting the debate about compulsory lectures in our medical school.  Attendance was poor at a series of lectures on important themes that mostly aren’t formally taught elsewhere in the curriculum.

Our University regulations don’t make lectures compulsory, but in the Medical School we say that attendance is compulsory at tutorials, PBL, practicals, and clinically-based experiences.  The reason for compulsion is usually stated as something to do with these being essential experiential events, or specifically about group working skills, and the learning from these can’t be got in any other way.  Group activities may also include an element of assessment around contribution.

"No discipline is ever requisite to force attendance upon lectures which are really worth the attending."  Adam Smith, 1776

“No discipline is ever requisite to force attendance upon lectures which are really worth the attending.” Adam Smith, 1776

Local feelings vary widely.  Some lecturers are outraged when attendance at their lecture is poor, others just disappointed, yet others thrilled to have a smaller, more engaged audience.  Some clinical modules state that attendance is compulsory; some even document it.  But in the medical curriculum’s early years, as across the university in general, attendance at lectures is not compulsory.

Some ask that if the learning objectives can be achieved in other ways, why should lectures be compulsory?  We’re dealing with adult learners who are learning to prioritise.  Others argue that ability to show up to scheduled events is an important professional attribute.

As we get more creative and interactive in our ‘large group teaching’, some of these events may be harder to replace with books. Does using particular teaching approaches blur the issue?

What do you think justifies making attendance at a teaching event compulsory? What else might we do to make lectures ‘unmissable’ to students without compulsion?  Suggestions below please – click on comments just below this, or use the box at the foot of the comments.

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Team-based learning, anyone?

TBL in DetroitJoel Topf is a keen nephrology blogger and postgraduate teacher who has recently become involved in a new undergraduate programme.  Read his enthusiastic account of Team-Based Learning for second year students in Detroit.

The concept of team-based learning is over 30 years old.  It was the invention of Larry Michaelson at the Univ Oklahoma Business Schoo.  It looks something like a cross between Flipped Teaching and Problem Based Learning,  with a dash of competition and point-scoring to catalyse the mix.  An important difference from PBL is the key role for an expert.  Very clever.  Looks very good.

There is an excellent video outlining how to do TBL (and why) linked from the TBL collaborative website, which has many more resources.  Wikipedia on TBL

You can buy those scratch cards here

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Improving the student experience

From another institution via beratemyprofessor.blogspot.co.uk

Student surveys are assuming increasing importance in league tables comparing institutions, and as students are asked to pay more toward their education they are  more questioning about what we deliver.  So this question is being commonly asked in academic circles.  This isn’t a detailed scientific discussion, but here are some things that our students hate:

  • Marks perceived as unfair because they are impressionistic or unreliable, as in
    • impressionistic marks for performance on attachments
    • essays vs. MCQs
  • Being given group marks as individuals.  Here’s why (another penetrating comment from the BerateMyProfessor blog)
  • Teachers not showing up
  • Late return of marks
  • Perception that nobody knows them
  • or worse, that nobody cares about them

And here are some proposed approaches

  • Personal tutors who know you in the workplace through the years
  • More feedback after assessments
  • More contact with a consistent teacher-leader to whom you, and your experience, are evidently important
  • Lengthening attachments and getting students more involved with the team
  • Better bus service (hardly dare mention this one)
  • Tell them repeatedly how good the place is, they are.  Probably this has to be believable.  And it could make them believe they are better without actually making them better – mixed blessing.

Clearly some of these are harder to fix than others.  Some may need just a little reorganisation, others may take a lot of resource.

From the Edinburgh Medic Memes Facebook page
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Improving feedback to students

Feedback is often reported to be a weakness in surveys of student experiences. This is a complex area and it is possible that the answers conceal some other message, and that students’ understanding of feedback is different from teachers’. But feedback may have deteriorated.

Running through the 20 students currently in the department, with photosThe photo shows staff of the Dept Medicine reviewing students at the end of their 8 week attachment at Queen Elizabeth Central Hospital Blantyre (College of Medicine, University of Malawi).  Sessions like this occurred in Edinburgh in the ‘old’ curriculum, but now seem to be a rarity.  Why?

  • Students have more numerous, shorter attachments than they used to, as specialties have become narrower and more numerous
  • Doctors are more numerous and rotate faster and work shifts, so doctors (especially junior doctors) are less likely to get to know students well
  • It is difficult to find time to have meetings like this this as doctors’ working hours have become tightly regulated and shifts mean they aren’t all there at one time

Making students integral

Probably won’t fix the whole feedback issue but can’t be a bad thing?

8am handover daily includes student case presentations or X-raysStudents presenting X-rays at the daily departmental morning handover meeting, Blantyre, Malawi.

When units don’t know their students so well, they are less likely to trust and rely on them.  In Malawi students are important to patient care. In the UK, until the recent piloting of Assistantships as a rather small part of Final Year, students had been largely relieved of a real clinical role.  The ethos was that they were there to be taught, not to provide service.  The pendulum had swung away from them having a core role for fear that patients would come to harm.

It would be crazy to suggest that Malawi has got it all right, as their shortage of doctors and healthcare resources is severe – but despite that, they have time for this.  They have realised that it is in their interests, indeed, as they rely on their students so much.  It behoves us to look again at our own practice.  How can we make students more involved and part of the team again in our resource-rich environment?  A number of approaches have been suggested, but what do you think?

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Flipped teaching

This is when you give students the lecture to read, or watch as a video, in advance (‘homework’) and then use your class time to work through problems (or perhaps cases, in the case of medicine), answer questions.  Nicely explained from a High School example on the video below, or in more detail here at geekdad (wired.com).

Should we be doing more of this in medical education?

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How to communicate inside a medical school?

A request for thoughts, not a pearl of wisdom.

Communication is an important issue and goes all the way from communicating with external bodies such as the GMC, to making all our students and teachers feel that they are kept in touch.  This question is predominantly about these last two groups – how do we keep them informed and engaged?  Sustainably?  Here are some ideas – please add yours:

  • Blog – short posts with MB ChB news aimed at Edinburgh undergraduates and teachers.  Include stuff they’ll be interested in (how many failed, got A grades), exclude dull and worthy (a room is closed for a fortnight)
  • Post headlines feed from blog to EEMeC, and wherever else we can.
  • An email Newsletter which is just headlines from the same, e.g. every month.   But where is the mailing list?
  • Printed newsletter – tried in the past and stalled.  Will it ever work?
  • Facebook anyone?  www.facebook.com/neilturn.  Other social media?

Please post your thinking as a Comment below

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