Mix up your EBM teaching

Actually you should mix up all your teaching. Keep it fresh and interesting to your learners. I am getting a Master in Educational Technology and as part of one of my classes I had to design a WebQuest activity. You can learn more about WebQuests from WebQuest.org.

A WebQuest is an inquiry-oriented lesson format in which most or all the information that learners work with comes from the web.

I developed a WebQuest on determining pretest probability. You can look at my WebQuest here. It is geared toward 3rd and 4th year medical students but could be used with residents also. Feel free to use it.

probabilityheader2

While using the Web to teach is nothing new it is good to change up how you teach. Instead of lecturing on determining pretest probability have your learners do this WebQuest on their own time and flip that part of your lesson on diagnostic testing. It can also be done during class time and many of the WebQuests on WebQuest.org are designed for in-class use. While I had to actually develop/code the website there are online WebQuest creators (just look on the WebQuest.org site for the Creating WebQuests tab).

Journal Club- The UAB Experience

Just about every internal medicine residency program has a journal club.  One could argue about the evidence behind this activity but it seems to serve its purpose if nothing else than to make housestaff read some journal articles (and not just UpToDate!). I think it does serve a purpose of encouraging critical appraisal/thinking about research publications. Doctors will always have to read new research studies. It takes time for studies to be incorporated into secondary publications like Dynamed and UpToDate. Furthermore, not everything makes it into these evidence-based resources.  Also research (published in every journal) is full of biases that lead to departure of the findings from the truth. Critical appraisal is the only way to detect them.

journal club

This is not our flier but one I found on the internet that I thought was interesting

Since 1999 or so I have been intimately involved in the journal club at UAB. At times I have run it completely but now I serve more as a guide and EBM expert for one of the chief residents who puts it all together. I think it has gotten greater buy-in from the housestaff coming from the CMR instead of me.

So I thought I would cover some of what we have done at UAB. Not that we are the world’s beacon for journal club but we have tried alot of stuff over the years. Some of it failed….some of it successful.

Time of day: we have done everything from 8am, noon, to at night at a faculty member’s house. What has gotten the best turnout is 8am before their day gets started.

Article Selection: This has been a debatable topic since day 1. We have done several things:
1) Latest articles in major journals
2) Rotating subspecialty articles (one month cardiology, one month GI, etc)
3) Article chosen by resident based on problems they saw during patient care
4) Article chosen by me to prove an EBM principle
5) Now we seem to be focusing on articles written by UAB faculty so that they can come as an expert guest.
6) We are considering using classics in medicine articles that are the foundation of what we do (eg first article on ACE inhibitors in CHF) because current residents are unlikely to ever read these articles.

Format: We seem to vary this almost yearly:
1) Faculty reviews article and asks questions of the housestaff about what various things mean
2) Teams of residents argue for or against using a drug, etc against another team of residents
3) Each individual reads the article and comes to JC not knowing what they could potentially be asked
4) A handout with Users Guides questions and a few other questions on design or applying the information is given out ahead of time but is only discussed by those willing to answer
5) Same handout given but with individual residents assigned specific questions to answer (this was the first time we could show that the residents actually read the paper ahead of time)
6) Groups of residents work on questions outside of JC on their own time (usually 3rd yr resident assigned to coordinate the group meeting) with the expectation to teach the other groups at JC. (this worked pretty good actually)
7) Last year we went to a flipped learning format where I put alot of material on edmodo.com that the residents were to do ahead of time (if they needed to) with assigned questions to be answered by individual residents. They felt like this was too much work to go thru all the material online.
8) This year we are to perhaps our most successful format (from resident satisfaction standpoint) where a handout of questions is answered in JC as a group project. A faculty expert gives a very short didactic talk at 2 points during JC on a very specific EBM topic related to the article (eg what is a likelihood ratio). The only expectation is that the article is read prior to JC. We still use somewhat of a flipped format where I reference a short video or 2 to watch about topics in the chosen article but its much less time intensive than last year.

I think overall what has been successful for us is when JC has the following elements:
1) Group work. Engaged learning is always desirable.
2) Clinical and EBM faculty expert present. Seems to give the article a little more value.
3) Case-based. We always solve a real world problem. I always tell the CMR making up JC to make sure the residents walk away with something they can use clinically.
4) Flipped light– giving the residents some information, but not too much, that they can review about EBM principles leads to many of them actually watching the videos or reading background papers. They come much more prepared and have a good basic knowledge that we can then build upon.

Jazzing Up Journal Club

I am preparing to write something about what I think works well for journal club. We’ve tried lots of different things here at UAB. I would like to hear from you about what you do for your journal club. What works well in your journal club? What doesn’t work so well?

We need a dialogue here so please enter some comments. I’ll collate what I get and then give my own thoughts about Jazzing Up Journal Club.

Interactive Video- The Future of Video for Education and Beyond

I recently discovered a cool tool for teaching- TouchCast. A TouchCast is an interactive video; meaning there is a background video and things popup that can be touched and opened up.

TouchCast Logo

I made a Touchcast on case-control studies. Check it out and see what I mean. Make sure you touch one of the YouTube videos or the web site that I put on the screen to see how it works.

I find this very exciting. I can make a background video that gives a 30,000 foot view of a topic and embed further materials (other videos, websites, etc) for those that want a deeper understanding.

So what are the limitations? For now the interactivity is limited to viewing a TouchCast via their app or their website for the interactive functionality. The videos can be uploaded to YouTube but the interactivity is lost. The length of the video is also limited to 5 or 6 minutes. This isn’t a killer for me because educational videos should be short and in this case I can embed hours of other videos if I wanted to. Finally, the other limitiation (for now, will be changed soon) is that its an iPad tool. A desktop version is coming soon. Hopefully an Android app also.

TouchCast has really broken ground here. This should open up more advancements that will do even more. The future is exciting for us flipped classroom types.

EBM Is In Jeopardy- Gamify A Lecture To Make It More Interesting

This week I did an EBM “lecture” based around the game show jeopardy. Now I know this isn’t anything new. Lots of teachers have used jeopardy format to teach. The point is that it took the content of “EBM Potpourri” (a group of topics that don’t fit well in other lectures that I give) and made it more interesting than a traditional 1 hour lecture (which is how I have given this lecture in the past).

The challenge when doing this to figure out your main teaching points and only include them since you don’t have a lot of extra space for less important topics (but shouldn’t we be doing this anyway?) The next challenge was to make gradually harder questions within each topic. I made some of the questions limited to certain learner levels only (I teach internal medicine residents that are organized into interns, 2nd years and 3rd years) to make sure every one participated independently at least somewhat. The residents only got about 40% of the questions right….but that wasn’t the point. The point was to convey my teaching points and to engage the learners. They worked in their teams (each team consisted of an intern, 2nd yr and 3rd yr) to solve problems. The competition between teams for “great prizes” (certificate of appreciation for 3rd place team, Rice-a-Roni to the 2nd place team, and lunch with me for the winners) made them take it a little more seriously.

If you would like the original PowerPoint file to use in your teaching I’ll be happy to email it to you. Contact me at UABEBM@gmail.com

What unique ways have you taught EBM topics?

Tools I Use to Make My Teaching Videos

I began developing an online course in EBM and use videos for instruction. I thought it would be useful to tell others what I use. Videos are a useful way to teach others and are more learner-centered in that learners can use them when they want and can skip around in them for the information they need.

First off your videos need to be relatively short: 3-5 minutes is optimal. Longer than 10 minutes and learners will abandon the video. You have to be thoughtful on how to break up a longer topic into shorter chunks. They need to be engaging either through your teaching style or material presentation. They need to be consistent– use the same backgrounds, intro and exits.

Here’s what you need to make teaching videos: (Note: I am a PC guy. Mac has good built-in software that I can’t really comment on as I dont use Macs)
1) Video Hosting Service: YouTube and Vimeo are 2 of the more popular hosting sites. Some of the tools below also have their own site to post videos on. I personlly like YouTube. Here is my YouTube channel.

2) Video Editing Software: I actually record myself giving intros and endings for each of my teaching videos. That way I have a “physical” presence. Because of this I need a video editor to splice these together with the main body of my video. There’s lots of video editing software out there. I use Corel Vidoe Studio Pro because it also contains a screen capture tool and seemed easy to use and wasnt too expensive ($60).

3) Screen Capture Software: I usually display a PowerPoint slide or a paper or a website when I teach. I use sceen capture software to record my computer screen and my voice. I like Screencast-o-matic because its easy and cheap (free). I bought the Pro version ($15/yr) so I have more tools available but the free version is good.

4) Video camera or webcam if you want to video something other than your computer screen.

5) Bamboo tablet: I use this to write on my screen when I explain/demonstrate how to make calculations. (http://www.wacom.com/en/products/pen-tablets/bamboo). This YouTube video shows me using the tablet and the digital drawing program I describe below.

6) Digital Drawing Program: this is the background I write (or draw) on with the Bamboo tablet. I like Autodesk Sketchbood Express because it was more intuitive to use and free. Khan Academy uses SmoothDraw but I didn’t find it as easy to use.

7) Microphone. Often they are built in to your computer or webcam. I bought a high def one off ebay for <$10 because I wanted improved sound.

8) Audacity (http://audacity.sourceforge.net/) is software for recording and editing sound. If you want to just do voice recordings this is a good program.

So that’s it. For a minimal outlay of money you can develop pretty good quality videos. There is a learning curve on editing. You will also have to decide your style. Look around at other videos and do what works for you. This guy has incredible videos but they take a little more time and skill to make.

Systems Give Us What They Are Designed To Give: Work Hour Restriction Outcomes

A colleague of mine (DB) has a great blog (medrants.com). He posted (http://www.medrants.com/archives/7199) an excellent observation that ABIM pass rates are declining since the work hour restrictions have gone into place. I commented back that why would we expect any different because systems give us exactly what they are supposed to give us. In this case less knowledgeable residents.

The proof is in the scores. Why? My theory is that they waste their off time with being off and not studying. When I was a resident in the mid 90s we had no restrictions, no admission caps and only 1 guaranteed day off a month. We stayed at the hospital until late afternoon at least if not early evening routinely. We studied alot during the day in our down time. The satellite library at the hospital was full of us studying (and yes BSing). I saw alot more patients and did alot more to them than this current generation. Interestingly I dont recall mass killings and mayhem at my training hospitals. But for some reason we have accepted a system (work hour restrictions and admission caps) without testing it ahead of time. No drug gets to market this way but for some reason its ok to let doctors get to market this way.

Doctors are on the clock

Being a doctor is complex. Clinical reasoning relies on matching the patient’s story to an illness script. You build illness scripts from studying books (print or electronic…doesnt matter) and by patient interactions. You have to see lots of patients to enhance and mature your illness scripts. Therein lies the problem…..less studying and less patients. Wow…how did we ever get these lower passing rates. Its hard to understand (sarcasm detected). Oh well it doesnt matter. I am sure the wonderfully designed quality measures will make it all better.