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Author: Brian S McGowan, PhD

ABSTRACT: Reframing Clinical Workplace Learning Using the Theory of Distributed Cognition

In medicine, knowledge is embodied and socially, temporally, spatially, and culturally distributed between actors and their environment. In addition, clinicians increasingly are using technology in their daily work to gain and share knowledge. Despite these characteristics, surprisingly few studies have incorporated the theory of distributed cognition (DCog), which emphasizes how cognition is distributed in a wider system in the form of multimodal representations (e.g., clinical images, speech, gazes, and gestures) between social actors (e.g., doctors and patients) in the physical environment (e.g., with technological instruments and computers). In this article, the authors provide an example of an interaction between medical actors. Using that example, they then introduce the important concepts of the DCog theory, identifying five characteristics of clinical representations-that they are interwoven, co-constructed, redundantly accessed, intersubjectively shared, and substantiated-and discuss their value for learning. By contrasting these DCog perspectives with studies from the field of medical education, the authors argue that researchers should focus future medical education scholarship on the ways in which medical actors use and connect speech, bodily movements (e.g., gestures), and the visual and haptic structures of their own bodies and of artifacts, such as technological instruments and computers, to construct complex, multimodal representations. They also argue that future scholarship should “zoom in” on detailed, moment-by-moment analysis and, at the same time, “zoom out” following the distribution of cognition through an overall system to develop a more integrated view of clinical workplace learning.

via Reframing Clinical Workplace Learning Using the The… [Acad Med. 2013] – PubMed – NCBI.

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ABSTRACT: Building Learning Communities: Evolution of the Colleges at Vanderbilt University School of Medicine

Learning communities, which are an emerging trend in medical education, create a foundation for professional and academic development through the establishment of longitudinal relationships between students and faculty. In this article, the authors describe the robust learning community system at Vanderbilt University School of Medicine, which encompasses wellness, career planning, professional development, and academics.The Vanderbilt Advisory Colleges Program introduced in 2006 initially focused on two goals: promoting wellness and providing career advising. In the 2011-2012 academic year, the focus of the colleges expanded to incorporate an enhanced level of personal career advising and an academic component. In the four-year College Colloquium course, faculty selected as college mentors teach the medical humanities and lead sessions dedicated to student professional development in the areas of leadership, research, and service-learning. This academic and professional development program builds on the existing strengths of the colleges and has transformed the colleges into learning communities.The authors reflect on lessons learned and discuss future plans. They report that internal data and data from the Association of American Medical Colleges Medical School Graduation Questionnaire support consistently high and increasing satisfaction among Vanderbilt medical students, across the metrics of personal counseling, faculty mentoring, and career planning.

via Building Learning Communities: Evolution of the Col… [Acad Med. 2013] – PubMed – NCBI.

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MANUSCRIPT: Social media use among patients and caregivers: a scoping review.

OBJECTIVE:
To map the state of the existing literature evaluating the use of social media in patient and caregiver populations.
DESIGN:
Scoping review.
DATA SOURCES:
Medline, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge and ProQuest (2000-2012).
STUDY SELECTION:
Studies reporting primary research on the use of social media (collaborative projects, blogs/microblogs, content communities, social networking sites, virtual worlds) by patients or caregivers.
DATA EXTRACTION:
Two reviewers screened studies for eligibility; one reviewer extracted data from relevant studies and a second performed verification for accuracy and completeness on a 10% sample. Data were analysed to describe which social media tools are being used, by whom, for what purpose and how they are being evaluated.
RESULTS:
Two hundred eighty-four studies were included. Discussion forums were highly prevalent and constitute 66.6% of the sample. Social networking sites (14.8%) and blogs/microblogs (14.1%) were the next most commonly used tools. The intended purpose of the tool was to facilitate self-care in 77.1% of studies. While there were clusters of studies that focused on similar conditions (eg, lifestyle/weight loss (12.7%), cancer (11.3%)), there were no patterns in the objectives or tools used. A large proportion of the studies were descriptive (42.3%); however, there were also 48 (16.9%) randomised controlled trials (RCTs). Among the RCTs, 35.4% reported statistically significant results favouring the social media intervention being evaluated; however, 72.9% presented positive conclusions regarding the use of social media.
CONCLUSIONS:
There is an extensive body of literature examining the use of social media in patient and caregiver populations. Much of this work is descriptive; however, with such widespread use, evaluations of effectiveness are required. In studies that have examined effectiveness, positive conclusions are often reported, despite non-significant findings.

via Social media use among patients and caregivers: a s… [BMJ Open. 2013] – PubMed – NCBI.

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ABSTRACT: Social Media Use by Health Care Professionals and Trainees: A Scoping Review

PURPOSE:To conduct a scoping review of the literature on social media use by health care professionals and trainees.METHOD:The authors searched MEDLINE, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge, and ProQuest for studies published between 2000 and 2012. They included those reporting primary research on social media use by health care professionals or trainees. Two reviewers screened studies for eligibility; one reviewer extracted data and a second verified a 10% sample. They analyzed data descriptively to determine which social media tools were used, by whom, for what purposes, and how they were evaluated.RESULTS:The authors included 96 studies in their review. Discussion forums were the most commonly studied tools 43/96; 44.8%. Researchers more often studied social media in educational than practice settings. Of common specialties, administration, critical appraisal, and research appeared most often 11/96; 11.5%, followed by public health 9/96; 9.4%. The objective of most tools was to facilitate communication 59/96; 61.5% or improve knowledge 41/96; 42.7%. Thirteen studies evaluated effectiveness 13.5%, and 41 42.7% used a cross-sectional design.CONCLUSIONS:These findings provide a map of the current literature on social media use in health care, identify gaps in that literature, and provide direction for future research. Social media use is widespread, particularly in education settings. The versatility of these tools suggests their suitability for use in a wide range of professional activities. Studies of their effectiveness could inform future practice.

via Social Media Use by Health Care Professionals and T… [Acad Med. 2013] – PubMed – NCBI.

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RESOURCE: In Connectivism, No One Can Hear You Scream: a Guide to Understanding the MOOC Novice | Open Education | HYBRID PEDAGOGY

I’m not a Constructivist, Behaviourist, Cognitivist, or Connectivist. This is not a call for a return to an older theory. I’m a pragmatist, like many educators. I flirt outrageously with every theory that will have me. I’m ideologically promiscuous. I go with what works, and I am ruthless in weeding out what doesn’t. I do this because there is no “one size fits all” theory. Because there is no “one size fits all” student. And because students, participants, and learners are the final metric that measures any theory, and experience is the proving ground for theory. Faith to a theory, ideological monogamy, gets in the way of the evidence.

This is the beginning of a conversation with myself and others about where my online practice should go, rather than the end of one.  I want to focus on the novice experience in cMOOCs, and how the theory may badly serve some of its participants.

What we think about who we are, and where we are, tells us how much we are likely to learn. This is key to the gap in Connectivist thought. Central to that gap, at the core of what I think Connectivism might be missing is this idea:
Motivation is the engine of effort, and the sense of self is the ticking heart of motivation. Our sense of self is formed by the experiences we have, the environments we have them in, and the people who design those environments. And that negotiated sense of self can engineer the success or failure of the educational experience. It can also shape our sense of ourselves long after the experience is over.

via In Connectivism, No One Can Hear You Scream: a Guide to Understanding the MOOC Novice | Open Education | HYBRID PEDAGOGY.

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RESOURCE: Why Online Programs Fail, and 5 Things We Can Do About It | Online Learning | HYBRID PEDAGOGY

Online learning in its current iterations will fail.

The failure of online education programs is not logistical, nor political, nor economic: it’s cultural, rooted in our perspectives and biases about how learning happens and how the internet works (these things too often seen in opposition). For learning to change drastically — a trajectory suggested but not yet realized by the rise of MOOCs — teaching must change drastically. And in order for that to happen, we must conceive of the activity of teaching, as an occupation and preoccupation, in entirely new and unexpected ways. We must unseat ourselves, unnerve ourselves. Online learning is uncomfortable, and so educators must become uncomfortable in their positions as teachers and pedagogues. And the administration of online programs must follow suit.

It’s important for us to be very specific about what we mean by failure. There are two kinds of failure we want to discuss here. The first kind of failure — an improper failure — does damage, breeds limitations, shuts down critical thinking, and disengages us from our pedagogical or learning processes. Our ethical commitment to students and the enterprise of education is too strong to abide this kind of failure.

via Why Online Programs Fail, and 5 Things We Can Do About It | Online Learning | HYBRID PEDAGOGY.

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RESOURCE: First look at analysing threaded Twitter discussions from large archives using NodeXL #moocmooc Jisc CETIS MASHe

There are three main reactions that are relatively easy to extract from twitter: retweets, favouring and replies. There are issues with what these actions actually indicate as well as the reliability of the data. For example users will use ‘favouring’ in different ways, and not everyone uses a twitter client that can or uses a reply tweet (if you start a message @reply without clicking a reply button Twitter looses the thread).

But lets ignore these issues for now and start with the hypothesis that a reaction to a tweet is worth further study. Lets also, for now, narrow down on threaded discussions. How might we do this? As mentioned in Sheila’s post we’ve been archiving #moocmooc tweets using Twitter Archiving Google Spreadsheet TAGS v3. As well as the tweet text other metadata is recorded including a tweet unique identifier and, where available the id of the tweet it is replying to.

via First look at analysing threaded Twitter discussions from large archives using NodeXL #moocmooc Jisc CETIS MASHe.

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RESOURCE: MOOCagogy: Assessment, Networked Learning, and the Meta-MOOC | Online Learning | HYBRID PEDAGOGY

Instruction does not equate to learning. This is the fundamental fly in the ointment of instructional design, and the epistemological failing of learning management systems and most MOOC platforms. Learning, unfortunately, is something no instruction has ever quite put its finger on, and something that no methodology or approach can guarantee. Instead, pedagogical praxis creates roads along which learning may take place along with plenty of other experiences; and assessment is merely a system of checkpoints along the way to evaluate how well the road, the vehicle, and the driver are cooperating. In other words, assessment doesn’t measure learning. Assessment measures the design of the instruction.According to old systems of instruction, massive open online courses are no different from other forms of online learning which are no different from correspondence courses. They are click-to-read-the-next-lesson environments that guide readers/students down a specific path where information in the guise of learning material has been contained so that it may be mastered. Learning is meant to happen in coordinated steps, and as long as preconceived outcomes appear to be met, it’s a supposed win-win for students and teachers.

via MOOCagogy: Assessment, Networked Learning, and the Meta-MOOC | Online Learning | HYBRID PEDAGOGY.

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Is adult learning theory enough?

For the past 20 years the professional guild of healthcare educators has been increasingly leveraging adult learning theory in the development of content and in the delivery of content to clinician learners. And every few years a meta-analysis is published exploring the impact of this education on knowledge change or attitudes or skills development.  And while there is little doubt that progress has been made, there remains this persistent reality that healthcare professional education is far from perfect, that despite what appear to be short-term advances in understanding and confidence, these changes rarely lead to the sustained ‘rapid learning healthcare system’ that is so desperately needed. This begs the question, why is knowledge transfer and knowledge translation so challenging in healthcare? And, what is missing from these educational programs that prevents them from driving broad scale and meaningful change?

These questions have bothered me for some time – without answers it seems that the profession of healthcare educators will continue to employ the same models, leveraging the same adult learning theory time after time after time again, without understanding what is missing. By all accounts, this is the definition of insanity…

Over the past 8-12 months we have spent a lot of time exploring these questions, but we have framed our exploration around a rather contradictory hypothesis: Instead of assuming the secret lies in the currently recognized adult learning theory, we began by assuming that these theories in and of themselves ARE NOT sufficient to drive learning. That is not to say that they are not important, simply to say that something else is needed.

This lead to our deconstruction of the learning process itself – what do clinician learners do as they receive the educational content being developed and delivered by healthcare educators?

And in brief, here is what we found:

Clinicians learners acknowledge that there are a distinct set of actions that they must take to ensure that medical education is successful. When these actions are efficiently and effectively taken learners describe their participation in medical education activities as being among ‘the most memorable learning experiences of their careers.’ But, when learners struggle to employ these learning  actions they describe their participation in medical education activities as being ‘hit or miss at best.’ This preliminary research suggests that without an adequate structure to support the ‘natural learning actions’ clinician learners are unable to learn effectively and instead are forced to take away one or two nuggets of information, ignoring 80-90% of the content that is available. And this, it seems, is the norm, not the exception.Self-Directed Clinician Learning_Small

Over the coming weeks we will be rolling out the next stages of our research program, we will be studying how clinicians leverage their learning actions in different settings, and we will be exploring whether different subsets of clinicians leverage different learning actions in different ways. These data will be collected from a number of continuing educational initiatives that we will be launching with our partner groups, and these data will be collected in partnership with several leading Academic Medical Centers, Medical Schools, and Medical Societies who have agreed to conduct more controlled studies in both the undergraduate and post-graduate settings and with different clinical disciplines.As an educator, this is truly frustrating and it is hard to look past the missed opportunities, but it is also very exciting – with this new understanding of what is needed we have begun to redefine the roles and obligations of the educator. It is no longer acceptable to develop, package, and deliver content to learners absent of a supportive structure that ensures the learning actions are effectively employed. Being an educator is more than understanding needs and creating content. Being an educator is more than providing lip service to the adult learning theory.

While there is little doubt that medical education is an essential element in the quality of healthcare both in the US and abroad, there is also very little doubt that our existing medical education models are far from having the impact that is needed. Our goal is to take a novel and evidence-based approach to this challenge. Our ask is that you think through how these new lessons might be applied in your setting and in you programs and that you remain open to the reality that the adult learning theories we have leveraged for decades, may not be enough to drive sustainable, critical learning and change.

 

 

 

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ABSTRACT: A tailored educational intervention improves doctor’s performance in managing depression: a randomized controlled trial.

RATIONAL AND OBJECTIVES:
To assess the effects of a tailored and activating educational intervention, based on a three-stage modified Prochaska model of readiness-to-change, on the performance of general physicians in primary care (GPs) regarding management of depressive disorders.
METHODS:
Parallel group, randomized control trial. Primary hypothesis was that performance would improve by 20 percentage units in the intervention arm. The setting was primary care in southern Tehran. The participants were 192 GPs stratified on stage of readiness-to-change, sex, age and work experience. The intervention was a 2-day interactive workshop for a small group of GPs’ at a higher stage of readiness-to-change (‘intention’) and a 2-day interactive large group meeting for those with lower propensity to change (‘attitude’) at the pre-assessment. GPs in the control arm participated in a standard educational programme on the same topic. The main outcome measures were validated tools to assess GPs’ performance by unannounced standardized patients, regarding diagnosis and treatment of depressive disorders. The assessments were made 2 months before and 2 months after the intervention.
RESULTS:
GPs in the intervention arm significantly improved their overall mean scores for performance regarding both diagnosis, with an intervention effect of 14 percentage units (P = 0.007), and treatment and referral, with an intervention effect of 20 percentage units (P < 0.0001). The largest improvement after the intervention appeared in the small group: 30 percentage units for diagnosis (P = 0.027) and 29 percentage units for treatment and referral (P < 0.0001).
CONCLUSIONS:
Activating learning methods, tailored according to the participants’ readiness to change, improved clinical performance of GPs in continuing medical education and can be recommended for continuing professional development.

via A tailored educational intervention improv… [J Eval Clin Pract. 2013] – PubMed – NCBI.

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