Blending Learning

This TEDx video features Dr. Joseph Kim discussing his recommendation for improving the relationship between teacher and learner.  While his talk is geared towards undergraduate university teaching, there are several pearls for medical teachers.


In order to improve teaching, he points out that we need to:

1. Structure courses to take advantage of technology:

This topic is getting a lot of airtime lately.  It even made the New England Journal of Medicine.  Blended learning, flipped learning, individual interactive instruction, asynchronous learning.  While the exact methodology employed varies, they all share an important principle: Give the learner the material on their time, at their pace.

Critics will cite difficulty with verifying completion of the material, but I think they're missing something.  Likely, they still depend on synchronous lectures to fill the valuable class time.

By putting the lectures online you take advantage of repetition, giving students the ability to master the material.  You also take advantage of adult learning by the learner the ability to skip forward if the material is too basic.

2. Rethink how we use class time effectively

Now Dr. Kim gets at the crux: we need to stop wasting learners time.  If the session fails to add value to their learning, it is wasteful.  Salman Khan, of Khan Academy fame, discusses how using video allows teachers more time with the learners in another powerful TED Talk.  By moving from the "Sage on the Stage" to the "Guide on the side" the teacher is now in the position to assess the learning and help the students master the material.

It is important to recognize that class time is now used to explore issues in greater depth.  Class time is now longer "lecture time" but is used for small groups, problem solving, or projects.  As Dr. Kim points out: learner build meaning and add a personal context to the material

The biggest threat to this type of teaching is time.  I've had the good fortune to spend the last five years teaching at a residency that utilizes this approach in a low tech fashion: assigned reading.  Each week our learners are assigned 50-100 pages of journal articles about a specific topic, such as head trauma, cardiac ischemia, or pulmonary infections.  The faculty then lead a two hour discussion every week about the topic.  We utilize many methods for leading the discussion: creating mind maps, reasoning through cases, guided discussions, role playing, etc.  It take a phenomenal amount of time to read the material and design the learning experience, but the learner engagement is phenomenal and our boards scores aren't too shabby either.

3. Make the pursuit of scholarly teaching a priority

What Dr. Kim is really getting at is the Scholarship of Teaching and Learning (SOTL), a term popularized by Ernest Boyer in his book Scholarship Reconsidered.  Educationalists view teaching as a continuum:

Teaching: routine instruction; teaching the way we were taught with little insight into how to improve education

Scholarly Teaching: Teachers who "inform" their own teaching; use pedagogy to improve practice; obtain feedback from students, outside/peer evaluators, and self-reflection to improve practice

SOTL: The actual research into what works and doesn't work in education

SOTL provides the evidence for evidence-based education, hence the need to make it a priority.  With SOTL, we can:

Improve learning outcomes
Improve instructional design
Improve teaching and faculty development

SOTL is a big topic, and I'll be writing on this more later.

So, using technology to flip the classroom, empowering students to learn, and actively investigating what works and doesn't work is the way forward?  As Dr. Kim concludes, by focusing on these three issues, "we can make informed decisions that will lead to better educational design and sound education policy."  I can't agree more!

Other References:

O'Brien, M. (2008). Navigating the SoTL Landscape: A Compass, Map and Some Tools for Getting Started. International Journal for the Scholarship of Teaching and Learning. 2(2): 1-20.

Better in Emergency Medicine 2012-08-27 10:25:00

Technology is constantly advancing.  New tools arrive on the scene each year, and often we don't know whether to ignore them or incorporate them into our teaching.  The slideshow below is a compilation of 100 tools that can be used help our students understand content. Take a look and let me know what tools you use in the classroom. How do you determine whether they're tools or gimmicks?



Better in Emergency Medicine 2012-08-27 10:25:00

Technology is constantly advancing.  New tools arrive on the scene each year, and often we don't know whether to ignore them or incorporate them into our teaching.  The slideshow below is a compilation of 100 tools that can be used help our students understand content. Take a look and let me know what tools you use in the classroom. How do you determine whether they're tools or gimmicks?



Better in Emergency Medicine 2012-08-27 10:25:00

Technology is constantly advancing.  New tools arrive on the scene each year, and often we don't know whether to ignore them or incorporate them into our teaching.  The slideshow below is a compilation of 100 tools that can be used help our students understand content. Take a look and let me know what tools you use in the classroom. How do you determine whether they're tools or gimmicks?



An Introduction to Medical Photography


I've always been a bit of a photobug.  I blame my grandmother who gave me my first camera when I was just a young kid.  Back in those days, we had this stuff called film.  The pictures were unpredictable and expensive, so I only took pictures of things I felt were important.  Fast forward 20 years, and the technology is incredible.  Digital photography is everywhere!  Cameras, phones, and maybe even glasses soon.

With the explosion in technology, it's very easy to take pictures of clinically relevant cases.  Images are a great teaching tool, but you need to get the right picture.  A few years ago, I attended the SAEM workshop on medical photography taught by Dr. Jason Thurman.  The course is great and if you have the chance to attend, I highly recommend it.  Here are some pearls I gleaned from their teaching as well as some additional hints to improve your skills.

1. It all starts with consent.  Like any procedure, to take a picture for educational purposes, you need to obtain consent.  This is likely to be institution specific.  Check with you institution to determine if you need an additional form.

2. What equipment do you need? These days, the quality of camera phones has improved dramatically.  That being said, dedicated cameras still have more functionality.  Digital SLRs offer the greatest functionality, but also cost a significant amount.  My advice would be to start small and if you think this is for you, move up to a dSLR.

3. Know the basics

Exposure: The amount of light that hits the sensor.  In photography this is controlled by the aperture and shutter speed.  These controls have a reciprocal relationship.

Shutter Speed: Simple; the amount of time that the shutter is open, expressed as a fraction of a second (1/60, 1/90).  Slow shutter speeds mean blurred motion if the subject is active.

Aperture: The opening in the lens that allows light through, expressed as the f-stop number; like gauge: bigger number = smaller opening.  Aperture is REALLY important because it controls the depth of field, which is basically the amount of the scene that is in focus. The smaller the aperture, the greater the depth of field.  This comes into play when taking close up or macro photos (like the eye above).  The closer to an object you are, the narrower the depth of field becomes.  Since you'll have to use a small aperture (f16 or smaller) your shutter speed will likely be slow, hence, you'll need a flash.

Gray World Assumption: All camera light meters try to make the detected scene 18% gray based on some light physics.  Because of this, scenes that are dark or bright end up messing up the exposure. (Think about the last time you tried to take a picture in bright sunlight or snow).  To compensate for this, watch the sensor and adjust the f-stop + or - one stop.  Fortunately with digital photography, we can view the pictures and make the adjustments on the fly (burned up a lot of good film trying to master this technique)

Lighting: There are 3 types of lighting: axial, texture, and flat.


Axial lighting involves holding the flash parallel to the barrel of the lens.  This reduces harsh shadows that might be created if the flash was placed in the shoe.  The image of the eye above was taken using axial light

Textural lighting adds dimension to an image by placed the light source at a 30-45 degree angle off to the side.

Image of a child with chicken pox taken using texture lighting

Flat Lighting produces the most accurate color.  It's accomplished by placing the flash on the side of the barrel or using a special flash called a ring flash.

Image of erythema migrans taken using a ring flash to produce flat lighting

4. Control the background: remove any distractions! (These, incidentally, can be an identifier)  Things like jewelry, tattoos, clothing all take away from image quality.  Place the body part in question onto a solid clean background (leftover surgical towels work AWESOME for this).  If possible, add a ruler to demonstrate scale.

Get Close, control the background, and use a scale

5. Get the right views: Think like a radiologist.  If photographing the face, get an AP, lateral, and oblique.  Think similarly for the rest of the body.  Don't be afraid to get a standard shot and then zoom in to focus on the pathology.

Now get out there, take a camera, take lots of pictures, share them, and Vive le FOAMe
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