How We Teach and How We Learn

Overview:

In this episode of EMRA*Cast, Dr. Jessie Werner discusses medical education with researcher and educator, Dr. Jeff Riddell. We cover adult learning theory, the current state of medical education and new developments. If you’re wondering where the CCC report came from, how to give and receive better on-shift feedback, and what we can do to improve medical education, then this episode is for you!

Key Resources / References:

• Norman, Geoffrey R. "The adult learner: a mythical species." Academic Medicine (1999).

• Gottlieb, Michael, Jeff Riddell, and Sara E. Crager. "Alternatives to the conference status quo: Addressing the learning needs of emergency medicine residents." Annals of Emergency Medicine 4.68 (2016): 423-430.

• Telio, Summer, Rola Ajjawi, and Glenn Regehr. "The “educational alliance” as a framework for reconceptualizing feedback in medical education." Academic Medicine 90.5 (2015): 609-614.

• Telio, Summer, Glenn Regehr, and Rola Ajjawi. "Feedback and the educational alliance: examining credibility judgements and their consequences." Medical Education 50.9 (2016): 933-942.

Key Points:

• Adult Learning Theory:
  • Malcom Knowles’ Theory of Andragogy has 5 main assumptions:
    • Adults are self-directed learners
    • Adults learn experientially
    • Adults approach learning based on tasks and social roles (adults want to know what they NEED to know)
    • Adults approach learning as problem-solving
    • Adults are intrinsically motivated to learn
  • Geoffrey Norman argues against these ideas as being largely untested
  • Adults and kids are actually more similar than different in how they learn
• When asking a question, or “pimping,” make sure you come at it with the right intent so as not to alienate learners. That being said, emotional activation (a little fear) can help you learn, as can the practice of retrieval (remembering)
• “Flipped Classroom”: lecture material is learned at home, asynchronously, and reviewed in conference
• “Interleaving”: mixing up topics rather than blocked topics i.e. when talking about pulmonary embolism you address it in multiple ways and emphasize varying concepts so that learners remember multiple aspects about it and how it ties in with various presentations or alternate diagnoses (not all PEs present with pleuritic chest pain!)
• The Educational Alliance: Residents make credibility judgments about feedback in the context of a relationship (i.e. if you have a relationship with your resident then the feedback goes over better)
• Directions of Graduate Medical Education
  • Technology is going to play a big role!
  • There are a lot of resources out there now. Curating those resources will be important! Educational resources are not just in textbooks or from large academic centers. FOAMed, podcasts, blogs, etc are coming from multiple places.
• Feedback:  
  • Formative: designed to help the resident improve (given directly to the resident in the moment)
  • Summative: a summary of how the resident is doing overall (this is usually in your CCC report or an evaluation you see 6 months later)