Category: medical education


Questioning strategies in Healthcare Training develop critical thinking, decision making, and problem solving in students. Bloom’s taxonomy of the six levels of cognitive learning can be used to provide a framework for creating questions. Bloom’s taxonomy starts from the simplest level of learning to the most complex level.  Simplest levels denote Knowledge and Complex levels denote Evaluation.

Sample Question for Knowledge Test:

Intravenous Urogram

Knowledge Test

Asking a learner to define Intravenous Urogram, (IVU) would test his/her knowledge levels.

Sample Question for Evaluation:

Intravenous Urogram

Complex Evaluation

A question is posed to the learner to  assess a request to perform an IVU on a patient allergic to iodine. Experiential activities/ simulations can be built to guide the learner in decision making. In this case, the learner gets to immerse in a simulated scenario, evaluate patient vitals, reports and assess the conditions under which an Iodine-allergic patient can be subjected to Intravenous Urogram.

Studies:

A baccalaureate nursing program study determined what proportion of terminal objectives for clinical nursing courses are high level objectives (analysis, synthesis, evaluation), and are the kinds of questions asked by teachers and students during clinical conferences of a high level also.  Despite the fact that stated objectives specified higher cognitive-level thinking, lower-level questions comprised 98.94% of the total number of questions asked by teachers and students in the clinical conferences surveyed.

Another study was performed within an Australian nursing program to examine clinical teachers’ use of questioning strategies.   The teachers’ years of classroom and clinical teaching experience, years of clinical experience, and academic qualifications were studied to see if an association between various qualifications and levels of questions existed.  Bloom’s taxonomy of the cognitive domain was used as a framework for the study.  The findings revealed clinical teachers asked more low-level questions (91.2%) than high-level questions (4.4%).

Lower level questioning do not promote critical thinking as they only trigger recall of information in the learner’s mind.  A simple recall of information does not enhance students’ understanding of the information in a meaningful way. Higher level questioning facilitates the development of critical thinking because it is aimed at higher cognitive levels, which involves application, analysis, synthesis and evaluation.   Educators should take advantage of stimulating questions more often to help create meaningful active learning instead of just prompting the simple recall of knowledge from students.

Scenario- based learning stages a context, within which learners live and work in their everyday life. It’s based on the concept of situated cognition, which is the idea that knowledge can not be developed and fully understood independent of its context(Randall 2002). Scenario-based learning puts the student in a situation or context and exposes them to issues, challenges and dilemmas and asks them to apply knowledge and practice skills relevant to the situation (www.ucl.ac.uk).

Scenario- based learning has particular advantages for practice- based discipline areas where the experience of practitioners is especially relevant to what constitutes knowledge and understanding in the field. Using scenario-based learning in the field of Healthcare has brought forward many such advantages to learners that count on practical experience in everyday activities.

Let us consider a case where Indira Gandhi National Open University conducted such a scenario-based learning project. 10 academic programs were chosen to be included into this project.

The following frame work was given to develop the scenarios:
1. Define critical competencies for graduates of the program
2. Identify learning outcomes for students in the program
3. Identify learning context and develop suitable learning scenarios that reflect the events in life and work of persons who have acquired these competencies
4. Define learning activities assessable and non assessable tasks.
5. Identify all learning resources and instructional opportunities
6. Identify and define cooperative and collaborative learning opportunities using technologies.
7. Identification and definition of opportunities for feedback and remediation.

Let us study a sample scenario as an example:

Discipline: Civil Engineering

Topic: Structural Analysis

Learning Objectives:

1) To distinguish between static and dynamic loads
2) To conceptualize the influence lines
3) To differentiate between Influence Line Diagram (ILD) and Bending Moment Diagram (BMD)

Scenario:

It was a shining morning of October. All students of your class are in cheerful mood traveling to Roorkee in Jan- Shatabdi Express for educational trip with Prof. Dutta.
Suddenly, you feel a shock as train stops abruptly. While waiting for the train to re- start, it is leant that due to some accident on the bridge ahead, the train will not move at least for next 5 hrs.
Out of curiosity you all move to the accident site with Prof Datta. You observe that there is a lot of distortion of the track and even the rails have gone out of place. While discussing the reasons of track failure, Amit points out the presence of visible cracks in the side beam
of the bridge. Suresh asks Prof. Datta whether the bridge failure is due to excess loading.

In turn, Prof. Datta asks the students, whether they remember different types of loading on the structures. You all start naming the different types of loading, you have seen earlier.

Learning Activity 1:

a) List out the different types of loading on structures.
b) Categorize the above list into static and dynamic loads.

After going through the list, Prof. Dutta asks you that why the live loads are not considered as dynamic load when the movement of goods and human beings are considered in the live load.

Learning Activity 2:

Identify the characteristics of static loads and dynamic loads.

Prof. Datta asks the learners to tie a rope across two poles tightly. He then asks Suresh to hang four bricks at four different places and observe the deflected shape of the rope.

Simulation 1: Prof Datta asks you to remove the three bricks from the rope starting from the right pole and observe the deflection of rope at mid point.

simulation activity

Simulation 2: The he asks to repeat the same exercise by moving the brick at points B, C , D and E subsequently and observe the deflection at mid point each time.

simulation activity

Conclusion: The whole scenario-based learning program was developed to be very challenging and was able to completely immerse the learners into the learning cycle.

 

Body Physics is where disparate systems share with each other under one single platform.

Google Plus

Collaboration Life

Perhaps Google took  a lesson to converge all sharing systems into one giant platform. Google is creating an unified army for battle. Google’s services are soon going to inter-collaborate into one giant social platform, and in the process steal some teeth from Facebook.

“We’d like to bring the nuance and richness of real-life sharing to software. We want to make Google better by including you, your relationships, and your interests. And so begins the Google+ project”, says  Vic Gundotra, Senior Vice President, Engineering at Google.

 

 

+Circles: share what matters, with the people who matter most

 

Circle around life

What’s in it: You share different things with different people. So sharing the right stuff with the right people shouldn’t be a hassle. Circles makes it easy to put your friends from Saturday night in one circle, your parents in another, and your boss in a circle by himself – just like real life.

Google Speaks:  “What do people actually do?” And we didn’t have to search far for the answer. People in fact share selectively all the time—with their circles.
From close family to foodies, we found that people already use real-life circles to express themselves, and to share with precisely the right folks. So we did the only thing that made sense: we brought Circles to software. Just make a circle, add your people, and share what’s new—just like any other day.

+Sparks: strike up a conversation, about pretty much anything

 

Sparking Life

What’s in it: Tell Sparks what you’re into and it will send you stuff it thinks you’ll like, so when you’re free, there’s always something cool to watch, read, or share.

Google Speaks: The web, of course, is filled with great content—from timely articles to vibrant photos to funny videos. And great content can lead to great conversations. We noticed, however, that it’s still too hard to find and share the things we care about—not without lots of work, and lots of noise. So, we built an online sharing engine called Sparks.

 

 

+Hangouts: stop by and say hello, face-to-face-to-face

 

Hangout with life

What’s in it: With Hangouts, the unplanned meet-up comes to the web for the first time. Let specific buddies (or entire circles) know you’re hanging out and then see who drops by for a face-to-face-to-face chat. Until teleportation arrives, it’s the next best thing.

Google Speaks: Just think, when you walk into the pub or step onto your front porch, you’re in fact signaling to everyone around, “Hey, I’ve got some time, so feel free to stop by.” Further, it’s this unspoken understanding that puts people at ease, and encourages conversation. But today’s online communication tools (like instant messaging and video-calling) don’t understand this subtlety. With Google+ we wanted to make on-screen gatherings fun, fluid and serendipitous, so we created Hangouts.

+Mobile: share what’s around, right now, without any hassle

 

Mobility in life

What’s in it: Taking photos is fun. Sharing photos is fun. Getting photos off your phone is pretty much the opposite of fun. With Instant Upload, your photos and videos upload themselves automatically, to a private album on Google+.  All you have to do is decide who to share them with.

Google Speaks: Getting photos off your phone is a huge pain, so most of us don’t even bother. Of course pictures are meant to be shared, not stranded, so we created Instant Upload to help you never leave a photo behind. While you’re snapping pictures, and with your permission, Google+ adds your photos to a private album in the cloud. This way they’re always available across your devices—ready to share as you see fit.

+Mobile-
+Huddle: Huddling your groups in

 

Huddle in Life

What’s in it: Texting is great, but not when you’re trying to get six different people to decide on a movie. Huddle turns all those different conversations into one simple group chat, so everyone gets on the same page all at once. Your thumbs will thank you.

Google Speaks: Phone calls and text messages can work in a pinch, but they’re not quite right for getting the gang together. So Google+ includes Huddle, a group messaging experience that lets everyone inside the circle know what’s going on, right this second.

Google Hopes you join in, but its entirely +You.

One of the basic objective for any  training program is to ‘maintain the capability to learn and grow’. Especially, in a set up where continous and multiple training programs are being developed and delivered, it becomes essential for the trainers to engage and stimulate the learner brain in a fundamental way, so that it keeps engaged, alert and adventure-seeking.

While designing an elearning program, or any training program, STANDARDIZATION is the last thing I would like to do. Standardization kills the excitement.

The brain is a high-speed assumptive device that loves to run ahead of sensory perception. Imagine watching a movie. As an exciting scene is percieved by our brains, our brain starts creating assumptions. It starts creating storyboards of future scenes. A stimulated brain learner more. The learning rate here is high. 

Only when it watches a dull and uninteresting scene, it lays dull and that is symbolic of low learning rates.

The brain is interested in reconstructing environments and is always looking for the surprising, unusual or different, says Michael M. Merzenich, chief scientific officer of Posit Science.

Life today is already so equipped- with tools, technologies and information availability. It has become more or less, so very predictable. We plan, we do, we get. There is a certain lack of unusualness, surprising and thrilling.

Learning and Training cannot be built or delivered with the standardized usual feel. “The more you engage your brain in ways that stimulate it, the more you’re doing to maintain your capacity to learn and to improve. It’s actually right at the heart of maintaining yourself in a fundamental sense”, Merzenich says.

People tend to take more breaks when they perform same, boring tasks- essentially predictable tasks. It is the nature of the task that prompts the engagement of the worker.

5 things that help eLearning maintain efficient learning rates

1. No to Standardization, Go to newness
2. Every minute be the First minute of your training program
3. Add distinctiveness to every chapter/ program
4. Challenge the learner brain with surpise-elements
5. Add variations in problems you let the brain face

Kenny Conley, a Boston police officer, was chasing a shooting suspect. During the chase, he ran past a brutal assault. Other cops were attacking an undercover cop because they mistakenly believed he was involved in the crime. Conley was eventually asked to testify about what he saw of the assault. He claimed he saw nothing. Jurors didn’t believe Conley’s claim that he didn’t see the fight. Instead they assumed he was part of a cover up of police misconduct. They convicted Conley of perjury and obstruction of justice.

Thankfully for Kenny’s legal battle, he is back at the police academy.

DO YOU WISH TO OFFER THAT DECADE FOR YOUR LEARNERS TO FALL BACK TO LEARNING?

Psychology professors Christopher Chabris (Union College) and Daniel Simons (University of Illinois) did an experiment that involved a video of a “gorilla” walking through a group of people passing basketballs. The unexpected gorilla stopped in the middle of the scene, faced the camera, thumped its chest and then walked off screen. When study subjects were asked to count the number of passes by players wearing white and ignore those of players in black, half of them did not notice the gorilla.

They asked people to run around a ¼ mile route on campus while chasing one of the researchers. The experimenters asked the participants to stay about 30 feet behind the researcher and to count the number of times he patted his head. Part-way through the route, they ran right past a staged fight about 25 feet off the route. They put the participants in either a low attention load condition (simply chase the guy) or a more difficult attention load condition (count the number of times he touches his head with both his left and his right hand). In daylight with the low attention load, 72% noticed the fight. But with high attention load, only 42% noticed the fight. Even in broad daylight, people can fail to notice a fight that occurs right beside their path if their attention is occupied.

That experiment is an example of what researchers call “inattentional blindness,” the failure to see something unexpected if one is focused on something else.

While you build your elearning course, you create your objectives and establish the objectives with learner in the beginning of the course. You then integrate instructional approaches that help your learners stay focused on the objectives and finally achieve them.

How many times have you thought what happens if learners get into “inattentional blindness”? Elearning programs are generally built to be intuitive. Intuition, however may have a side-effect, “inattentional blindness”. To prevent learners fall into inattentional blindness, mainstream instruction has to be delivered in a way that allows learners prevail the alertness of surrounding learning objects.

In an attempt and focus to achieve a result at the end of Lesson 2, try to hint back the learner of subtle take-aways of Lesson 1, failing which an elearning program will fall prey of inattentional blindness- a serious cognitive mishap.

Various instructional strategies are used to teach the content and procedural skills of a medical specialty. Two common instructional strategies have been described as the “bucket technique” and the “SOCO” method.

Bucket Model: The “bucket technique” is still commonly used in medical education and comes with the assumption that medical school faculty are “all knowing” and that medical student or resident minds are like empty buckets.

The goal of the instructional session is to fill the empty learner “buckets” with knowledge or “pearls of wisdom” from the faculty.

Major Set-back of Bucket Model: The problem with this method is that it is teacher-focused, not learner-focused and most often it is associated with the lecture format without clearly defined,  learner-centered instructional objectives. The learner then is expected to regurgitate all the knowledge in some useful order. Since the knowledge is rarely learned around patient presentations, recall is difficult when needed in the clinical setting as it has been memorized as a list of facts.

SOCO Model: The Single Overriding Communicating Objective  method more effectively promotes learning, Retention, and application of information to new situations. A brief teaching session, such as at the bedside,  might have only one single overriding communication objective (SOCO). A longer session, such as a Grand Rounds presentation, may have three or four SOCO’s. Such objectives should be learner-centered, measurable, and appropriate for the level of the medical student or resident. There may also be “enabling objectives” that must be met before the learner will be able to successfully meet each single overriding communicating objective.

Adult Learning

Adults learn best in a supportive environment where they are encouraged and have the opportunity to support one another. Joining together around a table or bedside with close interaction among all members of the group facilitates adult learning. Adults especially appreciate teachers who provide learning significance, ie. the “need to know,” and who share the responsibility of learning with the students. By providing clear goals and objectives, adult learners can “prepare mentally” for the instructional session without hidden expectations that promote unnecessary anxiety. Adults have a wealth of prior experience that can also be harnessed and built upon as new information and skills are taught. Adult learners remember best when they are actively experiencing learning in a problem-based or case-based format, during active, student-centered instruction with plenty of positive verbal and written feedback. Perhaps these principles of adult learning are said best in the triplet: “Tell me…I forget; Show me…I remember; Involve me…I understand.”

Studies of learning have demonstrated that only about 7% of information recall is dependent upon the actual content, and 93% of recall relates to how the content was presented. Accordingly, instructional strategies are most effective when they involve the learner. Since so much of what is effectively acquired and retained by the learner depends upon how it was presented, principles of oral communication should be followed closely, especially when using the lecture and small group discussion formats. The mood for learning can be set by:

1) approaching the class with real excitement and enthusiasm,
2) adding vocal variety for interest and clarity,
3) including purposeful pauses,
4) maintaining effective eye contact with each learner throughout the presentation,
5) showing a desire to communicate without over-dependence on notes,
6) actively involving the learner and,
7) ending using a strong conclusion with vitality.

Compared to written communication, oral speech has more personal references, more first and second person pronouns, shorter length of thought units, greater repetition, more mono syllabic words and more familiar words.

Instructional Strategy and Teaching Steps 

Utilizing the “events of instruction” or teaching steps gives the mentor or teacher an organized instructional strategy for optimally transmitting knowledge and assessing competency.

Recall Gagne’s Nine Events of Instruction

Healthcare Instructional Strategy

Learner-centered teachers humble themselves before their students and unpretentiously perform the highest form of teaching. They use instructional strategies to serve and uplift, not to control or manipulate.  They engage the learner in a mutual obligation to learn and they worry less about being seen as “experts” or “authorities.” Learner-centered teachers place learners in control of their own learning, serving as facilitators of the instructional session. As academic pride is stripped away, such teachers humbly influence students’ lives for good and become master teachers.


HTML 5 holds enormous promise for the browser experience without a plug-in requirement. Capabilities include drag-and-drop file copy, animation, video playback with synchronization, all sorts of transitions, interactive canvas and font manipulation, advanced typography, Web SQL data storage and rollback, online/offline testing and a myriad of others available now or under way.

If you are still unsure about HTML5, just take a look at some of Apple’s past bets. The company’s flagship technologies such as FireWire and SCSI, foresaw that CDs would replace floppies and that all computers would need Ethernet, and was using SIMM modules when others were still inserting memory chips one at a time.

Chrome, Firefox and Safari browsers now support HTML5. Microsoft is planning to support it, and maintains an excellent HTML5 Web site where it displays news, capabilities and emerging features about HTML5 and other technologies that have not yet been standardized.

And when combined with CSS3 and JavaScript, as in Apple’s HTML5 demo web site, its potential to create amazing Web experiences simply knows no bounds. Indeed, there appear to be no limits on the type and scope of applications built with HTML5. For example, there’s an effort to build HTML5 WebSockets, which permit bi-directional communication between the browser and the Web server, giving it the ability to update browser content without the need to reload the page. And as with all HTML versions, apps made with HTML5 would be cross-platform and would not reply on proprietary operating system-specific runtimes.
Read More at http://goo.gl/7vhnO