Setting the Stage to Advance Teaching in Medical Education: Development of Pedagogical Content Knowledge

 From the 3/5/2021 newsletter

Perspective/Opinion

Setting the Stage to Advance Teaching in Medical Education: Development of Pedagogical Content Knowledge

 

by Kristina Kaljo, PhD, and Erica Chou, MD, Medical College of Wisconsin, and Jennifer Brownson, PhD, University of Wisconsin-Milwaukee

 

Drs. Kaljo, Chou and Brownson share how their KINETIC3 workshop, "The Art of Teaching" is grounded in the principles of improvisation and theater - effective skillsets to incorporate when presenting complex content in medical school...

 

Preparing and advancing medical educators is a multifaceted process that requires a deep understanding of complex content, instructional methods, and diverse learner needs. Historically, medical educators do not receive formal teacher training, yet it is well documented that quality of instruction has significant impact on knowledge acquisition (Shulman, 1986). By bridging together an educator’s rich subject-matter knowledge with effective pedagogical skills, learners have the opportunity to experience transformational teaching. Pedagogical Content Knowledge (PCK) is the unique knowledge and skillset that educators have to effectively teach content using various tools and methods to engage learners (Lamb & Firestone, 2018). To foster this skill of engagement, we developed and facilitated a KINETIC³ workshop grounded in the principles of improvisation (Fu, 2019) and theater (Singh, 2004).

A unique, interprofessional team was established including Dr. Jennifer Brownson from University of Milwaukee’s School of Education, Dr. Chou and Dr. Kaljo. Of course, due to the impact of COVID-19, this two-hour ‘Art of  Teaching’ workshop was facilitated synchronously via Zoom. Theater, the stage and performance served as a literal backdrop. Participants progressed through three ‘acts’: creating your lesson, delivering your lesson, and adapting to the audience. Supported by the experiential learning framework (Kolb, 2014), participants explored and applied strategies within their own teaching. This included improvisation activities such as Mirrors and Half-Life, to encourage attunement and to practice editing teaching content. Sociodrama methods were also integrated to explore various learner perspectives and attitudes, and ways to adapt teaching.

The workshop was offered twice in the fall of 2020 with 38 participants: faculty across ranks, experience levels and specialties, nurses, trainees including: residents, fellows, and postdocs, and other academic teaching staff. By ‘setting the stage’ and modeling effective presentation strategies for medical educators, this workshop provided experiences and concrete opportunities to explore their teaching practice. Even in the virtual environment, engagement was apparent in the ways in which participants asked questions, reflected in the Zoom chatbox, and analyzed case scenarios. 

Theater and medical improvisation are unconventional but important pedagogical skills to incorporate within one’s teaching practice. Bridging these skills with existing subject-matter expertise, participants establish a foundation of pedagogical content knowledge to effectively present complex content. 

KINETIC3 is a supportive environment for medical educators to explore and apply educational theory and a pedagogical practice to encourage professional risk taking. We encourage you to apply for the upcoming KINETIC3 program!

Kristina Kaljo, PhD, is an Assistant Professor and Clerkship Co-Director in the Department of Obstetrics & Gynecology at MCW, specializing in curriculum and instruction, educational research and community-engaged research. She is a member of the Faculty Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Erica Chou, MD, is an Assistant Professor in the Department of Pediatrics at MCW. She leads the Interprofessional Education (IPE) thread in the undergraduate medical education curriculum, and is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Jennifer Brownson, PhD, is a lecturer in the School of Education at the University of Wisconsin-Milwaukee. 

 

The Power of Yet

 Invited Perspective

 

From the 2/5/2021 newsletter

 

The Power of Yet

 

 

Katie Dercks

 

 

 

In this essay, Katie Dercks, a fourth grade teacher, describes a thoughtful approach to fostering growth mindset that she and her teaching partner implemented in their classrooms …

 

 

 

“I can’t do this!” “I’m not good at this.” “I don’t get it!” These words have unfortunately found a common place within classrooms. They are a reflection of a child’s frustration and go deeper into the child’s own self-beliefs. I have been a teacher at St. Robert for nine years now, and I have watched as more students come into my fourth grade classroom with anxieties wrapped around tests, assignments and self-worth. Instead of putting the focus on learning and growing, these students are focused on “the grade” and looking “dumb” in front of peers. 

 

In an attempt to teach students their own worth and what they are truly capable of, my colleague and I decided to dig deeper into the idea of growth mindset. According to Carol Dweck, author of Mindset, people with a growth mindset believe that skills and qualities can be cultivated through effort and perseverance. Their goal is to grow their minds, embrace challenges and learn from feedback, a mindset we wanted for our students.

 

We decided to start with “The Power of Yet.” When we heard a child say, “I’m not good at math!” “I don’t know how to do that,” we would respond by reminding them that they haven’t mastered those things “yet.” For example, “You’re not good at this math yet; you just need more time practicing, thinking, and figuring it out!” We wanted students to understand that skills are acquired over time through practice and perseverance. We all have our strengths and weaknesses, and it is important we identify both in order to truly grow. 

 

Little did we know how much one phrase would change the culture of our classrooms and ourselves as educators. What seemed cheesy at first, commenting to students’ negative remarks with, “Remember the power of yet!” soon became echoed by students to themselves and their peers. It was a powerful realization that even if kids didn’t understand the deeper meaning of yet, they were beginning to play with the idea.

 

From then on, we decided to introduce more projects, activities and literature that highlighted each child’s strengths and weaknesses, using these as tools to help them grow. My colleague and I would model how to work through problems in front of the students, showing them that struggle is normal and working through challenges grows one’s brain and creates a feeling of success. As educators, we had to fight our instincts to jump in and help when a child was feeling challenged. We needed to allow them to struggle. When a child said, “This is hard!” our response would be, “Good. That means your brain is working. It is going to push you to find a new way of thinking.” When a child succeeded, we had to change our words of affirmation from, “I am so proud of you,” to “You should be so proud of yourself.” After all, validation has to come from within.

 

When a child really felt stuck, we would take a moment to stop and ask the class to come up with strategies their peer could use. It became normal practice to help one another and appreciate small victories. We had students explain how they felt when they improved and succeeded. We discussed the importance of positive self-talk; the idea of what we tell ourselves is critical to how we produce and succeed. 

 

By the end of the year, we saw that our efforts had changed the environment of our classroom. Students began to understand that every person faces his/her own struggle. One might struggle with math, while another student with behavioral issues may struggle with social interactions. Bullying decreased and the level of praise for one another was heightened. 

 

Do we think all students will walk out of fourth grade with total confidence ready to take on the challenges of the world? No, it’s a life process, but we have given them the skills and strategies of a growth mindset. One student, who has taken this to heart, writes at the beginning on top of her tests, “I’ve got this” and has encouraged others to do the same. That makes me smile…because they do. 

 

There are students who will always struggle with their inner anxieties and fixed mindsets, but we want our classrooms to be a start. We want students to remember as they move on in their education and life that the little things add up. The goal each day isn’t to win or lose, pass or fail, but just be a little better than they were yesterday. I, myself, still struggle with self-confidence at times, having to stop negative self-talk and the temptation to give up. And it’s important that students know this -- that even the teacher doesn’t have it completely figured out… yet.

 

 

 

Katie Dercks teaches fourth grade at St. Robert School in Shorewood WI.

Assessment of Communication Skills in Medical Education

From the 1/29/2021 newsletter

 

 

Assessment of Communication Skills in Medical Education

 

 

Mary Ann Gilligan, MD MPH

 

 

Dr. Gilligan, who has an interest in communication in medical settings, shares how she and colleagues are developing teaching methodologies and measurements of effective communication skills for medical students …

 

 

Expertise in communication skills is one of the essential components of clinical competence for doctors. Medical schools are required to include training in communication skills in their curricula. Historically, training has primarily occurred in the early years of medical school and the skills have not been consistently reinforced later in the clinical environment. Fortunately, we now have decades of research to help guide development of a successful program in communication skills training.

 

Assessment of communication skills is one key component of a successful program and is the focus of this article. However, in order to appreciate the role assessment plays, it is important to understand the other components. Core communication skills have been identified and models developed to facilitate teaching of the skills (e.g., Calgary-Cambridge, Three-Function, Smith). There is not one best model but, rather, each one has strengths and weaknesses. For a given program, it is important to choose a model on which to base the program that will provide a common language for both teaching and assessment of skills. There should be progressive building of skills across the curriculum, beginning with core skills in the early years with introduction of advanced skills (e.g., breaking bad news, motivational interviewing) in the later years when learners will be more likely have a chance to use them. The final component to a successful program is the “how” or methods used to teach: communication is a behavior and is best learned using active strategies with opportunities for practice and feedback.

 

 

Communication skills training at MCW

 

Improving communication skills training at MCW begins with changes in assessment, because assessment can drive curriculum change. A robust assessment program will provide the data needed to inform what and how communication skills are taught. Currently at MCW, one important method of assessment of communication skills has been the Objective Structured Clinical Examinations (OSCEs). In the last year, we used a validated communication skills checklist for M3s based on the Three-Function Model for the OSCEs with plans to expand usage to all OSCEs in the near future. Use of the checklist across all years of the curriculum will allow students to track their progress on skills over time. I have been working with Dr. Tavinder Ark and the Kern Institute Data Lab on expanding use of the checklist, analysis of data, and generation of reports for students. 

 

Assessment of communication skills on clinical rotations could serve as another important source of data on competence in communication skills but will require investment of time and effort, especially for faculty development.

 

We are on our way to developing a program that achieves the goals of assessment in medical education as defined by Kalet and Pusic: 1) to motivate and guide [learners] to continually aspire to higher levels of expertise, 2) to identify [learners] who are not competent to practice safely, and 3) to provide evidence that the [learner] is ready for…unsupervised practice.

 

 

For further reading: 

 

Kalet A, Pusic M. Defining and assessing competence. In Remediation in Medical Education: A Mid-Course Correction, Kalet and Chou, eds. Springer. 2014.

 

 

 

Mary Ann Gilligan, MD MPH is a Professor in the Department of Medicine (General Internal Medicine) at MCW. She is a member of the Curriculum and Faculty Pillars of the Robert D. and Patricia E. Kern Foundation for the Transformation of Medical Education.