6 Making the Most of Your Teaching

Active Learning

Active learning has become a major area of emphasis in medical teaching at the UW School of Medicine. Research shows that the techniques of active learning foster deeper engagement, critical thinking, and retention of complex medical concepts among our students. Ultimately, this enhances their preparedness for clerkships and clinical practice. We define active learning as any teaching technique that requires students to actively participate in their learning process. It is the opposite of the traditional lecture format where students sit in a large hall and passively receive information. Examples include: polling, pair-share, gamification, problem-based learning (PBL), and case-based learning (CBL). Foundations block faculty are encouraged to incorporate strategies for active learning in block teaching.  In Spokane, we rely heavily on case based small group sessions facilitated by clinical guides as a core active learning strategy. Considerable evidence exists that first-year students learn and retain material better when it is incorporated into these “real-world” situations and scenarios (see Freeman et al. (2014) Active learning increases student performance in science, engineering, and mathematics. Proc Nat’l Acad Sci 11(23), pp 8410-8415).

A full discussion of active learning research and methods is beyond the scope of this guide. For more information:

• Contact your regional block lead to meet faculty who facilitate small group sessions and are skilled in managing an active learning environment. They can arrange for you to observe a WWAMI class where active learning is taking place.
• Visit the website of UW School of Medicine CLIME (Center for Leadership and Innovation in Medical Education – clime.washington.edu  You’ll find an extensive collection of videos, handouts, etc. discussing active learning teaching resources.

Large group instruction

Block content is mainly delivered in a large group (lecture hall) setting.  Though the UW School of Medicine encourages block directors to incorporate as much active learning as possible into large group sessions, this remains a long term goal. Slide decks for large group sessions are generally designed to be delivered using the traditional lecture format. These decks are provided by block directors, and student attendance at these sessions is optional (and variable). As a large group instructor/lecturer, you will have access to all of the pre-class material provided to students and should familiarize yourself with these materials.  While students appreciate adherence to the content provided by the in-class slide deck, instructors can modify the slide deck, adding slides for clarification. We recommend that you not omit any slides as this is known to cause significant angst for students.  Large group instruction that engages students and requires them to use active recall, application and reductive reasoning skills, and elaboration is highly encouraged.  When planning your session, make sure to leave time for students to grapple with the content and formulate questions. Note that the lectures delivered in Seattle are recorded and available to all students by 5pm pacific time on the day of the lecture. Since students are in class for four consecutive hours, they appreciate time to use the restroom and take a mental break between sessions. We typically aim for 50 minute sessions with 10 minutes breaks. Large group lectures delivered in Seattle are recorded and made available to all students after 5pm Pacific time. Students may prefer to watch these lectures instead of attending large group sessions in Spokane for a variety of reasons.

Instructor Preparation:  Most faculty prepare for large group and small group using similar strategies:

• Familiarizing yourself with the learning objectives for the session, as the students are tested on these learning objectives. This also helps to stay on topic, matching up the classroom discussion with the learning objectives for that session.
• Engage with the pre-class preparatory material to become familiar with the depth of knowledge required of students. This is also helpful in preventing too much repetition.
• Study other material as needed to familiarize yourself with the topic – This could include revisiting the pathophysiology of disease processes, clinical correlates, latest research, etc. If you have access to AMBOSS (question bank) or First Aid (a Step1 content outline resource), taking a look at how your topic is covered within those resources can give you additional depth of knowledge context or provide you with ideas on how to cover your content.
• WWAMI-wide prep meetings with content expert faculty (skull sessions) are sometimes held prior to large group sessions. You are always welcome to participate. Contact your regional block lead for more information and Zoom links.

Creating Effective Slides

Most of us have had little to no training in creating effective and engaging slides. Students greatly appreciate clear, crisp slides. The “Handbook of Clinical Teaching” by Mookherjee and Cosgrove is an excellent reference for best practices on slide creation and delivering lectures. Chapter 8, ” How to Give a Great PowerPoint Presentation”  is co-authored by Andy Luks, Block Director, Respiratory and Regulation.  It is available through UW Health Sciences Library: How to give a great PowerPoint presentation.  You will need your UW NetID and Login for access.  This 9 minute video also outlines a few best practices for slide creation: 5 quick ways to improve your PowerPoint design – YouTube

Outside (3rd party) resources

Many students will use outside (3rd party) resources at some point in the first 2 years. These are paid services that present material in novel ways such as cartoon and story form (Sketchy), flashcards (Anki), or multiple choice questions (Uworld, Amboss). Although popular and useful for some students, they are not necessary to pass a course. In fact there are students who firmly adhere to a “No outside resources”  policy each year. Almost all 3rd party resources require a subscription which results in an additional financial cost to students. One exception to this is Amboss. All students enrolled at UW-SOM receive a subscription to this service. It is an excellent source of boards style multiple choice questions, and many block leads integrate Amboss questions into teaching sessions.

Facilitating Small Group – Clinical Guides:

The primary role of a Clinical Guide is to facilitate small group case-based learning sessions (CBL). The sessions are 1 to 2 hours long and are typically scheduled a day or two after the core material has been presented. Students work through clinical cases relevant to the current topic in the block. For example, when the topic is thyroid disease, the students are offered an in-person large group lecture on the physiology of the thyroid gland, followed by a large group lecture on the pathology of thyroid disease. Lectures on thyroid histology and anatomy dissections may also be incorporated.  The subsequent case based small group session involves discussion and problem solving for written clinical scenarios covering these topics.

Typical case prompts for small group CBL sessions ask students to generate a differential diagnosis, decide on the most likely diagnosis, recommend further testing, interpret the results, and discuss management. Students have access to small group cases and prompts ahead of time, though not case answers. Some level of student preparation is expected; clinical guides are not expected to teach the material during small group sessions. Rather, the role of the guide is to assist the students by redirecting the discussion when necessary, and filling in knowledge gaps while trying not to spoon-feed the answers. Guides are encouraged to ask open ended questions, and refer students to UW resources to seek out answers (course packs and slide decks) as needed. Some WWAMI sites assign a student to moderate/lead the discussion for each case. All students can access the answers to case questions after 5pm on the day of small group on Canvas. Please contact your regional Dean to observe a small group session if you have not already done so.

Small group Community Agreement

https://uwnetid-my.sharepoint.com/:w:/r/personal/wwamisp_uw_edu/_layouts/15/Doc.aspx?sourcedoc=%7BFD1D7394-DF01-48B5-9832-CE74593A2156%7D&file=Community%20Agreement.docx&action=default&mobileredirect=true

• Strive for starting and ending on time.  However…
  • If large group ends early, Small groups will NOT start early.
  • If large group looks like it will run late, the block lead will attempt to communicate to small group leads if possible.  If block lead is teaching, they will ask someone to send this communication or do it during a break.

Commit to ways to get everyone to participate: 

• • Use a decision wheel like wheel decide or spinner wheel
  • Ask a question with many answers (ie read an xray, differential diagnosis, etc) and go around the room for everyone to give an answer
  • Learn names so you can call on people – ask everyone to say names, or use name tags
  • Come up with a “script” of what you’ll say ahead of time to decrease awkwardness

Address when sudents read directly from the answer key:

• Interrupt when student reads from answer key
• Ideas/pearls/individual variation: HOW to interrupt
  • Give a reason – “everyone will get the answer key later, let’s try to think this through” or “the answer key is just a start, not the be all/end all – let’s think through this” or “we want to help you think on your feet like you’ll need to on the wards”
  • Ask a student to be brave nad put on their “growth mindset hat” – can someone who got this answer wrong explain why they thought that? Can someone who struggled with this question share how they finally got it?

Correcting inaccuracies:

• By being gentle, and try to allow for self-correction. Let non-substantive mispronunciations go.
• Ideas/pearls/individual variation:
  • Usually students self-correct – give them time.  Sometimes that’s hard when you don’t know how soon it will happen or whether it will happen at all
  • When someone says something incorrect, chances are that others in the room realize it and aren’t saying something – look around the room and see who disagrees and nudge them to speak up.  Or ask “does anyone else have any other ideas?”
  • Check in with every answer – both correct and incorrect – that way it isn’t so obvious because you only ask for “other ideas” when the answer is wrong

You can find an example of a student guide for small group cases here: Sample small group guide for students

Faculty guides include case answers and are available to faculty ahead of time. Here is the faculty guide for the above session: Sample small group guide for faculty

Even though answers are provided, the case based model of medical teaching requires preparation by clinical guides. Most faculty prepare for large group and small group using similar strategies:

• Familiarizing yourself with the learning objectives for the session, as the students are tested on these learning objectives. This also helps to stay on topic, matching up the classroom discussion with the learning objectives for that session.
• Reading the syllabus (course pack) or watching a pre-recorded lecture if available to become familiar with the depth of knowledge required of students. This will help to avoid contributing unnecessary clinical detail during the session. This can overwhelm students and take up limited class time.
• Study other material as needed to familiarize yourself with the topic – This could include reviewing lecture slides, revisiting the pathophysiology of disease processes, etc.
• WWAMI-wide prep meetings with content expert faculty (skull sessions) are often held prior to the small group sessions. Clinical Guides are welcome to participate. Contact your regional block lead for more information and Zoom links.

A 1 hour discussion on how we teach small groups in Spokane and the value of CBL small groups can be found here: CLIME Cafe – Student led small groups