IS S UE

9
Jun 2013

Electronic Newsletter for for Faculty Instructional Development

|Med/Ed News
Editor Karen Spear Ellinwood, PhD, JD, EdS

this issue

Reflective Practice, Reflective Teaching P.1 The AMES\OMSE FID Series P.2 Reflective Practice...(continued) P.3 Upcoming Events P.4

esources for preceptor & classroom educators online!

There are a variety of resources online for clinical and classroom educators, including links to learning modules, a guide for engaging students in inquiry learning, Microskills for teaching, and encourag-

Reflective Practice, Reflective Teaching and Reflective Learning: Teaching students to avoid cognitive error

ing students to examine for cognitive error.

The 2012-13 AMES\OMSE Faculty Instructional Development (FID) Series has come to a close, but you can access recordings of all 13 seminars onlinesimply Click&Go! - Use your UA NetID to access the videos! Find out more about team learning , CBI and other instructional methods and the recently developed online tools, ThinkSpace and GroupShare.

iagnostic error is the most common, most costly and most dangerous of medical mistakes, says a recent study, which suggests that the public health burden of diagnostic errors could be twice that previously estimated1. But how can we teach medical students to become the sort of physician who consciously avoids making such errors? The reflective practice of medicine encourages physicians to reflect before, during and after working a case2, 3. Considering divergent opinion, questioning or examining your hypotheses, and consulting others who exercise considered judgment is the foundation of evidence based medicine4. In other words, the key to evidence based

Figure 2. Cycle of Reflective practices Spear Ellinwood, Pritchard & Ellis (2013). RAT Orientation presentation.
Doceri is a registered trademark

medicine is reflective practice. Reflective practice means we think about how we are thinking about the case, rather than allowing ourselves to be directed to the most available answer2, 3, 4. Conveying these essential principles of reflective practice to medical students means we need to provide opportunities for them to engage in reflection as they prepare to work a case, while theyre working it, and after the case has been resolved2. This means clinical educators ought to engage in reflective teaching5, that is, thinking about how best to encourage students reflective thinking. Once a habit of reflection takes hold in practice, it is a logical extension to practice reflective teaching and model as well as cultivate students reflective learning practices. Continued on page 3
Fac ulty Ins tru ctional Develo pmen t

Check out our Faculty Instructional Development Calendar online!

Figure 1. Framework for Reflective Practice (Plack & Santasier, 2004) OMSE FID News

Recent Events

Click &Go!

About the FID Series

[24 June 2013]

AMES/OMSE Teaching Scholars Presentations and Tips for Publishing your Education Research
Scholars/Departments Emergency Medicine

he AMES\OMSE FID Series results from the partner-

regularly and engage in activities designed to support the professional and educational development of faculty. AMES has provided grants to supplement scholarly research when external funding has not been renewed and provides resources for teacher development. OMSE offers faculty instructional development and support to all faculty one-on-one for those who would like to explore new approaches or implement new technologies or ideas in their teaching practice. If you would like to consult with a professional educator or discuss opportunities for your department or community based faculty at your site, please click here to complete the online form. OMSE Faculty Instructional Development staff will work with you to design a customized plan for faculty instructional development for you, your department or site. The next FID series event will launch the 2013-14 academic year with Dr. Sean Elliot on How to create your educational portfolioAugust 22, 2013. For more information about upcoming seminars, go to please visit our website! /kse/

ship between the Academy of Medical Education Scholars (AMES) and the Office of Medical Student Education (OMSE). THE FID Series runs from August through June, and presents 13 seminars aimed at developing and improving the teaching and assessment skills and practices of basic science and clinical faculty, including preceptors, affiliate faculty, and residents. The College of Medicine in Tucson now has 19 AMES faculty members, who meet

Richard Amini, MD Rachel Cramton, MD Kristi Grall, MD Alice Min, MD

Immunobiology

Richard Freidman, PhD

Pediatrics

Lisa Stoneking, MD
! forget Dont rs oneoffe OMSE & group opment l e on-on tional deve luding c u n i r , c inst aculty esidents! f l l a r for tors & precep

On Tips for Publishing

Lupita Martinez, PhD, Assistant Professor, Department of Medicine

Celia OBrien, PhD, Director, Medical Education Research, OMSE

Faculty Development Events Calendar online!

Click here to RSVP!

OMSE FID News

Fac ulty Ins tru ctional Develo pmen t

[Continued from page 1]

Figure 3, Microskills 5 Plus 5! Adapted version by OMSE

Engaging students in reflective feedback conversations invites students self-assessment before offering instructor-assessment of their performance. You can do this by asking simple, direct questions: How do you think you did in the patient interview? Were you able to elicit the information you needed or identify resources for obtaining it? Did you sense whether the patient felt comfortable? Were there things you wish you had done differently? What and why? What might you do in the future? The goal is to cultivate a habit of reflection in practice so when our students become physicians, thinking things through before, during and after a case will have become second nature to them.

he structured approach to clinical teaching known as Microskills or the 1-minute preceptor, first introduced by Neher, Gordon & Stevens (1992)7, offers a quick tool to teach medical students in clinical settings. The UA COM Office of Medical Student Education (OMSE) has adapted this approach calling it Microskills 5 Plus 5!(Fig. 3), to emphasize reflective teaching and learning practices by: 1) representing the skills as an iterative cycle (Fig. 4) to foster the notion that what students learn about one case builds funds of knowledge for addressing future cases, and 2) insinuating reflective thinking into turning points in that cycle. For example, for Skill 2, OMSE has shifted the focus from encouraging students to probe for supporting evidence toward an exploration and examination of potential contrary evidence. The intent of this change is to avoid students development of pet hypotheses that might hinder them from considering the real problem from broader or multiple perspectives and promotes the examination of assumptions. Skill 3 asks educators to encourage students to infer the general rule in a given case and to critique its application. Thus, we remind students to avoid reflexive applications of familiar rules and encourFigure 4. Microskills 5 Plus 5! Cycle age them to consider new applications or question whether the rule ought to apply at all. Skill 5 adds the term Reflect to the final skill Correct, to reinforce that correcting procedure or verifying medical knowledge is not enough. We must ask students to articulate their thinking about what might be correct procedure or applicable knowledge, to explain why, and to self-assess as they explore how they could improve performance. Skills 4 and 5 of the Microskills 5 Plus 5! OMSE adapted model reflect the concept of reflective feedback conversations and suggested the 5 concrete tips for giving constructive feedback that comprise the Plus 5! These tips were derived from scholarly literature on giving formative feedback, and suggest that feedback should be: 1) timely offered (close to the event), 2) cue the student they are about to receive feedback (to allow them to reflect and prepare to engage more meaningfully), and 3) describe relevant observable behaviors (so students can respond to concrete information). Feedback is not evaluation. Whether in writing or in person, feedback ought to invite a conversation, and therefore involve students self-assessment of performance and reflection on what and how to improve. Such constructive feedback implies, as well, instructor-assessment. Whether your department or site uses the Assessment of Student Performance in Clerkship Form or the Mini-CEX (Mini Clinical Evaluation Exercise) or another assessment tool, you will determine how well students address the core competencies defined by ACGME. Check out our quick guide to assessment of student performance with examples of concrete behaviors you should expect of medical students in clerkship! We hope this guide helps you to engage students in reflective conversations and in giving constructive feedback. If you would like to invite OMSE FID team members to work directly with you or members of your staff, department or office in how to implement this teaching approach, please contact Karen Spear Ellinwood (Em. kse@medadmin.arizona.edu; Ph. 520.626.1743).
1 2 3 4 5 6 7 M. Graber, Gordon R., & Franklin, N. (2002). Reducing Diagnostic Errors in Medicine: Whats the Goal? Academic Medicine. Vol. 77, No. 10, pp. 981-992. M. M. Plack & Santasier, A. (2004). Reflective Practice: A Model for Facilitating Critical Thinking Skills Within an Integrative Case Study Classroom Experience. Journal, Physical Therapy Education, 18, 4-12. M.M. Plack & Greenberg, L. (2005). The Reflective Practitioner: Reaching for Excellence in Practice, Pediatrics. 116; 1546. Guyatt G, Cairns J, Churchill D, et al. Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. JAMA. 1992;268(17):2420-2425. doi:10.1001/jama.1992.03490170092032. K. Fryer-Edwards, Arnold, R.M., Baile, W., Tulsky, J.A., Petracca, F., & Back, A. (2006). Reflective Teaching Practices: An Approach to Teaching Communication Skills in a Small-Group Setting. Academic Medicine, Vol. 81, No. 7 , 81:638644. Cantillon, P. & Sargeant, J. (2008). Giving Feedback in Clinical Settings. BMJ: British Medical Journal, Vol. 337, No. 7681 (Nov. 29, 2008), pp. 1291-1294. Neher J.O., Gordon K.C., Meyer B., Stevens N. (1992). A five-step "microskills" model of clinical teaching. J Am Board Fam Pract. 5(4):419-24 (1992 Jul-Aug).

OMSE FID News

Fac ulty Ins tru ctional Develo pmen t

Save the date!

Date/Time Presentation Title Presenters Teaching Scholars and other faculty present their work in medical education research Medical Education Research Day

July 10, 2013

P rofessional D evelopment
The AMES\OMSE FID Series presents a topic relevant to teaching, assessment and/or medical education research from August through May each year. Please subscribe to our newsletter for current information on topics, presenters, and special events.

Contacts
Director, Faculty Instructional Development Chris Cunniff, MD Office of Medical Student Education (Comstock House) Em. ccunniff@peds.arizona.edu Ph. 520.626.5173

If

Instructional Development for all teaching faculty

you would like to volunteer to present

a topic, contact Karen Spear Ellinwood

Karen Spear-Ellinwood, PhD, JD, EdS Associate Specialist for Faculty Development Office of Medical Student Education (COM-3215) Em. kse@medadmin.arizona.edu Ph. 520.626.1743

OMSE is starting a new series for Residents as Teachers and community-based faculty beginning Fall 2013. Stay tuned!

Educational Support for Residents and Fellows

equest support for instructional development

T. Gail Pritchard, Ph.D. Interim Senior Learning Specialist Office of Medical Student Education (COM-3210) Em. tpritcha@medadmin.arizona.edu Ph. 520-626-2390

New Faculty Development Calendar online!

Assessment of Student Performance Susan Ellis, MA, EdS Program Manager for Assessment of Student Performance Office of Medical Student Education (COM-3215) Em. sellis@medadmin.arizona.edu Ph. 520.626-3654

MedEd eNews Volume 01 Issue 09

June 2013

Office of Medical Student Education ~ 1501 N. Campbell Avenue ~ Tucson, AZ 85724 ~ 520.626.1743 ~ Omse.medicine.arizona.edu