March 2020 Faculty Development: Tips for using learning theory to craft an effective PowerPoint presentation

Tips for using learning theory to craft an effective PowerPoint presentation

Eric Brown MD

March 2020

We have all endured slide-based lectures that left us yawning or scratching our heads in confusion. Presentations with too many slides, too busy slides, or hard to see fonts and diagrams are common in medical education and can sabotage even the most dynamic speaker or an otherwise fascinating topic. Here are some tips for crafting slide-based visual aids that will better support your learning objectives and keep learners engaged

  • Remember that slides do not have to be the default option
    • For every presentation you give, ask yourself whether slide-based visuals are the ideal means to deliver your message.
      • For example, a lecture that introduces and then uses a lot of new terms may be better served with a handout with definitions that learners can reference throughout the talk.
  • Use a logical, time-tested story structure
    • The three-act storytelling structure has been around for thousands of years and is firmly imbedded in most learners’ long-term memory.
    • By visually accessing this structure in your learners’ long-term memory, you are able to create a clear pathway for learning new information in their limited-capacity working memory.[1]
      • Act 1: Introduces the setting, main character (or subject), and an unresolved state of affairs.
        • Slide titles in this phase of your talk should reference emotions or situations already familiar to the learner.
      • Act 2: Drives the story forward by picking up on the unresolved state of affairs.
        • Use a story-board approach for organizing concepts and sub-concepts.
        • Limit major concepts to 4-5.
        • Use a slide hierarchy with color coding or other visual cues to anchor the learner.
          • In this graphic, major concepts are all on slides with orange backgrounds while supporting concepts are yellow and sub-concepts are white. Visual adapted from Beyond Bullet Points 
        • Act 3: Frames a climax and resolution around your topic
          • Recycling visual cues from the first “act” can help solidify conclusions
  • Apply Mayer’s principles for designing instructional multimedia presentations
    • Four evidence-based principles for reducing learners’ extraneous processing[2]:
      • Coherence: Exclude extraneous words, pictures, and sounds
      • Signaling: Highlight essential material with yellow boxes or high contrast
      • Redundancy: Do not add on-screen text to narrated animations or videos
      • Spatial Contiguity: Place printed words next to corresponding graphics

 

  • Watch David JP Phillips “How to avoid death by PowerPoint” and then apply his “6 rules”[3] https://www.youtube.com/watch?v=Iwpi1Lm6dFo
    • One “message” per slide.
    • No text sentences (instead use written words/phrases as talking points)
      • When audience members read a sentence while you are speaking it, they hear nothing!
    • Size: The most important part of your slide should be the biggest.
      • For example, the title or heading on the slide should be smaller than the points you are trying to make.
    • Use contrast to your advantage.
      • Dark background with light text
      • Use high contrast to draw attention to important areas of busy slides
    • Six or less ‘objects’ per slide

Hopefully these tips help keep your audiences more engaged during you slide-based talks. When in doubt, try this mnemonic:

ONE message per slide

FEW matching colors

VERY FEW fonts

PHOTOS, not clipart

[1] Atkinson, Cliff (2011). Beyond Bullet Points: Using Microsoft PowerPoint to Create Presentations that Inform, Motivate, and Inspire. Microsoft Press, USA.

[2] Mayer, R. E. (2008). Applying the science of learning: Evidence-based principles for the design of multimedia instruction. American Psychologist, 63(8), 760–769.

[3] Phillips, David JP (2011). How to Avoid Death by PowerPoint. Presentation Skills Ltd. Ted Talk Video available on YouTube and davidjpphillips.com

 

 

 

 

January 2020 Faculty Development: How do Advanced Practice Providers fit into IPE at academic medical centers?

How do Advanced Practice Providers fit into IPE at academic medical centers?

Angela Leclerc, PA-C

Does your service have one or more Advanced Practice Providers (APPs)?  Chances are you do, or you will!  Originally conceived in the 1960s to assist with the primary care shortage, APPs can be found in almost every specialty and subspecialty of medicine and surgery.  In addition, APPs now support a large part of the workforce at academic centers due to resident work hour restrictions, as well as the stable clinical competence a well-trained APP maintains.

APPs complete rigorous graduate programs prior to entering practice.  To be successful, the new APP requires additional postgraduate training as they are transitioning to practice.  A small percentage of APPs may complete a postgraduate residency/fellowship program in areas such as Emergency Medicine (EM), Critical Care Medicine, Cardiothoracic Surgery, Trauma Surgery or Hospital Medicine, just to name a few.  However, these postgraduate programs are not mandatory and 80% of applicants are new graduates (Maine Medical Center).  How do we leverage the current academic opportunities in your institution to incorporate and educate APPs, either through formal or informal postgraduate training, leading to improved safety, lower cost and improved retention through professional development?

Investing in the training of APPs leads to a high level of consistent competency (Figure 1) (1).

Figure 1

Clin Med 12(3):200-206 (2012)

The well-trained APP provides a consistent level of competence and beyond.  Here the graph on the left represents the PGY1-PGY3 resident while the graph on the right represents the fellow. The solid line labeled ”Physician Assistants” is the well-trained APP that has been practicing for at least 2 years on service.

Chekijian et al. aimed to describe best practices and considerations regarding the integration of APPs at four separate academic institutions in Emergency Medicine.  Yale has a postgraduate APP residency in EM that is 18 months in duration and directly parallels the medical residency for MDs with complete integration from the start date of the internship year through the 18 month program.  Expectations of review of board material also parallel the MD residency program.    At Brown, Physician Extender Development Program (PEDP) was developed for new graduate APPs for a 1 year period.  This includes 5 hours of lecture time each week with the EM residency program.  This program is overseen by the chief education APP as well as two other educational assistant APPs.  UMMS-Baystate program accepts up to two PAs a year into a 12 month residency program who are partially integrated into the physician residency program (2).

You may be curious of the impact of additional learners integrated with the residents and fellows.  Kahn et al. sent a survey to 1178 surgical residents to which 354 (30%) responded.  A large majority of the respondents were part of residencies where the APPs had been integrated into the ICU for 5 or more years (3).

Figure 2

J Surg Res 2015; 199:7-12

If you do not have a formal postgraduate training program to train your APPs, not to worry. Here are some quick tips you can incorporate now:

·         Incorporate your APP(s) into bedside teaching rounds
·         Invite new APPs to resident and medical school didactics
·         Train new APPs simultaneously with residents and medical students in simulation
·         Provide access to shared educations sites or drives for APPs (i.e. asynchronous learning)
·         Provide time for your APPs to attend Grand Rounds
·         Provide formal feedback and support for APP education in your department
·         Provide highly functioning APPs the opportunity to educate other learners on the healthcare team as well as participate ongoing professional development activities in the department
·         Put APPs in charge of the education of onboarding new APPs, have them collaborate with the department chief for incorporation of the new APPs with the medical student and resident learning activities

References:

  1. Ross N1, Parle J, Begg P, Kuhns D.  The case for the physician assistant. Clin Med (Lond). 2012 Jun;12(3):200-6.
  2. Chekijian SA1, Elia TR2, Monti JE3, Temin ES4. Integration of Advanced Practice Providers in Academic Emergency Departments: Best Practices and Considerations. AEM Educ Train. 2018 Nov 27;2(Suppl Suppl 1):S48-S55.
  3. Kahn SA, Davis SA, Banes CT, et al: Impact of advanced practice providers (nurse practitioners and physician assistants) on surgical residents’ critical care experience. J Surg Res 2015; 199:7-12.

November 2019 Faculty Development: Case in Point: How to Write an Effective Case Report or Series

Case in Point: How to Write an Effective Case Report or Series

William J. Sauer, M.D.

Case reports continue to play a critical role in the advancement of medicine, particularly with regard to new disease entities (e.g. AIDS and Kaposi Sarcoma), adverse reactions (e.g. thalidomide associated birth defects), as well as other novel observations (see Table1).  As an example, there is currently a lot of attention from the CDC and NEJM correspondence regarding vaping-associated lung injury, yet a well written case report was published over two years ago.

 

 

 

Although often labelled as low quality of evidence, the objective of these publications are entirely different from a randomized controlled trial.  Instead of directly impacting medical decision making, case reports should inspire creativity, promote engagement, and further investigations.  They function to alert clinicians of new or rare phenomena that cannot be described in RCTs.  Several specialties, including surgery, infectious disease, and pharmacology, rely on case reports to support their foundation of knowledge.

In an era of information overload, the delivery of these “clinical stories” is particularly important as the audience can quickly become un-engaged.  Several resources, including the CARE (CAse REport) guidelines and checklist, should be used to ensure accurate and intriguing presentation of the intended message.

Tips from the CARE Guidelines include2:

  • Clearly identify the message. The title should succinctly describe the primary interest the author hopes to describe.
  • Create a timeline. The patient(s) chief complaints, clinical course, and outcome should be articulated in a chronological and engaging manner.
  • Complete the remainder using specialty-specific information with references. Highlight key words as well as references (if available) to summarize findings.
  • De-Identify patient information. Informed consent needs to be obtained.
  • Follow journal-specific submission requirements/ guidelines. Unfortunately, a smaller number of journals are publishing case reports/ series.

 

1) Vandenbroucke JP.  In Defense of Case Reports and Case Series.  Ann Intern Med. 2001; 134(4):330-4 (see attached PDF for article)

2) CARE case reports guidelines.  www.care-statement.org. (see attached PDF for article)

3) Gagnier JJ, et al.  The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development.  Glob Adv Health Med. 2013; 2(5): 38-43.

4) Riley DS, et al.  CARE guidelines for case reports: explanation and elaboration document.  Journal of Clinical Epidemiology. 2017; 89:218-235

 

Tips for Being a Mentee

Tips for Being a Mentee

Rebecca Hutchinson, MD

Many of us have benefited from excellent mentors who have given their time, expertise and guidance to help us develop to our fullest potential.  Please see earlier MITE tip (link here to July 2018 MITE tip) on characteristics of great mentors, which include enthusiasm for the project and mentee, tailored career guidance, dedicated time, encouraging work-life balance and serving as a role model for mentorship.  In this tip, I’d like to focus on strategies to use as a mentee to maximize your gain from your relationship with your mentor.

  1. Be the driver.1-3 Mentors are busy people who have many competing demands.  You’ll get the biggest bang for your buck if you take ownership and responsibility for determining what to discuss in the mentorship meeting.  Come prepared; identify in advance the ways in which this particular mentor might be able to help you before your meeting.1,3 It’s also important to evaluate your mentor-mentee relationship intermittently to ensure that it is helping you meet your goals; don’t stay in a relationship out of obligation.3  There are tools that can help you evaluate the utility of a particular mentor relationship.4
  2. Let yourself struggle a little – but not too much — before asking for help.3 You’ll learn and develop more if you take risks and try to solve some problems on your own.  On the other hand, you won’t be productive if you spend too much time stymied by a road block.  The balance between reaching out and struggling through is dependent on the particular mentor-mentee relationship; don’t be afraid to ask for feedback in your mentorship meeting about this.
  3. Show gratitude for, and be respectful of your mentors time.2 Your mentor is a busy person.  If you’re hoping to submit an abstract or you need your mentor to write you a recommendation letter, make sure to allow a reasonable amount of time.  One week is the minimum to review an abstract; several weeks are necessary for a letter of recommendation.  If you’re not sure, check-in with your mentor about what a reasonable amount of time might be for the task.
  4. Be enthusiastic and accountable.3 Having a positive attitude and being accountable goes a long way.  Set specific, measurable goals with deadlines, and then meet the deadlines you set!  If you didn’t meet the deadline, be clear about why not.
  5. Have regular meetings and take notes during these meetings. Meeting regularly is a key component of mentorship.3  Take notes during your meetings.  Some experts recommend keeping a “mentoring journal” where you keep all of your notes in one place.3,5
  6. Be open to feedback and remember feedback is bidirectional.2,3 Be open to feedback and try to see it as opportunities for growth and development.  If your mentor edits your writing and there’s more red than black, don’t take the editing personally.   Also, remember that you can give your mentor feedback; UCSF has a template for feedback that is helpful.5
  7. Mutually agree on format of communication.3,5 Your mentor might mostly communicate through email and may not use text messages for professional interactions.  Have a conversation early in your relationship to understand your mentors preferred method of communication.

 

 

 

Straus SE, Chatur F, Taylor M. Issues in the mentor–mentee relationship in academic medicine: A qualitative study. Academic medicine. 2009;84(1):135-139.

Straus SE, Johnson MO, Marquez C, Feldman MD. Characteristics of successful and failed mentoring relationships: a qualitative study across two academic health centers. Academic medicine: journal of the Association of American Medical Colleges. 2013;88(1):82.

Moores LK, Holley AB, Collen JF. Working With a Mentor: Effective Strategies During Fellowship and Early Career. Chest. 2018;153(4):799-804.

Wadhwa V, Nagy P, Chhabra A, Lee CS. How effective are your mentoring relationships? Mentoring quiz for residents. Current problems in diagnostic radiology. 2017;46(1):3-5.

Faculty Mentoring Toolkit. https://academicaffairs.ucsf.edu/ccfl/media/UCSF_Faculty_Mentoring_Program_Toolkit.pdf. Accessed September 26, 2019.

 

Want CME Credit for reading this tip?? Go Here: https://mainehealth.cloud-cme.com/MITEmonthlytipoctober

 

Encouraging Reflection to Deepen Learning and Combat Burnout

Encouraging Reflection to Deepen Learning and Combat Burnout-Rebecca Hutchinson, MD

Kolb describes 4 stages of experiential learning, the type of adult learning that forms the cornerstone of medical education.1,2

Although all of these steps are important, reflection is believed to be particularly important to create deep or lasting learning.3  Reflection is a metacognitive process, or thinking about thinking; this process allows the learner to make connections between new information and prior experiences and knowledge.4  Effective reflection results in connections that increase accessibility of the learning, allowing application to relevant subsequent scenarios.  Reflection can be written or oral, there is no evidence to suggest superiority of one method over the other; this MITE tip will discuss methods of facilitating both.5

There are many ways that we can incorporate reflection into our education of medical trainees of all levels.  Prior to encounters, we can encourage reflection by explicitly discussing our objectives for the visit using questions such as: “What physical exam maneuvers might be most helpful to determine our management for the day?”  or “What questions should we ask the patient in order to further refine our differential diagnosis?”  This type of reflection will help the learner know what to focus on during the encounter, increasing the yield of the learning experience.  This type of ‘pre-visit’ exercise can help all members of the treatment team maximize their learning from a shared patient encounter even if they are not participating in an active way.  We can also encourage reflection after encounters.  Some examples of questions that could be used to reflect are:  “how did the physical exam compare to what we expected to find in this patient with advanced heart failure?” or “what emotion do you think the patient was having when you explained the plan for the day?”1

In addition to facilitating deep and lasting learning, reflection has also been shown to be an effective way to improve resiliency and well-being of the clinician as well as increase empathy for patients.6,7  It is particularly important to help learners take the time to reflect after challenging emotional experiences.  We can do this by having formal or informal debriefing sessions where all members of the care team have the opportunity to share how they are feeling or how the experience is impacting them personally.  We can also encourage reflection through writing, such as through the use of journaling.  Additionally, you could consider having medical students and/or residents do a writing exercise at the end of a month long rotation to encourage reflection.5  Some examples of prompts are: writing gratitude letters to patients, writing about a patient who surprised them and explaining why, reflecting on a time when they felt they communicated something difficult in a way that was effective (or not!).  One fun exercise to consider doing as a group to aid in reflection and team bonding is having everyone write a six-word story.  A famous example of this is “For sale: baby shoes, never worn,” attributed to Hemingway.  These writing exercises help our learners, but they can also help us.

References:

  1. Maudsley G, Strivens J: Promoting professional knowledge, experiential learning and critical thinking for medical students. Medical education 34:535-544, 2000
  2. Kolb DA, Boyatzis RE, Mainemelis C: Experiential learning theory: Previous research and new directions. Perspectives on thinking, learning, and cognitive styles 1:227-247, 2001
  3. Mann K, Gordon J, MacLeod A: Reflection and reflective practice in health professions education: a systematic review. Advances in health sciences education 14:595, 2009
  4. Sandars J: The use of reflection in medical education: AMEE Guide No. 44. Medical teacher 31:685-695, 2009
  5. Aronson L: Twelve tips for teaching reflection at all levels of medical education. Medical teacher 33:200-205, 2011
  6. Chen I, Forbes C: Reflective writing and its impact on empathy in medical education: systematic review. Journal of educational evaluation for health professions 11, 2014
  7. Zwack J, Schweitzer J: If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Academic Medicine 88:382-389, 2013

Can you really make your brain BIGGER: Using cognitive science to increase your study efficiency and retention

Can you really make your brain BIGGER: Using cognitive science to increase your study efficiency and retention by Jason F. Hine, MD-Emergency Medicine SMHC

How are we as clinicians going to keep up with the ever-expanding fund of medical knowledge?

The rapid expanse of medical knowledge is a well-recognized reality creating a daunting circumstance for us as clinicians- trying to keep up with what we need to know.1 There are several strategies to help the practicing physician keep up. These include:

  1. “Peripheral brains” such as smartphone apps and pocket cards
  2. Secondary journals- which were discussed in our November Monthly Tips
  3. Efficient study techniques

Wouldn’t it be great if you could improve the efficiency with which you study and learn?

Enter cognitive science. While this is a vast field of research covering a range of topics, one area of study has been in the production and retention of memories.  A summation of this field’s findings can be found in the book Make It Stick: the Science of Successful Learning.2 Cognitive scientists Henry Roediger and Mark McDaniel teamed up with story teller Peter Brown to outline how we can improve our efficiency in learning and memory retention. In its simplified form, this involves four processes:

  • Retrieval Practice (R) – As a medical student you cannot spend 3 grueling hours on acid-base analysis, put the book down and expect to nail an ABG interpretation 4 months later. To solidify a memory into our long-term bank we must practice using it. Quite simply, this is the act of pulling information (a memory) from our memory back. This is retrieval practice.
  • Spacing (S) – The idea of spacing is linked to retrieval practice but gives greater detail about when we should be retrieving memories. It is fine to practice retrieving a memory 30 minutes after it is created (ie shortly after you read a new article), but it is more powerful and efficient in creating memory retention when some time has passed. Allowing for a bit of forgetting to occur and making the retrieval effortful leads to greater retention.
  • Interleaving (I) – Interestingly, cognitive science has found that when we mix our study of different subject matter we often gain a greater understanding of each. This is thought to be related to pattern recognition across topics, rule generation, and the linking of memories in our brains. By mixing our review of several articles, therefore, we can improve our retention of the take-home from each.
  • Generation (G) – The concept of generation is akin to an active rather than passive learner. It explains that in creating from our memory we again reinforce the content and improve retention. Activities such as recollective summaries or content application are much more retention-producing than passive actions such as rereading.

So, after reading an article use these steps to “Make it Stick”:

  1. Take a moment to write out the key points of the paper and how they may affect your practice (R, G).
  2. Create an alert 1 week later (via smartphone, calendar, post it notes, whichever structure works for you) to remind yourself to do a recollection exercise where you spend two minutes writing all you can remember on the article, then review and correct (R, S, G).
  3. Create a notecard with the article title on one side and short summation on the other (S, G).
  4. Whenever you sit to read a new article, review the notecard and simply speak aloud the major summative points (R, S, I, G). Once the article and its content become second nature, the notecard can be filed or discarded.

While more effortful than our inherent learning strategies, this method of study based on cognitive science is more time efficient. For most of us, our typical pattern involves reading an article, putting it down, forgetting it, and rereading it months to years later when we realize the content is lost. In the proposed study construct, after the first active reading session the subsequent retrieval activities are quite short, collectively require less time, and are higher yield for actually remembering the topic.

To learn more on the topic of memory retention, please read Make it Stick or use these links to my podcast website for my summary and interview with the author.

References:

  1. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.
  2. Brown P, Roediger H, McDaniel M. Make It Stick : the Science of Successful Learning. Cambridge, Massachusetts :The Belknap Press of Harvard University Press, 2014.

November Faculty Development: Staying on Top of the Literature

Staying on Top of the Literature by Christopher Turner, MD Pediatric Surgery

When I was preparing for my pediatric surgery boards, I asked an emeritus professor for advice. He recommended what he had done for his boards: read every article ever published in the Journal of Pediatric Surgery. While this may have been feasible in 1979 with thirteen volumes, it was not feasible now with fifty-three. Not only have journals continued to churn out articles, they are doing it more quickly. The number of citations added to MEDLINE per year has almost tripled over the last twenty years from 322,825 in 1996 to 869,666 in 2016. Our ability to produce medical data as a community has exceeded our ability to consume it as individuals. I would like to offer you some strategies and resources to compete.

  1.      Primary Journal. Identify the primary journal for your specialty. Commit yourself to reviewing every issue.
    1. Make it a habit. Try to reserve time on your outlook calendar so it does not get skipped. Do it with a peer so you can hold each other accountable. Pair it with a treat (like a molasses cookie at Tandem!).
    2. If you like print, subscribe. If you like digital and free, consider Browzine (com). This is a service supported by our library that allows easy reading of most major journals on your tablet or phone. It also allows you to track individual journals and save articles.

2.     Secondary Journals. There are many services that curate the literature. Here are a few.

  1. Read (com/read-by-qxmd) or Case (https://www.casemedicalresearch.com) or Prime (www.unboundmedicine.com/products/prime). These apps send you the most popular articles in selected specialties. I have received a weekly email from Read since fellowship. It often shows me interesting articles that I would not have otherwise. Case allows you to listen to audio transcriptions of abstracts which might be useful for your commute.
  2. Journal Watch by the New England Journal of Medicine (org). A good option for medical specialties. It reviews 250 major journals and posts updates by email. The twelve specialties are cardiology, emergency medicine, gastroenterology, general medicine, HIV/AIDS, hospital medicine, infectious diseases, neurology, oncology, pediatrics, psychiatry, and women’s health.
  3. Patient Oriented Evidence that Matters (com). This sends email alerts with updates. I have not used it but it looks promising.
  4. Uptodate and Dynamed. Both of these review services also offer subscriptions to receive email alerts for “practice changing” updates. I have not used them either
  5. TDNet (com). This will send you the table of contents for the journals that you select. I find it clutters my inbox.
  1.      Deep Dive. Through myNCBI, it is possible to receive a regular email with all new publications from PubMed that match a particular search term. This can be overwhelming. It works well for very narrow topics and when you don’t want to miss a thing. Consider it for your research projects. Ask library staff to help you set it up.

I am sure many of you have your own habits and suggestions. Please send them to me if you are interested at cturner1@mmc.edu. I will try to post them here as comments.

I would like to thank Dina McKelvy and the library staff for their help compiling these resources and for their frequent kind assistance.

February Faculty Development: How to Get the Most Out of a Survey

How to Get the Most Out of a Survey
By: Kimberly Dao, Maine Track, M’18

‘‘Let’s just do a quick survey.’’
— Someone in everyone’s program

Surveys are an easily accessible and commonly used tool in many disciplines. However, the quality of responses and response rate can vary dramatically. Below are some basic tips to maximize your survey.

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August Faculty Development: Education Video Production: A How-To-Guide

Educational Video Production: A How-To Guide by: Alex Fiorentino, MD, Maine Track ’17

Learners of many types are increasingly utilizing online educational videos, and medical learning is no exception to this trend.  As an example, the massive open online course platform Khan Academy has generated a video series geared toward helping nursing students prepare for the NCLEX-RN licensing exam.  At the time of this writing, the platform’s overview of nephron function has been viewed more than 1.6 million times1.

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June Faculty Development: Use of Social Media as a Supplement to Medical Education Curricula

Use of Social Media as a Supplement to Medical Education Curricula by Nate Rogers, MD, Maine track ‘16

Though the majority of medical education literature has studied social media and issues of professionalism in relation to its use, medical professionals are beginning to recognize its potential as a powerful educational tool. Twitter and Facebook represent two of the largest and most widely studied social media platforms in medical education, with healthcare professionals finding creative uses of the apps to enhance learning.

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