Listen as our esteemed guest and education guru Dr. Kendra Van Kirk (University of Miami) discusses how to utilize backward design to ensure effective learning on the wards! We cover the three stages of backward design, how to identify specific learning objectives for each learner, and how to create instructional activities and assessments to confirm learning and understanding have occurred.
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The three necessary pieces required for learning to take place include:
A way to create educational content by first identifying the instructional strategy or learning activities. From the learning activities, the teacher then develops assessments. Finally, the teacher determines the goals and learning objectives for the lesson. This format results in instructional strategies and assessments that are only loosely connected to the goals and learning objectives of the lesson.
Pitfalls of Forward Design:
A framework described by Grant Wiggins and Jay McTighe that calls for educators to first determine the desired results (i.e. goals and learning objectives). From the identified goals and objectives the educator then designs the curriculum.
Stage One: identify your desired results
Stage Two: determine the assessments
Stage Three: create the learning experience and instruction (Emory 2014).
Applying Backward Design to the Wards
Stage One: Identify the desired results aka the learning objectives
Stage Two: Determine the assessments
Examples include:
Stage Three: The learning experiences
Examples include:
The educator must provide ongoing feedback to allow learners to correct misunderstandings and refine their skills.
Start with a casual conversation with your learner(s) to develop a relationship.
The goal and learning objective(s) for the week should be identified by the learner.
For learners that struggle to identify a goal and learning objective(s), Dr. Van Kirk recommends utilizing one of the following to guide the learner in identifying their learning objective(s):
Dr. Van Kirk keeps track of the goal and learning objective(s) for each learner on a notecard to refer to and make notes on the learning progression.
Learning objectives must be specific, measurable, achievable, and time-bound as they drive evaluations, outcomes, and learning activities.
Benjamin Bloom described the cognitive learning domain which takes into consideration the various levels of understanding we have when it comes to education. Per Bloom’s taxonomy the lower levels of understanding include a learner’s ability to list or explain the educational material. As you move up Bloom’s taxonomy, the skill demonstrated by the learner becomes more cognitively complex. For example, higher levels of understanding include differentiating between two concepts, comparing and contrasting concepts, creating new ideas, or analyzing new material based on what was learned (Adams 2015).
In order to reach higher levels of understanding, the learner must first effectively achieve lower levels of understanding.
Charlotte is a new attending on the wards. During her day one discussion with her upper level resident Paul, Paul tells Charlotte that his goal for their time together is to become more confident with making clinical decisions.
Paul further specifies he wants to develop management plans independently using evidence based guidelines.
Paul’s learning objective:
In order to support Paul, Charlotte as the attending must give resident Paul the space and independence necessary to create the management plans on his own.
Stage Two: Determine the assessments
Ways for attending Charlotte to assess resident Paul include:
Must ensure the assessment tool aligns with the initial goal and learning objective(s).
Stage Three: Instructional activities
Create learning experiences that align with Paul’s learning objective.
Self reflection helps learners solidify information and is a key component to experiential learning theory. Self reflection is also an important aspect of learner self assessment.
Dr. Van Kirk often asks her team to pause for 1-2 minutes to reflect about how the patient encounter went after stepping outside of a patient’s room during rounds. To promote self reflection, Dr. Van Kirk recommends asking the following questions:
To maximize the reflection process, tailor your questions to the deficiencies observed during the encounter inside the patient room.
Dr. Van Kirk then asks various groups of learners (i.e. medical students, interns, and residents) on her team to share their thoughts. She recommends against calling on individuals.
Self reflection sets the stage for feedback
After reflecting on a patient encounter, Dr. Van Kirk asks for feedback from the team. Feedback is multidirectional. Medical students can give the attending feedback. Interns can provide feedback to their co-interns. Residents can provide feedback to each other.
Dr. Van Kirk recommends using open ended questions to the team such as, “would anyone like to give feedback on how we could have improved the patient encounter?”
Pro Tips:
The attending must emphasize from day one that the overall goal on wards is to grow and become better as a group and as individuals in order to provide the best patient care. Without this understanding the process of self reflection and feedback cannot effectively take place.
Charlotte is on her second rotation as an attending physician. She has her day one goal setting meeting with her upper level resident Priscilla. Priscilla states she wants to improve her skills when teaching the medical students on the team.
Stage One: Identify the learning objective
Questions to help create a more specific learning objective:
Priscilla states she wants to provide a 5 minute chalk talk for the medical students by the end of the wards week.
To help create the learning objective for Priscilla, follow up questions are needed and may include:
Priscilla states she wants to cover oncologic emergencies during her 5 minute chalk talk for medical students after rounds.
Priscilla’s Learning Objective: By the end of the week, Priscilla will effectively deliver a 5 minute chalk talk about oncologic emergencies for the third year medical students on the wards team.
Stage Two: Determine the assessments
Priscilla’s chalk talk serves as a formal performance based assessment.
Dr. Van Kirk recommends utilizing a rubric to help assess the learning during formal performance based assessments. Rubrics should be provided to the learner prior to the assessment.
For Priscilla’s chalk talk the rubric may provide a checklist of items the chalk talk should include such as:
Stage Three: Instructional activities
Charlotte as the attending must teach Priscilla how to give a chalk talk via direct instruction (i.e. lecture based format). The direct instruction should cover the components of an effective chalk talk and possibly the various teaching modalities one can utilize during a chalk talk.
Charlotte as the attending can model what an effective chalk talk looks like by providing a chalk talk to the team for Priscilla to observe.
Resources for attendings
Dr. Van Kirk recommends medical educators read Understanding by Design by Grant Wiggins and Jay McTighe to enhance their teaching skills.
Take Home Points
Listeners will explain the three stages of backward design and how to utilize backward design to develop learning objectives for each learner on a wards team.
After listening to this episode listeners will…
Dr. Kendra Van Kirk reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Van Kirk K, Chaiklin C, Heublein M, Kryzhanovskaya E. “#21 Pedagogy on rounds: How backward design creates effective teaching.” The Curbsiders Teach Podcast. http://thecurbsiders.com/teach October 4, 2021.
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.
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