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As discussed under the section "Research and Roadblocks," there are many strategies to improve student understanding and to practice application of knowledge, each with its own affordances and constraints. In this section I propose a learning unit structure which combines a selection of the activities suggested by survey respondents and research studies. The hope is that by using these elements in tandem, the strengths of each can be harnessed for increased understanding, while also reinforcing each other in areas of weakness. This unit structure would be best applied to larger student cohorts.
The expectation is that this combination of formats will not necessitate major changes to the schedule of a curriculum, and with a little advanced planning should pose little to no increased time spent on campus for faculty or clinicians. At the same time, students will now have opportunities to synthesize and apply foundational biomedical science (FBS) and systems exposure on a weekly basis with real-life scenarios, allowing for scaffolding of knowledge and providing application modeling.
1: Lecture
1: Lecture
Students will be provided lessons/lectures, either live or asynchronously (recorded or written), in the whatever format is typically used throughout the week. Faculty and clinicians should be able to teach in their desired format.
Looking Ahead: As curriculum development progresses, faculty teaching concurrent subjects should coordinate topics covered on a weekly basis to make sure that complementary topics are covered around the same time (see element #2).
Additionally, any materials presented synchronously (i.e., live lecture) should be reviewed and if possible, pre-recorded. This will allow for greater flexibility to scheduling large group sessions (element #4)
2: Take-home activities
2: Take-home activities
On a weekly basis, students will be provided a few (2-3) board style questions based around clinical scenarios/vignettes (a clinical vignette is an abridged version of a patient's chief complaint and typically includes the patient history, physical exam, tests and treatment [Cui et al, 2011, as cited by Piryani & Piryani, 2019]). The questions should be related to the topics being discussed that week, and can be pulled from any board-style question bank.
The question/vignette should be presented with just the stem initially, and can be presented in an LMS page or as the introduction to a survey (a template survey can be viewed and copied from here). Students are then presented with a series of short answer questions that are open-ended in nature, related both to the topic as well as prompts for metacognition. The questions may be adjusted as desired but should include some semblance of the following:
Based on the information given, what is your differential diagnosis? (Include most likely, most dangerous, and a couple of other possibilities.)
What questions would you want to ask the patient to improve your differential?
Consider your medical education so far. What gaps can you identify? What areas might you want to study further to improve your assessment of this patient?
Related to question 3, what resources might you reference to improve your knowledge in this area?
(For the last question, restate the original vignette question, this time including the multiple choice alternatives.)
Note that for questions 1-4, responses may vary significantly, but can be utilized by faculty to review student understanding and self-assessment.
I propose that if implementing this proposal, element #2 should be graded to promote student participation and engagement. These activities should make up at least 10% of the final grade in the course. If including this activity for a grade, students should receive 75% credit simply for working through the activity. If they answer the final MCQ correctly, they receive 100% credit.
Above is a sample survey that could be used for the take-home activity. Click here for a copy of this template.
3: Self-reflection and feedback
3: Self-reflection and feedback
On the survey's submission confirmation page, students are presented with the correct answer and details they should have considered. This should include details related to which details of the scenario were relevant, why the solution was correct, and why the other alternatives were not correct. Students may be encouraged, based on the answer they gave, to review certain lectures.
4: Group discussion and feedback
4: Group discussion and feedback
At the end of the week, two or three hours of in-class time should be dedicated to a group learning session to go both review the cases in element #2 and 2-3 more clinical vignettes.
In the first hour, a clinician will review the cases assigned in element #2. This will be presented to the full cohort, reviewing how a clinician would approach thes scenarios and offering opportunity for questions and discussion.
In the second (and third, if available) hour, students split into small to medium-size groups with a clinician (or faculty member, if clinicians are unavailable) to moderate in each group. Clinicians/faculty will present new scenarios that are similar in scope and subject to the scenarios assigned previously, and students should be prompted to offer similar responses to the scenario as they were asked for in the take-home activity.
I suggest that this element should be graded to promote student participation and engagement. These activities should make up at least 10% of the final grade in the course. If grading participation, students might receive 50% credit for attendance, and then the other 50% given based off a 3-point scale subjectively determined by the faculty moderator of the small group (1 = Present, 2 = Present and prepared or engaged, 3 = Present and prepared and engaged).
References
References
Cui, D., Lynch, J. C., Daley, W. P., Yang, G., & Haines, D. E. (2011). The clinical vignette as a teaching tool for histology and anatomic pathology. The FASEB Journal, 25(S1), 417.5- 417.5. https://doi.org/10.1096/fasebj.25.1_supplement.417.5
Jaroudi, S., Wright, K., & Peiris, A. (2018). Retinopathy. Interesting clinical vignettes: 101 ice breakers for medical rounds. (pp. 28-29). Texas Tech University Health Sciences Center. https://www.ttuhsc.edu/clinical-research/documents/JMD-Cases-of-Interest.pdf
Piryani, R. M., & Piryani, S. (2019). Clinical vignette-based interactive discussion sessions: feedback from residents. Advances in medical education and practice, 10, 829–833. https://doi.org/10.2147/AMEP.S218157
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