Pediatrics

The Secrets of Successful

Curriculum Design:Putting the Learner at the Center of

Instruction

Teri Turner, MD, MPH, Med

Innovations Consultant for the AAP Committee on CME

Associate Professor of Pediatrics

Vice Chairman for Educational Affairs

Director, Center for Research, Innovation and Scholarship

(CRIS) in Medical Education

Department of Pediatrics

Baylor College of Medicine

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Teaching and Learning

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Listening isn’t learning and telling isn’t

teaching

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Objectives

•Articulate the difference between lecture driven instruction and

student-centered instruction

•Articulate the learning benefits of student-centered instruction

•Identify student-centered teaching strategies and tools and

discriminate between student-centered and lecture-centered

teaching practices

•Construct a lesson, or part of a lesson, using student-centered

design principles

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Teaching Adults: WIIFM Principle

•Want their learning to be relevant

•Prefer that their knowledge is

acknowledged and valued

•Want to be able to apply what

they learn now

•Want feedback on how they are

doing

• Knowles, M. (1975). Self-Directed Learning. Chicago: Follet.

• Knowles, M. (1984). The Adult Learner: A Neglected Species (3rd Ed.). Houston: Gulf Publishing.

• Knowles, M. (1984). Andragogy in Action. San Francisco: Jossey-Bass.

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Shift from Teacher to

Learner-Centeredness

“I never teach my pupils; I only

attempt to provide the conditions

in which they can learn.”

Albert Einstein

1. Weimer, M. (2002). Learner-centered teaching. San Francisco: Jossey-Bass.

2. Doyle, T. https://learnercenteredteaching.wordpress.com/learner-centered-teaching-

resources/definition-of-learner-centered-teaching/

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What are the Benefits to Learner

Centeredness

•Engages students in the hard and messy work of learning

•Strengthens motivation

•Encourages collaboration and peer-teaching

•Permits opportunities to connect learning to real life

•Encourages students to reflect on what they are learning and how

•Provides opportunities for higher order thinking

•Benefits the teacher as well

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The LEARN Curriculum and SBU School

of Medicine

•L = learning centered

•E = experiential

•A = adaptive

•R = rigorous

•N = novel

2016 Latha Chandran, MD, MPH

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If You Fail to Plan Then You Plan to Fail

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Kern 6-step Approach

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Systematic Process Just Like Research and

Patient Care

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Mind the Gap

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What do we want our students to learn?

What would make us happy from

all that we taught—(the skills,

content and behaviors) that our

students remembered and could

use one year after they finished

our course?

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Goals and Objectives

•Goals are like zip codes and objectives are like

street addresses

•They are signposts for learning and teaching

•Provide a framework for evaluation

•Place value or prioritizes content

•Must emphasize performance – What a learner

will DO

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DRAW THE KREBS

CYCLE

Krebs Cycle

www.en.wikipedia.org

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Focus Should Be On Critical Thinking

Bloom, Benjamin Samuel. "Taxonomy of educational objectives: The classification of educational goals ." (1956).

Anderson LW, Krathwohl DR, Bloom BS. A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of

educational objectives. Allyn & Bacon; 2001.

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It Takes More Than Knowledge

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ABCD’s of Objectives

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Activity

•Identify the goal(s) and objectives of your learning session.

•Make sure and identify at least one higher learning objective.

•Consider what skills should be practiced during the session.

•Focus your objectives on what the learner should be able to do.

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Cognitive Pause

•Think about a time you learned

something that has stuck with

you to this day.

•What methods did your teacher

use to help you learn?

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If You Only Know How to Use a Hammer…

You Tend to See Every Problem as a Nail

Abraham Maslow

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Why We Need More Learner Centered

Teaching

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We Have Information (Morbid) Obesity

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In 2020, information will double every 72

days

Levit, L., Balogh, E., Nass, S., & Ganz, P. A. (Eds.). (2013). Delivering

High-Quality Cancer Care:: Charting a New Course for a System in

Crisis. National Academies Press.

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How much do we retain 1 hour after

learning?

A. 10%

B. 20%

C. 30%

D. 40%

E. 50%

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How much do we retain 1 hour after

learning?

A. 10%

B. 20%

C. 30%

D. 40%

E. 50%

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We Forget Rapidly

Ebbinghaus H. Memory: A contribution to experimental

psychology. 1913.

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Refresher Training is Needed to

Maintain Competence

1. Pusic M. et al. Academic Emergency Medicine

Volume 19, Issue 12, pages 1476-1480, 2012.

2. Kerfoot BP. Spaced Education (2007-2016)

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When does a medical students attention

begin to wane during a lecture?

A. 10 minutes

B. 20 minutes

C. 30 minutes

D. 40 minutes

E. 50 minutes

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When does a medical students attention

begin to wane during a lecture?

A. 10 minutes

B. 20 minutes

C. 30 minutes

D. 40 minutes

E. 50 minutes

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Attention Span

Stuart J and Rutherford RJD. Lancet. 1978

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Active Learning is Better than Passive Learning1

Prince M. Does active learning work? A review of the research. Journal of

engineering education. 2004 Jul 1;93(3):223-31.

Interactivity is the Secret Sauce of Teaching!

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Active Learning Engages the Brain

1. Vannest JJ et al. J. Magn Reson Imaging (2009)

2. Friedlander et al. Academic Medicine (2011)

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Without Interactivity You Lose Learners

Quickly

Cantillon P, BMJ (2003)

Pediatrics Schunk, Dale H. Learning Theories: Pearson New International

Edition: An Educational Perspective. Pearson Higher Ed, 2013.

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Penny Memory Test

Which way does Lincoln’s head

face on a penny?

A. Left B. Right

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Too Much Content Overloads Working

Memory

1. Sweller J Cogn Sci (1988)

2. Leppink J, van den Heuvel A. The evolution of cognitive

load theory and its application to medical education.

Perspectives on medical education. 2015 Jun 1;4(3):119-27.

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Learning is Messy and Takes Work

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Methods to Increase Learner Engagement

•Patient cases

•Small group discussion

•Think-pair-share

•Quizzes

•Reflection

•Flipped/Blended classroom

•Projects

•Team based learning

•Role play

•One minute paper/Muddiest point

•Peer teaching

•Debate

•Brainstorming/Brain Drain

•Invented dialogues

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Armstrong E and Parsa-Parsi R. Academic Medicine 2005

Klein M and Vaughn LM. Medical Teacher 2010

Brooks-Harris and Stock-Ward. Workshops: Designing and facilitating experiential learning.

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Role of the Teacher when Using Kolb’s

McCarthy B, O'Neill-Blackwell J. Hold on, you lost me!: Use learning styles to

create training that sticks. American Society for Training and Development; 2007.

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Choosing Instructional Strategies

•Use multiple methods

•Dream big and adapt

•Interactive and fun

•Maintain congruence between

methods and evaluation

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Activity

•Match instructional strategies to your learning objectives.

•Consider the Kolb experiential learning cycle when identifying

strategies for teaching.

‐How will you engage the learner? (Why is this important?)

‐Share – What information is essential vs. important vs. nice to know?

‐Practice – How will they practice what they have learned?

‐Perform – If they are confronted with this issue, how can they apply what they have

learned and how do I know they can do it? (This is the relevance.)

•Do not use lectures as an instructional strategy for this exercise.

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The LEARN Curriculum and SBU School

of Medicine

•L = learning centered

•E = experiential

•A = adaptive

•R = rigorous

•N = novel

2016 Latha Chandran, MD, MPH

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Too Much Teaching and Not Enough

Learning

Objective #2 Identify at least 3 teaching techniques that promote

learning

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Just Because it was Taught Doesn’t Mean it

was Learned

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How Do You Know Learning Occurred and it was what you wanted them to learn?

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The Exit Ticket or One Minute Paper

•What is one thing you learned today?

•What will you do differently based on

what you learned today?

•What is one thing you still do not

understand and are going to go learn

more about? (aka the Muddiest Point)

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Questioning Techniques

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The Socratic Method Using Bloom’s

Taxonomy and the 3 Little Pigs

•Of what material did each of the 3 little pigs build his (or her) house?

•If the wolf had asthma, how would this have changed the outcome of

the story?

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Conducting a Cognitive Autopsy

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Debriefing Using Advocacy Inquiry

•Advocacy is an assertion, observation or statement

•Inquiry is a question

‐Debriefing with “good judgment”

‐Creates a context for learning and change

‐Seeks understanding through honest inquiry

‐Respects that the trainee is trying to do the right thing.

Rudolph JW, Simon R, Dufresne RL, Raemer DB. There's no

such thing as “nonjudgmental” debriefing: a theory and method

for debriefing with good judgment. Simulation in Healthcare.

2006 Apr 1;1(1):49-55.

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Example of a Cognitive Autopsy using

Advocacy Inquiry

•“Okay, that seems reasonable. I saw

you looking all around the room for

equipment, though, and that seemed

to prevent you from trying any

alternative approaches to oxygenating

the patient [advocacy]. Can you help

me understand what you were

considering at the time? [inquiry]”

Rudolph JW, Simon R, Dufresne RL, Raemer DB. There's no such thing as

“nonjudgmental” debriefing: a theory and method for debriefing with good

judgment. Simulation in Healthcare. 2006 Apr 1;1(1):49-55.

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Concept Mapping: It’s Not Just for

Grade School

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Concept Mapping Facilitates Deeper

and Longer Lasting Learning

Cutrer Castro, Roy and Turner. Medical Teacher. Dec 2011.

Copyright restrictions may apply.

West, D. C. et al. JAMA 2000;284:1105-1110.

Low-Scoring Concept Map

Copyright restrictions may apply.

West, D. C. et al. JAMA 2000;284:1105-1110.

High-Scoring Concept Map

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Role Play: Practice, Observation and

Feedback

You can’t know for certain how good a

musician is by how good they say they

are. (All providers think they are good

communicators – but would their

patients agree?)

We all have blind spots

Ericsson KA. Acquisition and maintenance of medical expertise: A

perspective from the expert-performance approach with deliberate

practice. Academic Medicine. 2015 Nov 1;90(11):1471-86.

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Promoting Self-reflection and Self-

monitoring

•Self-reflection after clinical

encounters

•Self-monitoring of milestones and

other performance-based

assessments

•Role-modeling and Peer-directed

self-reflection

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Team Based Learning

(and Assessment)

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Assessment Drives Student Learning

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Assessment Bites

•Pro Con Grid

•Summarizations

•Student Generated Test

Questions

•Audience Response or other

type of Quizzes

•Application Cards

•Scoring rubrics (i.e. for a debate)

•Case based discussion

Angelo, T.A. and Cross, K.P. (1993). Classroom Assessment Technologies

(Second Edition). San Francisco: Jossey-Bass Publishers.

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Activity

•How will you know your students learned?

•What types of assessment “bites” might you include in your learning

session?

•Are there questions you might want to ask the learners during the

session to gain an understanding of their learning– if so write these

down as well.

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Summary: Effective Teaching Practices to

Improve Learning

•Ask yourself first – Will what I am doing be effective?

•Tell learners why something is important

•Engage learners

•Make it relevant

•Help them apply what they have learned

•Help them problem solve their own learning problems

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Kern 6-step Approach

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Why be Systematic in Designing

Learning Experiences?

• Focus time and effort on the right solution

• May help achieve “buy-in”

• Lends credibility

• Ensures work is scholarly

• Leads to further refinement and improvement

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Armstrong E and Parsa-Parsi R. Academic Medicine 2005

Klein M and Vaughn LM. Medical Teacher 2010

Brooks-Harris and Stock-Ward. Workshops: Designing and facilitating experiential learning.

Pediatrics

Role of the Teacher when Using Kolb’s

McCarthy B, O'Neill-Blackwell J. Hold on, you lost me!: Use learning styles to

create training that sticks. American Society for Training and Development; 2007.

It’s not what you EXPECT,

but what you INSPECT

that learners see as important.

Pediatrics

The LEARN Curriculum and SBU School

of Medicine

•L = learning centered

•E = experiential

•A = adaptive

•R = rigorous

•N = novel

2016 Latha Chandran, MD, MPH

Pediatrics

Group Exit Ticket

•What did you learn today? What was most helpful to you?

•What was the muddiest point? On what topics would you like more

faculty development?