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Medical Education Curriculum: How do we change the game?

Explore the levels of Bloom's taxonomy in medical education, starting from Level 3. Learn how to play the game and negotiate the levels. Experience the bedside Bloom Game through patient-based learning. This blended learning game rewards both students and teachers. Discover the steps of the Bloom Game PBL case-study method and its benefits in patient-centered learning.

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Medical Education Curriculum: How do we change the game?

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  1. Medical Education Curriculum: How do we change the game? RakeshBiswas Department of Medicine, LNMCH Bhopal, India

  2. Medical Education’s Bloom Game • Level 1: R emember • Level 2: U nderstand • Level 3: A pply • Level 4: A nalyse • Level 5: E valuate • Level 6: C reate

  3. Start experiencing the game: Begin playing at Level 3 • Feel free to check out level 1 and 2 whenever you need to • Remember the levels? Go back one slide if you need to • Remember you don’t really need to be good at level 1. Use a few memory tricks (mnemonics, association whatever).

  4. Negotiating Bloom game levels • Level 1 and 2 is generally what is taught at school.  • Rabindranath began with Level 6 at school which means he never went to school • He remained forever at level 6 before and after his Nobel prize (i am not talking about the other games he played). 

  5. When do you reach Level 6? • I don’t know but when it happens it is time to drop out of college or school • Don’t drop out of schools that play level 6 (if any such exist)

  6. What are we going to do today? Off course we will play! What did you think? We’ll go from Level 3-4-5 to 6 with frequent look backs and stopovers at 1 and 2

  7. Bedside Bloom Game • Symptoms and Signs (Data capture and Pattern recognition Level 3) • Health Information Processing (Level 4 and 5 but you will also need to look up Level 1 and 2) • Level 6? Wait till we reach there. 

  8. Hands on Demo:

  9. Bloom game PBL (patient based learning)

  10. Bloom game PBL: Dos and Don’ts • Do leave your slippers, degrees and egos outside • Don’t hesitate to ask stupid questions • Don’t feel you are supposed to know all/any of the answers • Do make a sincere effort to search the answers with your team

  11. Bloom game PBL: Description • This game is played around the patient and an ideal number of participants would be 5-10 • There is a facilitator whose role is simply to ask questions encourage others to do the same and all participants are supposed to find the answers

  12. Bloom game PBL : Description • Even the most qualified super-generalist or super-specifist will know only 1% of the answers • This is a life-long game and the joy is in finding out more and more

  13. Bloom Game PBL : Rewards • Students will be assessed by their teachers from time to time with feedback that can be verbal, grades or even a PG seat! • Teachers will be assessed by the public and the industry with feedback that can be verbal, monetary or even a Nobel prize!

  14. Bloom Game PBL : Blended • This is a blended learning game with offline and online components • The offline component is at the patient’s bedside • The online component is around the patient’s online health record.

  15. Bloom game PBL : HOW?

  16. Every patient is a separate learning and helping case-study project

  17. Steps of Bloom game PBL: A Case-Study method Situation Objective Action Results Continuum

  18. Step 1 of Bloom game PBL: A Case-Study method Situation What was the background to the current state? What was happening? What was the problem? How was this identified?

  19. Step 2 of Bloom game PBL: A Case-Study method Objective What were the aims of the project? What was hoped to be achieved?

  20. Step 2 of Bloom game PBL: A Case-Study method Action What action was taken? Why was this action taken? What were the alternatives? What were the implemented improvements (tools/techniques)?

  21. Step 3 of Bloom game PBL: A Case-Study method Results What is the situation now? What was achieved through the action(s) and were objectives met? What was the measurable outcome of the action(s)? What are the patient, staff and organisational benefits?

  22. Step 4 of Bloom game PBL: A Case-Study method Conclusion/Continuum How is the achieved change sustainable? What was learnt and how could this learning be used in the future?

  23. Patient centred case based learning ‘What it is’ and ‘What it isn’t’

  24. ‘What it is’ and… “Patient-centrism extends beyond the initial diagnostic workup. It permeates every nook and cranny of doctor-patient interaction. That is what a calling is all about. Patient-centeredness involves minimalism in prescribing. Genuine patient-centrism would drastically reduce health care costs and result in more healed patients and more fulfilled doctors.“ Bernard Lown

  25. …and ‘What it isn’t’ “The patient looms large as a commodity to be seduced by medicalization, to be showered with drugs, subjected to endless tests, imaged to expose hidden recesses of anatomy, probed by magical genetic analyses for the Ur-self, and salvaged by so-called life-saving interventions.” Bernard Lown

  26. Two different Learning paradigms? Population based Patient centred Less structured Exploratory and explanatory Transferable in both implicit and explicit form. Retains context. Individualizable: i e Well applicable to specific problem instances • Very structured • Explanatory • Highly transferable, explicitly • Does not retain context. • Generalizable i e Easily applicable to generic problems BMC Medical Informatics and Decision Making 2004, 4:19 http://www.biomedcentral.com/1472-6947/4/19

  27. “Do you think me a learned, well-read man?”“Certainly,” replied Zi-gong, “Aren´t you?”“Not at all,” said Confucius.“I have simply grasped one thread which linksup the rest”Recounted in Sima Qian (145-ca. 89 BC)

  28. Offline and Online 24x7 Blended learning? Once students finish evaluating and learning around the patients in the bedside they may want to discuss further and learn more around the same patient online?

  29. Patient details uploaded to an online-patient-record-blog

  30. Online presentation in ‘Discussion Forum’ after uploading case to the online-patient-record-blog

  31. Shared learning gains: • The group can extract themes from your patient data leading to research questions that can be searched online • Most of these questions can focus on implementable solutions for your patient

  32. Assessment of Generalist Learning Competency Module 3

  33. So what? Strengths Weaknesses Opportunities Threats

  34. Patient based learning PBL Weaknesses • With introduction of PBL shall we lose students with a predominantly assimilator learning style? • Assimilators like accurate, organized delivery of information and they tend to respect the knowledge of the expert. • Assimilators aren't that comfortable randomly exploring a system and they like to get the 'right' answer to the problem.

  35. Patient based learning PBLWeaknesses • Should we tailor PBLs to each student’s preference or challenge them to grow in preferences they are not comfortable with? • We can sometimes cater to their learning preferences, by promoting “constructive friction” between teaching and learning?

  36. Further Reading Patient-Centred Learning Environments: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1484792/ Case-based medical informatics: http://www.biomedcentral.com/1472-6947/4/19 The User Driven Learning Environment: http://www.igi-global.com/viewtitlesample.aspx?id=73827&ptid=69668&t=the+user+driven+learning+environment

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