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3. Case-Based Module Small Group Learning Tutor / Facilitator Interactive Workshop William K. Hettenhausen DDS FACD FICD FPFA Associate Professor of Health Sciences - Clinical Sciences Division (3)

4. Learning Objectives After attending this session, the participant should be able to: • Tutor/facilitate case-based small group learning sessions including initial “icebreaker” orientation, “ground rules & house keeping”, role development and discussion of expected participation dynamics. 2. Create a learning environment that supports self- directed research and encourages a model of guided discovery, collegial resource sharing and interaction. 3. Assess participation performance of learners in CBL and TOS sessions. 4. Assess professional behaviour in small group sessions. (4)

5. Overview of Small Group Learning The goal of case-based small group learning at the Northern Ontario School of Medicine is to provide students with the knowledge, inter-professional skills and attitudes necessary to practice medicine in northern, rural and remote communities. CBL (Case Based Learning) and TOS (Topic Oriented Sessions) are designed with this overall goal as the guiding principle. To focus small group learning, faculty tutors are used to facilitate the learning process. The role of the tutor is that of a mentor or guide, open-ended questioner and student assessor. (5)

6. Overview of Small Group Learning To describe small group learning, is to describe an ever moving target. The learning dynamic, not only varies from group to group, it is constantly evolving and adapting to the interactive experiences of the tutor/facilitators and their students. The NOSM curriculum development teams provide on- line small group learning guides for students and facilitators, drawing on the latest demographics & epidemiologic studies of northern rural and remote communities. This ensures that the students will be well prepared to meet the medical health care needs of the patients they will encounter during their Integrated Community Experiences(ICE). (6)

7. CBL (Case-Based Leaning) Once a week, the students meet in groups of eight to ten for a two hour CBL session. These sessions set the stage for the following TOS (Topic Oriented Session) by providing an opportunity to learn about the background or community context, that the patient encounter will occur in. The session’s learning objectives are centred in: Theme 1: Northern & Rural Health Theme 2: Personal & Professional Aspects of Medical Practice Theme 3: Social & Population Health Students are encouraged to research population demographics, available community health care resources and the underlying determinants of health, as a background to individual patient care. (7)

8. TOS (Topic Oriented Session) Twice a week, the students meet in groups of eight to ten for a two hour TOS. The session’s learning objectives are centred in: Theme 4: Foundations of Medicine Theme 5: Clinical and Communication Skills in Health Care The first session involves the case presentation of a patient encounter. In the student guide, they are given details of the patient’s condition upon presentation, the findings of a physical examination, and any available test results. The students discuss and determine the key topics and issues that they will need to research prior to the second TOS. (8)

9. WGS (Whole Group Sessions) A WGS is held between the 1st and 2nd TOS session. During this session a content expert presents a power point overview of the clinical sciences relevant to the TOS and fields questions. This helps the students to assess whether the key topics and issues they identified during their first TOS were on track or not. It also provides them with any overlooked content they may need to address the learning objectives during the debriefing part of the second TOS. (9)

10. TOS (Topic Oriented Sessions) During the first half of the second TOS, they will debrief and discuss the implications of the patient’s medical history, physical examination findings, laboratory test results, differential diagnosis, treatment planning, patient care and prognosis. In the remaining half of the session, new topics and issues arising from the second patient encounter will be discussed, and key topics and issues determined prior to the debriefing at the beginning of the next week’s TOS. The students are encouraged to discover the key topics and learning issues in the context of the core medical sciences. (Anatomy, biochemistry, genetics, microbiology / immunology, pathology, pharmacology & physiology as well as diagnostics and prevention.) (10)

11. “MyCurriculum” An on-line facilitator’s guide provides tutor/facilitators with key topics and issues, which serve as a check-list for the student’s progress. It also includes some suggested questions to prompt the students in their quest to reach and understand the module’s learning objectives. Students are encouraged to take on a role like that of Sherlock Holmes in solving the case. The same detective- like skills are needed to arrive at an accurate medical diagnosis. The tutor/facilitators, on the other hand, are encouraged to take on a role like that of Dr. Watson, who says, “Unfortunately, I have no answers, only questions.” (11)

12. Small Group Learning Dynamics Self-directed learning is just that. Student groups may choose to tackle CBL or TOS scenarios differently, dependant on their content. They may choose to appoint someone to keep everyone focused on the learning objectives; they may choose a scribe or note taker, and a session time keeper. Some groups may choose to e-mail important articles, definitions, and URL links to each other directly, while others may choose to use MS Office OneNote, Google Docs or other folder sharing software to synchronize the results of their key topic and issues research during their sessions. (12)

13. Small Group Learning Dynamics When members of small learning groups with different learning styles first mix, there may be differences of opinion and challenging discussions. The facilitator’s role, during this initial interaction, is that of a moderator. It is important in arriving at an appropriate self-directed small group learning model, that each member of the team is given every opportunity to express their views and is shown proper respect. Facts students think are relevant, questions about aspects of the case they would like clarified, things that they didn't know or that they personally found to be particularly interesting, all qualify as avenues for active participation. (13)

14. Mid-Point & End-Point Module Assessments Midway through the Case-Based Modules, the Tutor/ Facilitator is asked to provide each student with a Mid-Point Assessment of their learning skills, and the group process. This includes comments on the learner’s strengths and any areas in need of improvement. It provides an assessment of the student’s professional behaviour and ability to demonstrate: “Respect for others, communication skills, responsibility, self-awareness and self-evaluation”. The assessment also indicates whether the student’s performance does not meet standards (= F), is marginal and in need of some improvement (= P) or meets standards (= P). (14)

15. Mid-Point & End-Point Module Assessments The Mid-Point assessment is formative and not summative, in that it is intended to give the student some initial feedback on how they are performing during the sessions and to adjust their performance accordingly. The End-Point Assessment is summative and provides the student with a final performance assessment. Time is allotted in the last CBL & TOS session of each module for the tutor/ facilitator to privately discuss the assessment with each student and to address any questions or concerns regarding their performance. (15)

16. Overview Conclusions One of the hidden benefits of small group case-based learning is that it encourages students to work together as members of a health care team, and to develop the skills to interact collegially with both their peers and other health care professionals in the provision of optimal patient & family centred care. (16)

17. Simulated Small Group Learning The 2nd segment of today’s session is designed to simulate the Small group learning model. Each table has 9 chairs. One is for a tutor/facilitator and the rest are for “students”. Each group will begin by choosing an experienced tutor/ facilitator, who will then initiate group discussion on “Icebreaking” and round table introductions. (17)

18. Simulated Small Group Learning In your handouts, there is a simulated small group learning page with observation note boxes for each participant. During round table introductions and the “Icebreaking”, each participant will record the name, of everyone. Any other notes or observations throughout the session will also be recorded here. (18)

19. Simulated Small Group Learning Each group will select a flip chart scribe to record the discussion under the following six topic headings: Focus Topic Encounter Learning Tasks Learning Objectives Key Questions & Issues Mid & End of Module Assessments (19)

20. Simulated Small Group Learning Time permitting, a spokesperson from each group will give a brief overview from the flipchart of their group’s discussion of each separate topic heading. Following the overviews, the floor will be open to a general discussion of case-based module small group learning including, comments, questions, & suggestions. (20)

21. Simulated Small Group Learning Focus: Sharing facilitation strategies that appear to work best Topic Encounter: Small Group Learning Overview (Group read) Learning Tasks: Identifying & resolving tutor/facilitator challenges Learning Objectives: Creating an optimal learning environment Key Questions & Issues: Discuss the use of technology Smart boards, laptops, tablets etc. Mid & End of Module Assessments: Discuss possible directions forTutor/Facilitators (21)

22. Dr. William HettenhausenDDS, FACD, FICD, FPFA william.hettenhausen@nosm.ca (22)