Innovations in Education: The Brewsters : The Who, What, When, Where, Why and How

1. Innovations in Education:The Brewsters:The Who, What, When, Where, Why and How Jeffrey Spike, PhD Thomas R. Cole, Ph.D. UTHSC-Houston February 24, 2012

2. Why did we create the Brewsters? • Everybody wants more or better ethics teaching • But no one knows how • The Brewsters are a pedagogical breakthrough • This approach involves a "choose-your-own-adventure" style of active learning where students make choices about ethical and professional dilemmas. • This project was launched in the Fall of 2011 with 755 students from 6 health professional schools. It has recently been converted into an e-reader and will soon be available for other institutions to use.

3. Academic Deans on Professionalism • Negative: Prevent cheating and plagiarism, address lack of professionalism. • Also: Great concern social networks spreading gossip and violating confidentiality on unprecedented scale. • Primary concerns were of behaviors, not lack of education as much as lack of discipline or appreciation of the importance of joining an established profession guided by a set of values or ideals. • Sometimes called “identity formation” • Challenge: change your identity/self-image to that of a professional, guiding maturation with mentoring (requires innovative pedagogy plus faculty development)

4. What is the Brewsters? An introduction to inter-professional ethics for health science students that consists of both fictional narrative and fact-based instructional materials. It is modeled after “Choose Your Own Adventure” books and is meant to be fun and entertaining as well as informative and educational. The story follows members of the Brewster family through their encounters with students, physicians, dentists, dental hygienists, nurses, an epidemiologist, and researchers. It unfolds in three acts: (1) Professionalism; (2) Clinical Ethics; and (3) Research Ethics. Each act is followed by 20 pages of instructional materials

5. How does ‘The Brewsters’ Work? In each act, students can choose which character they would like to be. They can, for example, be a medical student or a patient, or, in another act, they can be a researcher or a patient. They are faced with multiple decisions along the way, and each decision takes them to a different point in the story. (For example, if they make Choice A, they will be directed to page X. If they make Choice B, they will be directed to page Y.) After they finish each act, they read the corresponding instructional materials.

7. Who are the Brewsters? • Central characters are from “a typical American family” (i.e. a bit dysfunctional, but not all that out of the ordinary) • Meant to test their ability to listen empathically to people with problems, and not be judgmental • The parents are Wayne and Sheila (not a great marriage) and the kids are Walter, in med school, Stephanie a teen who wants birth control pills, and little Cindy with (psychosomatic?) stomach aches. • When his mother Gloria gets cancer, poor Wayne joins the sandwich generation

8. A major innovation • This same story is used in all six schools. So our students in every school will learn the basics that are being taught to the students in the other schools. It breaks down academic silos. • The story also reinforces the value of inter-professional education respect, cooperation, and teamwork. • Can be used for undergraduate education too: for example, if pre-meds were to learn some of their ethics side-by-side with other clinicians in training (e.g. nurses studying to be nurse practitioners) they might better appreciate the humanistic importance of their expertise. • Contrast that to the hidden agenda of large pre-med science courses whose goal is to wash out or otherwise discourage students. (Surviving such courses is more a test of competitiveness than compassion.)

9. The Brewsters as retrovirus designed to attack the hidden curriculum • Think of it as an antidote to a system geared to produce high test scores, which inadvertently sends the message that how you get them isn’t as important as that you get them • EBM: So, is it an effective antidote? • No one book can change the lessons learned from a hidden curriculum that starts in high school and continues through residency (see the recent stories on ‘airplane notes’ and ‘recalls’) • But it’s a start. Here’s some early data…

10. Average Score by School (out of 30) • School of Dentistry (n = 124) 27.47 • Graduate School of Biomedical Sciences (n = 109) 26.55 • Medical School (n = 240) 26.71 • School of Nursing (n = 224) 25.07 • School of Public Health (n = 39) 23.56 • School of Biomedical Informatics (n = 19) 23.21 Out of the 755 students, 53.0% of them (400 students) earned a 90% or greater on the post-test.

11. Evaluations (143 total) Average rating, based on a scale 1-5; where “1” is Strongly Disagree and “5” is Strongly Agree • When reading the stories, the “choose your own adventure” learning method was easy to follow: 4.49 • “Choose your own adventure” is an interesting method of presenting information: 4.42 • Reading the instructional materials after each act increased my knowledge of basic terms in health professional ethics: 4.26 • I enjoyed the self-paced aspect of this learning activity: 4.33 • The time it took to complete this learning activity was just right: 3.87 (average time reported was 4 hours) • This educational activity provided an adequate introduction to health professional ethics: 4.28 • This educational activity enabled me to see ethical issues beyond my own health profession: 4.18

12. Limitations of Study/Warnings • Only an introduction to the issues and terminology, but IN NO WAY is sufficient for a professional ethics education.  It must be followed up with some more detailed support in each year of school. • Is best way to INTRODUCE the subject, because it is engaging, interactive, and narrative based.   But is only an introduction.  So the quality of the overall ethics education will be judged by how well your curriculum follows up… • Will not replace anything already there, but is inserted prior to what’s already there, to generate a higher level of interest and comprehension in that material…