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Session Objectives. Factors leading to TBL implementationImpact from accreditation outcomes projectResident learning and faculty teaching timeDesire to apply adult learning principlesUndertake complex learning tasksReview of modified TBL as instructional strategy in our curriculumExploration o
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1. Implementing Team-Based Instructional Strategies in Psychiatry Resident CBT Training Kim A. Coon, Ed.D.
Bryan K. Touchet, M.D.
OU College of Medicine - Tulsa
Department of Psychiatry
2. Session Objectives Factors leading to TBL implementation
Impact from accreditation outcomes project
Resident learning and faculty teaching time
Desire to apply adult learning principles
Undertake complex learning tasks
Review of modified TBL as instructional strategy in our curriculum
Exploration of process and outcomes
3. ACGME Accreditation Mandates Stimulated instructional strategy review
Time required for volume of new learning material
Documentation of competency requirements
Traditional didactics fail to promote ideas of life-long and self-directed required for learning complex concepts
Use of adult learning theory may increase faculty effectiveness as well as promote resident learning complexities of therapy
4. Responsibility of Educators Facilitator and provocateur
Assist learners with reflection on learning process
Expand trainees’ frames of reference
Faculty, patients, peers and supplementary resources
Initiate innovative instructional strategies to promote high level learning
5. Learning Domains Bloom’s Taxonomy, 1956 Levels of learner activities & objectives:
(low level to high level)
Fact – list, recall, recognize
Comprehension – describe, explain
Application – demonstrate
**Analysis – compare and contrast
**Synthesis – create, develop, design
**Evaluation – defend, judge, predict
6. Adult Learning: Theoretical Foundations High level learning activities promote questioning of current knowledge and experiences through
Validation of beliefs through discourse
Critical assessment of new awareness
New action on reflective insight
Merriam SB & Caffarella RS: Learning in Adulthood: A comprehensive Guide, 2nd ed.
7. Error-correcting feedback loop
9. Adult Frames for Learning Enhanced learning frames incorporate
Actual clinical experiences
Group interaction to encourage reflection, information analysis, and skill comparators
Self-study, simulations of learning application and role play, case studies, and group problem-solving projects
10. Central Tasks of Adult Learning Primary Goal = teach the learner to learn
Conceptualize the learning process
Pay attention to initiating task of learning
Manage the process of learning
Recognize personal learning patterns
Self-understanding enhances learning
Specific tasks of effective learning:
11. Task #1 - Metacognition Understanding and directing one’s thinking and learning process through:
Planning
Best way to proceed with a learning task?
Monitoring
How am I proceeding through the task?
Adjusting
Directing and improving learning processes
12. Task #2 - Metamotivation Factors that energize and direct learning
Attention
Focus on the material to be learned
Reward and Enjoyment
Value and satisfaction of learning activity
Confidence
Learning task was worth doing
13. Task #3 - Memory Knowledge storage, retention, and retrieval
Organization
Structuring or processing of information
External Aids
Reinforce memory
Application
Remembrances or mental images to facilitate planning or carrying out learning
14. Task #4 - Critical Thinking Reflective thinking process using higher order thinking skills to improve learning
Test Assumptions
Evaluating learning material
Generate Alternatives
Imagining and exploring options
Conditional Acceptance
Developing best hypothesis Add Bloom’s Taxonomy hereAdd Bloom’s Taxonomy here
15. Task #5 - Resource Management Process of identification, evaluation, and use of resources
Identification
Locate best source of information
Critical Use
Appropriate resource choice
Human Resources
Integrate others into the learning process
16. Rationales for TBL Use Increasing motivation for learning through
Group dynamics
Engaging in-class activities
Emphasizing student or resident accountability for learning
Increasing learning efficiency
Promoting instructor role as facilitator
17. Research Support For Team Learning Active involvement in learning process results in better learning and retention of complex concepts (1)
TBL improves critical thinking, comprehension, and information retention (2)
Team-oriented approaches to realistic learning tasks improves decision making (3)
18. Psychiatric Training and TBL Levine and colleagues introduced TBL into student psychiatry clerkship experience
Touchet and Coon introduced TBL into psychiatry resident theory-intensive segment of psychodynamic psychotherapy didactics
19. Resident Feedback TBL Pilot #1 “I have learned so much more this year with this teaching method.”
“I’m finally getting this stuff – thank you!”
“I think TBL has been a very effective teaching tool.”
20. Second Pilot of TBL TBL training use in Cognitive-Behavioral therapy (CBT) curriculum
Modifications
Outcomes
Challenges
21. CBT TBL Format Rationale and goals for TBL implementation
Teams – mixed PGY level resident learners
Repetitive three-phase learning cycle
Phase I: Pre-class prep through on-line lecture and home practice
Phase II: Motivational Assessment Tool (MAT) by individuals and teams
Phase III: Team experiential learning projects and information analysis
22. Example: Online Didactic Slide Review Home Practice With Your Patient
If home practice is not completed, some time in the therapy session may be devoted to completing some of the assignment
Remind patient that more can be covered, and therapy moves faster, when practice outside of session occurs
Discussion of home practice
Does the patient see why practice helps?
Does patient understand what you want?
Did patient collaborate in the development of the new home practice?
23. Example: New Home Practice Assignment for Resident Learners Bring all handouts with you and keep handy for therapy and didactics
Read J. Beck: Basics and Beyond pp. 45-74
Read handouts about reasons for poor compliance with home practice
Identify personal reasons for not doing home practice (IF you’re not doing it)
Be ready to problem-solve compliance with home practice in didactics
TEAM LEADERS: Chose one of your CBT patients for your formal team project(s)
24. Example: CBT MAT #7 Name: ___________Date: _________
When creating and assigning home practice to evaluate automatic thoughts, briefly describe how the therapist can create a no-lose proposition.
J. Beck provided a list of questions for evaluating automatic thoughts. List as many as you can remember.
What are some additional ways to evaluate automatic thoughts without filling out a dysfunctional thought record (DTR)?
25. Example: Group Problem-Solving Exercise Addressing Opposition to Home Practice
Team One - Patient Response #1:
“I am just too busy to do this stuff at home.”
Team Two - Patient Response #2:
“My problems are caused by my husband, why should I have to work at changing?”
Team Three - Patient Response #3:
“I just don’t see the point of having to write down what I think; can’t I just tell you when I come in for therapy?”
26. CBT TBL Pilot #2 Pre-Post Test Cognitive Therapy Awareness Scale (CTAS)
Ten questions
4 true/false responses under each
Total possible score 44
28. Summary of TBL Implementation Demands for maintaining accreditation and adult education principles provided rationale for using TBL as an instructional strategy
TBL outcomes in our training program look promising
29. TBL Challenges Developing and maintaining resident motivation and accountability to learn outside and inside the classroom
Non-grading evaluation system
Residents who do not access assigned “lectures” or perform “home practice”
Residents who depend on their colleagues to process new information for them
Senior resident does work for team