Download Enhancing a Medical Student Clerkship with Team

Enhancing a Medical Student Clerkship with Team-Based Learning
Matthew N. Goldenberg, M.D., Kristina Money, M.D. and Derrick Hamaoka, M.D.
Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
RATIONALE
CURRICULUM
INSTRUCTIONAL PROCESS
Team-based learning (TBL) is an instructional strategy that has
been increasingly used over the past decade in a number of educational
venues including medical schools.
Orientation
TBL places particular value on cooperation between student team members and
on using class time for active, applied learning.
Pre-class
Assignment
At our institution, the didactic portion of the psychiatry clerkship had been
conducted in a lecture-based format with little prescribed active student
participation.
Students traditionally rated the lectures as fair, and some cited a desire for
more participatory learning.
Individual
Readiness
Assurance
Test (IRAT)
Group
Readiness
Assurance
Test
(GRAT)
Challenges
One medical school implemented TBL in its psychiatry clerkship and published
data indicating improved student satisfaction and superior standardized exam
performance.
Week 1
Application
Exercise(s)
Week 2
Week 3
Week 4
In order to increase student participation in and satisfaction with the didactic
portion of our psychiatry clerkship, we have transitioned from the lecture-based
format to a TBL format to teach core topics in clinical psychiatry.
Week 5
PRE-CLASS ASSIGNMENTS
READINESS ASSURANCE
Weekly Quizzes based on reading assignments.
10-questions, multiple-choice format.
Students take quiz individually first, then take same quiz as a team.
Patient Voices Series
10 minutes for IRAT, 10 minutes for GRAT.
Teams get instant feedback via scratch-off answer sheet.
Topics
Application Exercise
Interviewing and
Assessment
Psychiatric Emergencies
Mental Status Examination Videos
Case-based Exercise: Suicide Risk Assessment
Mood Disorders
Adjustment Disorders
Bereavement
Med/Psych Interface:
Cognitive Disorders
Eating Disorders
Somatoform Disorders
Mood Disorders Map
Case-based Exercise: Choosing an antidepressant
3Ds (Dementia, Delirium, Depression) Card Sort (from SLU)
Case-based Exercise: Somatoform Disorders
Case-based Exercise: Decisional Capacity
PTSD
Anxiety Disorders
Substance Use Disorders
Sleep Disorders
Substance Disorder Card Sort
Case-based Exercise: Combat Stress Control
Case-based Exercise: Anxiety Disorders
Psychotic Disorders
Violence
Biology of Mental Illness
Evidence-Based Exercise: Managing Agitated Behavior
Antipsychotic Effects Card Sort
Childhood Disorders
Personality Disorders
Defense Mechanisms
Case-based Exercise: Personality Disorders (from UTMB)
APPLICATION EXERCISES
45-75 minute activities
Teams work together to solve problems, accomplish tasks
Various Formats: Multiple-choice questions, card sorts, product generation
Open book, ungraded
Examples:
Mood Disorders Map
Teams may challenge answers via written appeals process.
Results:
FUTURE DIRECTIONS
Goal: Distinguish phenomenologies of various mood disorders from each other
Activity: Each team is given a poster and several colored markers and is asked to
draw a “mood graph,” plotting the symptom and time course of various mood
disorders or related phenomena (e.g. major depressive disorder, dysthymia, bipolar
disorder I and II, schizoaffective disorder, bereavement, adjustment disorder).
Mood is on the y-axis (in quality), and time is on the x-axis (in years). Words or
illustrations can be added to graph to differentiate some of the syndromes.
Cull evaluations of the clerkship to determine student satisfaction with TBL-based
instruction.
Suicide Risk Assessment
Examine NBME Psychiatry exam scores to determine any trends since
implementation of curriculum.
Use peer feedback in overall clerkship evaluation narrative.
Publish and otherwise disseminate teaching materials including both readiness
assurance tests and application exercises.
REFERENCES/ACKNOWLEDGEMENTS
Modify existing quizzes and exercises as needed and continue to develop other
educational tools.
Team-Based Learning for Health Professions Education: A Guide to Using Small Groups for
Improving Learning. Eds. Larry K. Michaelsen, Dean X. Parmelee, Kathryn K. McMahon , Ruth E.
Levine, (2007).
Incorporate TBL into other educational endeavors at institution, especially with
curriculum reform efforts.
Levine, Ruth et al. “Transforming a Clinical Clerkship with Team Learning,” Teaching and Learning
in Medicine, 16(3), 270-275, (2004).
Special thanks to the Team-Based Learning Collaborative and particularly to Ruth Levine, M.D. at
UTMB for inspiring the incorporation of TBL into the psychiatry curriculum at USUHS.
Goal: Identify static and dynamic risk and protective factors for suicide in clinical
cases. Discuss rationale for clinical decision-making (including hospitalization) of
suicidal patients.
Each team is given a written case of a patient who presents with depressive
symptoms and passive suicidal ideation. From the case history, they develop lists
of risk and protective factors and present their lists to the class for
comments/critiques.
Each team is then given a series of five clinical vignettes of suicidal patients.
They must list three concerning features of each presentation, and rank order the
cases in terms of acuity/severity and need for hospitalization.