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TBL CT David Hawkins, PharmD Professor and Dean California Northstate College of Pharmacy A soporific practice of showing powerpointless slides Encourages rote memorization Impairs critical thinking Impedes construction of knowledge Slaughters the mind Students learn how to think when they know what to think Knowledge can be transmitted directly to students Coverage is more important than depth Students will be awe-struck by your knowledge, expertise, and ability to entertain while educating the masses My observations of student laptops Medical student note-taking service Asking the same question 2 weeks after an exam The Capstone Exam Carefully crafted to test basic knowledge Administered at the end of 3 didactic years just prior to starting the 1 year experiential Average score 57.69 How do people learn? Lecture (5%) Reading (10%) Audiovisual (20%) Demonstration (30%) Discussion Group (50%) Practice By Doing (75%) “Why is it, in spite of the fact that teaching by pouring in, learning by passive absorption, are universally condemned, that they are still so entrenched in practice?” John Dewey Democracy in Education 1916, Page 46 Are you teaching your content as a skilled way of thinking? Are you teaching your content in a way that facilitates learning instead of encouraging memorization? Are you designing your instruction so that students learn how to focus on well-formulated questions or problems? Asking questions during the lecture to probe thinking Embarrasses or intimidates some students (the Pluto’s) Favors a small number of students who can answer any question(the Plato’s) After students answer question they tend to doodle (the Picasso’s) Lecturing Active Learning Lots of content Memorization Passive learning Lower order thinking Fundamental concepts Deep learning Engaged learning Higher order thinking Involving students in doing things and thinking about the things they are doing. Students learn content only by thinking through content. Activities that require students to engage in higher order thinking – analysis, synthesis, and evaluation Powerful influence of educational tradition Faculty self-perceptions and self-defining roles Discomfort and anxiety that change creates Difficulty in covering course content Increase amount of preparation time Students must do more than listen to learn. Students must read, write, discuss, or be engaged in problem solving to learn deeply. Students must engage in higher order thinking to learn content. Learning is not a spectator sport. Students must participate in the process and think about what they are doing. “Learning without thought is labour lost; thought without learning is perilous.” Confucius c. 500 B.C. What are the most fundamental concepts in my course? What do I need to do to help my students think through the fundamental concepts? What application activities do I need to develop so my students can apply concepts to learn content? What do I want my students to be able to do with the content they learn? Knowledge - recalling specific facts or general concepts Comprehension - demonstrating the lowest level of understanding 3. Application - using abstractions in concrete situations 4. Analysis - breaking down an idea or topic into its constituent elements 5. Synthesis - putting together elements to form a whole 6. Evaluation - making judgments about the value of materials and methods for given purposes 1. 2. Critical thinking involves application, analysis, synthesis, and evaluation. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Learn and apply new information and concepts Separate factual information from inferences Determine the accuracy, fairness, and relevance of information Identify and use criteria to evaluate ideas and evidence Draw valid conclusions Identify inappropriate conclusions Recognize assumptions, implications, and points of view Create new ideas and alternative solutions to problems. Formulate good questions Determine the purpose of things Analyzing Thinking Assessing Thinking Purpose Clarity Question Accuracy Information Precision Concepts Relevance Assumptions Depth Conclusions Breadth Implications Logicalness Point of view Fairness Richard Paul and Linda Elder, Foundation for Critical Thinking Determine the outcomes of CT within the discipline Choose a methodology through which students can sharpen their CT skills Allow students to process content through exercises that require analysis, synthesis, and evaluation Develop a valid, reproducible method for assessing CT skills Train all faculty how to teach for CT and how to assess CT skills 1. 2. 3. 4. 5. 6. 7. A tradition of didactic education based on the lecture and objective testing Faculty unfamiliarity with pedagogical concepts and techniques Lack of models and examples of success Too much content to cover Insufficient time and resources Requires more preparation and creativity Difficult to assess “The mind is not like a vessel for filling, but like a fire for kindling.” Plutarch c. 46 - 120 A.D. Problem-based learning Case-based learning Team-based learning PBL is an instructional method that simultaneously develops both problem-solving skills and knowledge base by placing students in the active role of solving real-world problems. Identify what is known Identify what one needs to know Formulate hypotheses Identify learning issues Research Learning Issues Present learning issues PROBLEM-BASED LEARNING PATHWAY Organization of the Visual Thinking Know Need to know Hypotheses Learning Issues Increases retention of knowledge Enhances transfer of concepts to new problems Enhances integration of basic concepts into problem-solving Enhances self-directed learning skills In PBL the problem is presented first, before students have learned basic and fundamental concepts, not after. The learning in PBL is student-directed and in CBL the learning is faculty-directed. In CBL, pertinent questions are usually formulated by faculty whereas in PBL the students come up with the questions that need to be answered to solve the problem. The learning is directed by the students Different groups of students will invariably come up with different learning issues Quite often the students fail to identify important learning issues even after a lot of probing PBL requires a lot of resources – a facilitator for each group Critical Thinking = Content (Paul and Elder) Students cannot become critical thinkers without sufficient knowledge about what they are thinking. Critical thinking must be learned within contexts and must entail knowledge of facts, rules, and processes within those contexts. (John McPeck) Preparation Pre-class Individual Study Readiness Assurance Individual Test Team Test Written Appeals Instructor Feedback Application of Course Concepts Group Assignments Michaelsen LK et al. Team-Based Learning for Health Professions Education Assigned readings Pre-recorded mini-lectures Guided learning techniques Individual Test – reinforces students’ memory of what they learned during individual study Team Test – Students orally elaborate the reasons for their answer choices and reach consensus Appeals – Teams challenge the instructor on quality of question or inadequacies of preclass assignments Instructor Feedback – Instructor responds to appeals and clarifies concepts and ideas Groups must be properly formed Students must be accountable for the quality of their individual and group work Students must have frequent and timely feedback Team assignments must promote both learning and team development 1. 2. 3. 4. What do I want my students to be able to do when they finish my course? What will students need to know in order to be able to do those things? While solving problems, what knowledge will students need in order to make decisions? What criteria separate a well-made decision from a poorly made decision using this knowledge? Significant (to students) Problem Same Problem Specific Choice Simultaneous Reporting Impact of Make-a-Specific-Choice Assignments Individual Thinking Make-a-list" •requires only low level cognitive skills (e.g. discrimination) •produces low commitment to output •portends low individual accountability "Make-a specific choice" •focuses on "Why?" •requires high level cognitive skills* •produces high commitment to output •portends high individual accountability Intra-team Discussion Inter-team Discussion "Make-a-list" •focuses on "What?" •requires only low level cognitive skill •produces low commitment to output •portends low group accountability "Make-a-list" •focuses on "What?" •requires only low level cognitive skill •produces low commitment to output •produces low group cohesiveness "Make-a specific choice" •focuses on "Why?" •requires high level cognitive skills* •produces high commitment to output •portends high group accountability "Make-a specific choice" •focuses on "Why?" •requires high level cognitive skills* •produces high commitment to output •produces high group cohesiveness Larry Michaelsen et al. Team-Based Learning for Health Professions Education Pre-class individual activity: Learn fundamental concepts from 8 page handout on pathophysiology, treatment, and prevention (8 different groups) Individual Readiness Assurance Test Scores: 20-80 Team Readiness Assurance Test Scores: 85-100 1. Prevention of recurrent gouty arthritis in a patient with a 24-hour urinary uric acid excretion > 1000mg should be accomplished with: a) colchicine b) indomethacin c) allopurinol d) probenecid 2. What would be the drug of first choice for treating an acute episode of gouty arthritis in most patients? a) colchicine b) indomethacin c) allopurinol d) probenecid Epstein Educational Enterprises Review Article on Gout from JAMA Case Study Discusses risk factors for gout including drugs that may increase serum urate concentration and therefore the likelihood of gouty arthritis in patients with a positive history 53 y/o man c/o severe pain in left big toe for past 2 days. PMH of 2 episodes of acute gouty arthritis in past 3 months, HBP for 10 years, and cholesterol problems. Currently receiving diuretic, Lipitor, and aspirin to prevent heart disease. Labs include high serum and urine urate concentration. BP is 130/80. Appropriate management of this patient’s condition should include: I. II. III. IV. Colchicine followed by probenecid Indomethacin followed by allopurinol Discontinue diuretic and start alternative BP medication Discontinue aspirin therapy a) b) c) d) e) I only II only I and III II and III II, III, and IV Purpose: To treat acute attack and to prevent recurrent attacks Questions 1. What is the most effective way to treat this patient’s acute attack? 2. What is the most effective way to prevent recurrent attacks in this patient? 3. What adjustments, if any, need to be made to this patient’s other medications? Concepts Pathophysiology of gout Treatment of acute gouty arthritis Prevention of recurrent gouty arthritis Risk Factors of Gout Aspirin to prevent heart attacks Information 1. Either colchicine or indomethacin can be used 2. 3. 4. 5. to treat acute attacks. Colchcine’s effectiveness diminishes 48 hours after onset of pain. Either probenecid or allopurinol can be used to prevent recurrent attacks. Probencid increases urinary uric acid excretion. Diuretics and adult doses of aspirin increase serum urate concentrations. Assumptions Colchicine will not work in this case Patient is at high risk of acute gouty arthritis Patient’s BP can be controlled with alternative antihypertensive therapy Baby aspirin will not significantly increase serum urate concentrations The lecture transmits information, not knowledge Knowledge must be constructed in the minds of students Knowledge construction requires critical thinking Active learning strategies promote critical thinking TBL is an efficient pedagogical frame for engaging students in critical thinking and active learning