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Back to personal page User: Donna Joyner

Project description

I would like to develop a course activity that contextualizes content learned in first and second year medical school coursework in the subject of Neurology that involves looking at cases of illness that would involve small group collaboration.

Needs Assessment

Describing the ideal

The ideal for my mini course is to provide two instructional opportunities for the students. The first is to give the students a chance to become familiar with illnesses that pertain to the body system when they are in the midst of learning the physiological details. If has been shown that expert physicians use a strategy called illness scripts when they practice medicine. Illness scripts are schema based on experience with patients who the expert physician have seen over the years. These experiences have taught the expert physician how the illness presents itself and how it usually proceeds. There is very little usage of physiologically detailed knowledge when diagnosing patients (Schmidt 2007). By introducing students to case studies based on actual patients and their illnesses, they will have the opportunity to begin the process of acquainting themselves with common illnesses. The second advantage would be to provide student a way to contextualize the didactic knowledge they are receiving at the same time.

Describing the reality

Learner characteristics: Medical Students are adult learners. They are Masters level graduate students. They are highly functioning students with excellent memory, metacognition, self regulating and test taking skills. They have had to prove themselves as such to gain admittance into Medical School. They have also had to demonstrate that they have empathy and the higher ideals needed to serve people in such an intimate way. In terms of prior knowledge, medical students are required to have participated in some form f health care delivery experience as a condition of entry into medical school. This is usually in the form of volunteering. They usually have an undergraduate degree in a related science, but not always. The medical student appears to be highly motivated. They come in with an academic record on being on or near the top of their class. Achieving high grades are very important to them and they tend toward academic competitiveness. Being a physician is high regarded and well rewarded in our society, so medical students have that extrinsic motivation to succeed as well. It is this very motivation that I am counting on in the design of my module.

Context analysis: The first two years of medical school are spent in didactic instruction, where the students study the entire body in detail. This instruction is primarily given in lecture, organized into units based on body systems and tested at the end of the unit. In the third year the student is then transitioned into clinical practice. They join physicians and their accompanying health care team in actual patient care settings with patients. Each student spends 10-12 weeks in different subspecialities to be able to experience all the types of physician they could be. In the fourth year they must make a decision as to which subspeciality they would like to enter in order to apply for a Residency – which is another four year paid apprenticeship they will need before they can obtain the license. The transition from the second to third year of medical school is abrupt. The students leave one instructional paradigm behind and must embark on another. The context constraints are primarily the considerable time and effort medical students need to devote to their studies in order to be successful. There is an overwhelming amount of content to cover and master. Although these are high achieving, high performing students, the cognative load is high and I question not only how much of this information makes it into long term memory, but also how much is ultimately needed in the expert practice of medicine. But adding any additional instruction into this curriculum is not practical or feasible. This is why I envision my mode and a voluntary self study.

My Goals

My goals are to facilitate higher cognitive learning by contextualizing didactic information Bransford 2000) in the actual practice of medicine, which ultimately is based on schema of known illness rather than physiological details of the body (Schmidt 2007). Another goal is to provide individual medical students an environment where they must work in teams to solve problems. This mimics the actual environment in which they will work. Diagnosis of illness is a problem solving process where solutions can be elusive. Patients present with symptoms and past health and family histories and it's up to the physician to decipher what the problem may be. Working with other members of the health care team is an important function for physicians trying to diagnose illness. So along with contextualizing what students are learning in their coursework in order to effect better outcomes both in short terms tests and in long term information retrieval, I also would like to add simulated experience that is relevant to their future practice, that is, experience with illness and also problem solving through team work.

Bransford, J. D., Brown, A. L., & Cocking, R. (2000). How People Learn: Brain, Mind, Experience and School. Washington D.C., National Academy Press.

Schmidt H. G., Rikers, M.J.P. (2007). How expertise develops in medicine: knowledge encapsulation and illness script formation. Medical Education 2007, 41, 1133–1139.

Learning Objective

Situation: Case studies of ill patients Learned capability: generates (Higher Order Rule – Problem Solving) Object of learned capability: illness diagnosis Action: in writing Special constraints: Must be in the form of a SOAP note

SOAP stands for Subjective, Objective, Assessment, and Plan. It is the standard form of medical notation for the patient record. The Subjective part contains the symptoms presented in the patients own terms. The Objective part contains diagnostic information, such as vital signs and lab tests. The Assessment part contains a lists of possible diagnosis in order of likelihood. The Plan is the actions the physician will take to address the problem.

Task Analysis