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Institutional Culture of Student Empowerment: Redefining the Roles of Students and Technology

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Abstract

Student engagement in medical education is progressing beyond passive participation in instructional activities toward embracing student empowerment that will develop independent and engaged healthcare professionals. This book chapter reorients the current understanding of student engagement by reviewing the importance of an institutional culture of empowerment and students as partners. We will provide concrete examples of groundbreaking leadership in student autonomy and empowerment undertaken at Southern Illinois University School of Medicine (SIU SOM), a recipient of the ASPIRE-to-Excellence Award in Student Engagement and the ASPIRE Stella Award Winner (The ASPIRE Stella Award is to recognize commitment to excellence in various areas. SIUSOM has received ASPIRE-to-Excellence Award in curriculum development, assessment, social accountability, simulation, as well as student engagement.) from the Association for Medical Education in Europe (AMEE). The coachability curriculum is a student-developed curriculum addition of intrapersonal and interpersonal skills. Some year 4 students choose to teach our year 1 students as tutors in problem-based learning (PBL). A reformed clerkship curriculum has abandoned shelf exams and instead focuses on clinical immersion and each student’s personalized education plans based on their educational needs. Programmatic assessment has been instituted that includes a progression committee that values and integrates student-adviser discussions and remediation plans. A recent initiative has developed an educational data dashboard system to embrace the institutional culture of student empowerment through transparency. The chapter concludes with ideas to facilitate an institutional culture of student empowerment.

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Article
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Article
Opinions differ as to whether problem-based learning (PBL) is an effective form of education. Some argue that, contrary to expectation, PBL has failed to promote in students higher levels of knowledge. Others maintain that PBL is a form of minimally guided instruction and therefore less effective and less efficient than instructional approaches that place a stronger emphasis on guidance of the student learning process. This chapter reviews the results of a large number of studies, comparing the performance of medical students and graduates of Maastricht medical school to that of medical students and graduates trained in conventional medical programmes in the same country. The results suggest that students and graduates of the PBL curriculum perform better (1) on tests of diagnostic reasoning, and (2) in the area of interpersonal and (3) medical professional competencies. In addition, (4) students in the problem-based school consistently rate the quality of their education more highly than do students in conventional schools. The same applies to national bodies of experts visiting the schools. Furthermore, the problem-based curriculum (5) turned out to be more efficient and effective, as witnessed by lower dropout and less delay. No differences were found with respect to (6) acquired medical knowledge.
Medical education is rapidly changing, influenced by many factors including the changing health care environment, the changing role of the physician, altered societal expectations, rapidly changing medical science, and the diversity of pedagogical techniques. Changes in societal expectations put patient safety in the forefront, and raises the ethical issues of learning interactions and procedures on live patients, with the long-standing teaching method of "see one, do one, teach one" no longer acceptable. The educational goals of using technology in medical education include facilitating basic knowledge acquisition, improving decision making, enhancement of perceptual variation, improving skill coordination, practicing for rare or critical events, learning team training, and improving psychomotor skills. Different technologies can address these goals. Technologies such as podcasts and videos with flipped classrooms, mobile devices with apps, video games, simulations (part-time trainers, integrated simulators, virtual reality), and wearable devices (google glass) are some of the techniques available to address the changing educational environment. This article presents how the use of technologies can provide the infrastructure and basis for addressing many of the challenges in providing medical education for the future.
Book
In this book we explore how and why faculty and students can engage as partners in teaching and learning in higher education. This collaborative process may not come naturally to students or faculty. Students often come to higher education from schools that emphasize high-stakes testing, not shared inquiry. Faculty have spent years developing disciplinary expertise, sometimes in rigidly hierarchical graduate programs, creating intellectual and cultural distance between our students and ourselves. Despite these and many other barriers, many of us have cultivated pedagogical habits that treat students as active contributors to learning and in some cases practices that invite students to be active contributors to teaching. As we will show, student-faculty partnerships—through which participants engage reciprocally, although not necessarily in the same ways— have transformational potential for individuals, courses, curricula, and institutions.
Article
Abstract Student feedback is a valuable asset in curriculum evaluation and improvement, but many institutions have faced challenges implementing it in a meaningful way. In this article, we report the rationale, process and impact of the Student Curriculum Review Team (SCRT), a student-led and faculty-supported organization at the Johns Hopkins University School of Medicine. SCRT's evaluation of each pre-clinical course is composed of a comprehensive three-step process: a review of course evaluation data, a Town Hall Meeting and online survey to generate and assess potential solutions, and a thoughtful discussion with course directors. Over the past two years, SCRT has demonstrated the strength of its approach by playing a substantial role in improving medical education, as reported by students and faculty. Furthermore, SCRT's uniquely student-centered, collaborative model has strengthened relationships between students and faculty and is one that could be readily adapted to other medical schools or academic institutions.
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Programmatic assessment is an integral approach to the design of an assessment program with the intent to optimise its learning function, its decision-making function and its curriculum quality-assurance function. Individual methods of assessment, purposefully chosen for their alignment with the curriculum outcomes and their information value for the learner, the teacher and the organisation, are seen as individual data points. The information value of these individual data points is maximised by giving feedback to the learner. There is a decoupling of assessment moment and decision moment. Intermediate and high-stakes decisions are based on multiple data points after a meaningful aggregation of information and supported by rigorous organisational procedures to ensure their dependability. Self-regulation of learning, through analysis of the assessment information and the attainment of the ensuing learning goals, is scaffolded by a mentoring system. Programmatic assessment-for-learning can be applied to any part of the training continuum, provided that the underlying learning conception is constructivist. This paper provides concrete recommendations for implementation of programmatic assessment.
Article
Purpose: To understand medical students' learning experiences in clerkships: learning expectations (what they expect to learn), learning process (how they learn), and learning outcomes (what they learn). Method: Using a longitudinal qualitative research design, the authors followed the experiences of 12 participants across their clerkship year (2011-2012) at the Southern Illinois University School of Medicine. Interview data from each participant were collected at three points (preclerkship, midclerkship, and postclerkship) and analyzed using a grounded theory approach. Additionally, the authors observed participants through a full clerkship day to augment the interviews. Results: Before clerkships, students expected to have more hands-on experiences and become more knowledgeable by translating textbook knowledge to real patients and practicing diagnostic thinking. During clerkships, students experienced ambiguity and subjectivity of attending physicians' expectations and evaluation criteria. They perceived that impression management was important to ensure that they received learning opportunities and good evaluations. After clerkships, students perceived that their confidence increased in navigating the health care environments and interacting with patients, attendings, and residents. However, they felt that there were limited opportunities to practice diagnostic thinking. Students could not clearly discern the decision-making processes used by attending physicians. Although they saw many patients, they perceived that their learning was at the surface level. Conclusions: Students' experiential learning in clerkships occurred through impression management as a function of dynamic social and reciprocal relationships between students and attendings or residents. Students reported that they did not learn comprehensive clinical reasoning skills to the degree they expected in clerkships.
Article
Objectives: The University of Virginia School of Medicine recently transformed its pre-clerkship medical education programme to emphasise student engagement and active learning in the classroom. As in other medical schools, many students are opting out of attending class and others are inattentive while in class. We sought to understand why, especially with a new student-centred curriculum, so many students were still opting to learn on their own outside of class or to disengage from educational activities while in class. Methods: Focus groups were conducted with students from two classes who had participated in the new curriculum, which is designed to foster small-group and collaborative learning. The sessions were audio-recorded and then transcribed. The authors read through all of the transcripts and then reviewed them for themes. Quotes were analysed and organised by theme. Results: Interview transcripts revealed candid responses to questions about learning and the learning environment. The semi-structured nature of the interviews enabled the interviewers to probe unanticipated issues (e.g. reasons for choosing to sit with friends although that diminishes learning and attention). A content analysis of these transcripts ultimately identified three major themes embracing multiple sub-themes: (i) learning studio physical space; (ii) interaction patterns among learners, and (iii) the quality of and engagement in learning in the space. Conclusions: Students' reluctance to engage in class activities is not surprising if classroom exercises are passive and not consistently well designed or executed as active learning exercises that students perceive as enhancing their learning through collaboration. Students' comments also suggest that their reluctance to participate regularly in class may be because they have not yet achieved the developmental level compatible with adult and active learning, on which the curriculum is based. Challenges include helping students better understand the nature of deep learning and their own developmental progress as learners, and providing robust faculty development to ensure the consistent deployment of higher-order learning activities linked with higher-order assessments.
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Building upon the disruption to lecture-based methods triggered by the introduction of problem-based learning, approaches to promote collaborative learning are becoming increasingly diverse, widespread and generally well accepted within medical education. Examples of relatively new, structured collaborative learning methods include team-based learning and just-in-time teaching. Examples of less structured approaches include think-pair share, case discussions, and the flipped classroom. It is now common practice in medical education to employ a range of instructional approaches to support collaborative learning. We believe that the adoption of such approaches is entering a new and challenging era. We define collaborate learning by drawing on the broader literature, including Chi's ICAP framework that emphasizes the importance of sustained, interactive explanation and elaboration by learners. We distinguish collaborate learning from constructive, active, and passive learning and provide preliminary evidence documenting the growth of methods that support collaborative learning. We argue that the rate of adoption of collaborative learning methods will accelerate due to a growing emphasis on the development of team competencies and the increasing availability of digital media. At the same time, the adoption collaborative learning strategies face persistent challenges, stemming from an overdependence on comparative-effectiveness research and a lack of useful guidelines about how best to adapt collaborative learning methods to given learning contexts. The medical education community has struggled to consistently demonstrate superior outcomes when using collaborative learning methods and strategies. Despite this, support for their use will continue to expand. To select approaches with the greatest utility, instructors must carefully align conditions of the learning context with the learning approaches under consideration. Further, it is critical that modifications are made with caution and that instructors verify that modifications do not impede the desired cognitive activities needed to support meaningful collaborative learning.
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This article aims to review the past practices of educational technology and envision future directions for medical education. The discussion starts with a historical review of definitions and perspectives of educational technology, in which the authors propose that educators adopt a broader process-oriented understanding of educational technology. Future directions of e-learning, simulation, and health information technology are discussed based on a systems view of the technological process. As new technologies continue to arise, this process-oriented understanding and outcome-based expectations of educational technology should be embraced. With this view, educational technology should be valued in terms of how well the technological process informs and facilitates learning, and the acquisition and maintenance of clinical expertise.
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The concept of school engagement has attracted increasing attention as representing a possible antidote to declining academic motivation and achievement. Engagement is presumed to be malleable, responsive to contextual features, and amenable to environmental change. Researchers describe behavioral, emotional, and cognitive engagement and recommend studying engagement as a multifaceted construct. This article reviews definitions, measures, precursors, and outcomes of engagement; discusses limitations in the existing research; and suggests improvements. The authors conclude that, although much has been learned, the potential contribution of the concept of school engagement to research on student experience has yet to be realized. They call for richer characterizations of how students behave, feel, and think—research that could aid in the development of finely tuned interventions
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Student engagement has become a key feature of UK higher education policy and analysis. At the core of this is a notion of engagement characterised by dialogue and joint venture. The article explores this by considering the role of student representation in university governance. It focuses on the system of course representation that is a feature of most British universities. Using a small-scale, exploratory study of key stakeholders within one UK institution, it examines the context within which such representation operates. Analysis suggests that a complex interaction between cultural, social, individual and structural factors shapes the nature of representation. It concludes that enhancing engagement requires institutions to resist managerialist impulses to regulate and control course representation. Instead, they should respond flexibly and reflexively to create an environment for meaningful engagement between students and staff.
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Research on dropping out of school has focused on characteristics of the individual or institution that correlate with the dropout decision. Many of these characteristics are nonmanipulable, and all are measured at one point in time, late in the youngster’s school career. This paper describes two models for understanding dropping out as a developmental process that may begin in the earliest grades. The frustration-self-esteem model has been used for years in the study of juvenile delinquency; it identifies school failure as the starting point in a cycle that may culminate in the student’s rejecting, or being rejected by, the school. The participation-identification model focuses on students’ “involvement in schooling,” with both behavioral and emotional components. According to this formulation, the likelihood that a youngster will successfully complete 12 years of schooling is maximized if he or she maintains multiple, expanding forms of participation in school-relevant activities. The failure of a youngster to participate in school and class activities, or to develop a sense of identification with school, may have significant deleterious consequences. The ability to manipulate modes of participation poses promising avenues for further research as well as for intervention efforts.
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This article offers a theoretical exploration of the student's experience of higher education by reframing how we view this, from a focus on surface/strategic/deep approaches to learning to a focus on alienated or engaged experiences of learning. The article focuses on alienation and offers seven different perspectives on how we might understand this experience of higher education. Implications are then drawn for how, as teachers, we might respond.
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Little is known about the acquisition of clinical reasoning skills in medical school, the development of clinical reasoning over the medical curriculum as a whole, and the impact of various curricular methodologies on these skills. This study investigated (1) whether there are differences in clinical reasoning skills between learners at different years of medical school, and (2) whether there are differences in performance between students at schools with various curricular methodologies. Students (n = 2,394) who had completed zero to three years of medical school at five U.S. medical schools participated in a cross-sectional study in 2008. Students took the same diagnostic pattern recognition (DPR) and clinical data interpretation (CDI) tests. Percent correct scores were used to determine performance differences. Data from all schools and students at all levels were aggregated for further analysis. Student performance increased substantially as a result of each year of training. Gains in DPR and CDI performance during the third year of medical school were not as great as in previous years across the five schools. CDI performance and performance gains were lower than DPR performance and gains. Performance gains attributable to training at each of the participating medical schools were more similar than different. Years of training accounted for most of the variation in DPR and CDI performance. As a rule, students at higher training levels performed better on both tests, though the expected larger gains during the third year of medical school did not materialize.
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The role and contribution of students to the governance of university departments is a relatively neglected area of inquiry. This study investigated the factors which student representatives perceived to help or hinder their effectiveness as student members of departmental committees. Twenty students from a range of disciplines were interviewed about their experiences in the student representative role. Students reported complex motivations and conceptions of the representative role and were particularly sensitive to the perceptions and expectations of academic staff. Role ambiguity was the greatest challenge reported by student representatives, and the overall effectiveness of the role was perceived to be reliant on the willingness and ability of academic managers and staff to engage in constructive dialogue with students. It is argued that universities need to adopt a more proactive approach to the development and support of student leaders and representatives. Yes Yes
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Written examinations are widely used for assessment in clinical clerkships and for licensure and specialty board certification, as opposed to assessment based on actual performance with patients. This reliance on written examinations is due to their ease of use and perceived objectivity and occurs despite the fact that the examinations assess few components of clinical competence. Simulated patients can standardize the presentation of a patient problem; and, if the patients are employed in an assessment in a manner parallel to the design of written test items, the assessment can have an objectivity similar to that enjoyed by written tests. Such an assessment allows the major components of clinical competence to be tested. The results and feasibility of using simulated patients in a multiple-station assessment of an entire senior class in January 1986 are described. A second assessment was administered to a different senior class in December 1986. This latter assessment was designed in collaboration with another medical school that administered the same assessment to its senior students in March 1987.
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The increasingly popular term 'problem-based learning' does not refer to a specific educational method. It can have many different meanings depending on the design of the educational method employed and the skills of the teacher. The many variables possible can produce wide variations in quality and in the educational objectives that can be achieved. A taxonomy is proposed to facilitate an awareness of these differences and to help teachers choose a problem-based learning method most appropriate for their students.