Are they getting it?

By David Taylor, Ed.D.

Every once in a while, new technologies come along that create a fundamental change in the way we perform ordinary tasks. Think of the cell phone or the iPod – chatting with friends and listening to music have never been the same. Through the Medical School’s Office of Educational Programs, two new technologies, one in the classroom and another in the clinical arena, have made an appearance over the last year and are quietly bringing about innovative changes in traditional aspects of medical education.

Encouraging interactive lectures

When we think back on our college years – the academic part anyway – we probably think of lectures – the tried-and-true delivery method that remains the cornerstone of medical education. PowerPoint slides and video have replaced the blackboard and Kodachrome slides, but students still sit in the lecture hall and absorb knowledge spoken by a professor. The operative word here is “absorb,” as in a sponge. It’s basically a passive act.

From time to time, the lecturer might ask a question and some intrepid soul will venture an answer or – rarer still – ask a question on his own. With 230 first-year students in one class, the level of interaction is, by necessity, very low. And what lecturer hasn’t wondered uneasily, “I know I covered all the material, but are they really getting it?”

Too often that lecturer has been stunned to find – hopefully from a student’s chance remark, but more often from the results of a midterm or final exam – that they weren’t getting it at all. What if that lecturer could pause every once in a while and find out, from every student out there, whether they really understood the key concept in that last set of slides?

Now a relatively low-cost technology is, for the first time, turning the lecture at UT Medical School into a two-way street. The Turning Point Audience Response Systems (ARS) allows the lecturer to throw questions out to the students so that all of them can reply electronically. The result of this polling is instantly tabulated by the software and projected for all to see as full color graphs within the lecturer’s own PowerPoint presentation.

The response is electronic

The effect on a classroom lecture is electric, and a bystander can feel the energy level rise in a class during the polling sessions. After attending an Educational Programs workshop, Darren Whittemore, D.O., dermatopathology fellow in the UT Dermatology program, began using the ARS with groups of 20 to 40 residents.

“You know if they’re getting it, because you can see right on the screen how they answered, and how many responded,” he says.

Dr. Whittemore teaches a diverse group that includes medical students, residents, and fellows from Baylor and UT, and he takes advantage of their innate competitiveness. He forms teams – such as Team Baylor or Team UT, or first- versus second- versus third-year residents – and the software allows him to present team results as the quiz progresses. Although an individual student’s responses can be displayed in front of the whole class, Dr. Whittemore believes answering as part of a “team” promotes the safe and “fun” aspect of interaction.

It is a hallmark of a powerful new idea that users who adopt it soon come up with variations and refinements that even the inventors had not considered. And the most powerful technologies change the very nature of the process they were intended merely to enhance. David Marshak, Ph.D., professor of neurobiology and anatomy, who lectures in the first-year Gross Anatomy class, uses the ARS to give a short quiz over the required reading at the beginning of his lecture. Not only does this quiz provide incentive for students to read assigned material before class – a crucial aspect of learning, according to Dr. Marshak and most faculty – but it allows him to tailor his lecture on the fly, identifying material the students might not have picked up from their reading.

Alison Barrow, first-year medical student, says, “I loved how Turning Point was used in our anatomy class, and wish there was uniform usage of the program within and even spanning across different departments. It was great knowing either that I was ahead of the curve, or that other people were having the same problems mastering the material that I was.”

She echoes Dr. Marshak’s contention that it gives useful feedback to the faculty: “It also made lecturers aware of problem areas, and often Turning Point clued them in so they could take the time to re-explain a topic they did not originally know was confusing.”

A sound pedagogy is behind the technology. Dr. Marshak notes that, “Being engaged, having someone ask you a question and trying to answer it, is by far the best way to learn the material.”

That, in a nutshell, is the definition of active learning, arguably the most effective approach to teaching at any level – and a new cornerstone of today’s medical education.

Tracking learning

Time tracking and evaluation sounds like pretty dry stuff, until you consider the hectic life of a medical student. When students enter the third year, they begin their clerkships, in which they rotate through outside clinics and teaching hospitals. As some would have it, their real medical education begins at that point.

Yet with students no longer in class, tracking the progress of their learning experience becomes more important, and obviously more difficult, than ever. In didactic courses, exam scores clearly inform students and faculty alike if students are “getting it.” But clerkships typically have only one exam, at the very end of the rotation. The clerkship director, who has ultimate responsibility for what students learn under his or her watch, depends on subjective evaluations of the students by their supervising physician. Exposure to real disease states and mastery of medical procedures is vital to becoming a doctor, but verifying that aspect of learning has always been difficult.

“Years ago we just sent them off for a month in the hospital or outpatient clinic, and we expected them to learn all they could in that month,” says Mark Hormann, M.D., associate professor of pediatrics, and an early proponent of the computerized tracking system known as One45. “There was no real expectation about what they were supposed to see, we were just hoping they would see enough so they could pass their test and be experienced.”