in Large Group Settings Sarah Williams, MDJames N. Lau, MD

Medical Education Scholars Program

Also thanks to:

Lauren Anderson Iman Ghaderi Abbas Hyderi Kathryn Roth

Goals & Objectives

By the end of this workshop participants will be able to: – Describe the effectiveness of active learning in a

large group setting – Appraise different methods of active learning – Discuss facilitators and barriers to implementing

active learning in a large group setting

Means: Active Participation!

Kolb’s Learning Cycle

Image Adapted From: http://www.ldu.leeds.ac.uk/ldu/sddu_multimedia/kolb/static_version.php

Concrete Experience [having an

experience]

Reflective Observation [reflecting on experience]

Abstract Conceptualization [learning from the

experience]

Active Experimentation [trying out what

you have learned]

Evidence: So What, Who Cares?• Prince et al, 2004– Meta-analysis – Data showed significant gains in measured

performance (effect sizes 0.31-0.54)– Scores up to twice as high– Improvement in both simple & complex concepts

More Evidence• Also large gains in deeper measures– Improved academic performance (0.51-0.64)– Improved perceptions of social support (0.54-

0.70)– Improved retention (0.46)– Improved attitudes (0.55)

Prince et al, 2004

Why Does It Work?• Attention span– Attention span ~15 minutes• 70% retained from first 10 minutes of a lecture• 20% retention from last 10 minutes

• Enhances student involvement – Significant indicator of future success

• Allows correction of misconceptions

Hartley & Davies, 1978

All are mechanisms that increase engagement both with the content and with colleagues

IT WORKS!

Cooperative Learning

Cooperative Learning Examples

Think-pair-share

Think-write-share

Buzz groups

Cooperative Learning Examples

Pros: short time commitment; engages group…

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Team Based Learning (TBL):/www.utexas.edu/academic/ctl/largeclasses/ - tbl

TBL Section: LayoutGroup Formation

I-RAT

T-RAT

Group Application Exercise

Debrief

Image Taken From :http://foodedlearningcommunity.blogspot.com/2010/07/team-based-learning.html

TBL – Paradigm

TBL: DebriefPurpose of IRAT/TRAT?

Purpose of Group Application?

Is TBL learner-centered?

Image Taken From: http://learnification.wordpress.com/2011/03/23/two-stage-group-quizzes-part-1-what-how-and-why/

A Case-based, Peer-Led Demonstration

Just-in-Time Teaching (JiTT)

JiTT: Review Online Assignments

3 methods to treat hyperthyroidism Medication to control secretion Radioactive iodine ablation Surgical removal of half or total

thyroid gland

JiTT: Review Online Assignments

Considerations for surgery:Medications ineffectiveNon-compliance with medicationsPatient choice

i.e. avoid radioactive iodineVery large nodule/glandRisk for thyroid cancerCompressive symptoms

difficulty swallowing, breathing

JiTT: Review Online Assignments

Areas of difficulty/confusion:

Most interesting aspect of reading:

54 year old woman with weight loss, palpitations, mild difficulty with swallowing

Her blood tests reveal the following:TSH <0.04 (normal 0.35-5.5 uIU/mol)FT4 1.52 (normal 0.7-1.80 ng/dL)

FT3 0.8 (normal 0.2-0.5 ng/mL)

In-Class Application

Ultrasound: Right Thyroid Nodule with hypervascularity

Nuclear Medicine Thyroid Scan: Increased uptake in right-sided nodule, suppression in the remainder of the gland

CASE SUMMARY

54 year old female

Symptoms: Hyperthyroidism, Mild Compressive symptoms

Blood tests: Hyperthyroid

Ultrasound: 3cm nodule in Right lobe with increased vascularity

Thyroid Scan: Hyperfunctioning nodule in right lobe

Fine Needle Biopsy: Intermediate risk for thyroid cancer (~15%); but no clinical risk factors for thyroid cancer

INDIVIDUAL RESPONSE

What is the appropriate management?

A. Right hemithyroidectomy

B. Total thyroidectomy

C. I131 radioactive iodine ablation

D. Thyroid suppression medication

Individual Response

What is the appropriate management?

A. Right hemithyroidectomy

B. Total thyroidectomy

C. I131 radioactive iodine ablation

D. Thyroid suppression therapy

CASE SUMMARY

54 year old female

Symptoms: Hyperthyroidism, Mild Compressive symptoms

Blood tests: Hyperthyroid

Ultrasound: 3cm nodule in Right lobe with increased vascularity

Thyroid Scan: Hyperfunctioning nodule in right lobe

Fine Needle Biopsy: Intermediate risk for thyroid cancer (~15%); but no clinical risk factors for thyroid cancer

GROUP RESPONSE

What is the appropriate management?

A. Right hemithyroidectomy

B. Total thyroidectomy

C. I131 radioactive iodine ablation

D. Thyroid suppression medication

Group Response

What is the appropriate management?

A. Right hemithyroidectomy

B. Total thyroidectomy

C. I131 radioactive iodine ablation

D. Thyroid suppression therapy

Just-in-Time Teaching (JiTT)

A teaching and learning strategy based on the interaction between web-based study assignments and an active learner classroom

Structures students’ reading before class

Provides feedback so the instructor can tailor the PI questions to target student difficulties

JiTT: Process

Topic 1: Reading

Assignment

On-line assignmen

t

Review Feedback

Address difficulties in class

Repeat with next

topic

2 conceptual questions

Online assignment In class Application

JiTT: Just-In-Time Teaching Benefits:

Maximize efficacy of classroom session so faculty and learners interact

Structure out of class time for maximum learning benefit

Create and sustain peer interaction

Novak & Middendorf, 2004

Peer Instruction (PI)Interactive teaching technique

Gives real-time feedback

Promotes classroom interaction to engage students and address difficult aspects of the material

Allows students to learn from each other

Students need to come to class with some basic understanding of the material

Crouch & Mazur, 2001; Mazur & Watkins, 2009

Peer Instruction (PI)

Pre-Reading• In order

to free up time during class, learners are assigned readings to complete prior to class

Mini-Present-ation• A

lecture is divided into short “mini-presentations”

• Each is focused on a central concept

Individual Test (Concept Test)• Multiple

choice question

• Addresses difficult material

• Individual commits to a answer

Small Groups• Learners

break into small groups and discuss their answers

• Trying to convince others that they are correct

Individual Re-Test • Learner

s answer the same question again [often chang-ing their answer]

Lecturer Goes Over “Correct” Answer(s)• Imme-

diate feed-back is given

Peer Instruction Types of Questions: • General theory • Apply concepts in different

contexts• Demonstrate how different

concepts are related

Notes about the Questions: • There does not need to be a “right” answer• All answers must be plausible • Make sure it is not too easy- must require higher order

thinking

Gallery Walk

Gallery Walk is a discussion technique that gets students out of their chairs and into a mode of active engagement

-Mark Francek

https://sites.google.com/a/mst.edu/certi/flc-active-learning/gallerywalks

Process

Before Class

-Create questions-Break learners into groups (3-6) -Write questions on large pieces of paper and spread around room

Setting Expectations

-Give clear directions -Colored markers -Learners assign roles

During Class

-Assign beginning station to each team -Groups rotate to each station -Instructor as facilitator

Synthesis

-Each group summarizes and synthesizes material -Oral presentations

Francek 2006

ModificationsGallery Run

Questions usually have concrete answers

Don’t need as much discussion

Don’t need to spend as much time at each station

Computer Tour Learners looking at

visuals rather than answering a question

Francek 2006

Assessing a Gallery Walk Different ways to use formative and/or

summative assessment

Can assess:Teamwork [peer evaluation]Oral presentations [rubric]Overall participation [yes/no]

ExamplesLearners write a pro and con about the

following controversial topic: Supplemental Nutrition Assistance Program (SNAP) cannot be used to purchase “empty calories”, e.g., chips, cookies, colas

Prepare a list of criteria for reducing the risk of heat related illness for inner city elderly. Prioritize the list and justify your rating

Benefits Teamwork:

Work in teams to synthesize information written from different groups/points of view

Flexible method: Can change time allotted, types of questions, amount

of questions

Promotes use of higher order thinking:Analysis, synthesis and evaluation

Encourages alternate approaches to problem solving

Gauge student misconception

Francek 2006

Kolb’s Learning Cycle

Image Adapted From: http://www.ldu.leeds.ac.uk/ldu/sddu_multimedia/kolb/static_version.php

Concrete Experience [having an experience]

Reflective Observation [reflecting on experience]

Abstract Conceptualization [learning

from the experience]

Active Experimentation [trying

out what you have learned]

Supporting Evidence• The following are

summaries of some important studies that confirm the efficacy of active learning strategies– Resources for you to use

with your colleagues and administrators

TBL Impacts on Performance• 178 students achieved 5.9% (>1 SD) higher

mean scores of pathology content with TBL strategy

– Students in the lowest quartile of the class benefited most (7.9% higher, SD 6.0)

–However, highest quartile group also showed sig gains (3.8%, SD 5.4)

Koles et al, 2010

TBL Impacts on Performance

• Over 20 years, over 99.5% of the teams have outperformed their best team member with an average of nearly 14%

• The worst team typically outperforms the best individual student in the class

Michaelsen et al, 1989

Improved Retention: PairsStudy: • 45 minute lecture broken up three times with 2

minute breaks• Students paused to clarify their notes during the

breaks

• Control: standard lecture

Conclusions:• Tested short term retention with free-recall exercise

immediately after: 108 vs. 80 correct facts

• 1.5 weeks later: long term retention: MCQ test: 89.4 vs. 80.9; 80.4 vs. 72.6 (72 students total)

Ruhl et al, 1987

Enhanced SynthesisStudy: • 256 first year med students learning physiology• 50 minute class divided into 3-4 sections, with short

presentations of 12-20 minutes

– 1 MCQ given on subject just presented • Simple recall & complex reasoning

– 1 minute to think/record first answer– 1 minute to discuss and possibly correct

Conclusions:• Percent of correct answers improved for both recall and

intellectual questions after discussion• Enhanced level of understanding/synthesis

Rao & DiCarlo, 2000

Deeper UnderstandingStudy: • Over 6000 students in intro physics courses

Conclusions: • Sig improved performance found with higher

interactive-engagement methods• Test scores measuring conceptual

understanding: approximately twice as high than in traditional courses – 2 SD above that of traditional courses

Hake, 1998