Reflecting on reflections

I was looking back at my notes and comments from our classes and there are distinct themes that stand out for me. I would like to classify these themes that emerged for me as the with the hidden curriculum of the course for me.

Preamble:

To begin with I was not sure how I would fit is; as I don't see myself as an active philosopher, but enjoy listening to philosopher's arguments and presentations. Was I looking though a lens and reserving my thoughts and views? It was almost a room of awe that I have often glimpsed at but never have the nerve or courage to step in and imbibe the dimensions of that space. After progressing through the year one of UTC I was confident to push myself to the next level. I had groped around and dabbled with the different methods and intricacies of teaching and had reached a space where I could see the influences of these course in my teaching philosophy. My mentor took the time to explain and give me material to read on to understand the result of the baseline tests. It opened my eyes to the type of teacher I am and how I could develop it further. My baseline tests have changed dramatically from before and after year one. I had a more balanced approach in the post tests. 

Blog one and metaphors: This was a great start; to go into the depths of what we see our students as and how we balance it as teachers. As a class we came up with very varying metaphors, octopus and sea voyagers; owl and chimpanzees, waiters and diners, coach and athlete and sheepdog and grazers. Overall, we the teachers were the guides in more or less structured learning environments. The management of the role as teachers and the infusing the learning environment with stimuli that generated learning out of hidden caves, creating opportunities to climb to new heights, providing different flavours and textures that may scintillate learning,  developing relationships where the students are willing to share and exchanges ideas while the facilitator is actively modulating the exchange within a safe environment and keeping in line with the relevance of the outcomes of the course. We claim to be are very involved teachers who respect and value the impact and responsibilities as teachers. Over the length of the blogs we supported our claims with evidence; we made an attempt at grounding the claim in critical reflection. The metaphor aligned with my philosophy of adult education (humanistic and progressive). This was our initiation into scholarly teaching.

Class two: questions, assumptions and rationale: A question that meets all the Rasmussen characteristics. In our blogs we teased out the assumptions and looked for evidence and relevance of the questions. Inquiry based learning and critical thinking set the direction toward a more autonomic learning environment. Definition of a course may need to be made explicit before the structure can be made sense of and every question has underlying assumptions that need to be addressed. These assumptions define the question and the rationale could be completely reflective but once it is based on relevant evidence you add value to the question. This was our initiation to the challenge phase.

Class three: research methodology was the theme I received from this class. Determining reliability, relevance and acceptability of the claims made in the references we used. I learned that if you could find even one falsifying evidence, then the claim hold no grounds. The logic of sound, justified claims is more in the relevance to support the claim. The logic that implied being that if the premises are right then the claim is right. We were challenged to support out claims with relevant and reliable research material and not accept all the evidence presented as absolutes. The challenge continues....

Class four, five & six: Do all of us have the same definition of what education is and how do we define it? This class rocked me and urged me to think of what am I basing my life's work on? Can we justify our belief as the truth?  The challenges at this point were deep and brutal. Why do we believe what we believe? what justification can we provide to support our belief and is that the truth..? Does acquiring education equate to being wise? At this point I looked at the learning methods and how learning could be deep and how it could be carried through to our daily activities if the learning was internalized. This theme continued in class 5 and 6. By then I realized that my belief is riddled with absolute facts and jargon; which, is not so absolute or clear for the recipient. The only way to make it obvious is to sometimes break the sequence into separate events and justify each. We continued to look at the connotations, implication and denotations associated with words we use. 

Class seven: We had a session of live blogging and receiving the feedback was interesting and insightful. At this point in our blogs we had explored the teachers we are and challenged how and where we could match the expectations we have from within out. What I found astounding was that each of us from such varied disciplined had identified the values and attitudes that could apply across the broad. That spoke to how education is knowledge, values and attitudes; irrespective of the discipline.

Class eight: revolving around the developmental piece for me was to develop a skeptical outlook toward what I read and come across. I had to change my lenses here; where knowledge is white light and the spectrum of colors being its application to knowledge being a kaleidoscope where these colors are combined in different changing shapes. The students bringing in their own knowledge base, adds more and more facets to the knowledge piece. Do I understand the changes and can I justify the direction of change and can I predict the next pattern formation or should I? What is my role as an educator? Can I add more color and throw in the skills and attitude with intention in a predetermined manner. Are we developing with the curriculum we develop?

My peers blogs took me through the theories of Plato, Socrates through the matrix  and aspects of training versus teaching, competencies and attitudes and how they apply professional courses. Various aspects of constructivism and positivism. Tranformational learning and reflective teaching and being a reflective teacher. I have so much more to reflect on. The last blog feedback on how much I want to incorporate as part of my philosophy so that I could model the behaviors.  I have gone back to my philosophy of apprenticeship and progressive teaching behaviors. Can the assessment tasks capture the beliefs, knowledge, values, attitudes reflected in the learning objective and demonstrated in the learning environment? I am now in a space where I can fuel my passion of teaching with appropriate values system that will definitely have a strong influence on teaching.

hidden curriculum

In the absence of being in class last week I was looking for direction to write up my blog and received it from the feedback from Jules and the blogs posted this week; hence the late post. I have evidence from the blogs to infer that one of the topics I missed last class was the hidden curriculum; which, ironically was what I wanted to hear about the most. 

So I went about researching hidden curriculum in medical education. I hit a very interesting article by B. Michalec describing how the curriculum had changed over the years to incorporate the hidden curriculum. What I found most fascinating is how a gap is built between the medical student and practitioners’ population with the rest of the population. The hidden curriculum is meant to bridge this gap. The author based the observation on interviews conducted with 1^st and 2^nd year medical students.  This gap as suggested by the author is brought about by developing the medical expertise and knowledge.  The students repeatedly get primed by medical educators that they are an elite group and the language and culture is different within. The author continues to comment on how hidden personal, cultural and gender clashes aired by the educator are carefully viewed and teased before the opinions are accepted or thrashed by the students. This takes me back to the question of how much of the hidden curriculum are we as educators practicing and internalizing before we expect the students to?

In my last blog I did touch on how the competencies are applicable even to me as an educator. I feel the need to develop these aspects as a teacher before teaching the philosophies to the students.  I definitely have an apprenticeship and developmental model when it comes to my teaching philosophy. Hidden curriculum are learning outcomes that are not explicit buy implied?..thanks Jules. Key features of the hidden curriculum in medical education are incorporating all the competencies associated with training to be holistic medical practitioners.  These competencies should potentially bridge the gap between the medical professional and the patient. For example: strong communication skills talk about being able to explain a medical condition at the level of grade 5. So when students prepare presentations that is one of the expectations of the language to be used to avoid medical jargon. Collaboration with other professionals gives a chance for students to understand the scope of other professionals they work with so that common goal of patient care is achieve efficiently. Professionalism however is not a simple word and has to be understood as suggested by Hodge; but, determined by personal, interpersonal and societal values. Considering all three domain are in flux assessment of professionalism needs to be multidimensional.

The questions I wish to continue with are how do my personal ethical practices influence the internalization of the competencies? How best can I walk the talk? I am challenging myself to be the educator that can explicitly and implicitly integrate the competencies expected to my students within the walls of the anatomy teaching modules.

1.      The pursuit of medical knowledge and the potential consequences of the hidden curriculum; Barret Michalec; University of Delaware, USA. Health;16(3) 267–281,© The Author(s) 2011,Reprints and permission: sagepub.co.uk/journalsPermissions.nav; DOI: 10.1177/1363459311403951.

2.      Assessment of professionalism: Recommendations from the Ottawa 2010.Conference; BRIAN DAVID HODGES et.al.

Blog 8

My original inquiry was: Why and how is it important for medical experts to be intellectually curious, intentional and mindful professionals? 

Over the weeks when I looked through the evidence and the implications surrounding this claim; I have revised my claim to read as the following:In the field of medical education; competencies such as communicator, collaborator, manager, health advocate, scholar and professional have risen as priority items to be deemed as facets that augment the medical expert.  

The demand for these competencies has emerged from societal expectations, as well as, the need for physicians to be equipped with the attitudes and skills needed to flourish in the system. Thus it is meaningful and relevant to the cliental and the society they serve. As a teacher, expertise of the subject is rarely sufficient to be a viable teacher. The competencies associated with the role such as compassion, communication, collaboration, student advocate, manager and professionalism are attitudes and skills that add to the characteristics of being an effective and affective teacher. If we explicitly emulate these characteristics in the process of teaching, we actually create a learning environment that is infused with these attitudes. The attitudes however, are not charged ions and cannot be absorbed by the students unless the students are primed with receptors (awareness). Similar to what we see with medical education. The competencies have to be emulated with exemplars that are radical and informative at the same time to catch the attention of the audience and transend into a transformational learning.

Transformational learning is learning that becomes a part of the learner. Learning environments that foster critical thinking, reflective practices, creative and experiential learning evokes transformational learning. The kind of experiential learning provided with a dissection lab (as described in my second blog how more that anatomical details are learned here), standardized patients (as described in previous blogs that students realize the magnitude of personalized communication and doctor-patient relationship), SIM lab (where automated  mannequins that simulate various clinical conditions are mimicked) students experience the whole idea of thinking quickly and sharply to make the appropriate decision to deal with the crisis. 
So far we have the learning objectives (LO) mapped to the teaching methods. The next stage is the assessment of the skills and attitudes. The direction to the competencies if outlined in the LO draws the students attention to it. If the teaching methods emulate the appropriate competencies explicitly, then students then feel more prepared to embrace the competencies. When students express the competencies if they are rewarded with repeated affirmation these competencies could be conditional responses. 

Assessments to measure the learning can be multilayered. The cognitive domain could be coupled with the affective domain. Generating rubrics do not completely irradiate personal biases of the assessor but does limit the chances of the results being shadowed by them. Until such time as robots will assess these domains it is not possible to eliminate the personal opinions and biases compeletly.  

Thus, I infer that information is the logos that make logical sense of why they are learning what they learn. When competencies are integrated into the learning we add the pathos aspect and we filter the product of logos and pathos with ethos to remove personal biases and misconceptions. 


Thank you peers and profs for your feedback, which, contributed to my thinking process.

Blog 7

The previous comments from my peers sent me on a search on measurements of professionalism, internalization of professionalism and whether professionalism is a cognitive or behavioural skill.

Internalization of professionalism is what I believe is the affective nature of the assessment component. I was looking the most popular mode of assessment for various levels of medical education (at the undergraduate and post graduate levels). There are several assessment modes including both formative and summative assessments. MCQs exams are one of the popular modes of assessment. Can MCQs be used to assess the affective domain? I would say yes, if the question is well structured and the distractors are well thought out. But does point to the internalization of the attributes? I would think not. Where and how can we even see an internalized behaviour playing out in front of the patient or peers? Peer reviews may be a better measure; as well as, repeated formative feedback during clerkship could illicit an actual observation of internalized professionalism.  I do not think any of the existing methods fully assess affective domains but could be a combination of various assessment tools including self reflection. I came across an article which described residents have a self reflective paper presentation on the "patient of the week". Where they discuss why it stood out and what diffuculties they came across as professionals.

As I was researching for a methodology of some kind I came across transformative learning and Jungian psychology⁴. “A learning in which we become fully aware of who you are, we are more fully able to enter into the community of humans. This is transformative learning, the emergence of self.” TPST is coxing us to do the same. When we are attempting to teach values that can be integrated in to the students’ inner being we are expecting transformative learning to occur. The more I read about it the more I would like to apply it. As the description implies it does push you to you uncomfortable zone, question the taken-for granted facts and figure out if the concepts or facts are warranted. I feel like that is what the exercise last class was pushing us to do. I would like to take the time to develop this skill and evaluate the claims in a more skeptical manner. Definitely a skill I need to work on.

Back to my question, the direction I would like to pursue is the following:

Professionalism and ethics:

Aspects of professionalism and ethics I would like to explore here are the following:

Nurturing and educating budding physician on the various competencies have a direct impact on the society they serve. My stand here today is that these competencies prepare the students to believe in their learned judgement calls. It also prepares them on the actions to be taken if a professional error has occurred. This confidence in being aware of how to handle the non-expert aspects of medical care renders a more positive work environment¹.

Clinical ethics tie in with professionalism and health advocate. “Competence in clinical ethics depends not only on being able to use a sound method for analysis, but also on familiarity with the literature of medical ethics².”

Paradigm as published on University of Washington School of Medicine website: http://depts.washington.edu/bioethx/tools/4boxes.html

Medical Indications: Consider each medical condition and its proposed treatment. Ask the following questions: Does it fulfill any of the goals of medicine? With what likelihood? If not, is the proposed treatment futile? Patient Preferences: Address the following: What does the patient want? Does the patient have the capacity to decide? If not, who will decide for the patient? Do the patient's wishes reflect a process that is informed? understood? voluntary? Quality of Life: Describe the Patient's quality of life in the patient's terms. What is the patient's subjective acceptance of likely quality of life? What are the views of the care providers about the quality of life? Is quality of life "less than minimal?" (i.e., qualitative futility) Contextual Features: Social, legal, economic, and institutional circumstances in the case that can: influence the decision be influenced by the decision e.g., inability to pay for treatment; inadequate social support

I have not come close to completion for this post but only got to the point to even a concept map of where I am heading. I need to research further.

1.     Positive Role of Professionalism and Ethics Training in Medical Education: A Comparison of Medical Student and Resident Perspectives; Laura Weiss Roberts, M.D.; Katherine A. Green Hammond, Ph.D.; Cynthia M.A. Geppert, M.D., Ph.D.; Teddy D. Warner, Ph.D.; Academic Psychiatry 2004;28:170-182. 10.1176/appi.ap.28.3.170.

2.     Albert R. Jonsen, Mark Siegler, and William J. Winslade, Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, 4th edition. New York: McGraw-Hill, Inc., 1998.

3.     Krupat, Edward PhD; Dienstag, Jules L. MD Commentary: Assessment Is an Educational Tool; Academic Medicine: May 2009 - Volume 84 - Issue 5 - pp 548-550; doi: 0.1097/ACM.0b013e31819f7fb9

4.     http://www.scribd.com/doc/26451894/Transformative-Learning-in-Practice-Insights-from-Community-Workplace-and-Higher-Education