Stacey Poznanski, Chris Chapman, Sally Stanten, Meg Wolff

CGEA 2013 – Cincinnati, Ohio

Normal lectures with a power point presentation full of bullet points does not lead to long term retention. We need to start with the acknowledgement of this fact. This inefficaciousness begs us to do something differently. We can still use the lecture format, but need to to make it more effective. If we can incorporate some of the higher order activities in the pyramid: demonstrations, discussions, practice and even teaching into our didactic sessions we can improve the efficacy of our sessions, making the time spent more worthwhile for students and teachers.

A study of attention during lectures has shown that the attention is the highest in the first 10 minutes and the last 4 minutes of a lecture. If we can reset attention span every 10 minutes by interspersing activities within, there may be more retention. Role play. Content overload (data emesis). Don’t put all the words on the slide. Streamline your message into 4 main points. Get away from your computer, do it away from the computer, come up with the points, then come back to the computer at the end. The only thing the people learn from spoon feeding is the shape of the spoon.

This starts with backward design: identify the desired results first, then determine the way to accomplish this. Starting with objectives which are broad, in lecture we give students the context to approach the material later. We don’t want memorization to occur in lecture.

**Commitment activity**. Get students to commit to an answer. This forces them to activate their prior knowledge. This can be done just with raising hands, using poll everywhere or even raising up colored cards, but you need to make it such that everyone votes. Everyone needs to participate.

Other ways to make it **interactive** is to use facilitated discussion: pose a question and have them answer.

**Backward design**. Start with the end in mind, the objectives, then design the learning activities from there. Try to use higher order learning objectives from Blooms taxonomy.

Using the **jigsaw technique **allows students to teach one another. Each student is responsible for only a small piece, and together the group teaches the whole thing. So ask your students to…

- Divide a task into a few components and assign several students to each component
- First ask the student think about their component piece by themselves
- Then assemble the students with others assigned the same piece to discuss. These are the
**expert groups**. There will be one expert-group per component piece. - Next each expert leaves the expert-group and joins a
**small group**. The small group has one student per component piece. Together, they make the whole. Each student teaches the small group their part.

**Technology** can be used for simple assessment. The poll everywhere site is good for remember and understand verbs. On the Learning Activity Management system (LAMS) website, everyone participates anonymously. They all answer even if the answer is “I don’t know.”

**A worked example**

This is probably best illustrated by an example. For the lecture on Toxicology, I would first need to break the topic into the broad ideas that the student should gain from this. Keep this number small, remembering that the NNT (number needed to teach) is 4. Any more, and the students will remember nothing.

At the end of this lecture, the student will be able to…

- Use the toxidromes to hypothesize potential poisoning exposures for a given patient.
- Calculate the anion gap and osmolar gap to identify potential poisonings.
- Create a management plan including initial resuscitation, decontamination, antidotes and enhanced elimination for a given patient.

Armed with these objectives, I need to know if they already have the skills necessary to do this. So there should be assessment built in.

- Give a few patient scenarios and ask them to identify potential poisons
- Give them a chemistry and ABG and have them identify potential poisons
- Give them a patient vignette and ask them which of the tools in their armentarium they would use

Pre-class activities would be to assign each student to one of the above tasks. They could watch the videos prior to coming to class, each has to watch one video. Using the **jigsaw method** with the objectives as the component pieces, they would teach each other toxicology. Then together this group would practice doing some problems. In the end we would put everything together by going through one case from start to finish.

Obviously there is more in toxicology that they should know which can be put in a handout. There is much more that they will not be required to know. With the context they got in lecture, they can now approach the written/handout material differently. They can more easily assimilate it into the knowledge they just gained.

- At home:
- Video: Worked example
- Objectives (within the blog post)
- Use the toxidromes to hypothesize potential poisoning exposures for a given patient.
- Calculate the anion gap and osmolar gap to identify potential poisonings.
- Create a management plan including initial resuscitation, decontamination, antidotes and enhanced elimination for a given patient.

- Pretest
- Give a few patient scenarios and ask them to identify potential poisons
- Give them a chemistry and ABG and have them identify potential poisons
- Give them a patient vignette and ask them which of the tools in their armentarium they would use

- Videos with example problems for each
- Toxidromes
- Calculations
- Treatment

- In class:
- Jigsaw
- Get together with your expert group: discuss the approach
- Get together with your small group: teach your piece

- Handout:
- Each toxidrome, what they are and which drugs are included
- How to calculate the anion gap (and MUDPILES) and osmolar gaps (with each correction factor)
- Various treatment options and what they work for

- Final assessment: work through the final case in your small group

- Jigsaw