Large classes

Decrease Class Size, Increase Learning

By Starr Sackstein

Regardless of the genetic makeup of any given class, too many students is a recipe for disaster and yet many districts keep student caps excessively high and wonder why student achievement isn't improving.

It is physically impossible for one teacher to meet with 34 students in a high school classroom individually every day, if we want that time to be meaningfully spent. Every child deserves to feel like the teacher is available to help with particular needs and struggles, but if the teacher slows down enough to address any one child, there is a chance many others will lose out.

How can we solve this never ending problem?

It's simple, reduce the class sizes or put more teachers in classes that must remain larger.

Setting up routines and rituals that allow students to take ownership of their learning takes time and if we want to do it so it works, and lessens the burden on the teacher, then we need to at least teach students these expectations across school settings in smaller classes like advisory and there must be a level of consistency kept.

Large classes can often be unwieldy to even the most successful and accomplished teachers and rather than spending time watching students flourish, teachers spend time managing behavior. 

We can all agree, that this is not what school should look like, yet in many places this is what happens. 

All or many of the following challenges can occur when there are too many kids in one room:

• increased probability of distraction or distractable behavior
• less time spent on instruction
• group work can be impeded 
• students don't get the close attention and feedback they require to succeed
• higher likelihood of incidents that can escalate
• less freedom to let students lead the lessons because there isn't much space to move around
• creativity can be stifled because the pace can be stop and go
• attendance can also be an issue in larger classes which also leads to other challenges
• loss of personal touch 
• difficulty building rapport and relationships with all students

In addition to the impact of having too many kids in a classroom, the additional workload for teachers outside of school assessing work and differentiating lessons appropriately can lead to accelerated teacher burn out. Let's face it working with more kids at once is more exhausting. We expend more energy to try to get them where they need to be.

If class sizes aren't going to be addressed because of bottom lines, either because of a lack of teacher resources or school funding, then we are going to have to find a way to function better inside of these undesirable situations.

E-learning

The Evolution of Multiple Choice E-learning

Henrik J. Mondrup

Move over rote learning: there’s a new development in multiple choice e-learning that facilitates and deepens the application of the learning and not just short-term memory. This is good news for companies who wish to develop the skills of their employees and prompt them to act on their learning, instead of simply testing their ability to remember.(Five principles for effective training design that leads to change)

Peer Instruction

This new generation of multiple choice includes peer instruction. It makes it possible to combine summative and formative assessment in e-learning, a benefit which does not occur during the one-way communication that characterizes multiple choice as we know it today. This is a huge step forward for e-learning because it creates a change-oriented experience that will take corporate e-learning to a whole new level.

"A change-oriented approach will take corporate e-learning to a whole new level"

Involving E-learners

“Tell me and I forget, teach me and I may remember, involve me and I learn.”– Benjamin Franklin

The brilliance of introducing peer instruction in multiple choice e-learning is that, for the first time, students are provided with an opportunity to involve themselves in the process, observe what their peers are doing, reflect on and then adjust their answer. This is important from a learning theory perspective. According to neuro-pedagogical research, if we want to facilitate a learning experience that leads to change, rather than as a means to test memory, involvement and reflection is key. (Illeris, 2013. Lieberoth, 2013. Mezirow, 2001).

"Reflection is the key to facilitate a learning experience that leads to change"

The Importance of Reflection

According to Bjarne Walgreen a Scandinavian professor who researches workplace competencies, it is through reflection that we learn how to act in a certain situation in order to achieve a certain goal (Walgreen, 2008). It is through reflection that we get to know more about how and why we should act when we use newly acquired knowledge in practice. But until now, it has not been technically possible to use multiple choice to create a formative assessment learning experience other than rote memory. Multiple choice e-learning has been limited to information dumping and cannot be seen as a complete learning experience (Suen, 2014).  Filling the heads of learners with facts without taking their motivation and engagement into consideration and only testing their recall of said facts makes for an empty learning outcome.

"Multiple choice e-learning has been limited to information dumping and cannot be seen as a complete learning experience"

Making Multiple Choice Matter for Participants

Peer instruction is finally breaking off its relationship with the old pedagogical approach to e-learning in use today. Adding a social element to e-learning makes it possible for participants to do more than choose a multiple choice answer: they get to explain and share their reflections about their choices and to learn from each other.

How Peer Instruction Works in Practice

Peer instruction has been developed by edX.org (today’s most valuable LMS developed by Harvard & MIT, worth more than $500 billion and accessible as open source at openedx.org), with an aim to take e-learning to a higher level. The way peer instruction works in practice is as follows (edX, 2016):

          Step 1. Explain Your Choice

          Step 2. Review Other Initial Responses

          Step 3. Revise Your Response

          Step 4. Review the Correct Answer

          Step 5. Compare Answers

Step 1: Explain your Choice

The learner is prompted to write an explanation for the answer chosen through multiple choice.

This step is their opportunity to provide a persuasive argument about why the answer is the correct one. The answer might include references to a course video, or a practical experience, or describing how the learner arrived at the choice he/she made.

Together, the answer that the learner chose and this explanation comprise his/her initial response. When the learner selects Next, his/her initial response is added to the collection of initial responses by all of the other course participants.

Step 2: Review Other Initial Responses

The learner then reviews the initial responses submitted by other course participants. The course team decides how many other responses the learner will see: they might see one response for each of the possible answer choices, or a set that is chosen completely at random.

This step gives the participant a chance to learn from the explanations that other learners submitted, and to reassess their own understanding of the topic.

Step 3. Revise Your Response

The learner can now decide whether he/she want to change the initial response by selecting a different answer choice, revising their explanation, or both.

This is an optional step. The learner can submit a final response that is the same as their initial response, or change it completely. When they move on to the next step, they learn the correct answer.

Step 4. Review the Correct Answer

The learner can now review the correct answer choice and the explanation provided by the course team.

Step 5. Compare Answers

Graphs that reveal the percentage of learners who selected each answer are shared to further help reinforce the learning. The first graph, below, shows the percentage of learners who selected each answer initially, and the second graph shows the percentage of learners who selected each answer after they had the opportunity to review the explanations that other learners provided. The learners can compare their own choices, and the correct one, to the answers from their peers. (The graphs appear after ten learners submit their final responses.)

This step can be just as thought provoking as the others. 

Successful Learning is Change

To me, a successful learning experience is about change. It’s about being able to use new knowledge in practice, to develop skills and competencies and to be able to do something better than before. This is the kind of learning that leads to more skilled employees. The development of peer instruction into multiple-choice e-learning is going to change the learning landscape, for better.   

Resources:

edX (2016). Explaining Multiple Choice Answers. Found at: http://edx.readthedocs.io/projects/open-edx-learner-guide/en/latest/completing_assignments/interactive_multiple_choice.html#interactive-multiple-choice

Illeris, K. (2013). Transformativ læring og identitet. Samfundslitteratur.

Lieberoth, A. (2013). Hukommelsessystemer og oplevelseslæring: Hvordan forvandler hjernen episoder til semantisk viden?. Cursiv, 11, 59-82.

Wahlgren, B. Høyrup, S. Pedersen, K. Rattleff, P. (2002). Refleksion og læring Kompetenceudvikling i arbejdslivet. Frederiksberg: Samfundslitteratur

Mezirow, J. (1991). Transformative dimensions of adult learning. Jossey-Bass, 350 Sansome Street, San Francisco, CA 94104-1310.

Suen, H. K. (2014). Peer assessment for massive open online courses (MOOCs). The International Review of Research in Open and Distributed Learning, 15(3), 312-327

Empathy

Medical students need to learn the potent medicine of empathy

 

Joe Raedle/Getty Images

By Wolfgang Gilliar

A few years ago at a large teaching hospital in Texas, a medical resident asked a nurse how to order an autopsy for a patient they were currently treating. It was a reasonable request. Autopsies help further the understanding of disease. There was just one problem: their patient, who was very much alive, was lying nearby. He’d overhead the request, and that’s how he found out he was soon going to die.

This story illustrates a broader crisis in medical education. Today, most schools myopically focus on turning out technicians. Through textbooks, lab experiments, and lectures, budding doctors learn the hard science of medicine. They memorize body parts, processes, and conditions, then dutifully demonstrate their knowledge in high-stake examinations.

This purely technical approach can obscure the human side of medicine and erode empathy — the ability to understand and care about what makes a patient tick. In fact, the empathy levels of medical students actually decline as they progress through school. Many become emotionally disengaged from the people they’re caring for — and that disconnect can impair care.

Forging a strong emotional connection with a patient can be just as important to the healing process as prescribing the right drugs or performing the right surgery. A 2012 study published in the journal Academic Medicine found that the rates of serious complications among diabetic patients were almost 50 percent lower among those whose doctors had high empathy levels compared to those whose doctors had low levels. Improving physician empathy has been shown to help overweight individuals with diabetes drop more weight, arthritis patients experience less joint pain, and those with high blood pressure reduce it.

A 2014 study published in the journal PLoS One examined a baker’s dozen of clinical trials in which doctors were taught empathy-building techniques, even simple ones such as making regular eye contact. Their patients fared significantly better than doctors who didn’t receive such training.

How does empathy do this? A patient who feels emotionally connected to his or her doctor is more likely to disclose important medical information and to follow the doctor’s advice. That connection can serve as the basis for true teamwork, with the patient working proactively with the medical team to improve health. Simply put, patients who feel cared about feel better and do better.

There’s also great promise in osteopathic medicine, which couples traditional medical interventions with skilled, specialized, hands-on treatments for the body’s complex system of nerves, muscles, and bones. “Healing touch” isn’t just a metaphor. This simple physical action evokes trust in patients.

Without empathy, doctors run the risk of alienating their patients. The relationship can become one-sided, with the physician simply dictating treatments and the patient following orders. Core emotional needs can be ignored, leading patients to feel lonely and downtrodden. And that deterioration of mood can make it less likely that they will experience positive outcomes from treatment.

 

Can medical schools teach empathy? Of course. Relationship-building and effective communication are skills. They can be taught, learned, and practiced.

To teach empathy and related “soft” skills, schools should consider starting up emotional intelligence boot camps — intense, immersive training programs that students complete before their formal medical schooling begins.

Such a program would assign students tasks that encourage them to build communication skills and directly address patient needs before they start classes and interact with the entire health team. Budding doctors would spend several months in a hospital or clinic bathing the infirm, changing bed sheets, taking blood pressures, and doing other tasks that help them connect with the humanity of their future patients. Equally important, this would foster constructive collaboration with nurses and other staff and build a firm foundation for respectful interprofessional teamwork.

At the New York Institute of Technology, our college of osteopathic medicine encourages students to engage in empathy-building exercises outside of the classroom. Our chapter of the Gold Humanism Honor Society recognizes students and faculty members who care for patients with compassion, empathy, and integrity. Our students also run a ceremony each year in which first-year students honor their “first patients,” the people who donated their bodies to science. It reminds the students that cadavers aren’t just training tools — they’re a precious gift from selfless donors and their families.

The quest for empathetic physicians should probably start even earlier. Medical schools could reassess how they select students, using metrics for hard skills like grades and Medical College Admission Test scores as guides, not exclusive criteria. Schools should create a well-rounded picture of each student by putting serious weight on his or her past work activities, personal interests, in-person interviews, and personal references. Being open to applicants who don’t fit the traditional mold, such as older people with previous careers, is another strategy.

To help mold the physician of the future, medical schools must rethink their books-before-people approach. A myopic focus on the technical aspects of fighting disease can lead to worse patient outcomes. Good doctors should be proficient in both the scientific and humanistic facets of medicine — truly caring for their patients while looking for a cure.

Wolfgang Gilliar, DO, is the Dean of the College of Osteopathic Medicine at New York Institute of Technology.

Wolfgang Gilliar can be reached at wgilliar@nyit.edu
Follow Wolfgang on Twitter @NYITCOMDO

Escolas médicas

Representantes de Entidades Médicas se reúnem com ministros para discutir rumos da Saúde e Escolas de Medicina no Brasil

Florentino Cardoso, presidente da AMB, Carlos Vital, presidente do CFM; Sigisfredo Brenelli, presidente da ABEM e Raul Cutait, cirurgião do Hospital Sírio-Libanês, se reuniram para discutir mudanças necessárias para saúde da população e educação médica no Brasil.

Os representantes falaram de temas como atualização de diretrizes e protocolos, Mais Médicos, atenção básica (primária) de Saúde, abertura de novas escolas médicas e ampliação de vagas em cursos existentes.

Na reunião com o Ministério da Saúde, Florentino disse ao Ministro que os médicos estão incomodados com a atual gestão da saúde no País. “Está chegando o momento que deveremos nos posicionar de maneira mais dura, mais ousada, porque a visão das entidades médicas é que mudou o governo, mas mudanças necessárias não ocorreram. A saúde pública está caótica. Sabemos do curto tempo, porém não vimos nenhuma luz mostrando que estamos na direção de transformações para melhorar o atual cenário ”, argumentou o presidente.

Em seguida os médicos se reuniram com o Ministro da Educação, Mendonça Filho. As entidades médicas prepararam uma pauta de assuntos como educação médica no país, objetivando contribuir com soluções concretas, que preservem qualidade e segurança dos pacientes. A principal queixa é a abertura de escolas médicas. “já temos escola de medicina, que estão tendo aulas no período noturno por não ter professor para dar aula durante o dia. Isso é terrível e irresponsável”, diz Florentino, que tem acompanhado a queda progressiva na formação médica.

 

Defesa do SUS

CFM cobra do governo medidas pró-SUS