Connecting Your Radiology Learning To Your Clinical Practice:

Using Personal Learning Environments, Learning Portfolios, and Communities of Practice

Michael P. D'Alessandro, M.D. University of Iowa College of Medicine / University of Iowa Children's Hospital

michael-dalessandro@uiowa.edu

www.educationalinformatics.org www.slideshare.net/michaeldalessandro

Introduction

• A few definitions first…

Personal Learning Environment

•  System that help learners take control of and manage their own learning including providing support for learners to •  Set their own learning goals •  Manage their own learning - both content and process •  Communicate with others in the process of learning

•  Learner-centric ~ "This is what I will learn today" •  Decentralized ~ RSS is glue that holds it together

E-Memory System

•  A digital archive of your life •  "Lifelogging"

•  Made possible / inevitable by •  Most memories are digital •  Near-infinite space to store them •  Ever-improving technology to recall them

•  Captures, stores, organizes and makes retrievable your experience + reflected wisdom

•  You become the librarian, archivist, cartographer and curator of your life

Learning Portfolio •  A digital archive of your medical

educational life = learning diary •  Document + store your clinical questions +

answers which aggregate into a physician's personal learning experience

•  For each case •  Question ~ Story ~ Answer ~ Impact on

Practice ~ Resources Used •  Educational construct

•  Adult learning theory = Learning situated in practice •  Schon's theory of clinical problem solving /

model of reflective practice / learning cycle •  Case-Based Learning

•  Constructionism ~ Learning by doing / Learning artifacts

Community of Practice

"Communities of practice are groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their understanding of this area by interacting on an ongoing basis."

- Wenger E. et. al. Cultivating Communities of Practice: A Guide to Managing Knowledge

•  Educational construct = Interdependent Learning Theory

Back To The Future

"In what my be called the natural method of teaching, the student begins with the patient, continues with the patient, and ends his studies with the patient using books and lectures as tools, as means to an end."

- Sir William Osler

Future of Medical Education •  CME traditionally disconnected from clinical practice, found

to be completely ineffective •  Long held dream of the few was to connect CME to clinical

practice - but technically difficult •  Advent of Internet, which can bring library to POC, makes

dream reality •  Connecting education to practice is best way to change

physicians' knowledge / attitudes / behaviors and improve patient's care / outcomes / lives •  ACCME, CME as a Bridge to Quality, 2006 •  Josiah Macy Foundation, Continuing Education in the Health

Professions, 2008 •  IOM, Redesigning Continuing Education in the Health

Professions, 2009 •  Molly Cooke, David M. Irby, Bridget C. O'Brien. Educating

Physicians: A Call For Reform of Medical School and Residency, Jossey-Bass, 2010

•  Most physicians do not know how to connect their learning to their practice •  Unaware of recent advances in E-memory systems

•  Purpose of this talk is to show you how to connect your learning to your practice and receive CME for it using a personal learning environment, learning portfolio and community of practice

Methods

• My personal learning environment

Web 2.0 Landscape •  Web 2.0 = Read / Write Web

•  Weapons of Mass Collaboration •  Blogs / Micro-blogs, photo / video-sharing, wikis, social

bookmarking, social networking •  Self organizing systems ~ Micro-learning •  Soul is sharing / connecting / iteration / openness

•  - Mark Pesce

•  Tools that support 4 C's for 21st Century •  Critical thinking •  Communication •  Collaboration •  Creativity

Your Interface To The CloudMobile Phone + Web Browser + App Store

Android Blackberry iPhone Windows Phone

"It is now clear that the long process of connecting everyone on Earth to a global telecommunications network, which began with the invention of the telegraph in 1791, is on the verge of being completed."

- Tom Standage, Finishing the Job (Special report on telecoms in emerging markets), The Economist, September 24, 2009

Seeking Answers / Decision SupportSpecialty-Specific Search Engines

www.searchingradiology.com www.searchingpediatrics.com

Difference between Radiology Search Engine + StatDX for Decision Support StatDX helps you quickly find an answer Radiology search engine helps you learn and remember the answer, especially when coupled with learning portfolio ~ Allows you to receive CME for the answer

Documenting LearningLearning Portfolio

PACS -> USB Excel iPhoto iPod / Lecture Flickr www.pediatriccommons.org

•  Why? •  For Yourself - Passion + Reflection!

"An unexamined life is not worth living" - Socrates

•  For Point-of-Care CME - questions are starting point for further learning •  For sharing with trainees and peers

•  Individuals face to face •  Groups in conferences and lectures •  World on Internet

•  Created + archived on PC ~ Shared on the Cloud

Receiving CME For Point of Care Learning

www.cincinnatichildrens.org - Up to 20 hours / year - myrsna.rsna.org

Sharing + TeachingCommunity of Practice

www.pediatriccommons.org

Learning portfolio can be shared with your community of practice for collaborative learning

An Invitation to the Future of Pediatric EducationPediatric Commons -- www.pediatriccommons.org •  A community of pediatric learning, teaching, sharing +

collaboration •  Goal - build a pediatric learning community around content,

conversations and connections for the purpose of improving children's health

•  Place to come learn pediatrics every day •  Enter cases into your learning portfolio

•  Store your experience, reflection, knowledge, wisdom •  MyTeachingFile ~ MyKnowledgeManagementSystem ~

E-memory system

•  Participate in your community of practice •  Contribute content, Engage in conversations, Make connections

•  Experience your personal learning environment •  Helps learners take control of + manage their own learning

•  Enables peer-to-peer and master-to-apprentice teaching •  Fulfills part of the requirement for Maintenance of

Certification •  Tieing your learning to your practice and awarding you CME

LearningPodcasts + Video + RSS

www.ctisus.org www.youtube.com www.apple.com/education/itunes-u/ reader.google.com

Activity stream / News wire

LearningeBooks + eJournals + Slide Sharing

iPad (ePubs + PDFs + PPTs) www.mekentosj.com www.slideshare.net

Joining The Pediatric CloudSocial Networking + Microblogging (= Activity streams / News wires)

www.linkedin.com twitter.com www.facebook.com Connections to professional identity (CV) Connections to news Connections to friends + personal / professional interests

Results

Evaluation of a Learning Portfolio •  A pediatrician's clinical experiences

coupled with reflection •  5 elements for each case •  Evaluation shows unstructured curriculum

unfolding in practice over 5 years (234 cases) •  Covers 100% of age ranges (n=9) •  100% of specialties (n=42) •  98% of symptoms (n=127) •  55% of diseases (n=707 [50-60% are pediatric]) •  90% of topics in 3 national pediatric curricula •  20 hours of CME / year •  "My reading is now focused on my patients" - D'Alessandro DM, D'Alessandro MP. Formative Evaluation of a

Pediatric Digital Library's Educational Content and Comparison to National Curricular Standards. Medical Teacher. 2008;30(9-10) 880-6.

•  Learner taking control of and assuming responsibility for their own learning by tying their learning to practice + receiving CME for it

•  Learning portfolio documents what you have learned •  Assessment by examination documents what

you don't know

My Personal Learning Environment Results

Tabbed browsing Mashups - www.igoogle.com myrsna.rsna.org

•  This is a way to enjoy rather than endure your 10,000 hour voyage towards expertise

•  My learning has never been so focused, so relevant, so interesting, so meaningful, so enjoyable

•  I have finally become a learning machine, passionately pursuing mastery of medicine

Educational Effectiveness of Social Networks Social Learning

•  Types of evaluation / assessment •  Formative / critique (CQI) vs. Summative / examination

•  Proposition: The house believes that social networking technologies will bring large [positive] changes to educational methods, in and out of the classroom. •  Assessment for learning (formative assessment)

•  Learning in the classroom built around peer support, self-assessment + questioning, peer assessment -- all coupled with learning logs - with teacher as a guide = Learning in a social network

- Ewan Mcintosh, The Economist Debate Series: Education - Social Networking, The Economist, January 2008

"Firm evidence shows that formative assessment is an essential component of classroom work and that its development can raise standards of achievement…"

- Paul Black and Dylan Wiliam, Inside the Black Box: Raising Standards Through Classroom Assessment, Phi Delta Kappan, November 1998

"Teachers found that the motivation and attitudes of their students improved, and the students achieved higher scores on externally set tests and examinations" - Paul Black et.al., Working Inside the Black Box: Assessment for Learning in the Classroom, Phi Delta Kappan Sept 2004

…So assessment by critique improves assessment by examination…

Educational Effectiveness of Communities of Practice

"Physicians interact with peers and mentors to frame issues, brainstorm, validate and share information, make decisions, and create management protocols, all of which contribute to learning in practice. It is likely that working together in this way creates the best environment for learning that enhances professional practice and professional judgment." - Parboosingh JT. Physician Communities of Practice: Where Learning and Practice are Inseparable. Journal of Continuing Education in the Health Professions. 2002. 22, pp. 230-230

Just One More Thing - Regaining Our Seat At The Table

•  We have lost face-to-face touch with our clinical colleagues •  Slovis TL. The Easier Path - A Blueprint For Failure. Pediatr Radiol. 2007

May;37(5):415-6

•  One way to address this is to attend their conferences •  Slovis TL. The Path Less Travelled - A Road To Success. Pediatr Radiol.

2007 Jun;37(6):513-4.

•  Pediatric Commons is another way to reconnect with our clinical colleagues in order to improve the quality of patient care •  Build online bridges of collaboration + friendship •  Take part in their conversations + get into their decision loops •  Digital natives do this in their personal lives ~ will want to do it in their

professional lives

"Can we use a system like Pediatric Commons to recreate / reproduce the daily informal clinical interactions + conferences we used to have before PACS?" - Shunsuke Nosaka, M.D. (NCCHD Tokyo)

Conclusion •  Components of future of pediatric education

•  Situate learning in practice with pediatric search engines •  Document learning in practice with individual learning portfolios •  Participate in community of practice by aggregating learning portfolios •  Interface via mobile phone •  Sum total is your personal learning environment

•  Goal is to create an environment which allows longitudinally over time •  Personal learning + reflection •  Master-to apprentice and Peer-to peer teaching •  …and ultimately - conversations about art and science of pediatrics

•  Tying education to practice is how to create and preserve a lifelong passion for medicine •  This is how to create medical learning machines who strive for and achieve excellence in

practice •  Philosophically must strive to pursue mastery of medicine, rather than merely

recertification

•  Pediatric Commons is small step on long journey towards fulfilling vision of future of pediatric education

For More Information… •  About this talk

•  http://www.slideshare.net/michaeldalessandro

•  About Pediatric Commons •  http://www.pediatriccommons.org

•  About what we do and why we do it… •  http://www.educationalinformatics.org