Patricia Beach MDKeith Bly MDVirginia Niebuhr PhD

Pediatric Grand RoundsMarch 9, 2012

BAY COLONY REMOTE AUDIENCE : SESSION

Download and run the “Responseware” app on your smartphoneOR

Point your web browser to http://www.rwpoll.com

We have no conflicts of interest to disclose.

This work is supported by

US Dept. Health & Human Services Health Resource Services Administration (HRSA)

Bureau of Health Professions

UTMB Department of Pediatrics’ Audience Response System purchased through the generosity of the McGovern Academy of Oslerian Medicine

US Dept. Health & Human ServicesHealth Resource Services Administration (HRSA) Bureau of Health Professions

Grant for Pediatric faculty development

Target: technology for educationObj 1: technology for instructionObj 2: information searching and managementObj 3: teaching about and with the EHRObj 4: technology for personal efficiency &

effectiveness

Objectives:By the end of this session, participants should be able to:

1.  create teaching activities which use ARS for polling, evaluation, knowledge assessment, and/or facilitation of discussion

2.  summarize published research about ARS effectiveness

3.  identify best practices for ARS use

4.  explain procedures for downloading necessary software and checking out our equipment

software to create & present interactive questions to display data charts and graphs in real-time to report and manage data

response devices: audience participates by submitting responses

response cards (clickers) using a response receiver

phone or computer using Internet-connection

turningtechnologies.comTurningPoint – interactive

PowerPoint (PC or Mac)

integrates into Microsoft® PowerPoint ®

1 2

47%

53%

1. Yes2. No

33%

23%17%

27%

1 2 3 4

1. Student2. Resident3. Faculty 4. Other

1. Polling • audience experiences/characteristics• opinions• evaluations

2.Recording attendance

3. Knowledge Assessment• Assessment of audience comprehension ▪ followed by teaching adjustment

• Testing for credit/grading▪ some software integrates database into

Blackboard

1 2 3 4

23%27%

33%

17%

1. Maternal smoking2. Lack of supportive partner3. Failure to use a breast

pump4. Mother’s return to work

4. Facilitation of discussionanswer- discuss- answer again

Over the past decade, drug oversight committees and professional organizations have debated evidence regarding any association between undiagnosed cardiac conditions and sudden death in youth started on stimulant medications for Attention Deficit Disorder.

1 2 3 4

27%

13%

30%30%1. Inform families that theoretic risk is

overstated and proceed with prescription.

2. Inform of theoretic risk, perform H&P to assess risk in this child; prescribe stimulants if negative.

3. Inform of theoretic risk and take a careful history regarding cardiac factors in this child, review EKG, prescribe stimulants if negative.

4. Inform of theoretic risk and seek cardiologist clearance prior to prescribing stimulant medications.

1. Inform families that the theoretic risk is overstated and proceed with prescription.

2. Inform of theoretic risk and take a careful history regarding cardiac factors in this child; prescribe stimulants if negative.

3. Inform of theoretic risk, take a careful history regarding cardiac factors in this child, and order an EKG; prescribe stimulants if all negative.

4. Inform of theoretic risk and seek cardiologist clearance prior to prescribing stimulant medications.

1 2 3 4

30% 30%

10%

30%1. Inform families that theoretic risk is

overstated and proceed with prescription.

2. Inform of theoretic risk, perform H&P to assess risk in this child; prescribe stimulants if negative.

3. Inform of theoretic risk and take a careful history regarding cardiac factors in this child, review EKG, prescribe stimulants if negative.

4. Inform of theoretic risk and seek cardiologist clearance prior to prescribing stimulant medications.

> 85 papers published since 1999.

36/38 studies show positive perceptions of technology (Kay and LeSage, 2009)

Students found technology easy to use Most liked• Increased student participation• Student self-assessment• Peer mastery• Pacing/re-teaching (Graham et al 2007, BYU)

Classroom Environment Benefits• Attendance improved• Attention improved• Anonymity facilitates increased

participation• Increased engagement

Learning Benefits• Increased interaction • Increased quantity & quality of discussion• Useful for peer instruction• Contingent teaching: modification based

on learners’ responses • Quality of learning clarifies/prioritized

content• Learning performance (more later)

Learning benefits, cont.• Formative assessment (non-graded)• Comparison of answers with peers▪ Popular with students▪ Promotes low-grade competitive

environment▪ Students like to monitor progress

ARS performance on clinical questions predicted performance on final exam (Alexander 2009, Mayo Medical School, Basic science course)

Exam performance improved when ARS had been used in discussion groups, but long term retention was no different with/without ARS(Doucet et al 2009, Univ Montreal Pharmacy, Vet students )

After anonymous ARS quiz during lecture, overall class exam scores not dramatically impacted, but lower-quartile students showed improved performance on target questions(Hoyt et al 2010, Stritch SOM, med students, anatomy class)

Prospective randomized trial: retention increased (pre- vs. post-test) following interactive lecture (21% change with ARS vs. 2% change without ARS)(Pradhan 2005, UMDNJ, ObGyn Residents)

Randomized trial: ARS had positive impact on exam performance immediately (p=0.02) and 3-months later (p=0.001) (Rubio 2008, Cincinnati, Radiology residents)

Use of questions embedded into lecture with or without ARS resulted in no significant change in test performance, suggesting that embedded questions, rather than ARS, resulted in improved retention (Stoddard 2010, Nebraska Med Ctr., 2nd-yr med students)

Forgot ARS clicker or clicker malfunction Learning Curve for teachers to develop

and embed questions (faculty development opportunity!)

Difficulty responding to student feedback on the fly

Decreased time for content coverage

Forgot ARS clicker or clicker malfunction Discomfort with new method of learning-

requires greater cognitive energy VERY uncomfortable with for-grade use Discussion increases chaos, poor partners When learners dislike being monitored

1 2 3 4 5

0% 0% 0%0%0%

1. Record attendance at conference

2. Allow learners to compare responses

3. Allow teacher to re-teach or adjust content to learner understanding

4. Facilitate discussion and peer-teaching (students sharing info so all learn)

5. Evaluate conferences

School of NursingClinical Laboratory Sciences –

Galveston, Odessa, Tyler attendance & quizzes

Continuing Education – Pedi Review Course Knowledge assessment – low stakes

Practice of Medicine- Year One

FEEDBACK FROM A FIRST-YEAR MED STUDENTSEPTEMBER 2010

A suggestion was made to have some sort of incentive for <the Friday wrap-up> (food, UTMB gear, etc). It seems like those of us who come are greatly diminishing in number and as the last lecture was not successfully recorded in Tegrity this is a shame.

These kinds of incentives, while costly, do seem to work for our class. Also speakers should try to interact more and direct their lecture to us rather than giving a normal lecture. What may work day to day does not always captivate our age group/med student audience.

POM-1 PEARLSPOM-1 PEARLSPATIENT ENCOUNTER AUDIENCE RESPONSE LEARNING SYSTEMPATIENT ENCOUNTER AUDIENCE RESPONSE LEARNING SYSTEM

MODULE 3 WEEK 7MODULE 3 WEEK 7

DR. KEITH BLYDR. KEITH BLYDR. SUSIE GERIKDR. SUSIE GERIK

FEBRUARY 24, 2012FEBRUARY 24, 2012

POM-1 PEARLSPOM-1 PEARLSMODULE 3 WEEK 7MODULE 3 WEEK 7

POM-1 PEARLSPOM-1 PEARLS

Which of the following Which of the following would be the most would be the most effective technique for effective technique for interviewing a interviewing a disinterested teen?disinterested teen?

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HISTORY REVIEWHISTORY REVIEW

A.A. Ask mostly closed-ended “yes or no” type questionsAsk mostly closed-ended “yes or no” type questions

B.B. Chat for a bit about friends, school, and hobbiesChat for a bit about friends, school, and hobbies

C.C. Limit the discussion to the specifics of the medical Limit the discussion to the specifics of the medical problemproblem

D.D. Try to build rapport through use of common teen lingoTry to build rapport through use of common teen lingo

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10

POM-1 PEARLSPOM-1 PEARLS

Which of the following is Which of the following is correct technique when correct technique when performing the abdominal performing the abdominal examination?examination?

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PHYSICAL EXAMPHYSICAL EXAM

A.A. Ask if there are any areas of tenderness while Ask if there are any areas of tenderness while palpating the abdomenpalpating the abdomen

B.B. Inspect then auscultate then percuss then palpateInspect then auscultate then percuss then palpate

C.C. Put the patient in the right lateral decubitus Put the patient in the right lateral decubitus position to elicit a fluid waveposition to elicit a fluid wave

D.D. Undrape from just below the sternum to just below Undrape from just below the sternum to just below the umbilicusthe umbilicus

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10

POM-1 PEARLSPOM-1 PEARLS

You find a wallet on the floor You find a wallet on the floor with cash but no ID inside with cash but no ID inside following the 8am lecture in following the 8am lecture in Levin Hall. Levin Hall. Of the following,Of the following, the most appropriate next the most appropriate next action is:action is:

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ETHICS & PROFESSIONALISMETHICS & PROFESSIONALISM

A.A. Keep it because there is no way to identify who it belongs toKeep it because there is no way to identify who it belongs to

B.B. Make an announcement at the start of the 9am lecture that Make an announcement at the start of the 9am lecture that if anyone has lost something valuable to come see youif anyone has lost something valuable to come see you

C.C. Put it back on the floor where you found itPut it back on the floor where you found it

D.D. Wait until somebody posts signs in the lecture hall that they Wait until somebody posts signs in the lecture hall that they have lost a wallet specifying the amount of cashhave lost a wallet specifying the amount of cash

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10

POM-1 PEARLSPOM-1 PEARLS

If you suspect an upper If you suspect an upper level medical student at level medical student at your site visit is your site visit is intoxicated, your first intoxicated, your first priority should be:priority should be:

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STUDENT WELLNESSSTUDENT WELLNESS

A.A. Get the student enrolled in a rehabilitation program Get the student enrolled in a rehabilitation program

B.B. Report your concerns to the Office of Student AffairsReport your concerns to the Office of Student Affairs

C.C. Have the student relieved from patient care dutiesHave the student relieved from patient care duties

D.D. Ask the student to submit a drug test to confirmAsk the student to submit a drug test to confirm

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10

POM-1 PEARLSPOM-1 PEARLS

Several models for taking a Several models for taking a spiritual history have been spiritual history have been published and used in clinical published and used in clinical practice. Which of the follow is practice. Which of the follow is part of the spiritual history part of the spiritual history determined using these models?determined using these models?

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SPIRITUALITY IN CLINICAL SPIRITUALITY IN CLINICAL CARECARE

A.A. Importance of faith is in the patient’s lifeImportance of faith is in the patient’s life

B.B. Ritualized practices and restrictionsRitualized practices and restrictions

C.C. Terminal event planningTerminal event planning

D.D. All of the above.All of the above.

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10

o You must have PowerPoint already installed on your PC

o Download and install the Turning Point software from turningtechnologies.comon both the PC for building and presenting the PPT

o Launch Turning Point, which functions as an additional "tab" within PowerPoint

o Check out Response System from Pedi Admin office (Tayna)

o Plug in the USB hardware receiver

o Pass out clickers to audience and/or log into online account

o Launch and run presentation with Turning Point

web-based polling using ResponseWare

Using RemotePoll™ with additional receiver at distant site and more clickers

Remember that effectiveness of ARS depends on quality of questions.

Design questions which allow learners to demonstrate or apply knowledge and/or discuss.

Use sparingly questions of learner experience (“have you …”) or requiring supposition (“what do you think will happen”)

Consider effective frequency of questions.

After responses are revealed, use the results to increase understanding and reasoning.

Modify direction of lecture if results indicate poor comprehension of the material (i.e. re-teach).

Don’t allow the technology to overshadow the content or the learning.