March 2020

posted in: 2020 Journal Clubs | 0

Group Texting to Teach Developmental Milestones

Use of a Group Text Messaging Application to Teach Developmental Milestones on a Pediatric Clerkship.

Berger S. Academic Pediatrics 2019.

Reviewed by Randy Rockney



What was the study question? Can group text messaging be an effective tool to teach developmental milestones on a pediatric clerkship?

How was the study done?  Short, <30 second, videos were texted to students’ cell phones each week of an 8-week clerkship at the University of Alabama at Birmingham medical school.  Two questions followed each uploaded video: “What skill is being demonstrated?” and “What is the child’s expected age?” Subsequent dialogue with the clerkship director (whose own children were the “actors” in the video) included further discussion about developmental milestones and feedback. Student participation and engagement with the approach were measured via student responses (“liking” or comments) in response to the videos. Student performance on NBME Pediatric subject exam questions related to growth and development was also assessed.

What were the results? Student participation in the curriculum over 13 clerkship blocks improved after the first two blocks and stabilized at approximately 50%. Student performance on the growth and development questions on the NBME exam did not change though student performance on those items at this institution was statistically higher compared to the national average over the entire study period.

What are the implications of these findings? Teaching developmental milestones in more traditional formats such as lectures can be a challenge as didactic lectures on that topic often receive poor evaluations. As noted by the author, “spreading the teaching of developmental milestones over the course of the block reduced the cognitive load and changed the learning environment from passive to active and student centered.” The direct dialogue between learners and the clerkship director whose own children starred in the videos enhanced the value of the activity and promoted incidental and valuable discussions of work-life balance.

Editor’s Note:  Remote learning activities using videos are a natural fit for younger learners who seek out similar educational resources on their own anyway.   They are especially valuable right now as many of us are seeking more strategies to enhance distance learning.  The student participation rates might be improved with the use of educational platforms like Poll Everywhere or Kahoot in place of a simple text message.  (JG)

Puzzling through a new active learning strategy

Using the jigsaw technique to teach patient safety.

Goolsarran N, Hamo CE, Lu W (2020), Medical Education Online, 25:1, DOI: 10.1080/10872981.2019.1710325

Reviewed by: Jon Gold

What was the study question?   How effective is the jigsaw technique compared to traditional small group learning to teach principles of diagnostic reasoning?

How was the study done? 51 first- and second-year internal medicine residents participating in a two-hour patient safety workshop were randomized to learn by either the jigsaw method or a traditional case-based method. Both groups began by reading a script describing a diagnostic error.

In the jigsaw method group, the residents split into groups of 3 to 4, then reassembled into “expert groups” to discuss one of three focused areas (cognitive errors, diagnostic reasoning or root cause analysis) with peers with the goal of becoming topic experts.  The experts then rejoined their original group and worked together to solve the case.  In the traditional method group, the residents were assigned the same task but stayed within the same small groups of 34 through the entire session, led by a faculty facilitator.

All residents completed a 10-question multiple choice quiz to assess knowledge of diagnostic reasoning before and after the workshop as well as one year later.  Residents also completed survey questions about their perceptions of the workshop.

What were the results? Groups scored similarly on the pretest but the jigsaw group performed better on the posttest (mean 84.5 vs 74.5, p = 0.001) and one-year follow up test (mean 80.7 vs 60.5, p =0.001).  While all residents thought the content was helpful, the residents in the jigsaw group were more likely to report that what they learned would impact future practice (91% versus 9%, p < 0.001).

What are the implications? Active learning strategies such as the jigsaw technique allow residents to learn a complicated cognitive task at least as well as traditional case-based teaching with better long-term retention, equivalent learner satisfaction and less need for faculty involvement.  This is another teaching strategy to put in your toolbox.

Editor’s Comments: In this study, students in both the traditional small group and the jigsaw group engaged in small group discussion in keeping with active learning principles. The unique aspect of the jigsaw group, however, was the peer teaching component when the original groups reassembled after each student became an “expert.” One of the big benefits to this model seems to be that students hold themselves accountable for teaching their peers. (KFo)

What students write about when they write about patients

Reflective Writing as a Window on Medical Students’ Professional Identity Development in a Longitudinal Clerkship.

Adams J, Mim A, Cleeves M, Gong J. Teaching and Learning in Medicine. ePub ahead of print

Reviewed by: Karen Forbes

What was the study questions? What do the written reflections of students in a longitudinal integrated clerkship in an underserved health care setting tell us about the role of longitudinal relationships with patients and role models in personal identity construction?

How was it done? Over two years, 15 students participated in an 11-month longitudinal integrated clerkship (LIC) that provided care to an underserved patient population. Students had to apply for selection into the LIC by writing a short essay outlining, among other things, their career commitment for caring for the underserved.  The LIC included a reflective writing curriculum whereby students were required to write three reflective essays based on prompts. These essays were analyzed through an inductive analytic approach.  Analysis of essays took place more than one year after students completed the program, and all students consented to participate.

What were the results? Qualitative analysis of 45 essays (3 per student) yielded six themes, each with two to four subthemes.  Five themes collectively described the importance of the role of authentic and longitudinal relationships between students and their patients. These included (1) care for the underserved; (2) therapeutic alliance; (3) humility and gratitude; (4) acting on behalf of the patient; and (5) resilience. The final theme, aspirations, described a health equity identity by tying together how these relationships allow students to create their professional identity. Students identified their relationships with patients as most meaningful part of their educational experience.

What are the implications? Professional identity construction is dynamic and is shaped by authentic experiences and relationships both with patients and faculty mentors/role models. Educators should consider the clinical contexts in which we place learners, as well as the student roles in care of patients and interactions with mentors. By ensuring authenticity of these roles and experiences, the ensuing impact on attitudes, values and professional identity of students may help future physicians meet the needs of specific communities.

Editor’s Comments: This is a study of LIC students’ written reflections targeted to gauge their perceptions of longitudinal relationships with patients as well as their commitment to the underserved. It is an example of how study of students’ narratives can give teachers and students insight into the students’ personal development as physicians. It would be interesting to compare similar narratives written by students on traditional clerkship pathways. Also of interest might be a follow-up study of the same cohort at different points in their career trajectories, like after residency or early post-residency. As a note, we have had a medical narrative assignment in my institution’s pediatric clerkship for nearly a quarter of a century and, while not as prescriptive as the assignment in this study, it has been a popular and useful addition. The students also find sharing the narratives in a group setting a wonderful opportunity to connect with their colleagues regarding their own personal development as physicians in the crucial clinical third year of medical school. (RR)