Valerie P Jackson, MD, FACREugene C Klatte Professor and ChairDepartment of Radiology and Imaging SciencesIndiana University School of Medicine

I have no financial interests to disclose

I am NOT an expert in Adult Learning Principles

I have attended usual array of schools and courses

Understand the characteristics of good and bad speakers

Understand Adult Learning Principles (ALP)

Introduce Case-Based Teaching (CBT)Explain Audience Response Systems

(ARS)Realize advantages and disadvantages of

ARS

this……. to this?

Unlike small children, adults- have foundation of life experiences and knowledge- want to connect learning with knowledge and experience base

Teachers should relate concepts and theories to audience’s experiences

Adults are- autonomous and self-directed- goal-oriented- relevancy-oriented- practical

Focus on aspects of lesson most useful to them in work

Need respect

http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/adults-2.htm

Free to direct themselvesWant to be actively involved in

learning Like to know how ‘class’ will help

them reach their goalsTeachers serve as facilitatorsTeachers guide to knowledge rather

than provide facts

Learners typically know their goals for class

Want organized curriculumTeachers should show learners how

they will reach their goals

Learners want to see reason to learn Information applicable to work, lifeWant to know how learning concept

will relate to familiar situationsWant to focus on what is important

and usefulNot necessarily interested to “just

learn” something

Acknowledge the learners experience

Give opportunity to voice opinion and knowledge in teaching setting

Don’t waste time on irrelevant stuff

Case based teachingProblem based learningBoth interactiveFocus on development of relevant

skills

Develop skills in analytical thinking and reflective judgment

Reading and discussing complex, real-life scenarios

Cases are stories with educational message

Can be done with large group

Call on people to answerRaising of hands/surveyTeams/split the roomPaper responsesOpen microphoneUse ARS

Keypads Radio frequency receiverGroup response softwareLaptop computerLCD projector

QuestionTime to selectRecognizes input from participantsDisplays data? Improves learning environment

Get to know the audience

Cro

ss-T

ab L

abel1. True

2. False

51%

49%

0/010

Cross-Tab Label0/0

1. Strongly Agree2. Agree3. Neutral4. Disagree5. Strongly Disagree

20% 20% 20% 20% 20%

1 2 3 4 5

10

Space ARS throughout talk to keep audience engaged

First half of this lecture was boring- you may not care about ALP- too many words- little/no interaction

Don’t save all ARS until the end

Cross-Tab Label0/0

1. 02. 1-33. 4-64. 7-95. ≥ 10

20% 20% 20% 20% 20%

Zero 1-3 4-6 7-9 10 ormore

10

Keep engaged

ARS

Cro

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ab L

abel

1.Yes

2.No

3.Doesn’t matter

33%

33%

33%

0/0

(1) = XX.X

(2) = XX.X

(3) = XX.X

10

10Cross-Tab Label0/0

1. Yes2. No

51% 49%

Yes No

Interaction with audience ➔ more participation

Increases attendanceFaculty perceived more favorablyAble to get audience attitudes and

opinions

Collins J. JACR 2008;5:993-1000

Immediate feedback ➔ Improved teaching and learning

Provides anonymous peer assessment

Collins J. JACR 2008;5:993-1000

Portable/wireless systemEasy for participants to learn/useCan track data anonymouslyFlexible so ‘on the fly’ questions can

be usedFacilitates CME for SAMSFun

ARS and interactive lectures improve quiz scores Family Medicine Residents

Schackow, et al. Fam Med 2004;36(7):496-504

Immediate (%)

1 month (%)

ARS + 96 67

ARS - 61 48

ARS and interactive lectures improve quiz scores Radiology Residents

Rubio, et al. AJR:190, June 2008

Immediate (%)

3 months (%)

ARS + 76 58

ARS - 60 27

Interactive Teaching improves image interpretation Fellow read 15 cases before training and

200 after didactic lectures. Weekly interactive tutorials with experts

compared fellow’s interpretations to pathology

Interactive training significantly improved accuracy in tumor localization extension

Akin O, et al. Eur Radiol. 2010 Apr;20(4):995-1002

Students report positive feedback for ARS Improved activity during lectures Enhanced learning Easier to ask questions during lectures Majority enjoy ARS lectures more Majority feel more engaged

Uhari, et al. BMC Medical Education 2003, 3:12Nayak, et al. Acad Radiol. 2008 Mar;15(3):383-9

Radiology instruction using ARS builds

students’ confidence knowledge of self-mastery insights for future studying

Uhari, et al. BMC Medical Education 2003, 3:12Nayak, et al. Acad Radiol. 2008 Mar;15(3):383-9

Instant feedback Allows educator to direct lecture and

discussion Gives trainees information about their

knowledge and performance Results in increased satisfaction for both

lecturer and trainee

Steinert & Snell. Med Teacher, Vol. 21, No. 1, 1999

Autonomous, self-directed learners Want to be actively involved in learning Can be used to guide knowledge

Foundation of experience Method to relate to life experience through CBT

Relevancy-oriented/practical Practice what learned

Desire respect Gives opportunity for audience to voice opinion

and demonstrate knowledge

Motivation Allows connection of teacher and learner Provides avenue for challenging learner Provides mechanism for feedback

Reinforcement Practice

Retention Proven to have higher % retention

Transference First step to applying knowledge learned

Need to transport and set upExpensive to use/buy/rentEffectiveness depends on instructor

competence and equipment reliability

Questioning reduces time for lecture content

Time to prepare the lecture longMay be seen as a gimmick/game

Collins. J Am Coll Radiol 2008;5:993-1000

Best to prepare questions in advance (can do spontaneous additions)

Files from other software can be difficult to import

System requires dedicated laptop unless speaker comfortable with ARS software

Not easy to return to earlier question Software has learning curve IT support helpful/necessary?

Fear of losing control Too much freedom for the audience

Fear of not covering all the information Have to reduce facts to incorporate

interactive nature Too much information results in less

retentionTime constraints

Steinert & Snell. Med Teacher, Vol. 21, No. 1, 1999

ARS-based lectures progress slower than didactic formats

Amount of material covered less than in didactic formats

ARS may not be designed ideally for radiology in that MCQs may not be ideal way to test in radiology However, studies show interactive learning

helpful Need for creativity in CBT

Nicholson and Bassignani. Unpublished data (UVa)

ARS

Cross-Tab Label

0/0

1. Vanilla2. Chocolate3. Chocolate Cookie Dough

4. Mint Chocolate Chip5. Other

25% 25% 25% 24%

1 2 3 4

10

Tips to limit negatives and maximize positives

Promote critical thinking through wording

Make topics/questions relevant to work Prepare for questions that might arise Keep simple, short, easy to read

10-15 seconds time per question Vary question types

MC, T/F, yes/no, Likert opinion

Collins. J Am Coll Radiol 2008;5:993-1000

Number options 1 to 10 Incorporate time for

questions/discussion of options Average 5 minutes per question Range is broad (many factors)

Insert question every 10 to 20 minutes Provide instructions to audience prior

to beginning Arrive early to review ARS and prevent

IT issues

Collins. J Am Coll Radiol 2008;5:993-1000

Impromptu questions More than one answer options

Choose all that apply Rank order

Anonymous record keeping for follow up Team play

Involve audiences to pick teams Assign points for questions/answers

Fastest responder CME, SAM testing

See ARS staff

The Worst is Over………..