Thursday, 26 February 2015

Preparation for formal PhD proposal - February to August 2015

February 2015
(assembling and demonstrating all previous work including over last 3 years since obtaining Maastricht MHPE in June 2012, see website above)

Draft proposal 

Re-imagining a medical and postgraduate training curriculum by integrating online with face to face learning and interaction
- a PhD proposal by Dr Goh Poh Sun
MBBS(Melb), FRCR, FAMS, MHPE(Maastricht)


Professional training programs are faced with the constant challenge of exponentially increasing curricular content, or curricular "bloat", crowding out curricular time allocated for student interaction and content assimilation, not to mention content integration.

The paradox is that professional training programs are lengthy multiyear, if not decade long training and apprenticeship encounters. As educators, we have not taken full advantage of the potential of educational technology to provide access to comprehensive, standardised, peer-reviewed, high quality content for both students, and instructors; during this lengthy training process. To revisit, and build upon fundamental principles and case-based experience; utilising the best available educational theory, including mastery training and deliberate practice principles, evidence from the literature, as well as local empirical experience. We have also not taken full advantage of the potential of educational technology and eLearning to make our teaching public, scholarly, and a showcase of educational scholarship.

In the next 5 studies, as part of a "PhD level" educational proposal, the role of educational technology, eLearning or technology enhanced learning will be reviewed in the context of a longitudinal medical training program, spanning the undergraduate, through postgraduate, to continuing professional development and lifelong learning settings. A series of studies will be proposed to evaluate, assess, and measure the impact of these educational efforts in revising a training curriculum.

Study 1 and 3 - eLectures vs traditional Lectures in undergraduate (study 1) and postgraduate (study 3) medical education

Lectures can (1) provide an efficient and time effective way to share complex information with large groups of students in an enthusiastic and engaging way; (2) present a framework to facilitate understanding and provide an introduction and overview of complex topics, helping integrate prior knowledge with current information for students; (3) customise the material for a specific cohort of students to address their learning needs; (4) be used to provoke thought and deepen understanding; and (5) be used to promote independent learning (Brown & Manogue (2001); Exley & Dennick (2004).

eLectures possess many of the advantages of traditional lectures; with the added functionality and advantage of widening access to high quality standardised peer reviewed content to both students and instructors; to learn from, and build upon (see background section).

A key advantage of making eLecture content available, in both packaged, and granular form (by indexing key take-home points, key tables and graphics and important references and review papers for example); is that students can review and revisit principles, and illustrative case studies repeatedly through their longitudinal training program (with timing and sequence both guided by instructors in an adaptive curriculum; and also on demand as and when required by students). This reinforces basic principles; and improves transfer (Baldwin & Ford,1988). The provision of eLecture content which students engage with repeatedly promotes learning.

eLectures can facilitate self-directed learning in students. eLectures offer curricular planners and educators greater flexibility to deliver and customise educational content, and facilitate an adaptive curriculum.

There are several ways we can evaluate and assess these assertions.

For example, for students, we can measure time to competency for undergraduates as an index for efficiency. We can measure time to proficiency, and mastery for postgraduates; as an index for efficiency. For both undergraduates, and postgraduates, we can assess understanding, knowledge retention, and ability to apply key ideas and principles as an indicator of effectiveness. For instructors, we can measure lecture preparation time as an index for efficiency. And assess the relative ease of evaluating teaching effectiveness using eLectures vs traditional lectures.

Study 2 - role of interactive eCases in undergraduate medical education

What is the role of interactive eCases in undegraduate medical education? Presenting typical examples of common clinical conditions serves to illustrate principles and key ideas introduced in the basic science units of a medical curriculum. More significantly, these clinical scenarios and case examples are the starting point of future clinical encounters, and serve as both knowledge anchors around which deeper experience can be built with exposure to further clinical case examples, as well as triggers to recall key practice points, while deepening understanding of basic science principles.

Students are progressively exposed to clinical scenarios illustrated with key points in the clinical history, physical examination findings, laboratory data and clinical imaging findings.

This process of building a firm foundation of clinical case based scenario recognition ("think fast", pattern recognition, or "what") supported by a firm foundation of increasing deeper understanding of basic science principles ("think slow" or "why") is fundamental to developing both forms of clinical reasoning, giving future clinicians the ability to quickly recognise common and important clinical scenarios, as well as the capacity and ability to reason from first principles with atypical clinical presentations, with less defined, multiple and conflicting clinical features.

Study 4 - role of interactive eCases in postgraduate medical education

Re-imagining a postgraduate training curriculum

A combination of eLectures (e=online; e=edited, 0.5 time traditional lectures), daily deliberate practice sessions with theme based interactive online sets of clinical cases for compare and contrast practice coupled with online and regular face to face feedback and discussion with clinical tutors; together with supervised daily clinical sessions with clinical teachers in a coaching role; augmented by individual resident ePortfolios for formative assessment and self reflection; can potentially dramatically reduce the training time required in postgraduate training programs, delivering a more personalised educational experience, focused on identifying an individual trainee's strengths and augmenting these, as well as strengthening areas of weakness in performance.

(These five studies will be capped off by a "Review of studies and PhD thesis"; or conference/medical education symposium presentation and review paper).

Study 5 - role of a hyperlinked indexed eRepository in continuing medical education (draft)

An eRepository, particularly one that is comprehensive, and representative of current, and actual teaching and training material, has a similar utility to that of a well stocked, well laid out, and clearly signposted and labelled grocery or market, with a well stocked frozen food/prepared meal section. To take this food and cooking analogy further, this resource would allow a chef, or cooking instructor/demonstrator, to devote his or her time more efficiently, and potentially more effectively, by focusing effort on actual cooking and demonstrating, rather than sourcing for ingredients.

Translating this analogy to an education and training setting, the instructor can focus on customising a teaching and training program, and refining an educational offering; rather than spending time sourcing for material, creating content from scratch, or looking through past presentations and training resources to attempt to update or customise these for a particular audience.

This paradigm also facilitates personalised content review by learners, who now can not only review previously presented packaged presentations, but also go back to the original source material and "raw ingredients", for example clinical scenarios, take home points, key references, key points made in these references, key illustrations (including graphics, radiology images, anatomy and pathology digital photographs), charts and tables.

This promotes a modular, potentially more standardised, systematic and programatic; customised and personalised review of educational material; particularly with the aid of prepared curricular plans, and the assistance of teachers and trainers in a coaching role. Digital access and accessibility promotes and widens access to this educational and training material; facilitates formal, informal and just in time learning and performance support; anytime and anywhere. This resource supports content review before class. Valuable face to face time and live class time is now available for more interactive discussion with peers and instructors, with a focus on deepening understanding, translating theory to practice, using group interactions and other active learning strategies ("blended" eLearning with face to face interaction; and the "Flipped Classroom" model).

For example, the potential of "collections of potential training situations for a wide range of professional tasks" is discussed by K. Anders Ericsson (2009), where he suggests "using collections of representative tasks with verifiably correct answers", which can "not only be used to measure objective performance of experts", but can "be used for training new recruits as well as maintenance testing and continued training of experienced professionals" (Chapter 18, page 422-423).

Ericsson concludes with this suggestion, that "with an increased interest in the lifelong development of professional performance, there should be an increase in the studies examining deliberate practice in many different types of professional activities, as well as designing training environments with challenging relevant situations that require immediate action and that can provide feedback and opportunities for repeated encounters of the same and similar tasks" (Chapter 18, page 425).

Above reflection jotted down while reading A radiological approach to benign and malignant lesions of the mandible (review article in Clinical Radiology, April 2015)

Assembling background reading/detailed literature review

This includes detailed re-reading of Chapter 10, The role of expertise in radiology image interpretation. Calvin Nodine and Claudia Mello-Thoms. In The Handbook of Medical Image Perception and Techniques. Edited by Ehsan Samei and Elizabeth Krupinski

Re-reading literature on the 4C-ID model

Blueprints for Complex Learning: The 4C/ID-Model by Jeroen J. G. van MerriĆ«nboer
Richard E. Clark and Marcel B. M. de Croock

4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93 by Vandewaetere M1, Manhaeve D, Aertgeerts B, Clarebout G, Van MerriĆ«nboer JJ, Roex A.

Placed order for following:

End February 2015

Time spent on PhD proposal last week Feb 2015 (total 4 hours reading, 1 hour assembling background reading material/literature review), 1 hour reflecting/documenting/communicating process.

March 2015

First week, time spent (total 2 hours) re-reading Chapter 10 by Nodine and Mello-Thoms. Section 10.1 to 10.7 in detail, then highlighted portions each day over several days and once more over weekend. This is an incredibly well researched and written chapter. Almost every paragraph is packed with insights, and reading and re-reading triggers ideas for applying theory to practice.

This week was mainly spent forward planning my time schedule over the next 6 months. This includes educational activities, review and debriefing session, and planning for faculty development workshops, local and overseas invited presentations, and a study trip.

Second week. Intend to allocate at least one hour each day to re-reading Chapter 10 by Nodine and Mello-Thoms. And half to one hour each day to the videos on demand on ECR-Live.

Just received three books purchased from Amazon early this week. Have started reading all three of them. Incredible collection of articles inspired by a series of meetings organised/co-organised by K. Anders Ericsson, bringing together multidisciplinary and cross disciplinary experts in the area of expert performance in multiple domains of professional performance. Have spent 10 hours distributed over 3 days carefully reading selected chapters in these three books, and am going to spend at least 10 more hours this weekend, while highlighting sections, and taking notes. Am greatly inspired!

Third week. Have completed careful reading of 8 out of 21 Chapters of Ericsson's book on the Development of Professional Expertise (taking another 10 to 12 hours or so). Brilliant work. I really appreciate and feel the difference between preparing for a Master's level research project compared to a PhD proposal. This field is deep; yet there are clear areas which are begging to be investigated further. Particularly at the interface of theory and professional practice.

Fourth week. Re-read 8 Chapters (see previous section), focusing on highlighted sections, as well as additional chapter on designing assessments (taking approximately 10 hours over the last week). Have spent this time reflecting further on material in these chapters, refining the draft PhD proposal, as well as thinking through ideas generated on how to transfer these insights into the teaching and training sessions and programs that I am involved in.

April 2015

First week. Further close reading of 3 Chapters of Ericsson's book on the Developing of Professional Expertise (taking another 10 to 12 hours or so). Particular focus on Chapters 15, 17 and 18. Spent the Easter long weekend (around 10 hours) reading an incredible book, The Power of Pull, by John Hagel, John Brown and Lang Davison (see below). For example, in Chapter 1, the description and illustration of explicit and tacit knowledge, "early-stage knowledge tends to have a much higher tacit component" and "in a rapidly changing world this is often the most useful knowledge".

Second and Third week April. Continuing in depth reading of "Development of Professional Expertise" (around 10 hours each week), focusing particularly on Section 4: The development of expertise and expert performance. Have been demonstrating and illustrating these ideas in postgraduate tutorials and day to day residency training (, and medical education faculty development presentations ( Attended a fascinating technology in pedagogy hour-long presentation by Stephanie Lo-Philip at CDTL, NUS which explored "visual literacy" and introduced the work of "Gustavo Mercado in The Filmmaker's Eye", see also

Working with Terry to prepare for study trip by EduTech team to Sydney - to visit the University of Wollongong (School of Medicine),   and   .

The AMEE eLearning committee is finalising the program for the eLearning symposium @ AMEE 2015, Glasgow. Working on the end of day 1 panel symposium,
and AMEE main conference symposium (report on eLearning symposium) format and Padlet walls.

The Lee Kong Chian Natural History Museum at NUS opened this weekend. Its website provides a wonderful example of a visual search categorical index.

Fourth week April. Have started to read "The Road to Excellence". Chapter 11, The Rage to Master: The Decisive Role of Talent in the Visual Arts by Ellen Winner is not only well well written, but also illuminating and thought provoking. "The interest, drive, and desire to work on something must be part and parcel of the talent."  "However, the desire to work so hard at something comes from within, not without, and occurs almost always when there is an ability to achieve at high levels with relative ease." "Because precocity and drive tend to co-occur, it is difficult to determine the relative contribution of each. However, the fact that precocity and drive so often co-occur is not simply a natural confound that befuddles our research efforts. This co-occurence also tells us something of critical importance, namely, that drive (or what I call the rage to master) is an eluctable part of talent." Spent over 8 hours during the weekend carefully reading Chapters 6 and 8  from "The Road to Excellence".  Chapter 6 on topic "Perceptual and Memory Processes in the Acquisition of Expert Performance: The EPAM model" makes for an engrossing read; and Chapter 8, "Creative Expertise: A Life-Span Developmental Perspective" is inspiring.

Last week of April and First week of May. After presenting at a CenMED workshop on Monday then spent a quiet week in Ubud, Bali; 

pausing to recap progress, continuing to read "The Road to Excellence", collecting my thoughts, preparing for two upcoming CenMED workshops and , and a 9 day trip to Almaty as visiting Professor

Returned from 9 day trip to Almaty, Kazakhstan as visiting professor. Very successful outcomes (see reflection piece above).

Weekend before 4th week May, 2015.
Continuing preparation for PhD proposal. Started reading "Essentialism" (below).

June/July 2015

Study visit to Melbourne Medical School, University of Western Sydney and University of Wollongong.

Local faculty member for MHPE-S program July 2015 (3 weeks)

Technology enhanced learning @ CenMED workshop July 24th, 2015

                                            Ideas are the currency of the 21st century

Ellen Kok (PhD) post doctoral researcher at Maastricht University
(Ellen was my MHPE Master Thesis Supervisor in 2011/2012 with Anique deBruin as co-supervisor)

Medical Education Peer Reviewed Publications (selected) - 2015 and 2016

The intention of writing a recent series of reflection pieces (article 3, 4, 5, 7 and 9), as well the other articles below, was to set down in print as many of the useful ideas / and pointers I could think of, and which I have found useful and currently use, on the subject of TeL and implementing this, distilled from my reading, practice, and scholarly inquiry since 2002, as well as from the last 6 years of faculty development presentations, symposia and workshops I have been involved in designing and have participated in at NUS, at APMEC and AMEE; and have presented as invited speaker to conferences in Colombo, Sri Lanka; Kaohsiung, Taiwan; Jakarta, Indonesia; and as visiting professor in Almaty, Kazakhstan.

1. Goh, P.S. A proposal for a grading and ranking method as the first step toward developing a scoring system to measure the value and impact of viewership of online material in medical education - going beyond “clicks” and views toward learning. MedEdPublish. 2016 Oct; 5(3), Paper No:62. Epub 2016 Dec 9.

2. Goh, P.S. Presenting the outline of a proposal for a 5 part program of medical education research using eLearning or Technology enhanced learning to support Learning through the continuum of Undergraduate, through Postgraduate to Lifelong learning settings. MedEdPublish. 2016 Oct; 5(3), Paper No:55. Epub 2016 Dec 7. 

3. Goh, P.S. The value and impact of eLearning or Technology enhanced learning from one perspective of a Digital Scholar. MedEdPublish. 2016 Oct; 5(3), Paper No:31. Epub 2016 Oct 18.

4. Goh, P.S. A series of reflections on eLearning, traditional and blended learning. MedEdPublish. 2016 Oct; 5(3), Paper No:19. Epub 2016 Oct 14.

5. Goh, P.S. Technology enhanced learning in Medical Education: What’s new, what’s useful, and some important considerations. MedEdPublish. 2016 Oct; 5(3), Paper No:16. Epub 2016 Oct 12.

6. Sandars, J., Goh, P.S. Is there a need for a specific educational scholarship for using e-learning in medical education? Med Teach. 2016 Oct;38(10):1070-1071. Epub 2016 April 19.

7. Goh, P.S. eLearning or Technology enhanced learning in medical education - Hope, not Hype. Med Teach. 2016 Sep; 38(9): 957-958, Epub 2016 Mar 16

8. Goh, P.S., Sandars, J. An innovative approach to digitally flip the classroom by using an online "graffiti wall" with a blog. Med Teach. 2016 Aug;38(8):858. Epub 2016 Jul 14.

9. Goh, P.S. Using a blog as an integrated eLearning tool and platform. Med Teach. 2016 Jun;38(6):628-9. Epub 2015 Nov 11.

10. Sandars J, Patel RS, Goh PS, Kokatailo PK, Lafferty N. The importance of educational theories for facilitating learning when using technology in medical education. Med Teach. 2015 Mar 17:1-4.

11. Dong C, Goh PS. Twelve tips for the effective use of videos in medical education. Med Teach. 2015 Feb; 37(2):140-5.

12. Liaw SY, Wong LF, Chan SW, Ho JT, Mordiffi SZ, Ang SB, Goh PS, Ang EN. Designing and evaluating an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care: randomized controlled trial. J Med Internet Res. 2015 Jan 12;17(1):e5.


"........The opposition between randomized controlled trials and expert opinion was fueled by the rise in the 1990s of the evidence-based medicine movement, which placed such trials atop a hierarchy of scientific methods, with expert opinion situated at the bottom. The doctor David Sackett, a father of the movement, once wrote that “progress towards the truth is impaired in the presence of an expert.”

But while all doctors agree about the importance of gauging the quality of evidence, many feel that a hierarchy of methods is simplistic. As the doctor Mark Tonelli has argued, distinct forms of knowledge can’t be judged by the same standards: what a patient prefers on the basis of personal experience; what a doctor thinks on the basis of clinical experience; and what clinical research has discovered — each of these is valuable in its own way. While scientists concur that randomized trials are ideal for evaluating the average effects of treatments, such precision isn’t necessary when the benefits are obvious or clear from other data."

"Clinical expertise and rigorous evaluation also differ in their utility at different stages of scientific inquiry. For discovery and explanation, as the clinical epidemiologist Jan Vandenbroucke has argued, practitioners’ instincts, observations and case studies are most useful, whereas randomized controlled trials are least useful. Expertise and systematic evaluation are partners, not rivals.

Distrusting expertise makes it easy to confuse an absence of randomized evaluations with an absence of knowledge. And this leads to the false belief that knowledge of what works in social policy, education or fighting terrorism can come only from randomized evaluations. But by that logic (as a spoof scientific article claimed), we don’t know if parachutes really work because we have no randomized controlled trials of them.

Antagonism toward expertise can also waste time and effort by spurring researchers to test the efficacy of things we already know work......."

above excerpt from NYTimes article below
Jamie Holmes, a fellow at New America, is the author of “Nonsense: The Power of Not Knowing.”

Interview with Bruce Poh, ITE's (Singapore) CEO in Straits Times, on 6 September 2014

"How do countries such as Germany and Switzerland celebrate their skilled workers?"

If you are a master craftsman in Germany, you're very well respected ... All this took centuries, and is due to their guild system that dates back to the mediaeval age.

A guild promotes a particular profession. The guilds were very powerful at the time, even politically, electing their people to the local government.

Their system must be followed. You learn from a meister (master craftsman), and after that you become a journeyman, journeying from town to town and learning from other meisters before you can become a craftsman and meister yourself."

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