Medical Education and eLearning Portfolio: 2021

Wednesday 29 December 2021

#Micro-Scholarship #Inspiration-of #Genesis-of

[Reflection/Insight after 'resting' - with following question, and answer: Poh-Sun Goh, 30 December 2021 @ 0526am, Singapore time]

What was inspiration of idea, and practice of 'Micro-Scholarship'?

The challenge, and task was 'how to start journey, and become productive, and successful, as a writer and scholar.

Inspiration came from several sources. Including:

"A journey of a thousand miles begins with a single step" - Lao Tzu

https://www.openculture.com/2013/02/seven_tips_from_ernest_hemingway_on_how_to_write_fiction.html [the daily morning writing, and afternoon 'fishing' routine of Ernest Hemingway]

The challenge to complete a rigorous MHPE program [Maastricht] - https://medicaleducationelearning.blogspot.com/2021/05/buildingblocksofscholarship-in.html

https://medicaleducationelearning.blogspot.com/2021/05/categories-of-scholarship-in-medical.html

Participating as faculty in workshops on SOTL and RIME (Research in Medical Education)

https://telmeded.blogspot.com/2020/10/micro-scholarship-and-digital.html

https://linktr.ee/PohSunGoh

https://microscholarship.blogspot.com/

Goh PS. Using a blog as an integrated eLearning tool and platform. Med Teach. 2016 Jun;38(6):628-9. doi: 10.3109/0142159X.2015.1105947. Epub 2015 Nov 11. https://pubmed.ncbi.nlm.nih.gov/26558420/

Studying the paths and process of attaining 'Mastery' over the last 12 years -

inspired by the seminal work of Anders Ericsson - Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med. 2015 Nov;90(11):1471-86. doi:10.1097/ACM.0000000000000939. PubMed PMID: 26375267. https://www.ncbi.nlm.nih.gov/pubmed/26375267/?ncbi_mmode=std

and George Leonard - in his book - 'Mastery - The keys to success and long-term fulfilment'. 1991, Plume. An Imprint of Random House, New York. https://jamesclear.com/book-summaries/mastery

https://www.instagram.com/p/CWejrPuvkHK/

https://www.instagram.com/p/CYKbdLgBqmS/

https://www.instagram.com/p/CYKZmxhBJko/

Saturday 4 December 2021

M3 Tutorial on Wednesday 8 December 2021 @ 1pm

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Entrada message to M3 students on Sunday, 5 December 2021

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Dear M3 SUR CG 14-25 Students, (74 students, 12 Clinical Groups),

For the Radiology session “Acute Abdomen”, this will be a one hour scheduled live interactive teaching session (on Zoom) this Wednesday, 8 December 2021, followed by self-study session of the presented and reference-further reading online content (see below). Please refer to Entrada and visit the blog for the open access online content curated by A/Prof Goh Poh Sun at this URL https://medicaleducationelearning.blogspot.com/2021/12/m3-tutorial-on-wednesday-8-december.html.

Remarks : One hour live interactive presentation by instructor, with live Q and A. Post session optional self study of content from presentation blog. For those students who are interested, please feel free to review the session outline and content before the tutorial.

We will be covering 7 major clinical conditions (below)

Radiology Bowel Perforation

Radiology Bowel Obstruction

Radiology Acute Appendicitis

Radiology Acute Cholecystitis

Radiology Acute Diverticulitis

Radiology Acute Pancreatitis

Radiology Colon Cancer

Best regards

Poh Sun

(This tutorial process has been iteratively refined over the last year, during the COVID-19 pandemic.

Learning takes place essentially as a process of self study, in each of you individually. Following by active discussion and use of this material in clinical practice. For this session, we will review and discuss your understanding during the live session this Friday. My role is to present compact, usable content, that you can both review and use, and come back to, as and when you require in the future. For those of you who are interested in how this tutorial process has been refined with previous tutorial groups please click to tap on this link - https://medicaleducationelearning.blogspot.com/2021/09/m3-tutorial-on-friday-1st-october-2021.html)

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Start here with background info and learning tips

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Some tips to increase your learning and training effectiveness and efficiency:

Poh-Sun Goh

1. Reflect on the purpose of your medical education and expected outcomes of your undergraduate education and clinical training process.

2. Your current clinical exposure to case based learning in the emergency department, wards, and clinics-outpatient settings builds on a foundation of pre-clinical basic sciences in year 1 and 2 of the medical program (with anatomy and pathology particularly applicable to the interpretation of radiology / imaging studies of your patients).

3. For the abdomen, think about what anatomical structures lie within the area of interest/clinical presentation, or may present with the clinical symptoms and signs exhibited by your patients. Ask yourself what radiological investigation you might request or review in order to make a diagnosis - to rule in, or rule out potential clinical diagnosis. Radiology helps you to "see living anatomy and pathology" in your patients. Thus confirm or exclude diagnosis. Keep in mind that early disease may have very subtle of "negative" imaging during the early stages of clinically symptomatic disease.

4. Review the Radiology studies for your patients. Ask yourself why certain investigations were performed. And in what order.

5. Correlate imaging findings with your clinical observations. Do they make sense, correlate with clinical findings, or do you have to entertain alternative diagnostic possibilities?

6. Use textbooks and a wide variety of online resources to improve your diagnostic and interpretative skills. Practice, practice, practice with reflection and feedback, using a range of resources, to increase your exposure to the variety and spectrum of clinical and imaging findings, both normal and abnormal, from typical, to less common and atypical (as you progress to increase your experience and mastery of clinical practice, and improve your knowledge and skills from undergraduate, through postgraduate to continuing professional development and lifelong learning settings).

7. Compare and contrast is one of the simplest and most effective methods to learn to recognise and differentiate between normal and abnormal XRs and scans. Review a series of normal XRs and scans, and then do side by side comparison between examples of normal, normal and abnormal, and examples of abnormal XRs and scans.

https://effectiviology.com/interleaving/ (mixed practice or interleaving superior to blocked practice)

and

https://www.learningscientists.org/interleaving

https://www.learningscientists.org/downloadable-materials

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Below section is guided learning path (Option 1)

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Session guide (one learning path) - start with 'Tips' section above, then explore material section below, all on open access websites. One path is to start with 'a curriculum', then explore an approach to the AXR, both normal, and abnormal. Followed by review of common pathology presenting as an acute abdomen on CT scans. Start with bowel perforation on erect CXR, and AXR, unknown cases, for example here, focusing on appearance of free air, and 'Rigler's sign' on AXR. Then move on to examples of acute appendicitis, acute cholecystitis, acute diverticulitis (focusing on the similarities between these three pathologies, and taking note of differences between normal and abnormal structures, paying attention to the wall of the structure, and the adjacent fat in particular). Then review bowel obstruction, on the AXR, and CT scan, paying attention to the strengths and weaknesses of the AXR, and added value of a CT scan - pay attention to visibility of bowel segment which is dilated proximal to obstructing point, and cause of obstruction shown on CT).

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Below section is alternative exploratory path (Option 2)

Starting with background information, and "curriculum"

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Below section for Google images search for thematic cases (for practice review, and click through for additional information for selected cases)

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Radiology Bowel Perforation

Radiology Bowel Obstruction

Radiology Acute Appendicitis

Radiology Acute Cholecystitis

Radiology Acute Diverticulitis

Radiology Acute Pancreatitis

Radiology Colon Cancer

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Section below for self-directed learning

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https://radiopaedia.org/articles/abdominal-radiology-for-students-curriculum

and

https://www.radiologymasterclass.co.uk/tutorials/abdo/abdomen_x-ray/anatomy_introduction

https://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal

Further reading/Radiology Masterclass

and

https://www.learnabdominal.com/
and
(see interactive CT cases without and with annotation on this online resource
https://www.learnabdominal.com/cases/abdominal-ct-101)

👁

Google and Entrada analytics for current tutorial

👀

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Friday 26 November 2021

APMEC 2022 Short Communication -

APMEC 2022 Kuala Lumpur

Virtual

12 - 16 January 2022

https://medicine.nus.edu.sg/cenmed/apmec2022/index.html

https://medicine.nus.edu.sg/cenmed/apmec2022/programs.html

https://medicine.nus.edu.sg/cenmed/apmec2022/special_course_ESME.html

Oral Presentation/Short Communication

The Role of Coaching in Health Professions Education

Poh-Sun Goh and Shefaly Shorey

One takeaway summary slide below:

Introduction

The aim of this short communication is to present findings, insights and practice points from a systematic review of literature in coaching in health professions education; and personal observations and reflections on practice from the two authors as in-house coaches, after recently graduating from a formal (ontological) coaching training program.

Methods

Our intention is to engage in the Scholarship of Integration, and Application - by presenting usable findings from a recently completed and published systematic review; and personal insights from reflective practice, both during a formal coaching training program, as well as internal coaches at the YLLSOM working with medical and nursing students.

Our recently published systematic review is - Shorey S, Ang E, Chua JYX, Goh PS. (2021). Coaching interventions among healthcare students in tertiary education to improve mental well-being: A mixed studies review. Nurse Education Today. Available online 16 November 2021, In Press. https://doi.org/10.1016/j.nedt.2021.105222

Both authors are graduates of The Coach Partnership/Newfield Coach Training Program for NUS YLLSOM (2021), and are certified associate coaches at YLLSOM.

Results

Coaching is a distinct role, and set of skills, that can add value and expand an educator’s toolkit in health professions education. Understanding and applying both theory, and a foundation in background knowledge, as well as professional training (as a coach) and practise in coaching skills are important.

In our systematic review, we identified the following as key usable findings -

careful preparation of both coaches and students (coachees)

incorporate both group and individual sessions

assign students to coaches based on their clinical interests

providing an option to change coach

consider conducting online coaching sessions using video calls

Our insights from reflective practice are -

the importance of formal training

to engage students (before, during and after)

to incorporate BEL (build awareness and observation in both coach, and coachee, of how they ‘show up’ - in body (physically), emotion, and language (use of words and thinking) - and through this develop the ability to intentionally shift how they communicate with ‘BEL’ and significantly influence themselves and their impact on others in a positive way

be mindful of “educator” and “mentor” roles

strategic pauses (during the sessions)

reflective journal/seeking feedback (on your journey as a coach)

technology ‘works’ (does the job) - WhatsApp + live Zoom for group, and individual coaching

Conclusion

Coaching is a distinct skillset, requires formal training, and forms part of the spectrum of practice we engage in as health professions educators - as teachers, instructors, supervisors, mentors, guides and coaches.

Acknowledgements - both authors deeply thank the following for their wholehearted support

Professor Kesavan Esuvaranathan, for championing and leading YLLSOM internal coaching program

Our teachers, mentors and coach trainers from TCP/Newfield Asia, who trained and certified us as in-house coaches

Our fellow in-house community of coaches at YLLSOM

Our student coachees

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Systematic Review

- Importance of formal training, reflective practice, and feedback (for coaches)

- Importance of coachees having clear idea of what coaching is (for), and is not

- In institutional settings, group and individual coaching can be complementary, and synergistic

- In Health Professions Settings, both generic and performance focused coaching has role - some degree of coach-coachee matching has role

- Option to change assigned coach in institutional setting is helpful - compare and contrast this with more organic arrangements outside participation in cohort formal coaching programs

- During COVID-19, live digital video only does the job (vs in-person analogue coaching or blended coaching)

Insights from Reflective Practice

- Formal training as coach is transformative - understanding oneself, then others, and the interactive dynamics of how both the coach, and coachee 'show up'

- The coach 'owns the process' - engagement - preparation before (background information - both coaching and coachee-coach, expectations, agreements, trust), during coaching (focused listening/observation - it is all about the coachee, not the coach; what does the coachee want to work on; how is coachee 'showing up'); and follow up after session and at follow up session

- BEL - body/somatic expression, emotion and language (use, choice) are indicators, information and insight sources, and levers for coach to work with coachee - insights and 'aha' / transformative moments arise from (within) the coachee - similar to learning (which occurs within student)

- Spectrum of conversation emphasis - with coaching at one end focused on 'listening-observing', asking questions, being present, and providing feedback - 'not' direct instruction, teaching, educator, mentoring (at the other end of the spectrum - with different roles). The coach 'should not work harder' than the coachee.

- It is all about the coachee, their experience, and what they take away from the coaching session - strategic pauses to 'check-in' with coachee is key step. The coachee 'owns the goal' of the coaching process. What they want to work on and get from coaching.

- Reflective practice, reflection, and ongoing professional development and training is important for coach

- Technology 'works' - to connect, and engage - e.g. WhatsApp + 'Live' video Zoom

Shorey S, Ang E, Chua JYX, Goh PS. (2021). Coaching interventions among healthcare students in tertiary education to improve mental well-being: A mixed studies review. Nurse Education Today. Available online 16 November 2021, In Press. https://doi.org/10.1016/j.nedt.2021.105222

Wednesday 24 November 2021

Pre-2B FRCR Tutorial - Radiology of skull vault lesions

➡ One 'digital literary' capability development 'search path' is:

Start with - radiology of skull lesions (Google text - key word - phrase - search) - focus on first page of results (will discuss how understanding search engine optimisation algorithms applies to this process)

Also do this - radiology of skull lesions (Google image search) - review breadth - spectrum of images presented - then click through to source and review

Repeat this process with 'key words' and phrases - from first set of results, iteratively, over several cycles.

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Pons Escoda, A., Naval Baudin, P., Mora, P. et al. Imaging of skull vault tumors in adults. Insights Imaging 11, 23 (2020). https://doi.org/10.1186/s13244-019-0820-9

https://insightsimaging.springeropen.com/articles/10.1186/s13244-019-0820-9

Gomez, C. K., Schiffman, S. R., & Bhatt, A. A. (2018). Radiological review of skull lesions. Insights into imaging, 9(5), 857–882. https://doi.org/10.1007/s13244-018-0643-0

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206383/

Ugga, L., Cuocolo, R., Cocozza, S., Ponsiglione, A., Stanzione, A., Chianca, V., D'Amico, A., Brunetti, A., & Imbriaco, M. (2018). Spectrum of lytic lesions of the skull: a pictorial essay. Insights into imaging, 9(5), 845–856. https://doi.org/10.1007/s13244-018-0653-y

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206388/

Colas L, Caron S, Cotten A. Skull Vault Lesions: A Review. AJR Am J Roentgenol. 2015 Oct;205(4):840-7. doi: 10.2214/AJR.14.13415. PMID: 26397334.

https://www.ajronline.org/doi/pdfplus/10.2214/AJR.14.13415

I. Lloret, A. Server & I. Taksdal (2009) Calvarial Lesions: A Radiological Approach to Diagnosis, Acta Radiologica, 50:5, 531-542, DOI: 10.1080/02841850902795274

https://www.tandfonline.com/doi/full/10.1080/02841850902795274

Arana E, Martí-Bonmatí L. CT and MR imaging of focal calvarial lesions. AJR Am J Roentgenol. 1999 Jun;172(6):1683-8. doi: 10.2214/ajr.172.6.10350315. PMID: 10350315.

https://www.ajronline.org/doi/pdf/10.2214/ajr.172.6.10350315

Hernan R. Bello, Joseph A. Graves, Saurabh Rohatgi, Mona Vakil, Jennifer McCarty, Rudy L. Van Hemert, Stephen Geppert, and Ryan B. Peterson. Skull Base–related Lesions at Routine Head CT from the Emergency Department: Pearls, Pitfalls, and Lessons Learned. RadioGraphics 2019 39:4, 1161-1182

https://pubs.rsna.org/doi/full/10.1148/rg.2019180118

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Above shared on focused internal WhatsApp tutorial discussion group Wednesday:

Just focus on 1. Images, and 2. Captions, and 3. Takeaways.

Learn to 1. Recognise, 2. Diagnose and defend diagnosis, 3. Articulate your approach. Briefly.

I would like each of you to find one useful review. Open access online. And share on this WhatsApp group. By 5pm this Thursday.

And ... I request each tutorial participant to bring along one personal takeaway from 1) review of curated articles on this topic; and .. 2) in addition to contributing one open access online resource or article on this topic, what you leant from this resource or article (that you found), and the search process - please post this resource or article on this WhatsApp forum by 5pm today, Thursday.

Post your found additional online resource, or article today by 5pm. Bring along your personal takeaways to discuss during 'live' online Zoom tutorial tomorrow Friday @ 0745am.

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Below 15 online articles-reviews sourced and shared by tutorial participants-pre2B FRCR residents on Thursday:

Kunimatsu, A., & Kunimatsu, N. (2017). Skull Base Tumors and Tumor-Like Lesions: A Pictorial Review. Polish journal of radiology, 82, 398–409. https://doi.org/10.12659/PJR.901937

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540006/?report=classic

Thust, S. C., & Yousry, T. (2016). Imaging of skull base tumours. Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology, 21(4), 304–318. https://doi.org/10.1016/j.rpor.2015.12.008

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899432/

Simin Bahrami and Catherine M. Yim. Quality Initiatives: Blind Spots at Brain Imaging. RadioGraphics 2009 29:7, 1877-1896 https://pubs.rsna.org/doi/full/10.1148/rg.297095123

Earwaker J. Anatomic variants in sinonasal CT. Radiographics. 1993 Mar;13(2):381-415. doi: 10.1148/radiographics.13.2.8460226. PMID: 8460226. https://pubmed.ncbi.nlm.nih.gov/8460226/

Rajakulasingam R, Botchu R, Vemuri VN, James SL, Subbarao K, Davies AM. Skull Imaging-Radiographs and CT revisited. Neurol India. 2020 Jul-Aug;68(4):732-740. doi: 10.4103/0028-3886.293481. PMID: 32859809. https://pubmed.ncbi.nlm.nih.gov/32859809/

Streicher, D.A.; Lee, M.J.; Allen, J.W.; Mullins, M.E.. Approach to Interpretation and Pictorial Review of the Radiographic Appearance of Calvarial Lesions in Adults. Neurographics, Volume 7, Number 2, 1 April 2017, pp. 101-114(14). https://doi.org/10.3174/ng.2170194

https://www.ingentaconnect.com/content/asnr/ng/2017/00000007/00000002/art00004#expand/collapse

Choudhary, G., Udayasankar, U., Saade, C., Winegar, B., Maroun, G., & Chokr, J. (2019). A systematic approach in the diagnosis of paediatric skull lesions: what radiologists need to know. Polish journal of radiology, 84, e92–e111. https://doi.org/10.5114/pjr.2019.83101

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479152/

Colas L, Caron S, Cotten A. Skull Vault Lesions: A Review. AJR Am J Roentgenol. 2015 Oct;205(4):840-7. doi: 10.2214/AJR.14.13415. PMID: 26397334. https://pubmed.ncbi.nlm.nih.gov/26397334/

Iman Khodarahmi, Hamza Alizai, Majid Chalian, Erin F. Alaia, Christopher J. Burke, Shira E. Slasky, and Cornelia Wenokor. Imaging Spectrum of Calvarial Abnormalities. RadioGraphics 2021 41:4, 1144-1163

https://pubs.rsna.org/doi/abs/10.1148/rg.2021200198

Ronald B. J. Glass, Sandra K. Fernbach, Karen I. Norton, Paul S. Choi, and Thomas P. Naidich. The Infant Skull: A Vault of Information. RadioGraphics 2004 24:2, 507-522

https://pubs.rsna.org/doi/10.1148/rg.242035105

Yim, Younghee & Moon, Won-Jin & An, Hyeong & Cho, Joon & Rho, Myung. (2016). Imaging Findings of Various Calvarial Bone Lesions with a Focus on Osteolytic Lesions. Journal of the Korean Society of Radiology. 74. 43. 10.3348/jksr.2016.74.1.43.

https://www.researchgate.net/publication/291396524_Imaging_Findings_of_Various_Calvarial_Bone_Lesions_with_a_Focus_on_Osteolytic_Lesions

Savarese, Leonor & Cintra, Murilo & Simão, Gustavo & Nogueira-Barbosa, Marcello & Bellucci, Angela & Teixeira, Sara. (2015). Calvarial Lesions in Children: A systematic approach based on clinical and imaging findings.

https://www.researchgate.net/publication/285927500_Calvarial_Lesions_in_Children_A_systematic_approach_based_on_clinical_and_imaging_findings

Welker KM, DeLone DR, Lane JI, Gilbertson JR. Arrested pneumatization of the skull base: imaging characteristics. AJR Am J Roentgenol. 2008 Jun;190(6):1691-6. doi: 10.2214/AJR.07.3131. PMID: 18492926. https://pubmed.ncbi.nlm.nih.gov/18492926/

Ju, H., & Paycha, F. (2021). Osteoblastic and hyperostotic craniofacial lesion detected by 99mTc-labeled methylene diphosphonate bone scintigraphy and single-photon emission computed tomography/computed tomography: a pictorial essay. Nuclear medicine communications, 42(2), 117–126. https://doi.org/10.1097/MNM.0000000000001318

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808364/

https://www.asnr.org/neurographics/5/1/19/ScalpLesions_files/frame.htm

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⬇

For quick review before, and discussion during 'live' tutorial session

Reflect on the well know aphorism "You see what you look for, you look for what you know"

"Understanding basic theory using a few illustrative examples. Mastering a topic by exposure to and experience with many examples

Typical examples or real-life scenarios can be used to illustrate theory, and help students understand fundamental principles. Mastering a topic usually requires exposure to and experience with many examples, both typical and atypical, common to uncommon including subtle manifestations of a phenomenon. The traditional method of doing this is via a long apprenticeship, or many years of practice with feedback and experience. A digital collection of educational scenarios and cases can support and potentially shorten this educational and training process. Particularly if a systematic attempt is made to collect and curate a comprehensive collection of all possible educational scenarios and case-based examples, across the whole spectrum of professional practice. Online access to key elements, parts of and whole sections of these learning cases; used by students with guidance by instructors under a deliberate practice and mastery training framework, can potentially accelerate the educational process, and deepen learning."

above from

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. http://dx.doi.org/10.15694/mep.2016.000105

"By reviewing research on medical performance and education, the author describes evidence for these representations and their development within the expert- performance framework. He uses the research to generate suggestions for improved training of medical students and professionals. Two strategies— designing learning environments with libraries of cases and creating opportunities for individualized teacher-guided training—should enable motivated individuals to acquire a full set of refined mental representations. Providing the right resources to support the expert- performance approach will allow such individuals to become self-regulated learners—that is, members of the medical community who have the tools to improve their own and their team members’ performances throughout their entire professional careers.'

from abstract of

Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med. 2015 Nov;90(11):1471-86. doi:10.1097/ACM.0000000000000939. PubMed PMID: 26375267.

https://www.ncbi.nlm.nih.gov/pubmed/26375267/?ncbi_mmode=std

What is the message from the "yellow curve" below?

"How could one use this material to dramatically reduce case review time?

Reduce study time?

Reduce residency duration?

Use training time in other ways?"

"How would you use this material to develop confidence and familiarity with less common conditions?

Given that time is limited."

"How do you stay sharp, not rusty, get better (sharper)."

[Practice. With feedback. With reflection. With increasing difficulty. Systematically. Regularly. With material that is at hand. At your finger tips.]

-Poh Sun (posted on 7 February 2018 @ 0358am)

This article investigates the relation between mind wandering and the spacing effect in inductive learning. Participants studied works of art by different artists grouped in blocks, where works by a particular artist were either presented all together successively (the massed condition), or interleaved with the works of other artists (the spaced condition). The works of 24 artists were shown, with 12, 15, or 18 works by each artist being provided as exemplars. Later, different works by the same artists were presented for a test of the artists' identity. During the course of studying these works, participants were probed for mind wandering. It was found that people mind wandered more when the exemplars were presented in a massed rather than in a spaced manner, especially as the task progressed. There was little mind wandering and little difference between massed and spaced conditions toward the beginning of study. People were better able to correctly attribute the new works to the appropriate artist (inductive learning) when (a) they were in the spaced condition and (b) they had not been mind wandering. This research suggests that inductive learning may be influenced by mind wandering and that the impairment in learning with massed practice (compared to spaced practice) may be attributable, at least in part, to attentional factors-people are "on task" less fully when the stimuli are massed rather than spaced.
above abstract from

Metcalfe J, Xu J. People mind wander more during massed than spaced inductive learning. J Exp Psychol Learn Mem Cogn. 2016 Jun;42(6):978-84. doi: 10.1037/xlm0000216. Epub 2015 Nov 30.

Kornell N, Castel AD, Eich TS, Bjork RA. Spacing as the friend of both memory and induction in young and older adults. Psychol Aging. 2010 Jun;25(2):498-503. doi: 10.1037/a0017807.

Inductive learning -- that is, learning a new concept or category by observing exemplars -- happens constantly, for example, when a baby learns a new word or a doctor classifies x-rays. What influence does the spacing of exemplars have on induction? Compared with massing, spacing enhances long-term recall, but we expected spacing to hamper induction by making the commonalities that define a concept or category less apparent. We asked participants to study multiple paintings by different artists, with a given artist's paintings presented consecutively (massed) or interleaved with other artists' paintings (spaced). We then tested induction by asking participants to indicate which studied artist (Experiments 1a and 1b) or whether any studied artist (Experiment 2) painted each of a series of new paintings. Surprisingly, induction profited from spacing, even though massing apparently created a sense of fluent learning: Participants rated massing as more effective than spacing, even after their own test performance had demonstrated the opposite.

above abstract from

Kornell N, Bjork RA. Learning concepts and categories: is spacing the "enemy of induction"? Psychol Sci. 2008 Jun;19(6):585-92. doi: 10.1111/j.1467-9280.2008.02127.x.

When students encounter a set of concepts (or terms or principles) that are similar in some way, they often confuse one with another. For instance, they might mistake one word for another word with a similar spelling (e.g., allusion instead of illusion) or choose the wrong strategy for a mathematics problem because it resembles a different kind of problem. By one proposition explored in this review, these kinds of errors occur more frequently when all exposures to one of the concepts are grouped together. For instance, in most middle school science texts, the questions in each assignment are devoted to the same concept, and this blocking of exposures ensures that students need not learn to distinguish between two similar concepts. In an alternative approach described in this review, exposures to each concept are interleaved with exposures to other concepts, so that a question on one concept is followed by a question on a different concept. In a number of experiments that have compared interleaving and blocking, interleaving produced better scores on final tests of learning. The evidence is limited, though, and ecologically valid studies are needed. Still, a prudent reading of the data suggests that at least a portion of the exposures should be interleaved.

above quote from

https://link.springer.com/article/10.1007/s10648-012-9201-3

Rohrer, D. (2012). Interleaving helps students distinguish among similar concepts. Educational Psychology Review, 24, 355-367

Learn To Study Using…Interleaving (The Learning Scientists)

http://www.learningscientists.org/

http://www.learningscientists.org/downloadable-materials/

http://www.bbc.com/future/story/20180208-an-effortless-way-to-strengthen-your-memory

Lechner HA, Squire LR, Byrne JH. 100 years of consolidation--remembering Müller and Pilzecker. Learn Mem. 1999 Mar-Apr;6(2):77-87.

Tambini A, Ketz N, Davachi L. Enhanced brain correlations during rest are related to memory for recent experiences. Neuron. 2010 Jan 28;65(2):280-90. doi: 10.1016/j.neuron.2010.01.001.

Norman, G. (2012). Medical education: past, present and future. Perspectives on Medical Education, 1(1), 6–14. http://doi.org/10.1007/s40037-012-0002-7

"Understanding basic theory using a few illustrative examples. Mastering a topic by exposure to and experience with many examples

above from

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. http://dx.doi.org/10.15694/mep.2016.000105

Goh P, Learning Analytics in Medical Education , MedEdPublish, 2017, 6, [2], 5, doi:https://doi.org/10.15694/mep.2017.000067

Matt M. Cirigliano, Charlie Guthrie, Martin V. Pusic, Anna T. Cianciolo, Jennifer E. Lim-Dunham, Anderson Spickard III & Valerie Terry (2017) “Yes, and …” Exploring the Future of Learning Analytics in Medical Education, Teaching and Learning in Medicine, 29:4, 368-372, DOI: 10.1080/10401334.2017.1384731

https://www-tandfonline-com.libproxy1.nus.edu.sg/doi/full/10.1080/10401334.2017.1384731

Chan, T., Sebok-Syer, S., Thoma, B., Wise, A., Sherbino, J. and Pusic, M. Learning Analytics in Medical Education Assessment: The Past, The Present and The Future. Education and Training, April 2018. https://onlinelibrary.wiley.com/doi/abs/10.1002/aet2.10087

Monday 18 October 2021

Riding Current and Future 'Global' Trends in Medical Education - Engaging in an interactive 'Local' Conversation, Faculty Seminar for Medical Education(FAME) @ KU (Korea University)

Faculty Seminar for Medical Education(FAME) @ KU (Korea University)

2 November 2021, 12.30pm - 13.30pm Seoul Time (11.30am - 1230pm Singapore Time, Tuesday, 2 November 2021)

"Riding Current and Future 'Global' Trends in Medical Education - Engaging in an interactive 'Local' Conversation"

Poh-Sun Goh

This purpose of this interactive session will be to explore 'Global' Trends in Medical Education, and how these might be 'Localised', customised, and applied to meet the needs of individual local users and stakeholders. The discussion will expand on recent published papers in the KJME, including by Park, Lee, Ho and Han [1], and commentary summarising and expanding on my keynote presentation at the KSME 2021 conference [2]. I will apply a Design Thinking perspective and lens to engage with the audience in an interactive conversation on this topic.

Riding current and future 'global' trends in medical education from Poh-Sun Goh

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One Slide Overview Below

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Global trends, Local needs, Design thinking - now for Future (Medical Education) from Poh-Sun Goh

"Among the 7616 abstracts initially identified, 28 full-text articles were selected to reflect medical education trends and suggest suitable educational programs. The integrative themes and subthemes of future medical education are as follows: 1) a humanistic approach to patient safety that involves encouraging humanistic doctors and facilitating collaboration; 2) early experience and longitudinal integration by early exposure to patient-oriented integration and longitudinal integrated clerkships; 3) going beyond hospitals toward society by responding to changing community needs and showing respect for diversity; and 4) student-driven learning with advanced technology through active learning with individualization, social interaction, and resource accessibility." quoted from abstract (results) from

Han, ER., Yeo, S., Kim, MJ. et al. Medical education trends for future physicians in the era of advanced technology and artificial intelligence: an integrative review. BMC Med Educ 19, 460 (2019). https://doi.org/10.1186/s12909-019-1891-5

"The deans’ perspective changes has shown the possibility of the deans’ generation aligning more closely with the current Generation Z medical students. They projected further innovations in teaching and learning methods, especially applying flipped learning and highlighted the need to invest in faculty development so medical educators can be equipped and competent in diverse ICT (information and communications technology) learning platforms. Also, the need for advance preparations in medical education for future similar public health crises were stressed. Unprecedented changes brought by COVID-19 positively impacted Korean medical education in parts and the Korean deans envisioned further innovations using the experiences gained during this crisis." - quoted from abstract (conclusion) from

Park H, Lee YM, Ho MJ, Han HC. How the coronavirus disease 2019 pandemic changed medical education and deans' perspectives in Korean medical schools. Korean J Med Educ. 2021 Jun;33(2):65-74. Epub 2021 Jun 1. https://www.kjme.kr/journal/view.php?doi=10.3946/kjme.2021.187

"... Continuous improvement and transformation of this lengthy longitudinal professional training and certification to practice path offers several, if not many opportunities to blend the “best use” of human guided training, feedback and coaching with technology tools and platforms (including AI, VR, AR, MR, robotics, simulation paradigms, and simulators, as well as pervasive or regularly sampled indicators and data of both performance and outcomes—with learning and performance analytics). We augment this with visibility, data, performance and outcome analysis and analytics of professional teams, and both localized and larger health systems and networks; in order to build a high functioning, high quality efficient and effective, safe clinical teams, and health systems, at local, regional, countrywide; and even at international levels. Why not? Blending the best of “human intelligence” and AI could potentially, can, and should allow us to scale best practices [1]." quoted from final paragraph from

Goh, PS. 'The vision of transformation in medical education after the COVID-19 pandemic'. Korean J Med Educ. 2021;33 (3): 171-174. Publication Date (Web): 2021 August 27. https://doi.org/10.3946/kjme.2021.197

Google image search for 'design thinking model from the Hasso Plattner Institute for Design at Stanford University'

see overview of topic from

Sandars, J. and Goh, P. S. (2020) Design Thinking in Medical Education: The Key Features and Practical Application. Journal of Medical Education and Curricular Development. Available at https://doi.org/10.1177/2382120520926518.

‘As cost progressively reduces, availability and usability of wearable tech for AR, VR, and Mixed Reality progressively increases, together with a deeper understanding of their appropriate use, including software and content for these “newer technologies”; and deeper understanding, wider access, and lower cost of simulation and gaming platforms and paradigms; combined with embedded, usable, and iteratively improving AI and Machine Learning; adoption and use of these technologies to complement, augment, supplement, and even replace previous more traditional methods of instruction and training will progressively increase. Technology will eventually seamlessly integrate even further into our clinical and teaching practice. Our role as educators will be to envision, plan, guide, support and oversee this process, expanding and deepening our role as teachers, instructors, content creators, curators, guides and coaches’ [1]. - above quoted from final paragraph from

Goh, PS. 'Medical Educator Roles of the Future'. Medical Science Educator. Online publication 30 September 2020. https://doi.org/10.1007/s40670-020-01086-w

End of Presentation

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Further Reading:

Global Trends in Healthcare

https://www2.deloitte.com/global/en/pages/life-sciences-and-healthcare/articles/global-health-care-sector-outlook.html

https://www.pwc.com/gx/en/industries/healthcare/emerging-trends-pwc-healthcare.html

https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-great-acceleration-in-healthcare-six-trends-to-heed

https://www.ahdbonline.com/web-exclusives/3149-global-issues-driving-us-healthcare-trends-in-2021-and-2022

https://www.forbes.com/sites/bernardmarr/2020/11/23/the-5-biggest-healthcare-trends-in-2021-everyone-should-be-ready-for-today/?sh=1fbf0e7321c0

https://trustees.aha.org/top-10-emerging-trends-health-care-2021-new-normal

https://healthcareglobal.com/hospitals/trends-global-healthcare-provision-across-world

https://www.tuvsud.com/en/resource-centre/stories/global-healthcare-trends

Global Trends in Medical Education

Thibault GE. The future of health professions education: Emerging trends in the United States. FASEB BioAdvances. 2020;2:685–694. https://doi.org/10.1096/fba.2020-00061

O'Brien, B.C., Forrest, K., Wijnen-Meijer, M. and ten Cate, O. (2018). A Global View of Structures and Trends in Medical Education. In Understanding Medical Education (eds T. Swanwick, K. Forrest and B.C. O'Brien). https://doi.org/10.1002/9781119373780.ch2

Future of Medical Education

https://www.qs.com/what-will-the-future-of-medical-education-look-like/

https://www.medhub.com/take-5-promising-medical-education-trends/

https://www.pennmedicine.org/news/publications-and-special-projects/penn-medicine-magazine/spring-summer-2019/3-questions-on-the-future-of-medical-education

Yeoh K. G. (2019). The future of medical education. Singapore medical journal, 60(1), 3–8. https://doi.org/10.11622/smedj.2019003

https://www.policymed.com/2011/11/open-education-trends-transform-the-future-of-professional-medical-education.html

Future of medical education after COVID

Changes to the Future of Medical Education due to COVID-19. by Varathagini Balakumar, 3rd Year Medical Student, Cardiff University School of Medicine, Cardiff University. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2221 (Published 05 June 2020) available at https://www.bmj.com/content/369/bmj.m2221/rr-1 (accessed on 31 October 2021)

https://www.hcplive.com/view/the-transformational-impact-covid-19-medical-education

https://www.uclahealth.org/u-magazine/medical-education-in-a-post-covid-world

Tan KI, Foo J, Ang BW, Chua JW, Teo DB. Perspectives of medical students on local medical education during COVID-19. Singapore Med J. 2020 Jul 16. doi: 10.11622/smedj.2020105. Epub ahead of print. PMID: 32668830. http://www.smj.org.sg/sites/default/files/CO-2020-212-epub.pdf

Google image search for 'design thinking model from the Hasso Plattner Institute for Design at Stanford University'

see overview of topic from

Goh, PS. 'Medical Educator Roles of the Future'. Medical Science Educator. Online publication 30 September 2020. https://doi.org/10.1007/s40670-020-01086-w

https://www.cnet.com/tech/computing/facebooks-next-vr-headset-cambria-coming-next-year/

https://www.cnet.com/tech/mobile/meta-facebooks-new-name-is-focused-on-the-metaverse-and-everything-else-announced/

https://edition.cnn.com/2021/10/28/opinions/zuckerberg-facebook-meta-rushkoff/index.html

https://www.cnet.com/tech/computing/new-report-claims-apples-ar-headset-will-sport-wi-fi-6e-arrive-in-2022/

https://www.cnet.com/tech/gaming/apple-vr-ar-headset-plans-latest-rumors-and-reports/

Microsoft takes on Facebook by launching metaverse on Teams (Financial Times)

https://9to5mac.com/2021/11/08/pokemon-go-creator-doubles-down-on-ar-as-apple-moves-ahead-with-its-own-headset-plans/

The NUS Medicine Story (10 May 2019, YouTube)

https://medicine.nus.edu.sg/events/vt/

https://medicine.nus.edu.sg/

https://medicine.nus.edu.sg/education/mete/

https://medicine.nus.edu.sg/cenmed/

https://medicine.nus.edu.sg/cenmed/about-us/history.html

https://nus.edu.sg/cdtl

https://cit.nus.edu.sg/

https://www.nuhs.edu.sg/research/research-stories/Pages/nuhs-embarks-on-holomedicine-research-in-singapore-using-mixed-reality-technology-to-enhance-patient-care.aspx

https://holomedicine-association.org/founding-members

https://www.nuhs.edu.sg/For-Patients-Visitors/teleconsult/Pages/default.aspx

https://www.straitstimes.com/singapore/health/nuhs-to-roll-out-new-apps-telemedicine-feature-to-entire-cluster-by-2022

https://www.straitstimes.com/singapore/health/the-shift-towards-a-digital-healthcare-system-is-inevitable-in-singapore-panel

https://www.straitstimes.com/singapore/health/novel-technologies-can-enhance-singapores-healthcare-system-masagos

https://govinsider.asia/vision/how-singapore-is-building-ai-for-predictive-healthcare-nuhs/

https://www.straitstimes.com/singapore/housing/queenstown-to-become-singapores-first-health-district-with-more-community

https://amee.org/awards-prizes/aspire-award

https://amee.org/awards-prizes/aspire-award#areas-of-excellence

https://www.aspire-to-excellence.org/

https://www.aspire-to-excellence.org/Areas+of+Excellence/

https://amee.org/amee-committees

https://amee.org/amee-committees/tel

https://www.aamc.org/what-we-do/mission-areas/medical-education/fostering-scholarship

https://www.aamc.org/professional-development/affinity-groups/gfa/faculty-vitae/defining-educational-scholarship

https://www.vumc.org/aet/sites/vumc.org.aet/files/public_files/AAMCEducationalScholarship.pdf

https://www.weforum.org/agenda/2021/02/digital-learning-covid-19-changed-way-we-educate-children/

https://www3.weforum.org/docs/WEFUSA_NewVisionforEducation_Report2015.pdf

Goh, PS. 'Medical Educator Roles of the Future'. Medical Science Educator. Online publication 30 September 2020. https://doi.org/10.1007/s40670-020-01086-w

Liu, Wenlin & Sidhu, Anupreet & Beacom, Amanda & Valente, Thomas. (2017). Social Network Theory. 10.1002/9781118783764.wbieme0092.

https://www.researchgate.net/publication/316250457_Social_Network_Theory

https://medium.com/swlh/social-network-theory-a-literature-review-for-understanding-innovation-programs-7f1c214e9a77

https://researchfeatures.com/diffusion-innovations-within-social-networks/

https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories4.html

Schuster, J., & Kolleck, N. (2020). The Global Diffusion of Social Innovations - An Analysis of Twitter Communication Networks Related to Inclusive Education. Frontiers in Education, 5. doi:10.3389/feduc.2020.492010 https://www.frontiersin.org/articles/10.3389/feduc.2020.492010/full

https://en.wikipedia.org/wiki/Diffusion_of_innovations

https://is.theorizeit.org/wiki/Social_network_theory

https://en.wikipedia.org/wiki/Social_network

https://telmeded.blogspot.com/2021/10/mit-open-courseware.html

https://www.pewresearch.org/fact-tank/2021/11/01/americans-differ-from-people-in-other-societies-over-some-aspects-of-u-s-hard-and-soft-power/?amp=1

https://brandfinance.com/press-releases/global-soft-power-index-south-korea-ranks-11th

From BTS to ‘Squid Game’: How South Korea Became a Cultural Juggernaut (NYTimes)

https://en.wikipedia.org/wiki/Healthcare_in_Singapore

Google search for 'iterative life cycle'

Google image search for 'iterative life cycle'

https://telmeded.blogspot.com/2021/11/humanpace-technologicalscale.html

Let us, then, be up and doing,

With a heart for any fate;

Still achieving, still pursuing,

Learn to labor and to wait.

- Henry Wadsworth Longfellow

https://www.poetryfoundation.org/poems/44644/a-psalm-of-life

Build thee more stately mansions, O my soul,

As the swift seasons roll!

Leave thy low-vaulted past!

Let each new temple, nobler than the last,

Shut thee from heaven with a dome more vast,

Till thou at length art free,

Leaving thine outgrown shell by life’s unresting sea!

- Oliver Wendell Holmes Sr.

https://www.poetryfoundation.org/poems/44379/the-chambered-nautilus

https://literarydevices.net/the-chambered-nautilus/

This (above) Wikipedia and Wikimedia Commons image is from the user Chris 73 and is freely available at https://commons.wikimedia.org/wiki/File:NautilusCutawayLogarithmicSpiral.jpg under the creative commons cc-by-sa 3.0 license.

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Dr Poh-Sun Goh

吳宝山

Short Bio:

Associate Professor, Department of Diagnostic Radiology, Yong Loo Lin School of Medicine (YLLSOM), National University of Singapore (NUS), Senior Consultant, Department of Diagnostic Radiology, National University Hospital and Associate Member, Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Member, AMEE TEL (Technology Enhanced Learning) Committee (since 2011)

Poh-Sun (MBBS(Melb) 1987, FRCR 1993, FAMS 1998, MHPE(Maastricht) 2012 and FAMEE 2017) practices on the clinician educator tract (80/20 time allocation clinical/education) augmenting his education and training time allocation with technology, and regular cumulative early morning focused scholarly efforts, spent developing and evaluating the use of open access online digital repositories in clinical training, and medical education faculty development, under a mastery training and deliberate practice framework. He focuses his efforts on the challenge of transfer to practice, in the widest possible settings, through use of reusable comprehensive digital content, iterative low cost proof of concept implementation combined with collaborations and partnerships to scale, all anchored on a solid foundation of theory and evidence. Am a certified Newfield/YLLSOM Associate Coach, successfully completing The Coach Partnership/Newfield Coach Training Program for NUS YLL SOM (2021).

More here https://linktr.ee/PohSunGoh