TRAINING and EDUCATION
How I Teach
“How I Teach” is ASH Clinical News’ forum for sharing best
practices in teaching hematology to medical students,
residents, and fellows. We invite essays providing insight
into teaching and modeling clinical practice (history-taking,
the physical exam, informed consent, giving bad news),
successful research mentoring, disease-specific tips, or
more general advice. In this issue, Marc J. Kahn, MD, MBA,
discusses the value of active learning.
INSTRUCTION
WITHOUT LECTURE:
Losing the Crutch
espite being an inefficient way to educate
people, the lecture has remained the most
commonly employed method for delivering course material in medical schools. The
educator Edgar Dale, creator of the “Cone
of Experience,” has been quoted as stating that we retain 20 percent of what we hear, 70 percent
of what we discuss with others, 80 percent of what we
experience, and 95 percent of what we teach others. Adult
learning theory (andragogy), as described by the educator
Malcolm Knowles, teaches us that adults learn best when
the learning process is collaborative and problem-based.
Yet, we consistently retain the lecture as the most common
form of “teaching.”
In 2013, Tulane University initiated the Health Education Adaptive Learning Experience (HEAL-X) for PhDs
in the biomedical sciences desiring an MD degree. This
42-month curriculum includes 18 months of preclinical
education that is based entirely on adult learning theory
and active learning principles; that is, we do not lecture
these students.
In this curriculum, normal and abnormal structure and
function are combined within each organ system block.
Traditional department-based teaching (Anatomy, Physiology, Pharmacology, etc.) is eliminated in favor of weaving
departmental instruction throughout the curriculum. As
one of the primary people responsible for HEAL-X and the
director of the hematology and neoplasia blocks, moving
away from passive lecture-based teaching was a welcome
challenge.
What We Did
In place of traditional course lectures, we applied three
teaching modalities:
1. Team-Based Learning (TBL)
2. Higher-Order Thought Questions
3. Drawing Exercises
TBL is an active learning strategy that takes advantage of
the diversity of participant skill sets to solve problems.
Prior to a TBL exercise, participants are assigned readings,
Web captures, textbook chapters, or other material that
they are responsible for reviewing ahead of time.
ASHClinicalNews.org
By Marc J. Kahn, MD, MBA
TBLs are typically divided into three parts:
• Part 1: an Individual Readiness Assessment Test
(IRAT) that involves 10 multiple-choice questions
derived from the readings that are answered and scored
individually.
• Part 2: a Group Readiness Assessment Test (GRAT)
in which teams of four or five participants answer the
same multiple-choice questions using a lottery-style
scratch-off. Points are deducted for multiple scratchoffs. During the GRAT, active learning occurs during
the subsequent group discussion regarding selection of
answer choices.
• Part 3: a Group Assessment Exercise (GAE) in which
teams answer higher-order questions followed by
audience response and discussion of the correct answers
among all students.
For the HEAL-X curriculum, we employed both a Coagulation TBL and a Leukemia TBL.
We also replaced lecture with posing higher-order
thought questions to the class. As with TBL, learners are
expected to review materials prior to class; these questions
are then discussed in class, in lieu of lecture.
For example, we might ask learners, “If you were going
to design a new drug to target diffuse large-cell lymphoma,
what would you target, and why?” or “Why do illicit cyclists
abuse erythropoietin? What advantages does it provide?”
Such questions foster discussions in class, allow learners to
learn from each other, and are active rather than passive.
Finally, we ask our students to engage their “right
brains” through drawing exercises. When we draw, we
notice subtleties that are lost with mere observation. While
the right brain communicates through imagery, the left
brain communicates through words. Yet, language cannot
always express the wealth of information conveyed by images. Da Vinci once said, “Writer, what kinds of words will
you fetch to awkwardly describe what drawing can instead
perfectly represent?” Van Gogh put it