Creating Effective Application Exercises: Basic Sciences

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Creating Effective Application Exercises Basic
Sciences

• John Pelley, PhD (Texas Tech) and Sebastian
  Alston, MD (Mercer)
• Team-Based Learning in Medical Health Science
  Education 4th Annual National Conference
• June 2-4, 2005 Dayton, Ohio

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Three Part Agenda

• Presentation/exercise/discussion (TBL) format
• Where to begin Setting the appropriate learning
  level (60 min)
• Writing it up Composing good questions (40 min)
• Developing discipline Getting students to
  cooperate (20 min)
• (last minute addition) 10 min for evaluation

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First A Few Trick Questions

• Talk with a neighbor about the following
  statements (5 min).
• Learning in teams
• throws the responsibility for learning on the
  strongest students. (T/F)
• emphasizes application and memorization. (T/F)
• is highly variable among students and hard to
  control. (T/F)

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What Are The Ways Of Knowing?

• Evaluation What is predicted? clinical
  treatment and management
• Inference What is concluded? diagnosis
• Comparison How are patterns related?
• Analysis How are facts grouped into patterns?
• Recall Just the facts maam
• (Each level uses the ones below it.)
• (see page 8 in handout)

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Learning Objectives Examples

• Evaluation Develop a treatment plan for a type
  2 diabetic.
• Inference Justify your diagnosis of type 2
  diabetes.
• Comparison Explain how type 1 and type 2
  diabetes are different.
• Analysis Give the characteristics of type 1
  diabetes.
• Recall Define hyperglycemia, ketoacidosis,
  glycosylation

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Memorization vs. HOTS

• Memorization
• Recall
• Higher Order Thinking Skills
• Analysis
• Comparison
• Inference
• Evaluation
• All five levels can be appliedbut
• Recall used in clinical procedures/protocols
• HOTS used in clinical problem solving

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Fundamentals For TBL Exercises

• Problem oriented learning requires a specific
  decision.
• A decision requires a rationalea guess is not a
  rationale!
• A rationale is reasoning that utilizes memorized
  information.
• Types of rationales
• Similarities, differences, groupings,
  cause-and-effect relationships

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Dialogue Linear Thinking vs. Integrative
Thinking

• Both linear and integrative learning are
  important
• Linear facts and specifics
• Integrative patterns and relationships

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Designing A TBL Exercise

• Start at the end the application exercise
• HOTS questions are essential
• One case vs. several cases time factor
• Step 1 (in handout, page 1)
• Too few is better than too many
• Three application question sets per hour
• 2-3 hour time blocks total
• 50 of time in application exercise
• Sample Case Application Question (page 2)

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• A 74 year old female has come to your office
  suffering from hyperventilation, malaise,
  dizziness, and muscle pains. She was diagnosed
  with Type 2 diabetes at the age of 50 and has
  managed her disease successfully with diet,
  exercise, and hypoglycemic agents. She was
  initially put on a hypoglycemic agent called an
  oral sulfonylurea (chlorpropamide), but recently
  was switched to metformin which is better
  tolerated in the elderly. Her blood pH is 7.2 and
  her serum lactate is 10X normal levels. Her
  creatinine clearance and serum creatinine
  concentrations indicate diminished renal
  function.

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Long Answer Choices

• This patient has a blood pH of 7.2 because
• ketones from excess fat mobilization are making
  her blood acidic.
• increased glycolysis and reduced TCA cycle
  activity leading to excess lactate formation.
• hypoxia resulting from inhibition of electron
  transport is creating excess carbon dioxide.
• increased blood sugar increasing glycolysis and
  lactate production in red blood cells.

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Or, Short Answer Choices

• Metformin action in the production of lactic
  acidosis is most analogous to which of the
  following?
• Fluoride
• Pentachlorophenol
• Cyclic AMP
• Oligomycin

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Barriers

• You dont know everything about the clinical
  aspectsor,
• You dont know how to integrate other disciplines
  (handout page 7, also TBL Collaborative).
• Hard to find people that can help.
• Time consuming to look things upcan you trust
  the internet?

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Group Exercise 1

• Utilizing templates to formulate higher order
  questions (10 minutes group, 20 minutes
  discussion)
• Directions are on the exercise handout.

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Group Exercise 2

• Developing a sensitivity to the quality of the
  questions (10 minutes group, 15 minutes
  discussion).
• Greatest opportunity for dialogue and problem
  solving?
• Integrative knowledge vs. memorized knowledge

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Group Exercise 3

• Developing a sensitivity to the quality of the
  answers (rational alternatives). (10 minutes
  group, 15 minutes discussion)
• Lead in Which of the following is the best way
  to correct her elevated pulse rate?
• Greatest problem solving challenge?
• Emphasis on HOTS rather than memorization

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Composing Good Questions

• Sample supporting materials Handout page 4
• Learning objectives reading assignments
• Supplementary information
• Resources for faculty Handout page 5
• Question templates
• Sources of case vignette questions
• Question formats
• Stick with Type A questions.
• Long answers are OK, but not too ambiguous

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Core Knowledge RATs and Learning Objectives

• Steps 2 and 3 in handout
• RATs can have HOTSor not.
• RATs should be relevant derived from
• application exercise answer choices
• patient data in case vignette
• RATs are not comprehensivebut objectives are!
• Objectives should be relevant derived from RAT.

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HOTS Level

• Which of the following would NOT produce lactic
  acidosis?
• Carbon monoxide poisoning
• Impaired gluconeogenesis
• Impaired pentose phosphate shunt
• Impaired pyruvate oxidation
• Cyanide poisoning

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Memorization Level

• The rate of glycolysis is increased by
• glucose 6-phosphate.
• fructose 2,6 bisphosphate.
• citrate.
• lactate.
• acetyl-CoA

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Getting Students To Cooperate

• (time permitting)
• Simultaneous reporting of teams
• Inter-group discussions management
• Answer-challenging methods
• Tell me about your thinking
• Evaluate the exercise