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5 tips for academic references

December 5, 2012
Post-secondary Education
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Just how important are your academic references for grad school admission?

I’ve written my share of academic references – never more so than the last couple of months, where one candidate requested a record of twelve (yes, that’s 12) separate letters – but I’ve never served on a university admissions committee. I’ve always been curious about their importance relative to other factors like grades, personal/research statement, publications and relevant experience. My curiosity was finally satisfied when I found myself sitting next to just such a person on a train (currently reviewing candidates for a competitive university program) and we got to talking.

The short answer is VERY IMPORTANT – and although I always knew that excellent references are key, I didn’t appreciate the full extent of their influence.

So, in the interests of supporting would-be grad students everywhere, here are some tips from the perspective of a referee:

1. Be strategic. Is it better to ask a more junior instructor from a small class you loved where you got an A-, versus a tenured, senior faculty member where you got the same grade in a large class you weren’t so enthusiastic about (and not sure the prof remembered anyone’s names)? Rest assured that the sessional might not remember individual students very well either, and the answer should depend on…

2. How will this person rank me relative to what comparison group? In my 10 years of writing reference letters, I have never been asked this question directly – yet this is the most crucial question you need to ask your referee. You are looking for someone who is going to rank you in the top tier, across all categories if possible. Let’s look at the previous example: Is it the junior prof’s first year of university teaching? If so, even a ranking in the top 1% of 20 students probably carries less weight than the seasoned, tenured prof’s ranking in the top 5% of 5000 students. Ask the question – if you don’t like the answer maybe it isn’t the right person.

3. Send your referee a summary of the personal accomplishments and key points you want to emphasize in your application. And can I add that writing clearly and concisely, without errors in spelling, punctuation, grammar and syntax should be a given. Trust me, if I disagree with you I will edit. If I agree I will amplify. I will also add my own content. Sending me only your CV and personal or research statement makes it harder to write the best letter I can for you.

4. Follow up and say thank you – whatever the outcome. This obvious courtesy is not always observed, and you might need me again when you decide to apply for your next degree.

5. Don’t give up! This isn’t really a tip about reference letters but I am adding it because grad school applications are a lot of work, and so discouraging when there is no offer. Keep applying and consider spreading your net a little wider next time.

Just please don’t ask me for all twelve letters at once?

True or False: Are multiple choice exams relevant to 21st Century education?

November 29, 2012
Clinical Education, Post-secondary Education
1 Comment

 

 

 

 

 

 

 

 

 

 

 

 

 

Will it be on the exam?

In-class exams may well be one of the most stressful – and for some, traumatic – experiences in a student’s life. This truism came front and centre last week at a certificate program I was teaching, geared to seasoned interprofessional practitioners. The varying responses to our in-class, summative, multiple-choice exam tended to cluster around the less enthusiastic end of the spectrum.

Why are exams so aversive?

One obvious reason is that they can be high stakes, as in this (admittedly oversimplified) equation:

high grades = approval + scholarship $$$ + grad school admission

Another reason may have to do with lack of autonomy: we didn’t write the exam questions, and we generally can’t know – or in many cases – anticipate – them in advance. And people inherently strive towards personal autonomy.

But I think that radical pedagogical analyses get closest to the crux of the matter, in their critical interrogation of power dynamics in the classroom, the stance of the professor as “expert”, and framing of “curricular content” (for example, Laura Béres 2008 article).

Constructivism frames learning as socially constructed by learners, where learning is meaningful and relevant to real life. In-class exams are, by nature, removed from real life and focus on content domains that the instructor sees as key.

This can be an uneasy alliance in progressive classrooms, and one that I am still struggling to reconcile… Especially in a knowledge landscape where locating information should take precedence over memorizing information (see Julio Frenk’s influential report in the Lancet, “Health professionals for a new century: transforming education to strengthen health systems in an interdependent world”).

Closing thought:

Exams do stimulate affective arousal, which is associated with enhanced memory retention. I’m just not sure that those memories correlate well with the exam content!

Tips for Engaging Large Audiences

November 21, 2012
Clinical Education
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What to do when it’s just you and several hundred people

Big room, big crowd, big sound system. It’s all about a big performance, right? In fact, the opposite is true. In my experience, larger audiences mean that it’s even more essential to take the approach of a one-on-one conversation.

What does that look like in the context of one presenter and hundreds of participants? Here are a few tips to keep in mind:

Talk to the audience as if you were at a really great social event with a group of professionals. In other words, you are kind of on your best behavior, but you can still be spontaneous, authentic and funny.

Tell stories – lots of stories. People are hard-wired to respond to, and remember, stories, so come prepared with anecdotes and examples. These can be some combination of work, practice or personal illustrations of key points. Just keep things brief and to the point.

If you’re using slideware rely on images versus text. This is a good principle for presenting to any size group, but it’s even more relevant with larger audiences where the sightlines may not be as good from every vantage point in the room.

Audit your presentation with a non-expert who has a really short attention span (I suggest a teen-ager). What parts of the talk do they like? Where are they bored? Adjust accordingly.

Promote direct interaction using methods such as: Individual reflection (“Write down the first thing that comes to your mind in response to the following statement…”); Peer-to-peer conversation (“take two minutes and turn to the person next to you and talk about…”); Rhetorical questions (“What would you do in the following situation?”); Video or audio clips with direction (“As you’re looking at this video, here’s what to watch for…”); A call to action (“What’s one thing you will commit to practicing after this session?”).

Reflect what’s happening in the here-and now. Is the room too cold or too warm? Are people tired or hungry? Is there an interesting event that’s all over the news? Acknowledge the “meta-context” in which the session is taking place.

I love giving talks to large audiences: the dynamic energy that happens when lots of people come together is socially infectious. It’s not you versus them – you’re all in it together.

The Universal Core Competencies in Health Care

November 8, 2012
Clinical Education
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Are the most important health care competencies the ones that can’t be taught?

 What, in your opinion, are the core competencies for practitioners working with women and girls who have concurrent mental health and substance use problems?

This was the question that I posed to a group of about 100 interprofessional clinicians at a recent conference session titled “Women and Concurrent Disorders (Addiction and Mental Health)”.

I posed the question before referencing the core competency domains identified by the Substance Abuse and Mental Health Service Administration’s 2011 document Addressing the needs of women and girls: Developing core competencies for mental health and substance abuse service professionals:

 SAMHSA Core Competency Domains

Sex and gender differences

Relational approaches in working with women and girls

Family-centred needs

Special considerations during pregnancy

Women’s health and health care

Interprofessional collaboration

I was curious to hear what this group of experienced and seasoned health care providers had to say about the core competencies that were top of mind. Without hesitation, hands went up and people called out examples: 

Practitioner-Identified Core Competency Domains

Empathy

Respect

Trust

Compassion

Listening

Care

It’s striking that no one mentioned any of the SAMHSA competencies, which focus on domain-specific knowledge and skills. Rather, the areas addressed by the audience emphasized process over content. Now, this is not to minimize the centrality of scientific and clinical knowledge and skills. Healthcare consumers expect this of us, and we as professionals expect it of ourselves.

But in those moments when the group named these key areas as most important, we collectively moved to the tacit underpinnings of excellence in healthcare: the human interactions that form the basis of helping. The things that are much harder to teach – if we can teach them at all.

View the full presentation on slideshare 

Personal Learning Networks (PLNs)

October 24, 2012
Clinical Education, Post-secondary Education
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Network of networks = your very own PLN

 

Today, there’s no problem finding information – the challenge is sifting through and locating the right information at the right time. And not just the right information at the right time – it’s also about access to tools and ideas that you never even knew you needed until you saw them. That’s where PLNs come in.

In the olden days before the advent of online academic journals and research databases, I always made at least one serendipitous discovery while browsing library holdings or leafing through print materials. I would be scanning a row of books looking for a particular call number, and suddenly notice a different book that was a great fit for some other topic I was researching. It’s hard to replicate that kind of happenstance when digital searches yield a specific document or information source with laser-like precision.

Plus, learning is not just about acquiring information – paragogy (a.k.a. the new andragogy) views learning as inherently non-linear and socially constructed via networks/peers. So PLNs – because they’re naturally hyper-textual and social – fit beautifully within a paragogical frame.

This article about PLNs at edudemic.com gives a great overview and rationale for the functions of various social media tools in building, customizing and contributing to your own composite, ongoing knowledge stream. Your very own PLN.

The 3 steps for success in school (and life)

October 16, 2012
Clinical Education, Post-secondary Education
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3 tips for success

 

Students want to know: “What do I need to do to succeed in this course?”

 

As in many things, the answer is simple (but not always easy). At the start of each semester I share the following three elements that, in my experience in university teaching, almost always translate into academic success.

  1. Show up: If you don’t actually come to class you miss important stuff.
  2. Be 100% present: If you show up and spend the class on your smartphone, you’re not really present.
  3. Do your homework: The real learning happens outside the classroom.

BUT here’s the caveat: It’s a three-legged stool. You need all three elements or you “fall off” (and if you start shaving away any of the legs, it gets a bit wobbly).

And I’ve found that these are pretty good rules to live by in life generally, whether in work, relationships, travel, and so on. When things get complicated it’s nice to take it back to the basics!

Freedom’s just another word for nothing to present

October 10, 2012
Clinical Education
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Your USB key is corrupted, and by the way the handouts weren’t printed

 

Bad deam? Worst nightmare? Or maybe the best and most productive 90 minutes possible. I’ve read that the Chinese character for crisis represents danger + opportunity, and nothing could be truer. This unwelcome scenario happened to me today when presenting to a small group of Medical Residents on the topic of Motivational Interviewing.

The moment I realized that “Plan B” (the handouts) was not an option, I decided to use (and trust!) the principles of Motivational Interviewing (captured by the acronym “A-C-E”, Autonomy, Collaboration and Evocation) as the foundation spirit for my approach. In other words, it’s all about relationships, and my primary goal was establishing a relationship with the group to help facilitate meaningful practice and learning.

So…what did we actually do? I demonstrated Motivational Interviewing skills with a volunteer who agreed to talk about physical activity and exercise as a hypothetical change goal  (a “real play” versus a “role play”). Frequent pauses, critical reflection and discussion allowed key points and clinical skills to emerge organically. In the second half of the session, the whole group participated in another activity focused on practicing – and again critically interrogating – reflective listening skills. We closed with each person articulating a specific practice goal based on their learning.

It’s all too easy to fall into the trap and habit of teaching as performing. In Motivational Interviewing I often talk about a “red flag” being when the practitioner is working harder than his or her patient; and today I was reminded that it’s energizing and affirming when the learners work harder than the instructor.

Maybe next time “Plan C” gets promoted to “Plan A”. That 90 minutes felt like freedom.

6 Tips for Facilitating Webinars

October 2, 2012
Clinical Education
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The good, the bad and the ugly

Over the last few years there’s been an explosion and widespread adoption of webinars as (in many cases) the primary or preferred strategy for delivering continuing education to large groups of geographically disparate people. It makes sense: education can be delivered in a brief, cheap and convenient form that has minimal impact on busy practitioners’ time.

But, just like classroom-based learning, there is huge variation in the quality, interactivity and utility of web-based learning. At their best, webinars are a model of multi-modal learning, with a dynamic and engaging facilitator, lots of interactive sidebar chat, and great use of visuals and reflective activities. At their worst, webinars are the workplace equivalent of a really boring TV show.

Here are a few tips culled from my own experience as facilitator and participant:

  1. It might not be a webinar: Sometimes network connections fail, either at your end or for participants. Send out a complete slide deck ahead of time and have a teleconference line just in case.
  2. I like text chat better than voice: In webinars, text chat is really seamless, especially with large groups (e.g., 100 or more). Encourage people to chat with each-other as well as the facilitator throughout the webinar. This brings me to two more points:
  3. Prime participants to participate: Most people regard online, text-based communication as more an act of publishing than as an act of speech. This cognition tends to constrain spontaneous conversation, so I ask participants to write down at least one question ahead of time. That way people are “primed” to participate, and once the ice is broken the group can really take off.
  4. You can’t do it all: With lots of sidebar chat it’s pretty much impossible to present AND read comments/questions at the same time. Having a moderator to help cue the presenter with key questions or pauses is essential.
  5. Ready for your close-up: Built-in computer webcams tend not to give the most flattering angle. Use a separate webcam for better camera postioning, add extra light, and talk to the camera. Participants want to feel connected to the facilitator.
  6. Less text more pictures: If text-heavy presentations are boring in person, they are even more deadly by webinar. (Plus, disengaged participants will toggle back and forth between a boring webinar and another, more interesting, website). Keep people engaged with well-designed content and activities.

I love the convenience of webinars, and done well they can really add value to an organization’s staff training and development strategy. The key phrase is “done well” – watching bad TV in the middle of the day is best kept for when you’re home in bed with a cold.

The Hive Mind in action

August 16, 2012
Clinical Education
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Lately everyone is asking “what happens after the workshop is over?”

In high school I worked as a cashier in my neighborhood convenience store. The pay wasn’t great, but at 16 what do you expect? However I got to see, over and over again, the actualization of the “let’s go to the corner store” meme: the place would be dead quiet (time to read a trashy celebrity mag cover-to-cover), then suddenly – how did all these people appear out of nowhere??? From a social anthropology perspective it allowed me to experience the “hive mind” in action.

Well, a similar phenomenon seems to be happening this summer: I am seeing a convergence in the training requests I’m getting that go beyond “can you do a one-day workshop”.  For the first time, organizations and individuals have been initiating the ask to explicitly integrate time and process on implementation during and after the course or workshop. Now, I’m not suggesting that in the past no one cared about implementation – in fact the opposite is true. It just seems like there is more attention being paid from the very beginning of the continuing professional education (CPE) process to a longer-term perspective and ultimate goal of performance improvement. This is in line with the proliferation of publications and calls for competency-based medical education, including recommendations in the 2012 “Future of Medical Education in Canada” report.

It’s exciting to me that organizations are starting to hold us educators accountable for what happens after the workshop is over. Positive course evaluations aren’t enough to demonstrate value when the real purpose of CPE is to facilitate change. And that’s a tough one. That’s why I no longer make New Year’s resolutions (they were always the same resolutions).

But the beauty of the hive mind is that it generates a certain energy. If our collective gaze (hive mind) is focused on the horizon as opposed to the windshield, I foresee some creative paragogical alternatives to “business as usual”.

What will continuing professional education look like in 100 years?

August 8, 2012
Clinical Education
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Continuing Professional Education in 2112

 

Predicting the future is a risky and uncertain business, despite what psychics and fortune-tellers might proclaim. Still, I’ve been thinking about science fiction transformed into reality by the successful landing of NASA’s Curiosity Mars explorer vehicle. How many years before the first humans embark on the six-month journey to another planet? All this wondering has inspired me to consider what continuing education might look like a century from now.

So here goes – some predictions for continuing professional education:

The focus of continuing education requirements for professionals will shift away from accumulating a set number of accredited CPE course hours, and reflect an assessment of the richness and density of practitioners’ electronic networks and their contributions within and beyond these networks

The primacy of skills in researching and locating information will be replaced by skills in creating/designing an individualized architecture to harvest, sort, store and share essential knowledge and ideas

There will not be slideware

Knowledge Curator will be a popular job title

The CV will be replaced by a tag cloud or an infographic resume with active links to relevant media, and this will be a more accurate reflection of professional contributions and experience

Education will be evaluated based on net benefit to learners in practice, and this will be possible at low cost due to the proliferation of mlearning applications and integrated performance databases

Didactic lectures will still exist, but they will look more like (high production value) TV commercials and less like (low production value) infomercials. They will be a lot shorter too.

For fun – here is a tag cloud for this website updated October 2012:

How to be a great teacher in 7 not-so-easy steps

July 17, 2012
Clinical Education
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1. First, forget about the teaching part. Teaching implies that you have a modicum of control over what people are learning. Nice as that sounds, it’s simply not true. Individuals learn or don’t learn. It’s really up to them.

 

2. Pay attention to the whole person, and multiply by the number of students in your class. They are: (grand)parents, sons, daughters, workers, travelers, artists, builders, athletes, collectors and teachers. They have amazing stories to tell. They honour you by being present.

 

3. Put yourself last. In other words, it’s about them not you. Their needs, their experience, their enjoyment, their comfort, trust, connection.

 

4. Stimulate curiosity and pique peoples’ interest. People value knowledge and skills that help them solve a problem or make some part of their lives easier or better. People also get engaged when they have a chance to examine and challenge their own or others’ assumptions, knowledge, values, ideas and beliefs. That includes your assumptions, knowledge, values, ideas or beliefs.

 

5. Make it fun. Children learn by playing, experimenting, risking and testing limits. So do adults.

 

6. Inspire further learning. It’s axiomatic that “the more we learn, the more we realize how little we know” (to paraphrase Socrates). In other words, it’s not so much the content that you cover in a class or workshop, it’s the gift of inspiring even one person to want to learn and practice more. Learning isn’t a single event – it’s a continuous process – so the goal is to initiate or inspire a continuation of that process.

 

7. And last but not least: don’t take it personally. Not everyone is in the right place at the right time for the right reasons. Learner autonomy means just that –and sometimes learning takes time to germinate. A long time. I guess that’s called wisdom?

 

 

 

Andragogy 2.0: Emerging Theories

July 10, 2012
Clinical Education
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Pushing the boundaries of education theory – A hurricane at our backs

How are teaching and learning theories evolving to take into account the opportunities and advances in social media and “Web 2.0”?

Andragogy, as a theory of adult learning, has been around since the 1980s, extending the notion of pedagogy to an adult learning context (Malcolm Knowles, discussed in a chapter I wrote on online learning theory).  I have been thinking about what a “2.0” conceptualizing of andragogy might look like, given the incursions of user-generated content into both live and online learning contexts. Two recent models – paragogy and heutagogy – have captured my attention as useful extensions of Knowles’ adult learning theory. These models may well constitute a kind of “Androgogy 2.0.”

Both paragogy and heutagogy present a model of learning that is (1) decentred, (2) non-linear, (3) peer-led and (4) self-determined. These characteristics map onto social media applications and the democratization of knowledge and information. Paragogical and heutagogical approaches also extend traditional adult learning frameworks through their emphasis on meta learning, or learning how to learn.

A new model for health care education is needed at this time for a number of reasons:

The explosion of evidence-based information in health care means that “just in time” learning may be more helpful and important than “just in case” learning.

Patient access to – and use of – internet-based health information means that providers need to understand how to access, assess, critique, and translate credible sources of information.

The new generation of learners are already “hyper-learners” (i.e. non-linear in their approach to accessing and processing information), and are accustomed to generating as well as consuming content.

Power dynamics in the classroom are already shifting towards learner-as-consumer, with all of the attendant opportunities and pitfalls that we are seeing. On one hand, learning is volitional, so it makes intuitive sense that learners should be autonomous and self-determining. Shifting the power dynamics in the classroom in favour of the learner can facilitate many-to-many communication and crowdsourcing. On the other hand, our educational structures and institutions are not set up to accommodate radically student-centred approaches, and as faculty we can find ourselves caught in the middle.

So what are the practical implications for clinical education? I have been experimenting with student-centred assignments and activities, as well as peer evaluation and use of social media, and the going is not always easy. The preconditions of psychological safety and willingness to risk are key, and I find that these strategies take considerably more of my time in coaching and reassuring. However based on students’ feedback, there is a depth and richness to the learning that goes beyond instructor-centric approaches.

In any case, when it comes to radically student-centred approaches to 21st Century health care education, “We’re not walking into a headwind, we have a hurricane at our backs.”

 

View a presentation on the topic of “Andragogy 2.0: Introducing emerging frameworks for teaching and learning: Paragogy and Heutagogy” on Slideshare