Patricia Beach MD
Keith Bly MD
Virginia Niebuhr PhD
Pediatric Grand Rounds
March 9, 2012
BAY COLONY REMOTE AUDIENCE : SESSION
Download and run the “Responseware” app on your smartphone
OR
Point your web browser to http://www.rwpoll.com

We have no conflicts of interest to disclose.

This work is supported by
US Dept. Health & Human Services
Health Resource Services Administration (HRSA)
Bureau of Health Professions

UTMB Department of Pediatrics’ Audience
Response System purchased through the generosity
of the McGovern Academy of Oslerian Medicine
US Dept. Health & Human Services
Health Resource Services Administration (HRSA)
Bureau of Health Professions
Grant for Pediatric faculty development
Target: technology for education
Obj 1: technology for instruction
Obj 2: information searching and management
Obj 3: teaching about and with the EHR
Obj 4: technology for personal efficiency & effectiveness
Objectives:
By the end of this session, participants should be able to:
1. create teaching activities which use ARS for polling,
evaluation, knowledge assessment, and/or facilitation of
discussion
2. summarize published research about ARS effectiveness
3. identify best practices for ARS use
4. explain procedures for downloading necessary software and
checking out our equipment
software



to create & present interactive questions
to display data charts and graphs in real-time
to report and manage data
response devices: audience participates by
submitting responses


response cards (clickers) using a response receiver
phone or computer using Internet-connection
turningtechnologies.com
TurningPoint – interactive PowerPoint
(PC or Mac)
integrates into Microsoft® PowerPoint ®
53%
1.
2.
Yes
No
47%
1
2
1.
2.
3.
4.
Student
Resident
Faculty
Other
27%
33%
17%
23%
1
2
3
4
1.
Polling
• audience experiences/characteristics
• opinions
• evaluations
2. Recording attendance
3.
Knowledge Assessment
• Assessment of audience comprehension
▪ followed by teaching adjustment
• Testing for credit/grading
▪ some software integrates database into Blackboard
1.
2.
3.
4.
Maternal smoking
Lack of supportive partner
Failure to use a breast pump
Mother’s return to work
33%
27%
23%
17%
1
2
3
4
4.
Facilitation of discussion
answer- discuss- answer again
Over the past decade, drug oversight
committees and professional organizations
have debated evidence regarding any
association between undiagnosed cardiac
conditions and sudden death in youth started
on stimulant medications for Attention Deficit
Disorder.
1.
Inform families that theoretic risk is
overstated and proceed with
prescription.
2.
Inform of theoretic risk, perform H&P
to assess risk in this child;
prescribe stimulants if negative.
3.
4.
Inform of theoretic risk and take a
careful history regarding cardiac factors
in this child, review EKG,
prescribe stimulants if negative.
Inform of theoretic risk and seek
cardiologist clearance prior to
prescribing stimulant medications.
30%
30%
27%
13%
1
2
3
4
1.
Inform families that the theoretic risk is overstated and
proceed with prescription.
2.
Inform of theoretic risk and take a careful history regarding
cardiac factors in this child; prescribe stimulants if negative.
3.
Inform of theoretic risk, take a careful history regarding
cardiac factors in this child, and order an EKG; prescribe
stimulants if all negative.
4.
Inform of theoretic risk and seek cardiologist clearance prior
to prescribing stimulant medications.
1.
Inform families that theoretic risk is
overstated and proceed with
prescription.
2.
Inform of theoretic risk, perform H&P
to assess risk in this child;
prescribe stimulants if negative.
3.
Inform of theoretic risk and take a
careful history regarding cardiac factors
in this child, review EKG,
prescribe stimulants if negative.
4.
Inform of theoretic risk and seek
cardiologist clearance prior to
prescribing stimulant medications.
30%
30%
30%
10%
1
2
3
4

> 85 papers published since 1999.

36/38 studies show positive perceptions
of technology (Kay and LeSage, 2009)

Students found technology easy to use

Most liked
•
•
•
•
Increased student participation
Student self-assessment
Peer mastery
Pacing/re-teaching (Graham et al 2007, BYU)
Classroom Environment Benefits
• Attendance improved
• Attention improved
• Anonymity facilitates increased participation
• Increased engagement
Learning Benefits
•
•
•
•
•
•
Increased interaction
Increased quantity & quality of discussion
Useful for peer instruction
Contingent teaching: modification based on
learners’ responses
Quality of learning clarifies/prioritized content
Learning performance (more later)
Learning benefits, cont.
•
Formative assessment (non-graded)
• Comparison of answers with peers
▪
▪
▪
Popular with students
Promotes low-grade competitive environment
Students like to monitor progress

ARS performance on clinical questions
predicted performance on final exam
(Alexander 2009, Mayo Medical School, Basic science course)

Exam performance improved
when ARS had been used in discussion
groups, but long term retention was no
different with/without ARS
(Doucet et al 2009, Univ Montreal Pharmacy, Vet students )

After anonymous ARS quiz during lecture,
overall class exam scores not dramatically
impacted, but lower-quartile students showed
improved performance on target questions
(Hoyt et al 2010, Stritch SOM, med students, anatomy class)

Prospective randomized trial:
retention increased (pre- vs. post-test)
following interactive lecture
(21% change with ARS vs. 2% change without ARS)
(Pradhan 2005, UMDNJ, ObGyn Residents)

Randomized trial: ARS had positive impact on
exam performance immediately (p=0.02) and
3-months later (p=0.001)
(Rubio 2008, Cincinnati, Radiology residents)

Use of questions embedded into lecture with or
without ARS resulted in no significant change in
test performance, suggesting that embedded
questions, rather than ARS, resulted in improved
retention
(Stoddard 2010, Nebraska Med Ctr., 2nd-yr med students)

Forgot ARS clicker or clicker malfunction

Learning Curve for teachers to develop
and embed questions
(faculty development opportunity!)

Difficulty responding to student feedback
on the fly

Decreased time for content coverage

Forgot ARS clicker or clicker malfunction

Discomfort with new method of learningrequires greater cognitive energy

VERY uncomfortable with for-grade use

Discussion increases chaos, poor partners

When learners dislike being monitored
1.
2.
3.
4.
5.
Record attendance at
conference
Allow learners to compare
responses
Allow teacher to re-teach
or adjust content to learner
understanding
Facilitate discussion and
peer-teaching (students
sharing info so all learn)
Evaluate conferences
0%
1
0%
0%
2
3
0%
0%
4
5


School of Nursing
Clinical Laboratory Sciences –
 Galveston, Odessa, Tyler
 attendance & quizzes

Continuing Education – Pedi Review Course
 Knowledge assessment – low stakes

Practice of Medicine-Year One
FEEDBACK FROM A FIRST-YEAR MED STUDENT
SEPTEMBER 2010
A suggestion was made to have some sort of
incentive for <the Friday wrap-up> (food, UTMB
gear, etc). It seems like those of us who come are
greatly diminishing in number and as the last lecture
was not successfully recorded in Tegrity this is a
shame.
These kinds of incentives, while costly, do seem to
work for our class. Also speakers should try to
interact more and direct their lecture to us rather
than giving a normal lecture. What may work day to
day does not always captivate our age group/med
student audience.
POM-1 PEARLS
PATIENT ENCOUNTER AUDIENCE RESPONSE LEARNING SYSTEM
MODULE 3 WEEK 7
DR. KEITH BLY
DR. SUSIE GERIK
FEBRUARY 24, 2012
POM-1 PEARLS
MODULE 3 WEEK 7
0%
0%
0%
0%
0%
POM-1 PEARLS
HISTORY REVIEW
Which of the following would
be the most effective
technique for interviewing a
disinterested teen?
0%
A.
Ask mostly closed-ended “yes or no” type questions
0%
B.
Chat for a bit about friends, school, and hobbies
0%
C.
Limit the discussion to the specifics of the medical problem
0%
D.
Try to build rapport through use of common teen lingo
10
Countdown
POM-1 PEARLS
PHYSICAL EXAM
Which of the following is
correct technique when
performing the abdominal
examination?
0%
0%
0%
0%
A.
B.
C.
D.
Ask if there are any areas of tenderness while palpating
the abdomen
Inspect then auscultate then percuss then palpate
Put the patient in the right lateral decubitus position to
elicit a fluid wave
Undrape from just below the sternum to just below
the umbilicus
10
Countdown
POM-1 PEARLS
ETHICS & PROFESSIONALISM
You find a wallet on the floor
with cash but no ID inside
following the 8am lecture in
Levin Hall. Of the following, the
most appropriate next action is:
0%
0%
0%
0%
A. Keep it because there is no way to identify who it belongs to
B. Make an announcement at the start of the 9am lecture that if
anyone has lost something valuable to come see you
C. Put it back on the floor where you found it
D. Wait until somebody posts signs in the lecture hall that they
have lost a wallet specifying the amount of cash
10
Countdown
POM-1 PEARLS
STUDENT WELLNESS
If you suspect an upper level
medical student at your site
visit is intoxicated, your first
priority should be:
0%
A.
Get the student enrolled in a rehabilitation program
0%
B.
Report your concerns to the Office of Student Affairs
0%
C.
Have the student relieved from patient care duties
0%
D.
Ask the student to submit a drug test to confirm
10
Countdown
POM-1 PEARLS
SPIRITUALITY IN CLINICAL CARE
Several models for taking a spiritual
history have been published and used
in clinical practice. Which of the
follow is part of the spiritual history
determined using these models?
0%
A.
Importance of faith is in the patient’s life
0%
B.
Ritualized practices and restrictions
0%
C.
Terminal event planning
0%
D.
All of the above.
10
Countdown
o You must have PowerPoint already
installed on your PC
o Download and install the Turning Point
software from turningtechnologies.com
on both the PC for building and presenting the PPT
o Launch Turning Point, which functions as
an additional "tab" within PowerPoint
o Check out Response System from
Pedi Admin office (Tayna)
o Plug in the USB hardware receiver
o Pass out clickers to audience
and/or log into online account
o Launch and run presentation
with Turning Point

web-based polling using ResponseWare

Using RemotePoll™ with additional receiver
at distant site and more clickers

Remember that effectiveness of ARS
depends on quality of questions.

Design questions which allow learners to
demonstrate or apply knowledge and/or
discuss.

Use sparingly questions of learner experience
(“have you …”) or requiring supposition
(“what do you think will happen”)

Consider effective frequency of questions.

After responses are revealed, use the results
to increase understanding and reasoning.

Modify direction of lecture if results indicate
poor comprehension of the material
(i.e. re-teach).

Don’t allow the technology to overshadow
the content or the learning.