Patient-Centered Explorations in Active Reasoning,
Learning and Synthesis
David E. Elkowitz, D.O.
Director of Undergraduate Medical Education,
Course Director
Assistant Professor
Departments of Pathology and Laboratory Medicine and Science Education
Hofstra North Shore-LIJ School of Medicine
About our School of Medicine
• Located on Hofstra University’s Campus, Hempstead, NY
• First allopathic medical school in New York since 1963
• Housed in new, state-of-the-art, 48,000 square foot,
Medical Education Center
• Offer MD, MD/PhD, and PhD degrees
About North Shore-LIJ
• Nation’s second largest, non-profit, secular health system
• Nation’s 16th largest, integrated healthcare network, and
the largest in New York State
• Services 7 million people at 16 hospitals on Long Island
and in Manhattan, Queens, and Staten Island
• 2010 National Quality Forum award winner – National
Quality Healthcare Award
Mission Statement
The School of Medicine, in a culture of
community, scholarship, and
innovation, is dedicated to inspiring
diverse and promising students to
lead and transform medicine for the
betterment of humanity.
Values
 Community
 Diversity
 Scholarship
 Professionalism
 Innovation
 Patient Centered
 Learning
 Reflection
 Humanism
 Vision
GUIDING PRINCIPLES FOR
CURRICULUM DEVELOPMENT
“Adult learner” environment
Focus on learning, not teaching
Integration of health, disease Built on experiential/ small
and intervention
group learning
Fully integrated, science and
clinical curriculum
Early meaningful patient
interactions
Assessment drives learning
Emphasis on scholarship, critical
thinking, lifelong learning
True to mission, values, drivers
Curricular Structure: Spiral Curriculum
Content revisited at multiple points in time;
increased difficulty, greater depth, consideration of
current context
Integration
• Science to science
• Science to clinical
• Science to pedagogy
• Departments
How Will Students Learn?
Develop, predict
Defend, appraise
Examine, contrast
Organize, solve
Summarize, interpret
Name, define
“FLOW” EXPERIENCES
IN RELATION TO CHALLENGES AND SKILLS
High
Arousal
Anxiety
Challenges
FLOW
Control
Worry
Apathy
Relaxation
Boredom
Low
Low
Knowledge &
Skills
High
Pedagogies
PEARLS
Socratic Style
Large Group
Small groups with a
process expert (studentgenerated content)
Small groups with a
content and process
expert
Large groups with a
content expert (directorgenerated content)
Guiding Principles
PEARLS as the Cornerstone
PEARLS- Patient-centered Explorations in Active Reasoning,
Learning & Synthesis
Major way that students address most basic science content
Problem-Based Learning/Case Based Learning Hybrid
Student-driven, facilitators there to guide process only (not
content)
Cornerstone for all other weekly session (including Structure)
Professional Skills
Structural Sciences
Basic Sciences
Content
PEARLS
Educational Philosophy
• Value learning over teaching
• Trust the students to learn much of the factual
knowledge outside of class
• Active learners every day
• Critical thinking, Problem solving & Knowledge in Actionscience that sticks
• Societal forces of the times
– Decision making under uncertainty
– Deliver effective and safe care
– Majority of care delivered outpatient setting
– Health care teams caring for patients
• Hybrid problem-based/case-based learning
pedagogy
• Students synthesize biomedical science in the
context of patient-centered clinical cases with peers
• PEARLS relies heavily upon formative assessments
to help achieve goals of competency based
component of program
Pillars Provide Structure to Achieve
Goals Of PEARLS Program
PEARLS Pillars
Goals of PEARLS
• PBL/CBL Pedagogy
• Group Dynamics
• Higher Order Thinking
• Leadership, PBL&I
• Teamwork
• Acquiring knowledge of
biomedical sciences,
Critical thinking
THE PILLARS AND GOALS INFORM ALL
ASPECTS OF PEARLS
•
•
•
•
•
•
•
•
Monday
Roles: leader, timekeeper, recorder
Patient-centered cases
Explore issues and Actively Reason through cases to
develop learning objectives
Mon-Wed Self Directed Learning
Wednesday- Synthesize and apply information with
peers in group
Wed-Fri/Friday repeat for second case
Weekend-complete end of week essay
• Mondays
– Cases strongly lead to LO’s
– Role of faculty member is minimal; quiet
• Wednesdays/Fridays
– Higher order discussions
– Faculty can facilitate this using PQ’s or questions to
probe critical thinking:
•
•
•
•
•
What exactly is your question?
Could you elaborate further?
How could we verify if that is true?
Can you sketch that for us?
What factors make this a difficult problem?
Reflection, Integration & Assessment Weeks
Monday Check-in
Monday
AM
Wed AM
• Self assessment
• Reflection
Friday AM
Mon/Wed/Fri Wrap-up
Monday
AM
•
•
•
•
Wed AM
Self & group assessment
Content & process
Facilitator framed component
Reflection
Friday AM
Multiple Perspectives
Biologic
Science
Population
Health
Patient
Society
Prevention
Case
Therapy
Course/Case Development

Interdisciplinary team
2. Align weekly
sessions with
vertical content
1. Establish
learning
objectives
5. Finalize
assessment
scheme, faculty
development
3. Assign LOs &
design weekly
sessions
4. Determine
required
resources
Evolution of Complexity of Cases
• Will cases change in any way over time?
• Spend fist 10 minutes generating DDx
• Add incorrect information to a case or mismatch
– Case states patient has 1st degree heart block but actual EKG has 2nd degree
heart block
• Leave off goals of cases ?
Pillars Provide Structure to Achieve
Goals Of PEARLS Program
PEARLS Pillars
Goals of PEARLS
• PBL/CBL Pedagogy
• Group Dynamics
• Higher Order Thinking
• Leadership, PBL&I
• Teamwork
• Acquiring knowledge of
biomedical sciences,
Critical thinking
THE PILLARS AND GOALS INFORM ALL
ASPECTS OF PEARLS
PEARLS Development
Faculty
• Philosophy
• Programmatic rules
• Journal clubs
• Tape review
• Simulations
• Observation/debrief
• Facilitator meetings
• PEARLS GO! sessions
Student
• Philosophy
• Programmatic rules
• Student leadership roles
• Wrap up questions/
assessment
• PEARLS GO! Sessions
• Outside sessions
6 STEPS TO SUCCESS AS A PEARLS FACILITATOR
As a facilitator, your role is to promote student development of
PEARLS course expectations by:
Knowing the PEARLS expectations for the course in which you are facilitating.
Having a solid understanding of each of the PEARLS expectations and how they
relate to the PEARLS pillars/goals.
Being able to describe and recognize a higher order discussion.
Assessing your group during each session along the PEARLS pillars and goals to see
which expectations they are meeting and which ones they are falling short on.
Posing questions to group to allow them to self-discover areas needing
improvement= “framing” the wrap-up.
Pushing your group through wrap-up framings and role modeling to achieve
excellence in the deficient areas.
Knowing the PEARLS Developmental Expectations
Students were asked to be able to demonstrate the
following:
•Explain the goals and pillars of the PEARLS program
•Adhere to the ground rules and recognize that they are informed by the goals and
pillars
•Consistently arrive on time for sessions
•Generate good learning objectives
•Consistently arrive prepared for sessions
•Contribute to good group dynamic
•Utilize the goal of the case to guide scope of discussion
•Utilize student roles of leader/timekeeper/scribe to organize sessions
Knowing the PEARLS Developmental Expectations
Students were asked to be able to demonstrate the following:
•Explain the role of the facilitator and why we are process and not content
facilitators
•Articulate what constitutes a good self-assessment
•Articulate what constitutes a good group leader
•Perform constructive self and group assessment
•Modify behaviors based upon areas identified during self-assessment and
group feedback
•Experiment with different ways of integrating pharmacology into group
conversations
•Articulate the difference between a first order and a higher order
conversation
•Prepare questions for discussion by group (triggers)
1.Why do medical schools use PBL/CBL programs?
2.What are the goals of the PEARLS program?
3.What are the PEARLS pillars?
4.How do the PEARLS pillars relate to the goals of the PEARLS program?
5.Why do we expect everyone to be on time all the time?
6.Why does every student have to prepare every LO for group instead of dividing
and conquering?
7.Why does everyone have to participate evenly in group?
8.Why do we have student roles in group (leader, timekeeper, scribe) and what is the
role of the student leader with regard to content?
9.Why shouldn’t students read directly off their notes during session?
10.What is the purpose of self and group assessments each session?
11. Why is it important to make sure group is on the same page with
respect to LO’s they have derived in Monday’s session?
12. Why do we make students generate LO’s in group instead of
giving them out at the start of a case?
13. Why should the facilitator sometimes allow group process to fail
without rescuing students during session?
14.What is the rationale for having students possibly leave a group
with “wrong information”?
15. How and by whom will students be corrected if mis-information is
discussed during a group discussion?
16. Define and describe the difference between a 1st order discussion
and a higher order discussion?
17. How would you answer a student who asks what sources he/she
should use in preparation for the learning issues?
18. How would you answer a student who asks why they have to
change groups at the end of the course, especially if their group is
working well and they don’t want to change?
19. What is the purpose of wrap-up?
20. What is the framing part of wrap-up and what is it based upon?