Audience Response Systems: Clicking Your Way to Enhanced Learning

1. Patricia Beach MD Keith Bly MD Virginia Niebuhr PhD Pediatric Grand Rounds March 9, 2012 Audience Response Systems: Clicking Your Way toEnhanced Learning BAY COLONY REMOTE AUDIENCE : SESSION Download and run the “Responseware” app on your smartphone OR Point your web browser to http://www.rwpoll.com

2. Disclosures & Acknowledgements • 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

3. pedi.edtech US Dept. Health & Human ServicesHealth 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

4. Audience Response System 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

5. Audience Response System 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

6. Pediatric’s ARS turningtechnologies.com TurningPoint – interactive PowerPoint(PC or Mac) integrates into Microsoft® PowerPoint ®

7. POLLING EXPERIENCES: Have you ever used an audience response system as a learner? • Yes • No

8. POLLING CHARACTERISTICS: Who is our audience? • Student • Resident • Faculty • Other

9. ARS Applications • Polling • audience experiences/characteristics • opinions • evaluations • Recording attendance

10. ARS Applications, cont. • Knowledge Assessment • Assessment of audience comprehension • followed by teaching adjustment • Testing for credit/grading • some software integrates database into Blackboard

11. KNOWLEDGE ASSESSMENTWhat factor is most contributory to cessationof breastfeeding after 1 month of age? • Maternal smoking • Lack of supportive partner • Failure to use a breast pump • Mother’s return to work

12. ARS Applications, cont. • Facilitation of discussion answer- discuss- answer again

13. FACILITATION OF DISCUSSION:Cardiac Risk and Stimulant Medications 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.

14. How should pediatricians best manage this issue? • Inform families that theoretic risk is overstated and proceed with prescription. • Inform of theoretic risk, perform H&P to assess risk in this child; prescribe stimulants if negative. • 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.

15. How should pediatricians best manage this issue?Discuss for 3 min—prepare to vote again. • Inform families that the theoretic risk is overstated and proceed with prescription. • Inform of theoretic risk and take a careful history regarding cardiac factors in this child; prescribe stimulants if negative. • Inform of theoretic risk, take a careful history regarding cardiac factors in this child, and order an EKG; prescribe stimulants if all negative. • Inform of theoretic risk and seek cardiologist clearance prior to prescribing stimulant medications.

16. How should pediatricians best manage this issue? • Inform families that theoretic risk is overstated and proceed with prescription. • Inform of theoretic risk, perform H&P to assess risk in this child; prescribe stimulants if negative. • 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.

17. Scholarship around ARS • > 85 papers published since 1999.

18. Tool or Toy? • 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)

19. Tool or Toy? Classroom Environment Benefits • Attendance improved • Attention improved • Anonymity facilitates increased participation • Increased engagement

20. Tool or Toy? 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)

21. Tool or Toy? 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

22. Does ARS help with learning?

23. Learning Performance • 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 )

24. Learning Performance • 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)

25. Learning Performance • 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)

26. ARS Challenges for Teacher • 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

27. ARS Challenges for Participants • Forgot ARS clicker or clicker malfunction • Discomfort with new method of learning-requires greater cognitive energy • VERY uncomfortable with for-grade use • Discussion increases chaos, poor partners • When learners dislike being monitored

28. OPINION POLLING: What do you think might be the most effective application of an ARS for the learners you teach? • 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

29. Use at UTMB • 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

30. 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.

31. 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 Title Slide

32. Select Category MODULE 3 WEEK 7 History Review Physical Exam Ethics & Professionalism Student Wellness Spirituality in Clinical Care ETHICS & PROFESSIONALISM HISTORY REVIEW PHYSICAL EXAM SPIRITUALITY IN CLINICAL CARE STUDENT WELLNESS

33. 01 History Review HISTORY REVIEW Which of the following would be the most effective technique for interviewing a disinterested teen? Ask mostly closed-ended “yes or no” type questions Chat for a bit about friends, school, and hobbies Limit the discussion to the specifics of the medical problem Try to build rapport through use of common teen lingo 10 Countdown

34. 01 Physical Exam PHYSICAL EXAM Which of the following is correct technique when performing the abdominal examination? 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

35. 01 Ethics 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: Keep it because there is no way to identify who it belongs to Make an announcement at the start of the 9am lecture that if anyone has lost something valuable to come see you Put it back on the floor where you found it Wait until somebody posts signs in the lecture hall that they have lost a wallet specifying the amount of cash 10 Countdown

36. 02 Student Wellness STUDENT WELLNESS If you suspect an upper level medical student at your site visit is intoxicated, your first priority should be: Get the student enrolled in a rehabilitation program Report your concerns to the Office of Student Affairs Have the student relieved from patient care duties Ask the student to submit a drug test to confirm 10 Countdown

37. 01 SPIRITUALITY IN CLINICAL CARE 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? Importance of faith is in the patient’s life Ritualized practices and restrictions Terminal event planning All of the above. 10 Countdown

38. Turning Technologies • You must have PowerPoint already installed on your PC • Download and install the Turning Point software from turningtechnologies.com on both the PC for building and presenting the PPT • Launch Turning Point, which functions as an additional "tab" withinPowerPoint

39. Turning Technologies • Check out Response System from Pedi Admin office (Tayna) • Plug in the USB hardware receiver • Pass out clickers to audience and/or log into online account • Launch and run presentation with Turning Point

40. Distance Education:when everyone is not in the same place • web-based polling using ResponseWare • Using RemotePoll™ with additional receiver at distant site and more clickers

41. Best Practices • 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”)

42. Best Practices • 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.

43. Questions/Discussion