CHANGING THE WAY MEDICINE IS TAUGHT

Jennifer Meka, PhD, director of the Medical Education and Educational Research Institute and assistant dean for medical education, center, with students.

STORY BY GROVE POTTER PHOTOS BY DOUGLAS LEVERE CHANGING THE WAY Medicine IS TAUGHT

walk through the new Jacobs School of Medicine and Biomedical Sciences’ building makes it clear that the teaching of medicine has changed. Large lecture rooms are scarce. Now you’re more likely to find rooms where small groups of people work closely together. A TODAY’S STUDENTS LEARN DIFFERENTLY, AND THERE IS MORE TO KNOW

That design is one signal that the days of lecture-learning are fading fast. Team-based and case-based interactive learning have been shown to create the kind of learning that leads to better, more durable retention of material and to improve problem-solving skills. But how does one learn to teach that way?

New medical education institute Enter Jennifer Meka, PhD, director of the Jacob School’s newly established Medical Education and Educational Research Institute (MEERI) and assistant dean for medical education. Working in concert with faculty, she is helping to transform the way medicine is taught at the school, aligning it with how students today learn and with best practices as defined by educational research. Her mission is to teach the teachers how to utilize evidence-based approaches to making learning more interactive, deep and durable, to promote the success of future physicians. “The goal for MEERI is to equip our faculty with the tools they need to train students as critical thinkers, able to clinically reason, while utilizing the ever-expanding volume of medical information they will need as future physicians,” says Meka, who holds a doctorate in education. “To do this, faculty need to understand how people learn and approaches to integrating this in their teaching methods. Layering the content with teaching students how to learn effectively prepares them for future learning.” Changing long-held teaching practices can be daunting, but Meka says she has been warmly welcomed and many teachers are eager to learn. “It’s an amazing place to be because everyone has their own area of expertise, but they all are open and willing to learn how they can be better teachers.” But the change is not easy. “It’s difficult to adapt to new ways of teaching for two reasons,” says Meka, who started at the medical school last March after serving

for six years as director of cognitive skills at the Penn State College of Medicine and director of the Woodward Center for Excellence in Health Sciences Education. “First, when many of the faculty were in medical school, they were in lectures from 8 a.m. to 5 p.m., so that is what they are accustomed to. The second challenge is it takes time to learn new strategies and to design the teaching, and it shifts the faculty member’s role in the classroom. Instead of pulling out the PowerPoint from the talk you gave last year on diabetes and updating some of the slides, you might have to write up a case and think through what questions you are going to ask and be deliberate in the sequencing of the questions. It can be more work up front and less work during the actual session, but the students get more out of it. And we know from the science of learning that this is the direction we should be taking in our teaching.” Another important facet of MEERI is the recognition of outstanding educators. To this end, Meka has worked with students, residents and faculty to implement the Moments of Excellence in Education: Recognition & Inspiration (MEE:RI) Program. “The program is designed to give students an opportunity to acknowledge the best practices in teaching strategies that they have experienced,” Meka explains. Students submit examples of these exceptional moments and each month the MEE:RI Program features one moment along with associated teaching tips and educational research to inspire faculty. Meka also is “working with programs and departments to develop additional longitudinal programming and to explore ways to collaborate around existing resources and initiatives across the university and beyond.” And her mission has support from the top. “Dean Cain has been incredibly supportive,” she says. “Early on, he invited me to the medical school’s executive council to talk about some of the programs we are working on. Department heads then reached out to me, and we started to look into some of their individual department needs.”

Internet has changed how students learn Alan Lesse, MD, senior associate dean for medical curriculum and vice chair for education in the Department of Medicine, says that efforts to reassess the educational process and the creation of MEERI are outgrowths of the school’s 2017 strategic plan. “If you basically summarize the first two goals of the strategic plan for medical education, strategic goal one is to improve the curriculum. Strategic goal two is to teach the teachers to be able to do goal one. So they are intertwined,” he says. “Essentially, we want to improve the curriculum, but we can’t improve the curriculum until we help the teachers teach it better and differently.” Students today also learn differently than in the past, Lesse says. “They don’t have to remember reams of information. They can look up something on the internet in a second, which impacts their attention, so I don’t think they memorize as well as students did in the past. “But the amount of information we needed to know when I went to school was much smaller,” he adds. “We didn’t have ready access to any information we wanted in our pockets on our phones. I used to carry around spiral books that had information I could look up if I couldn’t remember it.” Lesse is quick to point out that changing the way classes are taught is not an indictment of the old ways. “It’s clear that the old system works. I don’t consider myself a bad physician or handicapped because I did it the old way, which was lecture based,” he says. “But lots of studies now show that retention from lecture is lower than other forms of learning.” Basically, the internet has changed how students learn, he concludes, which calls for a fundamental shift in how they are taught.

Kassidy Amburgey, left, and Laura Artim, right, discussing a case.

From left: Arthur Gribachov, Gurkaran Johal, and Amit Bhambhani.

Fourth-year student Steven Foulis, in foreground, teaching second-year students. Facing him are Timothy Kung, left, and Shannon Coleman and Thomas Barbaccia, right.

Elle Fisch, MD, chief resident, Department of Obstetrics and Gynecology, left, and Suzanne Griffith, MD, clinical assistant professor of OB/GYN, right, teaching small group.

ne step toward changing teaching practices is to introduce evidence-based principles to both faculty and students so that they can use them effectively in their teaching and learning. “An example of this is introducing faculty to the concept of deep questions and having them ask two or three such questions during a session as well as at the end,” Meka explains. This exchange and the focus on the students’ explanation of the material, helps cement the knowledge. It also can show a teacher what students might not be understanding. Another tool is to give students cases to work through. “Our clinicians are really good at talking through cases and describing their approaches to patient care,” Meka says. “So one approach is for them to present a case and pose questions related to that case, then ask the students to turn to a neighbor, generate an answer, debrief them and explain their rationale, then have the faculty member do that, and give them different tools for how to do that. “This requires a shift in the teachers’ thinking because they’re used to saying ‘Here’s the case and here’s what we did,’” she adds. “A lot of times our teachers are already employing effective strategies, but they don’t have the label for it. Or they don’t know why it works or how they could use it elsewhere and so have more of an impact. When our faculty use cases in a deliberate way, they can promote cognitive flexibility in our students, which is essential in preparing them for future learning and practice. “The key task ahead for MEERI,” Meka concludes, “is to help our teachers learn how to build on what they are already doing to improve their teaching and the students’ learning.” Lesse says case-based learning does require a different approach. “It’s the concept of active learning where, instead of standing and lecturing, we pose problems. And it’s the concept of team-based learning, where people work together in teams to come up with an answer,” he explains. “It really is a different sort of mindset.” Preparing to teach involves deconstructing the old lessons and presenting them differently. “It’s called backwards design, where you determine exactly what you want to teach the students and how you’re going to ask questions to assess how much they know, and then you derive the content,” Lesse notes. “It’s not preparing the content first and then figuring out what the questions are later.” In short, today’s educators are benefiting from new data about how information is processed and are learning how to refashion their teaching techniques accordingly. “The teaching method is separate from the material being taught,” says Meka, who acknowledges that this can be a challenge. “The difficult part is getting the instructors to step away from the medical knowledge or the clinical skills piece and focus on the teaching piece. You don’t want them to get caught up in ‘Why didn’t you give this medication?’ or ‘Why didn’t you suggest they have this test?’ You want them to focus on how they asked a question when they were engaging with a student.” Of course the material is vitally important, Meka says, as is the ability to continue to learn. “The more we can teach students about the best ways to go about learning—how to develop stronger critical thinking skills, critical analytical skills, clinical reasoning skills—the better skills they will O

“It’s the concept of active learning where, instead of standing and lecturing, we pose problems. And it’s the concept of team-based learning, where people work together in teams to come up with an answer,” – ALAN LESSE, MD SENIOR ASSOCIATE DEAN FOR MEDICAL CURRICULUM

Students participating in an exchange. Pictured at the head of the table is Katelyn Benson, left, and Jenna Betz, right.

have when they encounter new diseases and new protocols.” Meka also is working with teachers to approach the process as valid educational research that can be shared with the entire medical teaching profession. “We want to do our work in a scientific way so that we can contribute to the educational field,” she says. “In addition to promoting best practices, we want to showcase the outstanding work that we are doing here at UB.” To support this endeavor, a MEERI Scholars Award program has been established to encourage Jacobs School faculty and staff to generate promising teaching and learning projects. Through the program, which launched in January 2020, award recipients receive feedback, educational programming and cross-collaborative support to help them develop their ideas into prototypes, pilots and smallscale innovations that lead to implementation in the curriculum and dissemination to the broader medical education community.

A step in the right direction All these efforts and more are aimed at helping students achieve their greatest potential by being immersed in a learning environment that consistently reflects best practice as defined by education research. One crucial tool used to assess whether they are reaching this potential is the United States Medical Licensing Exam. The first part of the exam is known as the Step 1 exam and covers all the scientific knowledge they have studied. For residency programs around the country, it has become a type of screening tool. At the Jacobs School, students take the Step 1 exam at the end of their second year. “The Step 1 exam makes students recall what they had in the first semester, first year,” Lesse says, “so we want to make that knowledge more durable.” The new teaching approaches are hard work and students initially do not like them, he notes, “but studies have shown that when something is harder to learn, that’s when you put in the effort, and it’s recalled much better than when learning it was easy.” Student readiness for the Step 1 exam will be taken into account as the new curriculum—set to launch in 2022—is being designed. “We

“The key task ahead for MEERI is to help our teachers learn how to build on what they are already doing to improve their teaching and the students’ learning.”

– JENNIFER MEKA, PhD, DIRECTOR OF MEERI

don’t want to teach to the test, we never want to do that,” Lesse says. “But given the importance of the test, we want to make sure that our curriculum provides a solid foundation so that students will do well.” Meka may have earned some credibility with students preparing for the Step 1 exam this year. Soon after beginning in her new role, she worked with the Office of Medical Curriculum to organize workshops in which she and upper-class students presented research-informed approaches to designing study plans. Students could also schedule individual consultations, and Meka met with 95 percent of the students in the second-year class and many of the first-year students. “Results are coming in, and the average score is higher than it was last year,” she says. “I think our students have found it very helpful to have a variety of options and resources to support their preparation for such an important exam.” Results like that will go a long way in helping transform the school’s teaching strategies. “It’s about elevating and cultivating this excitement and passion for education, while also providing support and resources for our teachers and students to implement evidence-based teaching and learning strategies,” Meka says. “The ultimate purpose of MEERI is to develop the best educational programs for our students.”