English_version_Application of isd_in_classroom_sea_eng_16_dec2011

Application of ISD
(Instructional System Design)
in Healthcare Professional
Education

Takahiro Matsumoto, M.D., Ph.D.
Assistant Professor
Department of Anesthesiology
Jikei University
takahiro_matsumoto@jikei.ac.jp

Overview
• Instructor Training in Clinical Medicine
– Utilization of ADDIE Model
• Application of PDS in M&M Conference
– PDS: Performance Development System
• Utilization of ISD in Healthcare Student
Lecture
– Applying Keller’s ARCS Model

28 December 2011 ISD for learning of health professionals 2

Contribution to Society
as an Anesthesiologist
• My Question:
– As an Anesthesiologist, how can I contribute to
the society by not just being confined in OR?
• My Plan:
– Establish In-Hospital Code Response System
– Set up scheduled CPR (cardiopulmonary
resuscitation) training courses
• Impression:
– Instructor Training was critical in CPR course


How to become an ICLS Instructor
(ICLS: Immediate Cardiopulmonary Life Support, in Japan)
• Criteria for Instructor
1. Finish ICLS Course → 5 Assistant Instructor Experience
2. Finish ICLS Course → 2 Assistant Instructor Experience +
Instructor Training Workshop
• Remarks
1. Become Assistant Instructor upon finishing ICLS Course
• Pick what you can do among various Instructor tasks （a good
example of Legitimate Peripheral Participation?）
2. Instructor Training Workshop is NOT a must
• You can become an Instructor with Assistant Instructor Experience
only


How to become an AHA Instructor
• AHA Core Instructor Course
– Eligibility: AHA BLS/ACLS/PALS Diploma
– Textbook: AHA Core Instructor Course Textbook
• AHA Instructor Course
– Eligibility: AHA Core Instructor Course Diploma
– Textbook: AHA BLS/ACLS/PALS Instructor Kit
• Note
– All Instructors MUST have finished Core Instructor
Course


AHA Core Instructor Course
(AHA: American Heart Association)

• A prerequisite for AHA Instructor
Candidates
– Self-directed learning via DVD
– Interactive online learning program
• Outstanding Learning Program!
– Must have been written by a Didactics pro
• Back Cover of The Textbook Says:
– “Core content is based on … core instructor
competencies identified by the International
Board of Standards for Training, Performance
and Instruction (ibstpi)”
ISD for learning of health professionals 6

ibstpi Instructor Competency
• ibstpi：The International Board of
Standards for Training,
Performance and Instruction
– Development of standards in the
areas of training, performance and
instruction
– Composed of professionals in ISD
(Instructional System Design)
ibstpi • 18 Competencies
– 5 Domains
– 98 Performance Statements


ibstpi Instructor Competency
Professional Foundations
1. Communicate effectively.
2. Update and improve one’s professional knowledge and skills.
3. Comply with established ethical and legal standards.
4. Establish and maintain professional credibility.

Planning and Preparation
5. Plan instructional methods and materials
6. Prepare for instruction.

Instructional Methods and Strategies
7. Stimulate and sustain learner motivation and engagement.
8. Demonstrate effective presentation skills.
9. Demonstrate effective facilitation skills.
10. Demonstrate effective questioning skills.
11. Provide clarification and feedback.
12. Promote retention of knowledge and skills.
13. Promote transfer of knowledge and skills.
14. Use media and technology to enhance learning and performance.

Assessment and Evaluation
15. Assess learning and performance.
16. Evaluate instructional effectiveness.

Management
17. Manage an environment that fosters learning and performance.
18. Manage the instructional process through the appropriate use of technology.


Also Available in Japanese Translation
• Matsumoto T, Application Of
Instructor Competency In
Education For Health
Professionals, JJHPD, 1; 41-52,
2011.
• Matsumoto T, Japanese
Translation of Ibstpi Instructor
Competency Chapter 4, JJHPD,
1; 53-62, 2011.


ADDIE Model
A D D I E

• The five letters denote the phases which represent
dynamic, flexible guidelines for building effective
training and performance support tools.
– Analysis ：
– Design ：
– Development：
– Implement：
– Evaluation:
（ http://en.wikipedia.org/wiki/ADDIE_Model ）


Ibstpi Instructor Competency and ＩＤ
A D D I E
Professional Foundations
1. Communicate effectively. I
2. Update and improve one’s professional knowledge and skills.
3. Comply with established ethical and legal standards.
4. Establish and maintain professional credibility.

Planning and Preparation D D
Practicing ID in
5. Plan instructional methods and materials
6. Prepare for instruction.
I Instructional Methods and Strategies
7. Stimulate and sustain learner motivation and engagement.
8. Demonstrate effective presentation skills.
9. Demonstrate effective facilitation skills.
Instructor
A
10. Demonstrate effective questioning skills.
11. Provide clarification and feedback.
12. Promote retention of knowledge and skills.
Competency
13. Promote transfer of knowledge and skills.
14. Use media and technology to enhance learning and performance.

Assessment and Evaluation
15. Assess learning and performance. E
16. Evaluate instructional effectiveness.

Management
17. Manage an environment that fosters learning and performance.
18. Manage the instructional process through the appropriate use of technology.


Instruction: Is It An Art or Science?
Science of Medical Care⇒ Nursing, Medicine, Basic Science
Standards of Medical Care⇒ Guidelines

Bringing the Art of
Medicine into Science
Bringing the Art of
Instruction into Science

Standards of Instruction⇒ Instructor Competency
Science of Instruction⇒ ISD (Instructional System Design)


What Are The Teaching Resources For
Instructors?
The strongest is their own past
experiences as learners (e.g.
mimicking the way you have been
taught)

The second strongest is the
knowledge about teaching came
from reflecting on their own
teaching experiences

（Irby, DM, Academic Medicine
68 ;10:760-3, 1993）
Application of Teaching Science is in Growing
Demand Among Healthcare Provider Education

Healthcare Professional Education Based
On ISD & Instructor Competency

Good Healthcare Providers

Clinical Practice Adhering to Instructor Competency

Understanding & Practicing of
ISD during Students

Proposed Facilitator Course In
Healthcare Professional Education
• Basic Course
– Goal: Educate Instructors with Basic Skills of
– Contents：
• ibstpi Instructor Competency 1, 7, 11, etc
• Advanced course
– Goal: Educate Facilitators and Managers of
– Contents:
• ibstpi Instructor Competency 1, 9, 10, 15, 16, etc

Summary 1
• ibstpi Instructor Competency
– An International Standard of Instructor
• Faculty Development Based on ISD
– Application of ibstpi Instructor Competency


APPLICATION OF ISD IN M&M CONFERENCE
(PDS: PERFORMANCE DEVELOPMENT SYSTEM）


Malfunctioning M&M Conference
• What M&M should be:
– Peer reviews of complications occurring during the
care of patients
– Constructive learning to modify behavior and
judgment
• What M&M in Japan is:
– Usually “Punitive” and discouraging environment
– Often ends up blaming other parties
• May cause someone to leave the practice
– Same ol’ conclusion “Study hard, practice hard!”


Creating a Paradigm Shift in M&M
• M&M needs to change because:
– You learn less in punitive environment
– Discouraging environment creates poor teamwork
– Performance will not improve solely by training
• Can we change M&M into an effective and attractive
opportunity to learn?
• Let’s apply ISD to M&M
– PDS (by John Keller) can be a powerful tool
• PDS: Performance Development System
– Article: HOW TO LINK ISD and HRD TO ORGANIZATIONAL
NEEDS
– http://isd-resource-space.wikispaces.com/file/view/How+to+Link+HRD+to+Organizational+Needs.pdf


(http://isd-resource-space.wikispaces.com/file/view/How+to+Link+HRD+to+Organizational+Needs.pdf)

PDS-Based M&M: Case 1
• Present the case
• Find out the international guidelines and/or
organizational rules related to this case
• Describe the “gap” between ideal
performance and real world medicine
– e.g. One week longer hospital stay than guidelines
– Important to extract good performances as well


PDS-Based M&M: Case 2
• Cause Analysis (What’s missing?)
– Skills & knowledge: e.g. ability to detect volume
depletion
– Environment:
– Motives and Expectations:
– Incentives and Rewards:
• Seek Solutions for Individual Cause


PDS: Solutions Linked to Causes
Possible Causes - Lack of: Possible Solutions – Look at:
• Skills / Knowledge • Training – formal or OJT, Job
aids
• Environmental Constraints • Work redesign

• Appropriate Incentives • Recognition for excellence,
Promotion based on
performance
• Individual Motivation
• Confidence building

(http://isd-resource-space.wikispaces.com/file/view/How+to+Link+HRD+to+Organizational+Needs.pdf)


Summary 2
• Malfunctioning M&M Conferences
– Punitive, discouraging meeting
– Blaming one another
– Negative effect on camaraderie and facilitate
quitters
• Applying PDS to M&M
– Will enable systematic approach to the problems
that cannot be solved by training


APPLICATION OF ISD IN
HEALTHCARE STUDENT LECTURE


Reality Check #1:
Goal Settings for Med Students
• Ideal
– Become a clinician who honors scientific evidence
– Become a clinician who cares about patient safety
– Become a medical science researcher
– Become a medical officer in the government
• Reality
– Must pass the medical board exam
• Some med schools have reverted back to classic lecture style
after their pass rates dropped
• Governmental aid to the med school will be cut if pass rates
drop


Reality Check #2:
Issues in Med School Lecture
• Dysfunctional Lecture
– Lacking Syllabus. Non-functional if any.
– Poor Attendance
• Napping, yaking in classroom
• Many students feel attendance is irrelevant to passing
the board exam
– Multiple issues on faculties
• Same ol’ classic lecture
• PBL (Problem Based)
• Med school didactics need a drastic change

Improving Med School Didactics with ISD
• Application of ADDIE Model
– A: Creative lecture content
– D & D: Utilization of Classroom Response System and
Mobile Based Voting System
– I: Avoid “lecturing” in the classroom
– E: Achievement evaluation and feedback via Mobile
Based Voting System after the class
• Confirmation of Kirkpatrick Level 3
– Establish study groups which can be attended
voluntarily


Two Weeks Prior to the Class
• Anesthesia Chair put me in charge of the keynote
lecture of Anesthesiology for Med Students
• I analyzed the specific function of this lecture:
– Introduction to Anesthesia and related medical fields
– Impact on students & residents till they graduate
• Getting prepared
– E-mail the lecture topics to students
– Have students vote on their interested topics via
Mobile Based Voting System


Anesthesia-Related Goals for
Med Students
• Passing the Exams
– OSCE, Graduation Exam, Board Exam
• Achieve the Basis for Medical Professional
– Understand Pathophysiology
– Learn Basic Technical Skills
– Care Patient Safety
– Be a Scientist
– CME


Topic Examples Related to
“Passing the Exams”
• Select questions from past Board Exams
• Explain Anesthesia-related questions


Topic Examples Related to
“Pathophysiology”
• What does Blood Pressure implies? How low can
it be?
• Pathophysiology and treatment of tachy- &
bradycardia
• How much oxygen does your patient need?
• Where do you start reading the ABG?
• Basics of selecting IV fluids
• Basics of pain management
• When do you start giving red cells?

Mobile Based Voting System “ShuKeitai”
• Developed by Kimura
Inormation Technology
– http://www.k-
idea.jp/company/syuukeitai.
html
• Post the website and QR
code
– http://mana.3esys.jp/tju/1/


Vote Result 1
learning

science
issues

patient safety

physiology

examination

0 20 40 60
vote
• Physiology and Exam Topics were popular.


Vote Result 2
pain management
red blood cell transfusion
infusion
issues

blood gas analysis
oxygen needs
bradycardia & tachycardia
blood pressure

0 10 20 30 40 50
vote
• Brady- & tachycardia, pain management were popular
among pathophysiology topics.
– Decided to defer pain management to other lecture opportunity.


Lecture Planning Based on Vote Result
• Main Topics
– Pathophysiology and treatment of Brady- &
tachycardia
– Past board exam questions
– Why do you learn? – Significance of Learning
• Lecture Style
– Small-Group Discussion
• Avoid one-way talking as much as possible
– Use Classroom Response System


Mishaps on the Day of Lecture
• Underestimated the attendance
– About 70 students showed up instead of usual less
than 20
– Only 20 sets of 3e-analyzers available – could not
utilize
• http://www.k-idea.jp/3e/analyzer/index.html
• Bad reception for mobile device in the classroom
– Could not use “ShuKeitai”
• Detected one sleepyhead


Post-lecture Feedback
• Aim
– Assess the achievement level after the lecture
• Had the students answer the past Board Exam
questions
– Get the opinion about the lecture
• Number of Responds: 30
– Actual number of respond unknown due to
dropped data calls


Post-lecture Feedback 1
• Q. What was most impressive about this
lecture?
– Lecture was not one-way 8.51%
– Lecture made us think 40.43%
– Significance of physiology 23.40%
– Significance of Patient Safety 7.45%
– Dangerousness of focusing on just passing the
board exam 20.21%


• Q. What needs to be improved about this
lecture?
– Could not learn much 12.50%
– Inadequate lecture resource 10.71%
– Could not understand well 3.57%
– Felt too lengthy 1.79%
– Nothing to improve 71.43%


• Q. How do you feel now after taking this
lecture?
– Bored 1.72%
– No change 17.24%
– Want to learn more 60.34%
– Want other teachers do similar lecture style
20.69%


Summary: Lecture Designing
• Preparation
– E-mail the lecture topics
– Students vote for topics via Mobile Based Voting
System (MBVS)
• In-Class
– Lecture on topics based on Voting result
– Stress on small-group discussion
• Post-lecture
– Achievement confirmation via MBVS
– Feedback via MBVS

Provide the Opportunity for
Voluntarily Studying
• Set up “Clinically Oriented Physiology” study
group
• Schedule
– Once a week, starting 7pm, lasts about 90 min
– No set day of the week
– Announce the meeting by mailing list
– Textbook: “Principles of Physiology for Anaesthetists,
2nd ed”
• Accomplished 1st and 2nd meeting so far
– Dec 1st and 12th , 7pm till past 8pm
– 20 people attended (mostly pre-clinical med students)

Testimony from a med student after “Clinically
Oriented Physiology” study meeting
• I have been skipping most of the classes
recently because I was so disappointed with
the studying style that puts stress on
memorizing stuff…
• But now I am wondering how exciting it could
be to connect my knowledge of physiology to
clinical medicine.
• I believe I can start learning real medicine by
attending your study group.


The Effect of Mobile Device Voting System

• What I found in this lecture
– Motivates the students
• 70% of the students voted to pick the lecture topic
– Able to Confirm Achievement
• Can ask to vote for understanding during class
• Can perform post-lecture quiz (test)
• Future
– Possibility of “Ubiquitous Style” Lecture
• Enables to attend the class without physically being
there


Function of Face-to-Face-Style Lecture
• Functions confirmed with this lecture
– Functionality to achieve information and knowledge
will actually decline
• What students want is the information you can ONLY achieve
through lecture
– Most important: Function to AWAKEN the desire to
study
• Students started to attend voluntary study group
• Future Plan
• Team-Based Learning
• Workshops


Caveat
• Need to take into account that not all students
have web access on cell phones
– Make announcements or send documents via e-
mail


Summary 3
• Classroom Response System will change the
lecture style
– Pre-lecture: Vote for lecture topics, post quiz
– In-class: Acknowledge students’ reaction and
achievement (unsuccessful this time)
– Post-lecture: Acknowledge the desire to learn
• Construct an effective and attractive learning
environment
– Function of the lecture is to awaken the desire to
learn and facilitate team-based learning
• Not so effective in transmitting information to students


Take Home Messages
• Application of ISD to Healthcare Provider
Education
– ADDIE Model for faculty development
– PDS for M&M Conference
– Keller’s ARCS Model to motivate students in the
classroom
• Systematic approach such as ISD is required in
Healthcare Provider Education


Acknowledgement
This presentation was originally created in
Japanese. It was translated into English by:
David R. Okano, M.D., Ph.D.
Assistant Professor of Clinical Anesthesia


English_version_Application of isd_in_classroom_sea_eng_16_dec2011

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