CLICKER QUESTION

Question :

JT is a 63 year old female who presents to her physician with complaints of fatigue and shortness of breath on exertion, both of which are progressively worsening.  She reports no chest pain, cough, or peripheral swelling.  Her physical examination findings include a normal pressure, a normal and regular heart rate, and decreased radial pulses.  Her lung exam is normal.  Auscultation of her heart reveals a loud S1, no third heart sound, an opening snap, and a low pitched diastolic murmur that is heard most prominently at the apex of the heart.  An echocardiogram reveals a pressure gradient between the left atrium and ventricle of 10 cm of water.

Given the history, physical findings, and findings on echocardiogram, considered the diagnosis.  Which of the following would be the preferred treatment for this patient?

a.       Mitral valvuloplasty

b.      ACE inhibitor therapy

c.       Mitral valve surgery

d.      Aortic valve surgery

The purpose of my question was to stimulte cognitive processes. Students must consider all of the patient’s signs and symptoms, think through the differential diagnosis, then determine the most likely diagnosis. Then the list of answers are the possible  treatments. There is only one right answer. What I decided to change is to add another possible answer: e. none of the above. The reason is that if they reached the incorrect diagnosis, none of the answers would be correct. This would allow them to consider the characteristics of the true diagnosis, and the clinical difference between their proposed diagnosis and the true diagnosis.

HOMEWORK:

1.       What is the big take home message(s) from the Prezler paper.

For me, there were two big themes that I pulled out of this paper.

The first is that students in upper division courses were less likely to view clicker questions as valuable to their learning.  The authors propose that the reason was that most of the students moved into the upper division courses without having used clickers in previous courses.  The clicker questions represented change in what those students are used to.  What I take from this is that in higher-level courses, the instructor must present the students with and evidence-based rationale for using clickers in their classroom.  Also, it is important to use quicker questions that are of a higher cognitive level.

A second refers to figure 6.  These data demonstrate that in both lower and upper division courses, clickers improved performance on exams.  This was the most objective data presented in this paper and my opinion.

2.       Using the information from Caldwell’s paper, write two high quality clicker questions that will provide meaningful information about student understanding.

Question 1:

JT is a 63 year old female who presents to her physician with complaints of fatigue and shortness of breath on exertion, both of which are progressively worsening.  She reports no chest pain, cough, or peripheral swelling.  Her physical examination findings include a normal pressure, a normal and regular heart rate, and decreased radial pulses.  Her lung exam is normal.  Auscultation of her heart reveals a loud S1, no third heart sound, an opening snap, and a low pitched diastolic murmur that is heard most prominently at the apex of the heart.  An echocardiogram reveals a pressure gradient between the left atrium and ventricle of 10 cm of water.

Given the history, physical findings, and findings on echocardiogram, considered the diagnosis.  Which of the following would be the preferred treatment for this patient?

a.       Mitral valvuloplasty

b.      ACE inhibitor therapy

c.       Mitral valve surgery

d.      Aortic valve surgery

Question 2:

JT is a 53-year-old male who presents to his physician with exercise intolerance, shortness of breath on minimal exertion, and ankle swelling.  His medical history includes a diagnosis of coronary artery disease.  He had coronary artery bypass surgery 6 years ago.  His electrocardiogram shows normal sinus rhythm, a normal PR interval, and a QRS duration of 180 ms.  His most recent echocardiogram revealed an ejection fraction of 31% and a large anterior area of akinesis.

Of the following, what treatment would improve his overall survival and improve his symptoms?

a.       An implantable cardioverter-defibrillator

b.      A right ventricular pacemaker

c.       Amiodarone therapy

d.      An implantable cardioverter-defibrillator and a biventricular pacemaker

Feedback for Dr. Boyer

Thank you very much for your talk today. The information will be valuable for me. I am especially interested in Delicious and Presi and will try these out. You may find me in STEM 709.

Question for Dr. Boyer:

I teach a very short course (4 classroom sessions) called Research and Design. I don't have the time or resources to do an actual experiment in class. Are there electronic technologies available that I could use to simulate an experiment? 

Thank you!

ACTIVE LEARNING STRATEGY:

"How do we apply active learning strategies in our own classes?"  Tell us what activity you would try, how you would set it up, and what learning objective you would be targeting through this activity. 

I would like to try many of the strategies that we discussed on March 8.  The strategy that I chose for this task is "bookending." 

My definition of active learning is a way to engage students by providing valuable learning experiences (doing and observing) and reflective dialog (with self and others).

When teaching a challenging concept, “bookends” can be useful.  This allows for student participation before and after the lecture piece.  At the beginning of class, I would assign groups that will be composed of 4 or 5 students.  Each group will get a short list of questions relating to the previous homework assignment.  During 2 or 3 minutes of collaborating in their small groups, students can organize in advance what they know about the topic and set expectations as to what the lecture will cover. Then, there would be a whole class discussion about their responses, that will help students review and organize what they observed and learned. Next, I would complete a short lecture.  After the lecture, I would then assign each student to a new group where they would be asked to write a summary of the lecture or other group exercise designed to enhance recall and application of the lecture topic. Sharing will help students to work together and build a sense of positive interdependency upon one another. Studies on the brain and learning show that learners remember most about the first few minutes and last few minutes of a learning experience (Willis, 2006).

By breaking up the lecture into pre and post learning activities and having learners process the material in cooperative learning groups, I think you would decrease the amount of lecture time, but research supports that this will enhance what is learned and build relationships among the learners.

Reflection: Perspective of the student

Students are comfortable with summative assessment (SA) because that has been the traditional method, and they have learned to study with this method in mind. If they are successful, they continue to develop skills to perform on these kinds of assessments. They are comfortable with SA. They have practiced and have learned how to be successful on SAs. They have learned to manage their time based on the syllabi; when is the test, when is the assignment due.

With formative assessment (FA), we are asking them to make a change. Changes are difficult for everyone. It can create frustration.

Assessment for the student is feedback. The feedback must be constructive in a way that helps the student gain understanding of their knowledge and how to adjust their learning to meet the required goals. Of importance, is explaining to the student WHY you are assessing them in the way you are (your rationale), and what you want them to get out of the assessment.

College students are adults and intelligent. They want to know that the teacher respects them, and that they are a team. Then, when the teacher explains their rationale for FA and how students can benefit from this method of assessment, students will be amenable to change and engage in a new learning method. 

REFLECTIONS: formative assessment

This was a difficult exercise for me.  I think what went well was that we knew that we needed to get a sense of what the students already had knowledge of, and how they would assess their own students. We created a strategy to accomplish this which was the easiest part of this exercise.

We discussed goals and outcomes, and decided that these were the same without looking back or thinking about what we had previously read in Backward Design. I spent a lot of time on the readings for Tuesday, but did not make connections between those and Thursday’s readings.

When I first looked over the template, it made sense. I found that trying to use it is a lot more challenging than I thought. It was also a bit awkward trying to use the tool in a group before trying it on my own first, but the exercise has provided me with a way to approach the task. I think it is difficult to identify strategies to truly measure the students’ understanding and will take time and creativity. Using formative assessment allows you to create a structure for your unit but also allows the instructor to measure student learning based on evidence and adapt to the needs and misconceptions of the students.