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Reflection on Block 1 – towards compliance for those with moderate severe asthma

The most straight forward of assignments has proved anything but … not for how to write this 2000 word piece, that is straight forward, but rather committing to a subject, then narrowing down the theme, possible research question and then dig up some papers … and not simply offer the lot, but give the five ‘that say it all’. To pick five how many must you read, at least as abstracts. I made three false starts, even read a PhD thesis on blogging before deciding it is a minefield. I may like to blog but I no more want to research it for an OU assignment than sort out pebbles on Brighton Beach. Lifelogging, memory and neuroscience all interest me … but are too big to get my head around in a few months – a few years perhaps. Looking at my notes I see I have papers also on augmented learning for field trips and museum visits. Then I returned to a platform that caught my eye three yesrs ago on H807 when I interviewed Dr. B. Price Kerfoot of Harvard Medical School on ‘Spaced Education’. So far this system has been usef with doctors, to support their learning and decission making … the next step will be patients. One of the humdingers here is ‘compliance’ – taking the medication you are prescribed if you have a chronic condition. What dawned on me this afternoon is that as a asthmatic I am the perfect patient – compliant to the nth degree. What surprised me is that such a large percentage of asthmatics are not. But with alleregies – a double-whammy of irritations, I ignore the nasal steroids and antehistemines almost completely. Compliant, and defiant in one go so just about canceeling the two out. But why? This is what fasciantes. You know you need to take something to avoid a return of the symptoms, but as there are no symptoms you stop taking the medication. Anyway, I am sifting through papers to set me straight and to offer some answers. If you have a moderately severe chronic condition and wish to share your medication regime or attitude please speak up – asthma, allergies, diabetes, epilepsy, other mental illnesses – chat on Skype? Meanwhile I checked my preventer inhaler – it was empty. I at least had a spare and will get a repeat prescription in tomorrow.

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Research Terms

RESEARCH TERMS

The many methods used all have names. In a brave attempt at getting my head around these I’ve started this list for the terms I stumble upon in H809 and related reading.

CRD : A cluster randomised design – by class as it is impractical to teach different things to the same group. (Torgerson and Torgerson 2001. p. 321)
CCT : Case Control Trial – A characteristic of this approach is that the two sets of schools may well be different in a number of aspects other than the intervention being tested, and this may affect the results. i.e. Schools needed to have been either chosen randomly or chosen because the had a similar intake and similar results.
Epistemological : the study or a theory of the nature and grounds of knowledge especially with reference to its limits and validity. (Merriam-Webster)
Ethnography : studying a particular culture by learning to live the life of its members (Hammersley & Atkinson, 1994).
Exploratory RCT: The explanatory trial design is probably the one with which most people are familiar.   (Torgerson and Torgerson 2001. p. 320)
Evidence based research: Randomized Control Trials  (RCT) – as Dr B. Price Kerfoot et al (2006-2012)
Interpretive paradigm: qualitative methods.
IRD. An individual randomised design – as with Spaced Education at Harvard Medical School under Dr. B. Price Kerfoot. (Torgerson and Torgerson 2001. p. 321)
Positivism: a belief in the application of a particular model of the methods of the natural sciences. In Wegerif: verification of hypotheses, numerical measurement, tests of statistical significance and experiments.
The pragmatic RCT : the environment in which the trial is conducted is kept as close to normal educational practice as possible, though the sample has to be far larger to detect smaller changes. (Torgerson and Torgerson 2001. p. 320)
Quantitative: of, relating to, or involving the measurement of quantity or amount. (Merriam-Webster) Coding schemes and publicly verifiable criteria to make categorisations. (Wegerif and Mercer.  1997. p. 271)
Qualitative: of, relating to, or involving quality or kind. (Merriam-Webster) Interpretative method (Torgerson and Torgerson, 2001) Interpretative analysis of transcribed speech = qualitative.  Are the techniques valid? The study of shared knowledge over time. Crook (1994) ‘Qualitative analysis can be effective for generating theories but not so effective for rigorously testing them (Hammersley, 1992).

REFERENCES

Hammersley, M. (1992) What’s Wrong with Ethnography. London: Routledge.

Kerfoot.B.P., Yineng Fu, Baker.B., Connelly.D., Ritchey.M.L., Genega.M.G. (2010) Online Spaced Education Generates Transfer and Improves Long-Term Retentionof Diagnostic Skills: A Randomized Controlled Trial, Journal of the American College of Surgeons, Volume 211, Issue ,September 2010, Pages 331-337.e1, ISSN 1072-7515, 10.1016/j.jamcollsurg.2010.04.023.

Torgeson.C.J., and Torgerson.D.J. (2001) The Need for Randomised Controlled Trials in Educational Research British Journal of Educational Studies , Vol. 49, No. 3 (Sep., 2001), pp. 316-328

We forget, it’s only natural – what can we do about it?

Fig.1. The Forgetting Curve. Ebbinghaus (1885)

‘The psychological conclusion demands a distribution of repetitions such that some of them should be produced at a later time, separated from the first repetition by a pause’. (Vygotsky, 1926)

More recently, in the last ten years in fact, Dr B Price Kerfoot of Harvard Medical School (2006) created a platform called SpacedEd (now Qstream) that uses multichoice questions, typically and most successfully with first year medical students, where sets of questions are randomised then sent out as text or email to tackle, I suppose, what Ebbinghaus (1885) identified with his ‘Forgetting Curve’. An evidence based paper on the effectiveness of ‘spaced learning’ showed how there was better retention three months, six months and a year down the line.

REFERENCE

Ebbinghaus, H (1885) Memory: A contribution to experimental psychology.

Kerfoot, B, P (2006) SPACED EDUCATION. Interactive Spaced-Education to Teach the Physical Examination: A randomized Controlled Trial.

Vygotsky, L (1926) Educational Psychology

FURTHER LINKS

Formative Tests Aid Retention

Spaced Ed

SpacedEd is a platform designed to allow learners and teachers to harness the educational benefits of spaced education.

Spaced education is a novel method of online education developed and rigorously investigated by Dr. B. Price Kerfoot (Associate Professor, Harvard Medical School).

It is based upon two core psychology research findings:the spacing effect and the testing effect.

In more than 10 randomized trials completed to date, spaced education has been found to:

  1. Improve knowledge acquisition
  2. Increase long-term knowledge retention (out to 2 years)
  3. Change behavior
  4. Boost learners’ abilities to accurately self-assess their knowledge.
  5. In addition, spaced education is extremely well-accepted by learners.
  6. The spacing effect refers to the psychology research finding that information which is presented and repeated over spaced intervals is learned and retained more effectively, in comparison to traditional bolus (‘binge-and-purge’) methods of education.
  7. The testing effect refers to the research finding that the long-term retention of information is significantly improved by testing learners on this information.
  8. Testing is not merely a means to measure a learner’s level of knowledge, but rather causes knowledge to be stored more effectively in long-term memory.
  9. The spaced education methodology is content-neutral and thus can be utilized to learn most anything.
  10. Potential applications range from teaching chemistry concepts to high school students to reinforcing Arabic language skills among health workers in the Middle East.
  11. It can also be used to reinforce educational material which was initially presented in the classroom.
  12. The full multi-media capabilities of the Internet can be harnessed to create a rich and effective learning experience.

Asynchronous Spaced Education becomes synchronous and game-like

I might have interviewed Dr Price Kerfoot of Spaced-Ed for H807, ‘Innovations in E-learning’ a year ago.

I finally caught up with him this afternoon two weeks into the Spaced-Ed transmogrification that is Qstream.

We used Skype. Clear barely broken sound. Sharp video in colour. It worked.

It was a fascinating discussion.

I should have asked to record and done so.

Next time. I’m sure the conversation has only just begun.

Though armed with a set of questions used in TMA02 of H807 non were necessary. I’d prepared them to follow a narrative flow, and that is what we did.

We have something in common, we were both at Balliol College, Oxford.

I was there as an undergraduate 1984, he was there five years later as a Rhodes Scholar taking a BA in Medicine. Dr B P Kerfoot is now an Associate Professor of Harvard Medical School. He is also a passionate educator and e-learning entrepreneur. I suspect we will continue to hear a great deal about him – he has a passion for education, reminding me of the late Randy Pausch, even the Robin Williams character from Dead Poets Society; there is an unstoppable, engaging warmth backed by a profound intellect.

The narrative

Price had finished his surgical training when he went into education, an odd elective he admits, but one that through circumstances and surely an innate interest has proved fruitful.

What is the problem?

I didn’t need to make this prompt. You strive to fix something when you see it isn’t working. Learning outcomes from first year medical students were poor. Why, in US terms, spend $1000 dollars on a course only to find a year later that the traditional methods of acquisition and retention of knowledge has failed.

No problem, no fix.

Price looked to web-based teaching to create learning modules. Two concepts were devised, the spacing of questions proved successful. This is from one of a dozen papers authored by Kerfoot and his team; each one, naturally, a worthy, academic, professional appraisal.

Two reports are cited as we talk, one on the effect on the hippocampus of rats, another on phosphate levels in fruit flies. As an OU student these reports are readily available.

There is physiological evidence that ‘spaced learning works’.

This matters:

a) you want something that works,

b) you want something that will justify the investment.

We give it away, academics in the US are commercially savvy.

Its as if in the UK academics (individuals and institutions) are like bachelors and spinsters, whereas in North America they are eager to marry.

More importantly the research has shown that the Spaced-ed approach improves patient outcomes the goal it was found that cancer screening of patients improved by 40% for the year spaced-education was introduced.

In 2006 the methodology was submitted by Harvard for a patent application. Entrepreneurs and venture capital companies were also approached.

It’s a shame the Spaced-Ed blog hasn’t been maintained, though you’ll get some further insights here.

What began as continual education in medicine has expanded. If you go to the Spaced-Ed website there are all kinds of courses you can take, typically 20-30 questions of the multi-choice type fed to your laptop, SmartPhone or iPad. Writing these multiple choice questions is an effort and requires skill to get right,, indeed I can admit to wanting to create what I thought would be a simple set of questions relating to teaching swimming … but the correct construction of the questions, let alone the creation of appropriate images has held me back. It isn’t as easy to get this right as it looks. You don’t want to feed your audience lame questions, nor do you want to overstretchthem. There is also some negative feelings about Multi-choice, perhaps we have all had negative experiences at school … I personally remember what we described as ‘multi-guess’ that was so often used in Chemistry classes. Though clearly effective, not enough people have been persuaded to pay for these sets of questions, even a dollar or so.

The challenge, has been to move on from asynchronous to synchronous, real time learning, including video and other rich media. The new platform promoted as Qform is an Facebook App and Twitter-like in its approach. People elect to follow a Qstream which goes out to everyone. You join in collectively, rather than alone, which creates a sense of participation and competition. If I understand this correctly, as I’m yet to give it a go, you pose a response to an open question that others read. You then vote on the various responses given. As Price, engaging as Robin Williams in Dead Poets Society enthused about the platform I thought about Skype and Elluminate, even forum threads. Indeed, I wonder if we could all organise to be online and go to one of these threaded conversations to turn an asynchronous environment into a synchronous one. Harvard is also the home of Rotisserie, which rotates a threaded conversation between online learners to ensure that everyone has a turn… and of course Facebook.

Gameification is the key. You respond in a way that other s like and you get points for it and your name appears on a leader board.

Rich content and a range of responses is what’s new. And its live And its competitive

And so Qstream delivers synchronicity and a sense of community Price also talked about how to make it possible for answers to questions to become searchable in Google – I guess with the inclusion of the right metadata. I didn’t need to say it to find I’m told the more controversial responses would generate the most responses. Now it’s starting to sound like the format of the Oxford Union Debating Society – I guess Price went along there at some stage too. By listening to two sides battle it out you form your own opinion.

One final statistic – 85% of those studying urology in North America (that’s the US and Canada) are using Dr B Price Kerfoot’s 23 question Spaced-ed multi-choice Q&A.

The competitors are Quora, Stackoverflow and FormSpring or some such … I’ll go take a look.

REFERENCES

REFERENCE

J Gen Intern Med 23(7):973–8

DOI: 10.1007/s11606-008-0533-0

© Society of General Internal Medicine 2008

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