Impact on student learning
The change in the approach to the readings was valuable. Students benefited from explicit instruction on how to read and evaluate a research article, and the consistent format of the reading quizzes helped students internalize this framework. The strong performance on the quizzes suggested that students mastered the ability to read and evaluate a research article by the end of the course, and anecdotal evidence hints that they may have even transferred this skill to other topics or courses. Not only is this greater independence in consuming research important for lifelong learning, but it also allowed for more class time to be devoted to discussion of the merits of the research and the application of the research to clinical cases. In focusing class discussion on the strengths and weaknesses of each study, I learned that students have difficulty evaluating the severity of a given weakness. Specifically, students had some ideas about what constitutes a "good" research study so they could identify potential shortcomings; however, they had trouble weighting these shortcomings. Is the problem so severe that we completely doubt the validity of the findings? Or can we look at the data and determine that the problem didn't compromise the findings? In the next offering of this course, I plan to spend more time discussing how to determine the severity of a given departure from "best practices" in research. In addition, I think this issue could be addressed further in undergraduate coursework. Although our undergraduate students complete a course on general research methods, it may be useful to incorporate discussion of research methods in content specific courses so that students can see how these general research issues play out in specific content areas.
Demonstrating application of the evidence to clinical cases in each class helped students see the link between research and clinical practice. It also gave them a more in-depth understanding of how to apply that specific piece of evidence to clinical practice. However, it did not improve their ability to integrate multiple pieces of evidence. On the midterm written case reports, 2005 students showed similar integration problems as the 2004 students. This midterm attempt at clinical application and the subsequent feedback and discussion did help students learn how to integrate multiple pieces of evidence to specific cases, yielding improved performance on the final oral case. My approach to in-class application of evidence to clinical cases may need revision. Specifically, in 2005, we applied each piece of evidence to the clinical cases independently, rather than integrating evidence from the previous class with the current class. Students may learn how to integrate evidence better if each piece of evidence were layered on top of the next in the in-class application demonstrations.
Another method that may help students understand that integration is expected is the development of a grading rubric that emphasizes this point and could be distributed prior to case report deadlines. Although I have an internal framework for judging the quality of student case reports, I have not solidified this framework, nor have I shared it with students. For the past two offerings of the course, I avoided creating a rubric because I wasn't sure what the students were capable of. Thus, the grading was always a relative scale with students differentiated relative to one another rather than compared to a gold standard of quality. Now that I have seen what students are capable of and have adjusted my teaching methods to steer them towards the outcome I want, it is time to develop a rubric to better communicate course standards to students. I have constructed a preliminary rubric (see grading rubric) that lists the traits and what I would like to see for each trait. Thus, if every item were checked on this scale, the performance would be considered "perfect." I need to refine this scale to determine intermediate levels of performance for each trait because it is unlikely that every performance from every student will meet this gold standard.
Next steps for 2006:
Provide specific instruction in how to judge the severity of
a departure from standard research practices.
Change the approach to in-class examples to layer each new piece of evidence on top of the old evidence to foster the development of integration skills earlier in the course.
Refine grading rubric by determining intermediate levels of performance for each trait.
Printable version of all poster pages
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