The most vital component of small group work is the group leader, who is ordinarily the instructor or a tutor. The leader's role in the group is not merely to listen to the different participant comments, but also to assist in identifying any biases, errors, or misconceptions among the members. An effective group leader provides only minimal intervention, but is always attentive and uses specific techniques that promote an intellectual experience for all the members.

The office of CDM offers both group and one-to-one training for Small Group instructional improvement.                                

The World Wide Web has the potential to be more than a source of information. When properly designed, web pages can provide learners an array of instructional activities that give information, allow an opportunity for practice, and then provide feedback to inform the learner of his/her strengths, weaknesses, and suggestions for enrichment or remediation.

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Giving Feedback

Feedback is communication to another individual for the purpose of facilitating self-awareness and self-understanding. Because adults are essentially driven by internal motivators (i.e., satisfaction from successful task completion, recognition, or self-esteem), effective feedback is an integral part in helping adult students reach their maximum potential.¹

Effective feedback is non-judgmental and provides the student criteria by which to measure his/her skills, knowledge, and attitudes and also provides the student information to validate his/her own feelings or impressions about how well or poorly he/she performed. Without feedback, mistakes may go uncorrected, good performances may not be reinforced, and learners may develop an inaccurate perception of their performance. Therefore, feedback becomes an essential component in education simply because it provides information that the learner can use to make adjustments in completing one simple objective or in reaching a long-term goal.

1. Sachdeva, A. K. (1996) Use of effective feedback to facilitate adult learning. Journal of Cancer Education 11(2), 106-118.

The office of CDM offers both group and one-to-one training for instructional improvement in Feedback.                                         

Effective Questioning

To acquire competence in questioning, an instructor needs the opportunity to practice and develop the necessary skills. This opportunity may be in the form of faculty development workshops, the use of self-study procedures, peer observation, and/or the use of videotaping and critiquing.

Effective questioning can provide useful information about the knowledge and skills of each student. This information obtained through questioning can be used to provide feedback to students about their strengths and weaknesses. Questioning can also be useful in obtaining information about the effectiveness of the educational program. The information obtained from this questioning can be incorporated into the process of continuous quality improvement.

The office of CDM offers both group and one-to-one training for instructional improvement in Effective Questioning.

Educational Research

Educational research is designed to test theories of teaching and learning, while practice-oriented educational research is focused on assessing relationships between variables of interest and the effects these variables produce or do not produce. The typical research paradigm is determining the direction and magnitude of one or more teaching process variable (the frequency, intensity and/or duration of a well-defined teaching method) with one or more outcome variable (knowledge, behavioral skills, attitudes/values, and thinking abilities). For example, academic faculty may want to know the relationship between case-based teaching (the teaching process variable) and students’ clinical problem-solving ability (the outcome variable). Comparative studies, in which the effects of two or more teaching processes on one or more outcome variables, are also of interest to faculty in helping determine which method is the best bet for achieving a particular educational outcome. For example, faculty may be interested in determining whether a lecture course or a case-based course is more effective in increasing students’ knowledge or problem-solving ability. The results of such studies have implications for the allocation of limited financial resources.

A type of educational research different from the process-outcome paradigm is developing valid and reliable measures of variables of interest to faculty. Measures of clinical problem-solving are not yet well developed, but are of increasing interest to some faculty. For example, Objective Structured Clinical Exams (OSCE) represent a relatively new methodology for measuring students’ clinical performance abilities under standardized conditions. Through well-constructed educational research, faculty can determine if the OSCE meet their goals in measuring students’ clinical problem-solving skills.

The office of CDM offers educational research consultation.

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Medical Education Literature

CDM provides faculty access to a number of medical education journals housed in our office area (VH L206) and also offers copies of any of the articles. For a complete listing of the journals titles and for information to other medical education literature, click here.

Course, Clerkship, & Instructor Evaluation

The role of the Coordinator of Data Collection in course/clerkship, instructor/preceptor assessment and other means of assessment in Undergraduate Medical Education is an important one.

Course Evaluations

In the assessment of the medical school courses, data are analyzed, tables are generated for reporting purposes, and organization and continuity in the evaluation process is maintained for both faculty and students.

Basic Science Evaluations: Evaluations are performed at the end of each course. An overall report of the basic science evaluations is generated by the joint efforts of the Coordinator and medical students. This report is accessible to all students and faculty and is located in Medical Student Services. Copies may also be checked out from the coordinator in CDM. Course evaluation information is collected on 33 items that are routinely on each course's course evaluation questionnaire. The core questions remain the same each year for each course so that a comparison can be made. The report is provided to the Assessment Subcommittee and each of the Course Directors.

Third Year Clerkship Evaluations: Evaluations of the third year rotations are done at the end of each block rotation. There are two questionnaires currently being used to collect the data. One is an overall clerkship evaluation where students have the opportunity to evaluate the rotation as a whole, specify areas that are excellent and also areas needing improvement. The other questionnaire is for evaluating the clinical faculty/residents/interns with which the students came in contact with while on the rotation. Areas are provided for written comments to list the things that were done well and suggestions for improvement. Comments are returned to the Clerkship Directors prior to the next rotation, and a final report of the numerical data for both questionnaires is provided after the last rotation of the academic year. An individual report is provided to the Clerkship Director of any faculty on whom 10 or more questionnaires are completed. A combined report of the overall assessment of all clerkships is then produced to show a comparison of all clerkships. This report is distributed to all Clerkship Directors, Department Chairs, and the Assessment Subcommittee.

Medical Education Committee Assessment Subcommittee (MECAS)

Data are analyzed and reports are generated for the various evaluations and projects for the Assessment Subcommittee. Among others, these projects include the above mentioned Course/Clerkship evaluations, the retrospective surveys, and the Residency Director Survey. There are currently three retrospective surveys: (1) the Pre-clinical Survey, administered in June to the students who have just completed their basic science years; (2) the Senior Retrospective Survey, administered in April to the students who will graduate soon, and; (3) the Resident Survey, administered in July to graduates of the UASOM who are completing their first year of residency. (In July, their Residency Directors are surveyed about their knowledge and skills.) Results of these data are reported to the Assessment Subcommittee and distributed to the Course/Clerkship Directors.

For additional information about the services provided, contact Theresa Logan, phone (205) 934-3834

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Clinical Evaluation

Most medical students undergo fairly rigorous testing of what they know about basic science and clinical medicine through locally developed exams and the sequence of National Board of Medical Examiners’ exams. The assessment of a student’s clinical skills typically occurs during the two clinical years when students are completing clinical rotations in the different specialties. The typical method for these assessments involves making one or more observations of a student’s clinical performance during a clinical rotation. This observation is commonly made by one or more residents and/or by an attending who rates the student on several criteria that may be as specific as "skill in performing venipuncture" or as global as "exhibits professional behavior." This methodology, while relatively quick to complete since the process involves marking a rating form, has the disadvantage of producing unreliable data since it involves many observers making observations under different conditions. The lack of clinician training in the use of the form and the variable number and conditions under which students are observed are other main causes of the unreliability of the ratings.

In response to this problem, an alternative methodology, the Objective Structured Clinical Exam (OSCE), has emerged in the last decade and is being used by more schools. This methodology requires students to rotate through several stations and respond to questions or problems posed by either simulated patients or a paper and pencil test. There is a time limit for each station, and students work through all of them in a sequential fashion. The advantage of this methodology is that testing conditions are standardized, and raters are trained to give reliable ratings of students’ performances. The disadvantages include the time and cost of training simulated patients and the relatively limited number of clinical skills that any one OSCE can test.

Regardless of the method used, one of the issues that must be confronted is standard setting; that is, what score will constitute the minimum acceptable performance. A related issue is what to do with students who do not achieve the minimum level of acceptable performance. A standard that is too high may cause too many failures, necessitating burdensome remedial programs. A standard too low may cause students to enter residency programs inadequately prepared. Good clinical evaluation methods are needed to ensure that students will be successful for the next stage of their careers and will achieve and maintain the public’s confidence.

The office of CDM offers both group and one-to-one training for instructional improvement in Clinical Evaluation.

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Clinical Teaching

The aim of clinical teaching, traditionally, is  to develop student competence in clinical skills. Stritter and Flair define clinical instruction as "the teaching/learning interaction between clinical teacher and student which normally occurs in the intellectual vicinity of a patient and focuses on either the patient or some clinical phenomenon which concerns a patient or a class of patients".⁶ 

Teaching medical students in clinical settings affords opportunities for them to:

• learn about the different medical problems
• his/her diagnosis
• etiology
• treatment and prognosis
• correlate the underlying pathophysiology and other basic science disciplines to the signs and symptoms
• practice the deductive reasoning process of diagnosis
• practice the procedural skills associated with different assessments and treatments
• practice the behaviors associated with professional conduct

While much of this learning will be the result of independent activity of the student—reading texts and articles, observing skilled practitioners conduct a procedure, seeking out advice from faculty--- the attending and residents play an important role in planned, direct instruction of students. One of the unique characteristics of teaching in the clinical setting is that what is taught is dependent on the patient problems available at that time. This means that both the attending and resident teachers must be opportunistic in identifying learning opportunities appropriate for the student and provide time for the student to investigate, interact with the patient, perform monitored skill practice, and receive timely, targeted feedback.

Clinical teaching is being recognized by some as central to the whole curriculum in undergraduate medical education and not just reserved for the clinical years. Because of the increasing inclusion of instructional activities, such as problem-based learning focused on clinical cases in the preclinical portion of medical school, clinical teaching is being introduced in these early years simply to illustrate the basic sciences. This early introduction of clinical teaching in the preclinical years allows students an opportunity to practice their clinical skills and gain assurance and confidence in the quality of their capabilities prior to working with real patients.⁷

6. Stritter, F. T., & Flair, M. D. (1980). Effective clinical teaching. Maryland: U.S. Department of Health, Education and Welfare. National Medical Audiovisual Centre.

7. Barrows, H. S. (1990). The practice of clinical teaching. In W. Bender, R. Hiemstra, A. Scherpbier & R. Zwierstra (Eds.), Teaching and assessing clinical competence (pp. 10-15). Groningen: BoekWerk Publications.

The office of CDM offers both group and one-to-one training for instructional improvement in Clinical Teaching.

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Test Construction

One of the important tasks of any instructor is developing and implementing tests to assess students’ knowledge, skills, and attitudes. These assessments are typically done early in a course and at the end so that some idea of students’ progress can be determined by examining the change in scores. Assessments of attitudes typically involve locally developed or standardized attitude surveys. Observations of a person’s behavior in simulated or real settings also allow inferences about attitudes. Skills, like interviewing a patient or examining the heart are usually evaluated by observing the student performing the behavior in real or simulated conditions and using a checklist to determine if the relevant behaviors were performed. The most frequent test used by faculty is the knowledge exam. While essay, short answer, and oral exams can be used, the multiple choice exam is most frequently used because of its ease of administration and scoring.

Multiple choice questions can be written to assess students’ abilities to recall and recognize the correct answer. Since physicians are required to solve problems, multiple choice questions that assess students’ abilities to use information correctly (application questions) may better reflect their growth in problem solving. A complete guide for writing these questions can be downloaded for free from the National Board of Medical Examiners.

The office of CDM offers both group and one-to-one training for instructional improvement in Test Construction.                                        

Test Item Analysis

After a multiple choice exam is administered, it is often useful to examine each item and the responses students marked in order to eliminate or improve those items that did not work well and to keep those items that did. To do this analysis some useful statistics, the Difficulty Index and the Discrimination Index, can be computed.

As the name suggests, the Difficulty Index is an indicator of how hard or easy the item was to get correct. While there are several ways of computing this Index, the simplest is the proportion of the class who got the item correct. A test in which the items have Difficulty Indexes around .5 will most likely create the greatest spread of scores. An item with an index of .0 to .2 is usually thought of as too difficult, while an item with an index of .7 is considered too easy. Changing the answers or the stem wording can change the Difficulty Index.

The Discrimination Index is an indicator of how well an item distinguished between those who likely knew the subject (the high scorers) from those who likely did not (the low scorers). Simply put, it is the proportion of high scorers who got the item correct, minus the proportion of low scorers that got the item correct. A value of 1.0 means that only the high scorers got the item correct, while a value of 0.0 means only the low scorers got the item correct. Values of .4 or higher are considered  desirable. Values less than that suggest that the item should be revised or eliminated. Item Difficulties and Discrimination Indexes are given in the analysis of multiple choice exams processed by CDM's Test Services.

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Test Scoring

CDM Test Services provides scoring and analysis of exams for the UASOM. Scantron sheets for several types of multiple choice exams are available. Standard forms kept by Test Services are:

• UAB F-1299: 150 questions A-E options
• UAB F-1295 250 questions A-E options
• UAB F-5249 140 questions A-Z options

Packets containing scannable forms, an instruction sheet, and a TAP (Test Analysis Program) information sheet may be picked up in room L206 Volker Hall. Basic test analysis includes:

• reliability
• mean difficulty index
• mean discrimination index
• maximum score
• minimum score
• mean score
• standard deviation
• score distribution
• item analysis
• grading and posting lists

Item analysis by quartile is available upon request. By permission of the instructor, students may obtain an individual student report or a copy of their scantron sheet for an exam. Custom scannable forms are available for exams if necessary.

Upon request, CDM Test Services also maintains an electronic gradebook for UASOM classes. This program, GAS, (Grade Averaging System) is used primarily to calculate course averages, but can be used to add bonus points, adjust class means, or make other modifications to test scores or averages. GAS calculates summary statistics for all scores and averages, correlation coefficients, histograms, and produces grading and posting list, as well as student individual reports. For additional information about the services provided, contact Theresa Logan, phone (205) 934-3348.

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Instructional Design

Although learning may occur without instruction, instruction can greatly activate and support the processes of learning. If instruction is to bring about effective learning, it must somehow be designed to integrate events that will do the most effective job. Thus, the design of instruction must focus on creating the conditions under which learning best occurs with the given learner, subject content, and instructional facilities/setting.

The office of CDM offers both group and one-to-one training for Instructional Design improvement.                                                

Writing Effectively

Effective writing is a skill that can contribute in many ways to one's success in biomedical research, clinical care, communication to patients and the public, and service in national organizations and on state and local committees. Being able to write effectively is a "gift" which few people possess. Instead, it is a "skill" that many people have developed and one which many people feel the need to develop. There is no injection that one can take to immunize oneself against poor writing. Instead, developing the skill of effective writing is a day-to-day activity that requires attention to the "little things" of grammar, punctuation, word choice, phrasing, and logical unfolding of one's thoughts. In addition, these efforts invariably prove to be more valuable when combined with feedback from a colleague concerning one's success in clearly communicating the intended message.

The office of CDM offers both group and one-to-one training for instructional improvement in Effective Writing.

Effective Lecturing

Lectures are the most popular form of teaching in medical education.³ A well-developed and well-presented lecture can be a stimulating and enriching experience for both student and instructor. However, a poorly prepared and presented lecture can result in an uninteresting and ineffective learning experience. A poor use of a lecture is  to present information available in  textbooks or other readily available sources of information. A better practice is use the presentation to demonstrate how students can use principles and concepts in his/her thinking.

If an instructor elects to retain the lecture as the primary educational methodology in his or her course, it is important that he or she recognize that exclusive use of the passive lecture constrains learning.⁴ The challenge is to make the lecture to serve as an effective learning tool. Student involvement in the educational process will increase when active learning techniques are incorporated in the lecture. This, in turn, will enhance the educational experience for the learner. 

4. Bonwell, C. C., & Eison, J. A. (1991). Active Learning: Creating excitement in the classroom. Washington, DC: George Washington University.

The office of CDM offers both group and one-to-one training for instructional improvement in Effective Lecturing.                                                                                                  

Computer-Assisted Instruction

Computers can play an important role in the teaching/learning process occurring in medical education. Computer-Assisted-Instruction (CAI) is an area of computer use most often designed for direct instruction, skill development, tutorial, and enrichment. Software programs are available or can be developed in formats for many subjects and skill areas. CAI has been used for practice in thinking skills, problem solving and decision making, and for doing research. Usually each program is designed for a specific instructional purpose (drill, practice, problem solving). CAI-type software programs can be used for many learning activities. The capability of the computer to interact with individual students and to provide immediate feedback makes it the key to computer assisted instruction.

Media Selection

The effectiveness of course design depends upon the media selected to help communicate the content. Each medium has its own strengths and weaknesses. These must be kept in mind when matching the medium to the learning environment.

The challenge is to find ways to use media to enhance or enable student learning. What does it take to have a successful learning experience?

Observation Techniques

Making an observation involves the use of the five senses, singularly or in any combination. Observation is a fundamental scientific skill. It is obviously very important to the practice of medicine. Observational skills are just as essential for effective teaching. It is the initial method by which the instructor collects information to understand his/her world, comparing it to his/her cognitive, procedural, or affective knowledge base.

Teachers observe what students say or do and compare that to their knowledge base. These observations of students and resultant comparisons are very important, as they form the basis for the next instructional step - a continuation with no comment, the provision of positive or negative feedback, or a redirection of instruction to address an identified student need. It is a particularly useful skill in individualized, laboratory, small group, and clinical instruction.

The office of CDM offers both group and one-to-one training for instructional improvement in Observational Techniques.

Instructional Video Resources

CDM has the following videotapes available for check out. If you are interested in checking out a tape or having CDM personnel conduct a workshop incorporating these video tapes, please contact Julie Walsh, EdD.

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