Knowledge Building in Continuing Medical Education

Continuing medical education has been characterized as didactic and ineffective. This thesis explores the use of Knowledge Building theory, pedagogy, and technology to test an alternative model for physician engagement—one that emphasizes sustained and creative work with ideas. Several important conceptual changes in continuing medical education are implied by the Knowledge Building model—changes that extend the traditional approach through engagement in (a) collective responsibility for group achievements rather than exclusive focus on individual advancement and (b) work in design-mode, with ideas treated as objects of creation and assemblage into larger wholes and new applications, with extension beyond belief-mode where evidence-based acceptance or rejection of beliefs dominates. The goal is to engage physicians in “cultures of participation” where individual learning and collective knowledge invention or metadesign advance in parallel. This study was conducted in a continuing medical education End-of-Life Care Distance Education course, for family physicians, from 2004 to 2009. A mixed methods case study methodology was used to determine if social-mediated Knowledge Building improved physicians’ knowledge, and if so, what social network structural relationships and sociocognitive dynamics support knowledge improvement, democratization of knowledge, and a metadesign perspective. Traditional pre-/posttest learning measures across 4-years showed significant gains (9% on paired t-test = 5.34, p < 0.001) and large effect size (0.82). Social network analysis of ten 2008/2009 modules showed significant difference in density of build-on notes across groups. Additional results demonstrated a relationship between high knowledge gains and social network measures of centrality/distribution and cohesion. Correlation of posttest scores with centrality variables were all positive. Position/power analyses highlighted core-periphery sociocognitive dynamics between the facilitator and students. Facilitators most often evoked partner/expert relationships. Questions rather than statements dominated the discourse; discourse complexity was elaborated/compiled as opposed to reduced/dispersed. Themes beyond predefined learning objectives emerged and Knowledge Building principles of community responsibility, idea improvability, and democratization of knowledge were evident. Overall, results demonstrate the potential of collective Knowledge Building and design-mode work in continuing medical education, with individual learning representing an important by-product. There were no discernible decrements in performance, suggesting significant advantages rather than tradeoffs from engagement in Knowledge Building.Ph

Guest Editor's Remarks: Journal of Biocommunication Special Issue on Legacies of Medicine in the Holocaust and the Pernkopf Atlas

The 2019 Toronto Symposium, THE VIENNA PROTOCOL: Medicine's Confrontation with Continuing Legacies of its Nazi Past, was sponsored by Biomedical Communications, Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto and the Neuberger Centre for Holocaust Education. https://www.holocaustcentre.com/hew-2019/the-vienna-protocol &nbsp; Prof. Leila Lax, coordinated the Symposium and was inspired by its presenters to create an online collection of Holocaust education resources. She is grateful to the Editor-in-Chief, Gary Schnitz and the Journal of Biocommunication Management Board for their dedication to scholarship, ethics, and the advancement of knowledge, in support of this Special Issue, that deals with contemporary controversies from a dark time in history, that is part of our professional legacy - and memory. This Special Issue is dedicated to the memory of the victims portrayed in the Pernkopf atlas. Image credit: Table of Contents image provided by the Medical University of Vienna, MUW-AD-003250-5-ABB-151. &nbsp

Towards Informed Use of the Pernkopf Atlas: (Video presentation can be accessed from the HTML)

Knowledge of the dark history and inherent ethical dilemmas of Pernkopf's atlas is essential to individual decisions on use. Seventy-five years after the Holocaust, the legacy of Pernkopf’s Atlas of Topographical and Applied Human Anatomy continues to unfold. Informed use of the atlas needs to be integrated in academia and in practice. This paper advocates for the adoption of The Vienna Protocol and improving informed use of the atlas by: (1) updating and inserting an information letter in as many volumes as possible, so that the history can be known before use; (2) conducting and publishing a research study within the medical art community, to examine knowledge of the history of the atlas and elevate awareness; and (3) creating a museum archive and permanent exhibition of the original anatomical illustrations, to document historical facts, disseminate visual evidence, and illuminate embedded controversies. Moving towards informed use, in these ways, provides opportunities for continued ethical discourse, personal reflection and future Holocaust education. Through informed use we memorialize and pay tribute to the Nazi victims portrayed in the atlas. Image credit: Table of Contents image provided by the Medical University of Vienna, MUW-AD-003250-5-ABB-223. &nbsp

The Case of Ken Lowery: Visual Knowledge Building and Translation of Volumetric Radiographic Imagery for Dynamic 3D Medical Legal Visualization

Advancements in medical imaging technology allow for the use of 3D volumetric radiographs in personal injury trials. Volumetric radiographs provide more comprehensive information than 2D imaging (i.e. CT scans/MRIs) but are more complicated for a judge and jury (non-medical audiences) to understand. The purpose of this medical legal visualization research project was to create and evaluate a plaintiff expert witness presentation that incorporates volumetric radiographs, combined with 3D anatomical models and animated sequences to improve understanding of complex medical information (e.g. to clarify the full extent of the traumatic brain injuries) and to obtain feedback on design strategies

Translating Face-to-Face Experiential Learning to Video for a Web-Based Communication Program

The cultural, legal and ethical aspects of medical practice in Canada can be problematic for International Medical Graduates (IMGs) to access and learn. The professional behaviours that depend on effective communication often challenge IMGs as they attempt to enter the Canadian medical system. The Communication and Cultural Competence Program provides a complex interactive web-based environment in which IMGs can learn and practice skills required to navigate these specific elements of medical practice. The educational design of this web site is based on the theory of knowledge building (Scardamalia & Bereiter, 2003). This paper examines how video simulation is used on the web site to support this design. Experiential simulation pedagogy, typically used in high-fidelity face-to-face encounters, is analyzed. Strategies to translate this pedagogy to an e-learning format to operationalize authentic knowledge building are described. Commentaries replace live facilitation and a communication tool, the Observation Guide, allows learners to participate in the simulation. This examination provides insight into the complexity involved in creating on-line resources that extend beyond clinical content repositories, illustrating the potential for web-based programs to provide reflective and recursive learning. A wide skill set with a broad base of support was necessary to create a virtual environment with depth and authenticity. Translating the process from live simulation to a mid-fidelity digital video format allowed for deeper understanding of how the unique skills of experienced simulators impact the educational process. This multi-dimensional e-learning platform has potential for teaching complex skills in medical programs. Les médecins diplômés à l’étranger (MDE) peuvent avoir des difficultés à accéder aux aspects culturels, légaux et éthiques de la pratique médicale au Canada et à les apprendre. Les comportements professionnels qui dépendent de l’efficacité de la communication posent des difficultés aux MDE lorsqu’ils tentent d’entrer dans le réseau de la santé canadien. Le « Programme de communication et de compétence culturelle » offre un environnement virtuel interactif complexe permettant aux MDE d’apprendre et de pratiquer les compétences requises afin d’intégrer ces éléments particuliers de la pratique médicale. Le concept pédagogique de ce site Web est basé sur la théorie de la construction du savoir (Scardamalia & Bereiter, 2003). Le présent article traite de la façon dont la simulation vidéo sur le site Web est utilisée pour appuyer ce concept. Il analyse la pédagogie expérientielle faisant appel à la simulation généralement utilisée dans les rencontres en face à face en haute fidélité. Il décrit les stratégies visant à traduire cette pédagogie en un format de cyberapprentissage afin d’opérationnaliser le concept de construction du savoir authentique. Les commentaires remplacent l’animation en direct et un outil de communication, le Guide d’observation, permet aux apprenants de participer à la simulation. Cette analyse donne un aperçu de la complexité de la création des ressources en ligne qui vont au-delà des référentiels de contenu clinique et illustre le potentiel des programmes sur Internet d’offrir un apprentissage réflectif et récursif. Une longue liste d’habiletés et un soutien important ont été nécessaires pour créer un environnement virtuel caractérisé pas sa profondeur et son authenticité. La transformation du processus de simulation en direct au format vidéo numérique de moyenne fidélité a permis de mieux comprendre l’influence des compétences uniques des simulateurs expérimentés sur le processus pédagogique. Cette plate-forme de cyberapprentissage multidimensionnel possède le potentiel d’enseigner des compétences complexes dans les programmes médicaux

Beyond Learning Management Systems: Designing for Interprofessional Knowledge Building in the Health Sciences

This paper examines theoretical, pedagogical, and technological differences between two technologies that have been used in undergraduate interprofessional health sciences at the University of Toronto. One, a learning management system, WebCT 2.0, supports online coursework. The other, a Knowledge Building environment, Knowledge Forum 2.0, supports the collaborative work of knowledge-creating communities. Seventy students from six health science programs (Dentistry, Medicine, Nursing, Occupational Therapy, Pharmacy and Physical Therapy) participated online in a 5-day initiative to advance understanding of core principles and professional roles in pain assessment and management. Knowledge Forum functioned well as a learning management system but to preserve comparability between the two technologies its full resources were not brought into play. In this paper we examine three distinctive affordances of Knowledge Forum that have implications for health sciences education: (1) supports for Knowledge Building discourse as distinct from standard threaded discourse; (2) integration of sociocognitive functions as distinct from an assortment of separate tools; and (3) resources for multidimensional social and cognitive assessment that go beyond common participation indicators and instructor-designed quizzes and analyses. We argue that these design characteristics have the potential to open educational pathways that traditional learning management systems leave closed

Visualizing the Neurobiology of Trauma: Design and evaluation of an eLearning module for continuing professional development of family physicians in the Online Psychiatric Education Network

Traumatic experiences can change brain structures and compromise emotional, cognitive, and bodily functions, thereby debilitating patients. Yet, trauma is not well understood by physicians and few educational resources are available, despite its prevalence. The goal of this design research project is to develop and evaluate 2D animations in a case-based eLearning module. Complexities of post-traumatic stress disorder, including physical, emotional, and sexual abuse, are difficult to teach, talk about, and visually portray. Results of this study elucidate effective design dimensions of graphic narratives, keywords, and animations