I recently saw an NPR clip about a highly innovative approach to medical education launching with this year’s entering class at the University of Vermont’s Larner COM. In a nutshell, the goal is to eliminate lectures. The head of this initiative, Dr. William Jeffries, is our guest today.
Dr. Jeffries is the Senior Associate Dean for Medical Education at University of Vermont’s Larner College of Medicine. He earned his PhD in Pharmacology from the University of the Sciences in Philadelphia and then went on to serve as Associate Dean of Creighton University. He arrived at UVM in 2009 and has served since then as the Senior Associate Dean for Medical Education. He was also on the board of the IASME, the International Association of Medical Science Educators, from 2008 – 2015. And he is the co-editor of the book, An Introduction to Medical Teaching, where he authored the chapter on lectures. Welcome!
Can you give us an overview of the three major levels of UVM’s curriculum? [1:55]
The first portion is Foundations – it’s geared towards establishing the scientific foundations of medicine. It’s 15 months long. Students learn basic science in a medical context. Next is the clerkship level – it’s about a year long. Students rotate among the traditional medical disciplines and get a first-hand look at the disciplines and healthcare for patients. They also have the option of taking an alternative Longitudinal Integrated Clerkship, where students are embedded in a primary care practice and manage a panel of patients for the whole year, and learn the disciplines through that.
The third level is Advanced Integration – it’s a combination of required and elective courses to prepare them for residency and their boards.
Is there clinical exposure during Foundations, and is there coursework during the clerkship portion? [4:20]
Yes and yes. There’s an integrated community preceptor experience. The first day that students see a patient is the first day of orientation.
What is active learning? [5:25]
It’s the process of putting the learner in a situation where they’re compelled to apply knowledge to solve problems. It’s often group oriented but not necessarily. For example: memorizing a map is passive learning; putting that knowledge to work by driving somewhere new is active learning.
You literally wrote the book on lectures in medical education. Why dump lectures? [6:30]
There’s nothing wrong with lectures as an information delivery unit – it’s just the difference between using a knife or a food processor to cut vegetables. Lectures aren’t the most efficient way to learn.
Our medical knowledge is growing rapidly. It’s impossible to tell students everything they need to learn. We need to focus on giving students the tools they need to be effective physicians. We know active learning is better for retention.
Can you give an example? How would it work, say, if you’re teaching the basics of pharmacology? [10:20]
In pharmacology, in medical education right now, the students have been driving a derivative approach – they want to know what drugs are on the test, which basically reduces all of pharmacology to a table. Which is helpful in categorizing drug action, but will be completely unrelatable in the future. A better way would be to have the students themselves create such a table from their own notes or notes you provide to them – and then use that table to solve problems about patients, drugs, etc.
Unless you apply knowledge and understand why it’s important, you’re not going to retain it.
The more we use an active learning approach, the better off our students will be – and the better off their patients will be.
It seems more fun and engaging. [13:00]
It is more fun and engaging for everyone – once you start teaching this way it’s energizing.
How have students and faculty responded? [13:26]
Change is hard. Right now both students and faculty have a reason to like lectures – most faculty already have lectures prepared, and they often really enjoy speaking in front of a class. From a student perspective, a lecture gives a boundary around what the test will cover – you know the lecture covers the exam. But the problem with that is that it trains students to prepare for the exam – we want students to focus on the patient, not on the test.
Can you give an example of active learning? [16:25]
We use a few modes of active learning: problem based discussion, lab, team based learning, and our version of a flipped classroom.
In our Team Based Learning model: students would study at home and learn facts (say the topic is liver pathology). Then they arrive and take a short quiz on the topic – these are hard questions, the average score is usually around 60%. Then they take the test again in a small group. Working together, there’s some peer teaching going on, and the scores rise to over 90%. After that, they work through individual cases on liver disease – each group comes up with their answers.
Students have little studying to do after this – they tend to remember the material they studied and the logic behind it.
Have you seen an increase in test scores or match rates with the move to a new learning approach? [23:00]
When we introduced team based learning, our test scores (internal grades on our school exams) increased.
There have been studies of active learning vs lectures that show an increase in grades and reduction of failure rates in courses that use active learning.
Have you tried to measure student satisfaction? [27:09]
One of the courses we’re focusing on is a nutrition course. The course ratings have gone from the mid-2s to the mid-4s on a five-point scale.
How is the new approach affecting admissions? [28:30]
If a student is looking for a traditional lecture curriculum, our school is going to be less and less attractive to them.
We have changed our admissions process and gone to an MMI interview format. The stations of our MMI are centered around the competencies in our curriculum. We’re looking for students who’ll thrive in our active curriculum.
Should applicants to UVM have both clinical and research experience? [30:22]
I think it’s important because students should know what they’re getting into and what the profession is about. The best way to do that is to have medical exposure. But we’re also expecting altruism (seen through community service, etc). Research is a great demonstration of scientific curiosity.
Last year UVM received 5975 applicants, interviewed 619 applicants, and ended up with a class of 117. I know the mean MCAT score is 512 and the average GPA 3.82, but I suspect more goes into the process than those two numbers. How on earth does UVM winnow it down? [32:45]
It’s not an easy process. We have a great admissions team and a lot of devoted faculty who work with admissions.
We look at the applications. We have a screening process which involves MCAT and GPA, and also experiences that make students stand out. We also look at diversity – we want a diverse class. We give students a questionnaire as part of the secondary application, and they have the chance to write a diversity statement then.
There’s a pretty rigorous pruning of the pool by 90%. We then have a pool of Vermont students and out of state students. We rank these students and invite the top ones to come to the MMI – and the MMI is then the way we distinguish among the remaining students. At the MMI, each station is rated by an evaluator. There’s also a teamwork exercise (also evaluated). They receive scores for the MMI, which is then used holistically in the evaluation process.
We have a rolling admissions process – there are still spots open late in the process.
How can students (people thinking of applying in the future) prepare for active learning? [39:50]
They may already start to see these approaches in their undergraduate classrooms.
You learn through questioning – take the knowledge and question. Use your ability to think and recall.
Studying by rereading doesn’t help recall. Test yourself – do questions on the material. Study in a way that makes sense.
Any advice for applicants planning to apply to UVM next year? [44:05]
Be yourself. And be excellent in something – we want people who have some level of commitment to something and are focused on taking it to the next level. Those are the things that help you stand out as an applicant.
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