David E. Elkowitz, D.O.Director of Undergraduate Medical Education,

Course Director Assistant Professor

Departments of Pathology and Laboratory Medicine and Science Education Hofstra North Shore-LIJ School of Medicine

Patient-Centered Explorations in Active Reasoning, Learning and Synthesis

About our School of Medicine

• Located on Hofstra University’s Campus, Hempstead, NY• First allopathic medical school in New York since 1963• Housed in new, state-of-the-art, 48,000 square foot,

Medical Education Center • Offer MD, MD/PhD, and PhD degrees

About North Shore-LIJ• Nation’s second largest, non-profit, secular health system • Nation’s 16th largest, integrated healthcare network, and

the largest in New York State• Services 7 million people at 16 hospitals on Long Island

and in Manhattan, Queens, and Staten Island• 2010 National Quality Forum award winner – National

Quality Healthcare Award

The School of Medicine, in a culture of community, scholarship, and

innovation, is dedicated to inspiring diverse and promising students to

lead and transform medicine for the betterment of humanity.

Mission Statement

Values Diversity

Professionalism

Patient Centered

Reflection

Vision

Community

Scholarship

Innovation

Learning

Humanism

SOM Competencies

GUIDING PRINCIPLES FOR CURRICULUM DEVELOPMENT

“Adult learner” environment

Integration of health, disease and intervention

Fully integrated, science and clinical curriculum

Early meaningful patient interactions

Focus on learning, not teaching

Built on experiential/ small group learning

Assessment drives learning

Emphasis on scholarship, critical thinking, lifelong learning

True to mission, values, drivers

Curricular Structure: Spiral Curriculum

Content revisited at multiple points in time; increased difficulty, greater depth, consideration of current context

Curriculum Overview: 1st 100 Weeks

Typical Week

Integration • Science to science• Science to clinical• Science to pedagogy• Departments

How Will Students Learn?

Summarize, interpret

Name, define

Organize, solve

Examine, contrast

Defend, appraise

Develop, predict

“FLOW” EXPERIENCESIN RELATION TO CHALLENGES AND SKILLS

Control

Chal

leng

es

Low

HighLow

High

Knowledge & Skills

FLOW

ArousalAnxiety

Worry

Apathy

BoredomRelaxation

Pedagogies

PEARLS

Small groups with a process expert (student-

generated content)

Socratic Style

Small groups with a content and process

expert

Large Group

Large groups with a content expert (director-

generated content)

Guiding Principles

PEARLS as the Cornerstone

PEARLS- Patient-centered Explorations in Active Reasoning, Learning & Synthesis

Major way that students address most basic science content

Problem-Based Learning/Case Based Learning Hybrid

Student-driven, facilitators there to guide process only (not content)

Cornerstone for all other weekly session (including Structure)

Bas

ic S

cien

ces

Stru

ctur

al S

cien

ces

Pro

fess

iona

l Ski

lls

PEARLS

Content

Educational Philosophy• Value learning over teaching• Trust the students to learn much of the factual knowledge

outside of class• Active learners every day• Critical thinking, Problem solving & Knowledge in Action-

science that sticks• Societal forces of the times

– Decision making under uncertainty– Deliver effective and safe care– Majority of care delivered outpatient setting– Health care teams caring for patients

PEARLS: Patient-Centered Explorations in Active Reasoning,

Learning and Synthesis

• Hybrid problem-based/case-based learning pedagogy

• Students synthesize biomedical science in the context of patient-centered clinical cases with peers

• PEARLS relies heavily upon formative assessments to

help achieve goals of competency based component of program

Pillars Provide Structure to Achieve Goals Of PEARLS Program

PEARLS Pillars• PBL/CBL Pedagogy• Group Dynamics• Higher Order Thinking

Goals of PEARLS• Leadership, PBL&I• Teamwork• Acquiring knowledge of

biomedical sciences, Critical thinking

THE PILLARS AND GOALS INFORM ALL ASPECTS OF PEARLS

• Monday• Roles: leader, timekeeper, recorder• Patient-centered cases• Explore issues and Actively Reason through cases to

develop learning objectives • Mon-Wed Self Directed Learning• Wednesday- Synthesize and apply information with

peers in group• Wed-Fri/Friday repeat for second case• Weekend-complete end of week essay

PEARLS in Action

• Mondays– Cases strongly lead to LO’s– Role of faculty member is minimal; quiet

• Wednesdays/Fridays– Higher order discussions– Faculty can facilitate this using PQ’s or questions to probe

critical thinking:• What exactly is your question?• Could you elaborate further?• How could we verify if that is true?• Can you sketch that for us?• What factors make this a difficult problem?

Reflection, Integration & Assessment

Reflection, Integration & Assessment Weeks

Monday Check-in

• Self assessment• Reflection

PEARLS Formative Self & Group Assessments Lead to Skills in PBL&I and SBP

Monday AM Wed AM Friday AM

Mon/Wed/Fri Wrap-up

• Self & group assessment• Content & process• Facilitator framed component• Reflection

PEARLS Formative Self & Group Assessments Lead to Skills in PBL&I and SBP

Monday AM Wed AM Friday AM

Multiple Perspectives

Case

Society

Patient

Biologic Science

PopulationHealth

Prevention

Therapy

Patient-Centered Cases: Created by Integrated Design Teams to Expand the Perspective for Learning

Course/Case Development Interdisciplinary team

1. Establish learning

objectives

2. Align weekly sessions with

vertical content

3. Assign LOs & design weekly

sessions

4. Determine required resources

5. Finalize assessment

scheme, faculty development

Evolution of Complexity of Cases

• Will cases change in any way over time?• Spend fist 10 minutes generating DDx• Add incorrect information to a case or mismatch

– Case states patient has 1st degree heart block but actual EKG has 2nd degree heart block

• Leave off goals of cases ?

Pillars Provide Structure to Achieve Goals Of PEARLS Program

PEARLS Pillars• PBL/CBL Pedagogy• Group Dynamics• Higher Order Thinking

Goals of PEARLS• Leadership, PBL&I• Teamwork• Acquiring knowledge of

biomedical sciences, Critical thinking

THE PILLARS AND GOALS INFORM ALL ASPECTS OF PEARLS

PEARLS Development

Faculty• Philosophy• Programmatic rules• Journal clubs• Tape review• Simulations• Observation/debrief• Facilitator meetings • PEARLS GO! sessions

Student• Philosophy • Programmatic rules • Student leadership roles• Wrap up questions/

assessment • PEARLS GO! Sessions• Outside sessions

6 STEPS TO SUCCESS AS A PEARLS FACILITATOR

As a facilitator, your role is to promote student development of PEARLS course expectations by: Knowing the PEARLS expectations for the course in which you are facilitating.

Having a solid understanding of each of the PEARLS expectations and how they relate to the PEARLS pillars/goals.

Being able to describe and recognize a higher order discussion.

Assessing your group during each session along the PEARLS pillars and goals to see which expectations they are meeting and which ones they are falling short on. Posing questions to group to allow them to self-discover areas needing improvement= “framing” the wrap-up.

Pushing your group through wrap-up framings and role modeling to achieve excellence in the deficient areas.

Knowing the PEARLS Developmental Expectations Students were asked to be able to demonstrate the

following:

•Explain the goals and pillars of the PEARLS program

•Adhere to the ground rules and recognize that they are informed by the goals and

pillars

•Consistently arrive on time for sessions

•Generate good learning objectives

•Consistently arrive prepared for sessions

•Contribute to good group dynamic

•Utilize the goal of the case to guide scope of discussion

•Utilize student roles of leader/timekeeper/scribe to organize sessions

Knowing the PEARLS Developmental Expectations Students were asked to be able to demonstrate the following:

•Explain the role of the facilitator and why we are process and not content

facilitators

•Articulate what constitutes a good self-assessment

•Articulate what constitutes a good group leader

•Perform constructive self and group assessment

•Modify behaviors based upon areas identified during self-assessment and

group feedback

•Experiment with different ways of integrating pharmacology into group

conversations

•Articulate the difference between a first order and a higher order conversation

•Prepare questions for discussion by group (triggers)

1.Why do medical schools use PBL/CBL programs?

2.What are the goals of the PEARLS program?

3.What are the PEARLS pillars?

4.How do the PEARLS pillars relate to the goals of the PEARLS program?

5.Why do we expect everyone to be on time all the time?

6.Why does every student have to prepare every LO for group instead of dividing

and conquering?

7.Why does everyone have to participate evenly in group?

8.Why do we have student roles in group (leader, timekeeper, scribe) and what is the

role of the student leader with regard to content?

9.Why shouldn’t students read directly off their notes during session?

10.What is the purpose of self and group assessments each session?

11. Why is it important to make sure group is on the same page with

respect to LO’s they have derived in Monday’s session?

12. Why do we make students generate LO’s in group instead of

giving them out at the start of a case?

13. Why should the facilitator sometimes allow group process to fail

without rescuing students during session?

14.What is the rationale for having students possibly leave a group with “wrong information”?

15. How and by whom will students be corrected if mis-information is discussed during a group discussion?

16. Define and describe the difference between a 1st order discussion and a higher order discussion?

17. How would you answer a student who asks what sources he/she should use in preparation for the learning issues?

18. How would you answer a student who asks why they have to change groups at the end of the course, especially if their group is working well and they don’t want to change?

19. What is the purpose of wrap-up?

20. What is the framing part of wrap-up and what is it based upon?