The PAPERs Podcast

Episode Host: Jonathan Sherbino.

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Episode article

Karkera S, Devendra N, Lakhani B, Manahan K, Geisler J. “A review on modern teaching and learning techniques in medical education”. EIKI Journal of Effective Teaching Methods. 2024 Jan 26;2(1). 

Episode notes

Background (Jonathan)

I’ve been reflecting this week on the variety of literature we discuss on the pod. If I were to conduct an ethno–subject–quasi-experimental–thematic–auto–crossover–nonequivalent–thematic analysis (insert Varpio’s head exploding), here are some areas we dive into. No surprise, I’m passionate about tech and experiments with stats, even though neither comes naturally to me. We frequently talk about professional identity—thanks to Linda. And Laura, you keep us grounded (see what I did there?) And Jason,… I’m overwhelmed by the temptation for a cheap joke… your interest lies in policy and system design. 

As I look back, I realize what sparked my journey into health professions education: a desire to become a better teacher. My graduate thesis, a workshop-based innovative curriculum design, reflects that commitment—though calling it “innovative” might be stretching it a bit. So, this week is a return to the “essentials” – the literature to support teaching and various instructional methods. To centre our conversation, I’m digging into a journal I’ve never explored before: the Journal of Effective Teaching Methods (JETM – love the abbreviation) It’s published by the European Institute of Knowledge and Innovation, which markets itself as a scientist-founded, independent academic organization focused on promoting professional development and continuing education. 

Before diving into the article, it’s crucial to acknowledge the foundational literature that shapes our roles as educators. Just because we’ve been students for so long doesn’t mean the teaching habits we’ve adopted over time are optimal or even effective. Survivorship bias might suggest that some practices have lasted because they work, but that shouldn’t stop us from reassessing our instructional methods. It’s time to explore new approaches, discard outdated practices, and gain a deeper understanding of why certain techniques are effective. 

So, let’s delve into this study by Karkera and colleagues from Trinity Medical Sciences University in Saint Vincent and the Grenadines in the Caribbean. 
/ Jonathan

Purpose of the article

From the authors: “to discuss and analyze different teaching-learning methods in contemporary medical education.” 

What becomes apparent – essentially in the discussion – is that this is a micro-monograph of alternatives to a large group didactic (i.e., lecture) format. 

Methods

This is a synthesis of pre-defined instructional methods. I prefer to categorize this as a “narrative” review.  See the Litr-ex (Literature Reviews Explained) site for more details on narrative review.

A systematic search of Pubmed (FYI: the authors separately searched Medline, which is included in Pubmed) and the grey literature via Research Gate and Google Scholar using free text search but not MeSH headings. 

English articles from 2000-2023 were included if they were peer-reviewed, open-access, and had a sample of>150 participants.  

Results/Findings 

From 25 articles, 10 articles were included in the synthesis. Eleven teaching methods are described. They are summarized in table format below. 

Instructional method	Description	Opportunity	Challenge
1. Case-Based Learning	Involves analyzing real-life or hypothetical cases to apply theoretical knowledge to practical problems. Typically done in groups, where students discuss and dissect complex cases to reach conclusions or solutions, building analytical and decision-making skills in a collaborative setting.	Encourages critical thinking and practical application. Develops teamwork and communication skills. Improves retention by linking theory to real-world scenarios.	Requires well-structured cases that align with learning goals. Can be time-consuming. Effective group participation can be challenging.
2. Evidence-Based Medicine	Emphasizes using the best available, current, and relevant research to make clinical decisions. Integrates research evidence, clinical expertise, and patient values, ensuring that medical practice is grounded in well-supported evidence.	Enhances patient care with data-backed decisions. Reduces errors and promotes best practices. Supports efficient, cost-effective treatment strategies.	Requires familiarity with research databases and analytical skills. Time-intensive to gather, interpret, and apply evidence. Needs understanding of biostatistics.
3. Problem-Based Learning	Focuses on student-led inquiry where learners work in small groups to solve open-ended problems, typically with minimal guidance. The problem serves as a trigger for learning new information and fosters self-directed learning.	Develops critical thinking and problem-solving skills. Encourages teamwork and collaborative learning. Promotes long-term retention through active engagement.	Demands active student involvement, which not all learners may embrace. Requires skilled facilitators. Group dynamics can affect learning outcomes.
4. Simulation-Based Learning	Uses high-fidelity simulations, mannequins, or virtual simulations to replicate clinical settings, allowing students to practice skills in a controlled environment without risking patient safety.	Provides hands-on practice without patient risk. Allows repeated practice to master skills. Builds confidence for real-life scenarios. Encourages teamwork and communication.	High setup costs for equipment and software. Needs space and scheduling for simulation labs. Instructors require specialized training to facilitate effectively.
5. Social Media & E-Learning	Integrates online resources, video lectures, and social media for learning, allowing flexibility and access to a wide range of multimedia materials. Often used for remote or asynchronous learning, enhancing flexibility for students and teachers.	Flexible, accessible, and asynchronous. Offers diverse resources and platforms for varied learning styles. Supports continuous learning with global access.	Limited clinical skill development compared to in-person learning. Potential for technical issues. May result in reduced engagement without structured guidance.
6. Peer Tutoring	A method where students learn from each other, typically pairing a more knowledgeable student with a peer who needs support. Encourages cooperative learning and fosters supportive relationships among students.	Enhances comprehension through collaborative learning. Builds student confidence and academic motivation. Promotes interpersonal skills and peer support.	Requires careful planning to match tutors with peers. Needs ongoing supervision and feedback to be effective.
7. Observational Learning	Involves learning by observing skilled professionals or peers performing procedures. Often used for motor skills and procedural tasks, allowing students to visualize and then replicate skills.	Easy to implement with minimal resources. Useful for understanding complex procedures through demonstration. Applicable to a variety of instructional settings.	Passive learning approach may not engage all students. Time-consuming and can lead to disinterest. Limited retention without hands-on practice.
8. Team-Based Learning	Structured learning that emphasizes team collaboration and problem-solving. Students prepare individually, then work in teams to complete group tasks, often including immediate feedback from instructors.	Promotes teamwork, communication, and accountability. Increases engagement through peer interaction. Provides a real-world collaborative experience.	Requires effective management of group dynamics. Some students may dominate, while others remain passive. Resistance from students unfamiliar with team assessments.
9. Flipped Classroom	Inverts the traditional classroom structure by having students study lecture materials at home and engage in interactive activities in class, promoting active learning during class time.	Facilitates active learning and class discussions. Encourages self-paced pre-class preparation. Allows teachers to focus on interactive, high-level activities in class.	High preparation time and resource demands for instructors. Relies heavily on students completing pre-class work. Limited immediate feedback during individual study.
10. VR/AR Learning	Utilizes virtual and augmented reality to create immersive, interactive learning environments. Especially useful for complex, hands-on tasks and 3D visualizations of anatomical structures or surgical procedures.	Provides an immersive, hands-on experience. Useful for practicing complex tasks without risk. Enhances understanding of 3D structures and spatial relationships.	Expensive to implement and maintain. Requires technical expertise and setup time. Limited accessibility for students without necessary devices.
11. Gamification	Integrates game elements (e.g., points, rewards, levels) into learning activities to increase motivation and engagement. Often includes competition and progress tracking, making learning more interactive and enjoyable.	Increases motivation, engagement, and active participation. Encourages retention through interactive tasks. Allows creative exploration of complex topics.	May not be effective for long-term retention. High initial implementation cost. Limited mainstream acceptance in medical education.

Educational Approaches in Learning

Conclusions

From the authors:  

“Flexibility is key in medical education, and our curriculum should be adaptable enough to accommodate and incorporate multidisciplinary teaching models effectively and contextually… the conclusion advocates for an adaptable and student-centered approach in medical education, recognizing the evolving nature of the learning process and the unique needs of individual learners.” 

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Transcript of Episode 76

This transcript is made by an autogenerated text tool and some manual editing by the Papers Podcast team. Read more under “Acknowledgment”.

Lara Varpio, Jonathan Sherbini, Linda Snell, Jason Frank.

Start

[music]

Jason Frank:
Hey, welcome back to the Papers podcast. All the health professions, education, literature that you need is here and the crew is assembled, the team, the squad, the minor intellectual giants in their own mind, all of us are here. I got Linda.

Linda Snell:
Hi, everybody.

Jason Frank:
I got Lara.

Lara Varpio:
Hey, y’all.

Jason Frank:
And I got Jon.

And by the way, last episode, I mentioned that maybe Jon and I played hockey together. And it was quite a sight. There’s video.

I’ll be accompanying Jon’s paper with the video. But take it away, Jon.

Jonathan Sherbino:
Jason, you were a phenomenon on the ice. I’ll leave it ambiguous to determine whether that’s positive or negative. I will say, though, in response to that, I went to the gym today and decided to do lower body workout.

Say, you know what? I need to keep up with the good Dr. Frank. And so I’m going to be firmly ensconced in this chair, probably not able to move because my legs are decided.

That’s it. Dead lifting and squats are enough. And maybe not a good idea before I sit in this chair for two hours of recording.

Let’s transition from Jason’s eye tomfoolery to something that people actually subscribe to. The other podcast that we run where we go through the minutiae of our every day, not well subscribed to. I don’t know why.

I’ve been thinking this week about what’s the spectrum? What’s the scope of the things that we cover here on the pod? And I did a little ethno-subjective quasi-experimental thematic auto-crossover non-equivalent thematic analysis.

Insert Varpio’s head exploding.

Jason Frank:
I love how you used all of Varpio’s words all in one sentence.

Jonathan Sherbino:
I did. I put them into a blender and said, pop him out and give me something. Anyway, here’s my opinion on some of the stuff we cover, which is, you’re not gonna be surprised to hear that I love tech and I love experiments. And if there’s stats, even the better.

But I’m not good at either. So that’s what’s that. Linda, you’re our professional identity person.

And then Lara, you keep us grounded. See what I did there? Ooh, ooh, ooh, bad.

That was good. That was good. I got to tell you, J.F., I am just like, it’s every bit of my prefrontal cortex not to take a cheap shot at you.

Jason Frank:
That’s all right.

Jonathan Sherbino:
Deep breath. But I think you like a lot of the policy and system design stuff.

Jason Frank:
I do.

Jonathan Sherbino:
But if I was going to rewind the clock a little bit and say, what got me into health professions education? Where did my own journey start?

It was that desire to become a better teacher. In fact, my graduate thesis was on a workshop-based innovative curriculum that, you know, maybe innovative is a little bit of a stretch, that looked to reorganize how we could deliver teaching in a very practical way to clinicians in practice. And so I kind of want to use that as a rationale for returning to what I’m going to call the essentials.

The literature that supports what we do as teachers, which is probably one of the fundamental characteristics or pieces of our professional identity that informs who we are as researchers and as clinician educators. So I went to a journal that I’ve never heard of before. It’s called the Journal of Effective Teaching Methods, JETM.

I love that abbreviation. You know, I love a little abbreviation here and there. It’s published by the European Institute of Knowledge and Innovation.

It is not a predatory journal. I did a bit of background to make sure that I wasn’t promoing someone that’s going to spam your inbox. So don’t worry, we’re not doing that.

But it’s a scientist founded independent academic organization from Europe that promotes professional development and continuing education. Now, before we dive into that article, I’m going to leave a bit of a cliffhanger, not naming the article. I’d like to hear a little bit about the foundational literature that’s shaped our own roles as educators.

So Jason, Lara, Linda, what’s an innovative instructional method you’ve used? Or what’s something you’ll never try after you gave it a first kick and realize, oof, that’s a solid zero? Or is there something that’s frustrating you as a teacher right now that requires an innovation?

Should we have some kind of hackathon motivated by, from our audience to solve something and produce innovation? What say you?

Jason Frank:
Oh my goodness. I have a lot of things in your second column, things that I’ve messed up that I’m not a master of in terms of teaching. But I want to mention one that, you know, I’ve introduced a few years ago that I keep going back to because it seems to work.

So this is about didactic. So you’re booked to do some sort of teaching session, often for medical students. And we do these frequently.

You know, there’s some classic lecture you’re supposed to give. That is such a snooze fest. It’s boring for the students.

It’s boring to teach the same topic over and over. And then how to make it interesting. Some of my colleagues will do flip classroom, they’ll record something and then they’ll bring a mannequin or whatever.

I am a huge advocate of squeaky toys and candy. And this is my version of gamification. Thank you, Lara, for the smile.

So when I have to do one of these boring lectures and the students come and they’re tired and they’re post-prandial and, and they’ve had like, you know, lots and lots of boring lectures in their life. I say, Hey, get into small groups. We’re going to have a little competition here and friendly game.

And then everything, all the content of the, of the lecture I put into a little game. I give squeaky toys. So people can’t just put their hand up.

They can’t shout out the answer. They have to do the squeaky toy, which makes everybody laugh. It’s a little lighter.

And then they compete for a jar of candy, which seems to motivate medical students at a 10 out of 10 level. And so that’s my go-to and it works.

Jonathan Sherbino:
I’m going to summarize that as the Pavlovian approach to medical students. I’m not sure if they’re going to love that, that interpretation, but okay, sure.

Lara Varpio:
So the, the teaching approach, the teaching approach that I really enjoy and that I kind of long for is going all the way back to my graduate days when I was a graduate student in the humanities. And we used to have these hours long sessions where all we did was debate and discuss and have contentious ideas and do all those sorts of things. And interestingly, they often started around five o’clock and then the next thing, you know, it would be seven and then the conversation would move to a pub somewhere and drinks and food.

And it would just be hours and hours of talk and thought and discussion. And the professor always came. And so I do kind of miss that.

Though the one thing I’ll say, Jason, you reminded me of something I used to do and maybe I’ll bring it back one day, but I used to make a bingo card for my learners of key ideas. And when we had gone through, because I don’t always plan my discussions, I just sort of go. And so the idea was when they could fill up the bingo card and yell bingo, we were done.

Linda Snell:
So like you, I detest formal didactic one-way lectures and I really like the group discussion-y type of things. So much that along with a colleague, we actually wrote a paper many, many years ago on the interactive lecture, how to make them more interesting. So I think where lectures can be made more interactive and more interesting.

If I were to pick one of my favorite ways of teaching, it would be a debate. But actually, unlike Lara, yours sound like yours were informal. I love formal debates.

And it really depends on the question and who’s moderating the debate to keep us on track. And probably a little bit of pre-discussion, not to script things, but just so again, we can keep on track and make it a learning point.

Jonathan Sherbino:
Okay. So we’ve heard some ideas around teaching innovations, mostly things that have been successful for us. And part of the challenge we have as both students and as teachers, we’ve been in the game for so long that the habits we’ve adopted, some of them are great.

Some of them are supported by theory and by evidence. Others are just there because they’ve been there. So is it an issue of survivorship bias?

So I’m going to bring to you what I’m calling a survey or a micro monograph, meaning it’s kind of like, here’s all the things that you can think about around teaching. The study is entitled A Review on Modern Teaching and Learning Techniques in Medical Education from the EIKI Journal of Effective Teaching and Methods in January of this year. The first author is Karkera et al., who are colleagues from Trinity Medical Sciences University in St. Vincent and the Grenadines in the Caribbean. Shout out to that medical school. Please come and invite me to come and learn about your teaching methods. Only after they invite me.

Lara Varpio:
I want to go first.

Jonathan Sherbino:
Any months of January, February, March in Canada, I’d be very available. So here is the purpose. I’m going to quote the authors to discuss and analyze different teaching learning methods in contemporary medical education.

They call this a review. It’s a synthesis of predefined instructional methods. I’m going to leave some space for us to discuss what kind of review or what kind of synthesis this is.

But essentially they do a systematic search of PubMed. They also separately searched Medline, which I’ll just flag for audience is a sub domain of PubMed. So if you search PubMed, you don’t have to do a separate search of Medline.

And then they looked at the gray literature. And here they looked at ResearchGate and Google Scholar using free text search, but they never used any type of mesh headings in PubMed. They restricted their article review from 2000 to 2023.

And they only included studies that were peer reviewed, open access, and it had a sample of more than 150 participants. There’s no rationale for why they had that exclusion criteria. That’s just there.

And so I’ll look to Linda, Jason and Lava (Lara) to talk to you. What do you think about this as a review? What can we learn?

What are the limits of such a type of review? And maybe we can have a conversation about how the health professions education literature is starting to think more rigorously or more intentionally or that there is specific language that’s now being applied to the various viewpoints or the ways that you’re trying to synthesize literature.

Linda Snell:
So I’m going to use one of Lara’s comments, which is there are a couple of things in here that gave me cause for pause.

Jonathan Sherbino:
That’s been copyrighted.

Linda Snell:
Oh, dear. All right.

Lara Varpio:
Well, she’ll buy me a drink the next time we’re together. That’s every time you use it, you just gotta buy me a beer.

Linda Snell:
Perfect. You just keep track because we’ll see each other in a couple of months and I’ll be probably getting you very drunk.

So one of the inclusion criteria was that the papers had to be open access. And to me, that cuts down on a lot of papers. Having said that, if they felt they got enough papers, that’s fine.

But as we get to the results, we’ll see they really didn’t have that many. And when they were broken up into categories, there may have been one or two per category. So I’m not sure whether this is complete.

Therefore, I think, okay, a narrative review used very loosely would address this.

Jason Frank:
It’s kind of a funny paper in the method section. Let’s be honest. And that’s not the value of this paper going forward.

I agree, Jon, you can’t call it systematic. It had funny search strategy, funny inclusion exclusion criteria. The open access one stood out.

The sample of greater than 150 stood out. There’s just a whole bunch of things in their choices. I was wondering if the open access thing had to do with their institution’s access to journals.

I was wondering if that’s a strategic choice for them or for their readers. I wasn’t sure. But basically it wasn’t systematic and I wasn’t sure about why they chose certain papers for certain methods.

And maybe it’s neither here nor there. That’s not the value.

Linda Snell:
Let me just add that the sample of 150 strikes me that these people may be looking, may be coming from a basic science lecture, the whole class type of context, because that would exclude almost all clinical teaching. And they do talk, as we’ll hear about, some methods that could be used in the clinical setting. But with over 150, that gives me, and here you go another beer, Lara, cause for pause.

Lara Varpio:
Okay. So I’m not going to reiterate the critiques but because one of the things that’s interesting about this paper, and I thought we’d spend just one minute on it, is the idea of the search terms. Because the search terms of this paper, they had seven search terms that they used and they searched for medical education, learning techniques, team-based learning, problem-based learning, case-based learning, evidence-based learning.

And then some of their categories like were team-based learning, problem-based learning, case-based learning. So your search terms drive what you find. But I think the point here is that your search terms are really important but they’re also incredibly hard to build because you want breadth, you want to find all the relevant material but you need specificity.

You only want the relevant material. So how do you go about doing that? Number one, your best friend’s a librarian.

Every time. Just can’t say enough about those information scientists. They are vitally important.

But I thought I’d offer just a quick tip on how I go about building my first draft of my search terms but when I’m going to talk to a librarian. So this isn’t a magic to answer. This is not anybody’s documented excellent methodology.

This is what Varpio does when she’s got to start somewhere. So the first thing I do is I’ve, it’s an iterative process. The first thing I do is I find four or five, six papers that I absolutely know should be included.

These manuscripts are right in the sweet spot of things I want. And then if I have five or six papers that really have, this is not within the scope of what I want. They’re adjacent.

They’re not irrelevant like completely but they’re not within the circle of things I want. And then you do that deconstruction work of trying to figure out the words that are in the papers you do want and not the ones that are in the papers you don’t want. And then when you run your first search, you turn those into key topics.

You turn those into your mesh terms. And once you conduct your first search now you have a two litmus test, if you will, because the articles that you really wanted to be included should be found. They should be identified and the articles that were adjacent but not particularly relevant should not be included.

And so now we’re in this iterative process of trying to figure out why did that miss the ones I want versus why did it capture the ones I didn’t. I mention this, dear listener, because if we have one linchpin moment in your literature review it’s your search terms. It’s figuring out that I’m getting the right things.

So this is how I start my process because once I can start doing that iteration once I’m working with a skilled librarian it’s a lot easier if you go in with a bit of a sense of what you’re trying to get, what you’re trying not to get, and then you use those two piles of papers as litmus tests for your original search.

Jonathan Sherbino:
Part of the reason I chose this paper was to talk a little bit about where syntheses and the categorization of syntheses are going in health professions education. And this is where there’s a plug that has a bit of conflict interest for both Lara and myself. We’re part of a project.

It’s called Literature Reviews Explained. There is a link to the site in the abstract for this episode. So go to paperspodcast.com and you can find the link. See how we’re just gamifying the whole system where you go to all the things that Lara and I want you to read. And a shout out to Dina Hamza who’s been really one of the leads in that project.

Lara Varpio:
Yes, Dina Hamza.

Jonathan Sherbino:
And there I think in a very nice way it talks about eight categorizations for different types of syntheses and we’re not meant to say these are the only eight but I think these are the where the field is starting to move. 20 years ago the differentiation of what was a synthesis was you’re a meta-analysis or you weren’t. And that’s being deconstructed.

But it means though that we need to be thoughtful when we talk about what type of synthesis are we. The authors just say they’re a review and probably a decision editor should push back on them and say what type of methodology, what type of approach are you using and give us the label so that there is a common pre-existing or you’re signaling to the audience this is how I’m going to tackle it. For example, is this a narrative review?

They talk about what their synthesis or their search is. We’ve heard some critiques of it but they miss two really fundamental points. They never talk about this is who we are.

This is the reflexivity statement that talks about here’s who we are, here’s how we’re going to approach this, this is the perspective we’re going to take. I think the 150 participants says that they’re looking for so-called big studies that offer objective so-called truth. That would be my interpretation from a breadcrumb there.

The second part of narrative review does it has to say is here’s how I’m going to try to organize the literature. I’m going to try to make an argument about here’s where the literature is, here’s where it is not and here’s where it might need to go from the perspective that I’m taking. And what we really find more is that this feels a little bit more like a monograph of here’s a survey.

If you want all of the instructional methods that we included, here’s a little snapshot of what they are. It’s not offering a synthesis that takes all the literature and has a meta inference that comes out of it. So I would direct our audience to start thinking a bit more when we say a review, what do we mean and what kind of review are we doing?

How are we trying to synthesize and make a coherent argument of where the literature is? And there’s a whole bunch of different approaches. One last shout out to Javeed Sukhera who wrote a great paper on narrative reviews in JGME and that’s really the basis for the section at Literature Reviews Explained.

So I’ve shouted out enough. Let’s go to the results. They only found 25 articles.

They had pretty limited inclusion criteria and they included 10 in their synthesis. They identify 11 instructional methods. I’m going to talk you through them quickly and I’m going to ask Lara, Jason, Linda to identify one of those methods and unpack it a little bit more as to why they think it’s great, why they think it won’t work in some contexts and how they perhaps have used it.

So the 11 methods and this is a teaser for you, a listener to say, hey, maybe I want to pull this manuscript or should I go over to Papers Podcast, pull the abstract where we have condensed this all into a really nice table. It’s a 12 by 4 table. So there’s 48 cells for you to read.

Lara Varpio:
The listeners can’t see you dancing about your 12 by 4 table.

Jonathan Sherbino:
The numbers make them happy. I did a lot of work putting together that table, I will tell you. Thank you, GPT.

All right, case-based learning where you use a real or hypothetical case as a stimulus, evidence-based medicine, which is to ask a question and do a clinical query and critique the literature supporting it. Problem-based learning, it’s student-led based on a problem with small group kind of facilitation. Simulation-based learning where you mimic typically a procedure or a team-based interaction and have an opportunity to practice and receive feedback.

Social media and e-learning, the use of various digital resources allowing a flexibility of delivery in asynchronous learning. Peer tutoring using near peers to help teach and share and to coach one another. Observational learning where probably the most profound thing we do as teachers is by how we act and how we’re observed.

Team-based learning, a structure often where you ladder various levels of learner into the work of solving a question or a problem and they do it in a collaborative way. Flipped classroom, Jason talked about that briefly at the opening where you do the lecture at home and then you come to class to do the homework with the teacher. Virtual reality and artificial reality type of learning, typically seeing only really anatomy and in surgical procedural learning.

Here, currently in HPE where you give an immersive, interactive environment where you’re allowed to see things in ways that go beyond kind of typical visual, spatial types of learning. And then the last is gamification where you introduce the idea of points and competition to enhance motivation. I think that’s something about Jason’s candy and squeaky toys.

So over to you, co-hosts, what stood out for you? Unpack it for us.

Lara Varpio:
So team-based learning is the one I picked because it’s super fun. It was introduced to me by Paul Haidet and Ruth Levine who came to visit when I was still living and working in Ottawa, Ontario, Canada. And I had the best time.

So team-based learning is built on four foundational principles, four foundational ideas. So number one, learning in teams is importantly different and beneficial for learning, but those teams need to be carefully formed and managed. Principle two is that students need to be held accountable for the quality of their individual and group work.

Three is that students need frequent and timely feedback. And four is that team assignments should promote both learning and team development. So when you put those four together, those foundational principles, you can bring a team-based learning to life in many different ways.

But team-based learning has a set of techniques that they suggest. And those techniques involve pre-class preparation. There’s a fair bit of expectation on that.

Then individual readiness tests in the classroom, then team readiness tests, some in-class feedback and clarification sessions, and then group problem solving. But those are just techniques that are traditionally held. They are the ones from the canonical team-based learning texts, but you can modify them.

There’s room for movement in there. But as these authors in this article point out, team-based learning can enable different educators from different orientations to collaborate in teaching. So you can have your basic scientist educator as well as a clinician educator actively working together.

And it’s a great way to bridge theory and practice. So the learners have to come perhaps with some theory in mind and then in the classroom, they have to apply it. So I really do love team-based learning.

One word of caution. It requires that you as educators are savvy managers of group dynamics because it is a group-based learning activity. So if there’s one person dominating the conversation or if there’s one person who’s just not saying anything at all, these are things you have to actively work against.

So the importance of building your student teams and being able as an educator to manage those group dynamics are really important.

Jason Frank:
So I’m going to pick Sim. So simulation-based learning. Love, love this topic.

It’s a whole world. I am not a master of Sim. There are people who are gurus of Sim in my center.

Glenn Posner, who runs our Sim Center. Andrew Hall, who’s a researcher of Sim. And lots and lots are wonderful practitioners.

So this is, they define it as using high fidelity simulations, mannequins, equipment or virtual equivalent to replicate clinical settings, allowing students to practice skills in a controlled environment without risking patient safety. So that’s the wonderful, powerful premise of Sim. There’s a reason why sports, the military, astronauts, like everybody uses Sim because it really works well for the human brain.

You get to try on something that is close to an authentic type setting and scenario and do it over and over again until you’re good. So the advantage of this is that you get hands-on practice, which our brain loves. It’s interactive, active, without patient risk, allows repeated practice.

So you get that mastery learning element. And can build confidence. And you can do this as groups or an individual.

The downside that’s in the paper is that this costs a lot of money and you need extra training. I think there’s a spectrum of Sim available. I do Sim when I teach medical students an intro to trauma.

So ABCs and putting on collars and a little bit about airway and so on. You can do that with very little cost and it’s really hands-on. It’s really fun.

And I can see the difference when I see that med student back in the emergency department out of the Sim Center applying what we’ve learned. So just love me some Sim.

Lara Varpio:
I just want to say you can do a low cost Sim. Wasn’t it Jeff Norman who had a paper once about doing really a simulation with like a styrofoam cup and some pencils and whatever. And the results showed that the learners gained skills.

So yeah.

Jonathan Sherbino:
Yeah, it’s not Jeff. It’s Stan Hamstra was the senior.

Lara Varpio:
Oh, that’s who it was.

Jonathan Sherbino:
It is Eddie Matsumoto doing it for his thesis.

Lara Varpio:
So cool. Styrofoam cup, right?

Jonathan Sherbino:
I’ll promo Eddie Matsumoto who is a surgical educator in my shop. Oh, way to go.

Linda Snell:
All right. So, you know, the other part of Sim just to carry on this conversation is the part where you’re simulating communication skills or teamwork that doesn’t demand high facility, high fidelity, sorry, or task trainers. And they kind of missed out on this.

You know, I had trouble choosing here. It’s kind of like minestrone soup. So in minestrone soup, you’ve got a whole bunch of ingredients and they come together to make this wonderful meal.

And you start with some things. You start with the onions and the garlic. And then you add a few things in later.

And depending on the amount of time it takes to cook, et cetera. So it’s the same here. There are a whole bunch of interventions here.

And whether you like the carrots in the soup or the pasta in the soup is really depends on a lot of things. It depends on who your audience is and the number of people in your audience. And the problem I’ve got here is that in some cases, some of these teaching techniques are meant for smaller groups, bigger groups, individuals, et cetera.

The other thing I’m a little bit confused about is that I don’t lump things together the same way they do. I wouldn’t mix social media and e-learning. I would expand on simulation, for instance.

So I have trouble picking.

Jason Frank:
I agree, Linda.

Linda Snell:
Yeah.

Jason Frank:
It’s a funny slice.

Linda Snell:
Yeah, it is. It’s a funny way of slicing it. So I have trouble picking one thing out here.

Having said that, if I had to pick one, I’d probably pick the flipped classroom just for fun, because I think it’s fairly clearly explained here. And it is something that can be used in my setting. You don’t have to have 150 students to do it.

You can do it in a much smaller group.

Jonathan Sherbino:
Welcome back to the Cooking Podcast, where we will get you in 20 minutes or less, a delicious homemade meal.

Jason Frank:
Or fast food.

Jonathan Sherbino:
Before we go to our round of votes, I do want to highlight another element that I thought was really nice from this manuscript.

They created a mini infographic that explains each of these 11 instructional methods. You can dispute how you like the clumping or the sorting or the dividing. But the mini infographics are under a Creative Commons license, and the license allows you to reproduce them and adapt them.

So if you are looking for a nice way to pull out a whole bunch of images and put together in a nice little survey for an introductory train-the-teacher kind of workshop or a resident-as-teacher kind of workshop, most of that work has been done for you here. Here’s a conclusion from the authors, and then I’ll get some concluding thoughts from the hosts. They quote, Flexibility is key in medical education, and our curriculum should be adaptable enough to accommodate and incorporate multidisciplinary teaching models effectively and contextually.

We advocate for an adaptable and student-centered approach in medical education, recognize the involving nature of the learning process and the unique needs of individual learners. That’s certainly a conclusion I can get behind. So let’s go to our round of votes.

What’s the impact of this paper for you, Linda, Lara, Jason?

Linda Snell:
If you look at my personal impact, I don’t think it’s very high. So I’m going to adjust your question to what is the impact of this paper for a certain group of people. And that group of people, I think, would be teachers who are just starting out, possibly those who teach a lot in large groups.

And I think for that group of people, I’d give this a three. It does give you a taste. It gives you a tasting menu if we’re going to continue the food analogy.

For somebody who’s already an experienced teacher who’s used some of these methods, I think it doesn’t go far enough. Hence the three.

Lara Varpio:
For the exact same reasons, Linda, I’m going to give this paper a three as well. Exactly the same reason. It’s really useful for that, for those clinician educators who are new to the process, trying to hit the ground running, understand the landscape.

Perfect. Three.

Jason Frank:
You guys are so generous today. This paper has got lots of challenges on the method side and the content’s not super new and there are other better sources for the content. But here is the real value of this paper.

This paper is all about the infographics, as Jon mentioned. So if you have a presentation or you’re talking to somebody about a method, the infographic is a great way to start. And if you’re teaching a class like to novices and health professionals education about methods, the infographics are of pretty good value.

So I’m going to give it a two for that.

Jonathan Sherbino:
I’m going to give it a three. I wanted to have a conversation around the different types of synthesis that are coalescing in the HPE literature. And the methodology they employ there is challenging if it leads to conclusions that are evocative or push our thinking.

But when they’re simply trying to say, hey, let’s do a survey of a bunch of teaching methods and offer you an explanation and where they work well and where they don’t. I don’t think that there is a great flaw because this is assembling a lot of material that probably each of us, if asked to describe flipped classroom, we’d probably just start from scratch and write it and would never actually look to a reference. And so I don’t think the challenges in the methods warrant a dismissal of the findings, which is a survey of 11, potentially arbitrary, certainly not exhaustive, different types of instructional methods.

And I think if you took the table that you can create from this or you took the infographics that are available and you gave it day one to the resident as teacher or day one to the clinical teacher workshop and said, OK, here’s a survey of a bunch of stuff. This will get you into the shallow end and you will then need to build on this, realize there’s more than instructional methods, realize you’ll need more information to dive into each of these methods by themselves. That’s a way to go.

This is not a synthesis of all the simulation-based learning because there are three journals straight off the top of my head that I can think of that are solely dedicated to simulation-based education. And so how would you even organize all of that literature all by itself? It’s the survey.

And so for that reason, I think it’s pretty reasonable. Learners, listeners, you can debate with us about the merit of this topic in this episode. Authors, Karkera et. al., you can reach me for my free workshop.

You tell me you want a gamification, you want a PBL, I’ll bring any of it on my own dime if you can get me into the Caribbean sometime in the Canadian winter, I think that’d be great.

Jason Frank:
You’re schlepping now, Jon.

Jonathan Sherbino:
No, I am schlepping right now.

Please get me out of Canadian winter. But you can reach us at thepaperspodcasts at gmail.com or at theinternetpaperpodcast.com. Thanks for listening.

Lara Varpio:
Talk to you later.

Linda Snell:
Bye-bye.

Jason Frank:
Take care, everybody.

Jonathan Sherbino:
Take care, everybody.

Jason Frank:
You’ve been listening to the Papers Podcast. We hope we made you just slightly smarter. The podcast is a production of the Unit for Teaching and Learning at the Karolinska Institutet.

The executive producer today was my friend, Teresa Sörö. The technical producer today was Samuel Lundberg. You can learn more about the Papers Podcast and contact us at thepaperspodcast.com.

Thank you for listening, everybody. Thank you for all you do. Take care.

Acknowledgment

This transcript was generated using machine transcription technology, followed by manual editing for accuracy and clarity. While we strive for precision, there may be minor discrepancies between the spoken content and the text. We appreciate your understanding and encourage you to refer to the original podcast for the most accurate context.