I have been the course director for the 2nd year Medical Pharmacology course since 1997. This is a team-taught course consisting of ~100 contact hours and 11 exams. I am responsible for teaching ~25% of course content and I am involved with all small group teaching & most review sessions. For the past decade I have worked with other course directors to transform the 2nd year curriculum from a traditional curriculum where each course is taught independently (and out of sync), into a more learner-centered curriculum where the content in different courses (e.g. pathology, clinical diagnosis, microbiology, pharmacology) is taught in a highly coordinated thematic manner (by disease & organ system).
At the end of the 1997-98 academic year a survey by the student honor society (Owl Club) concluded “56.6% of students felt that exams did not effectively assess the information presented.” In response to these complaints I initiated (with the help of my faculty!) the development of learning objectives for every contact hour & self study, as well the construction of new block exams that emphasized these objectives. Over the years I have also developed a series of 39 on-line interactive quizzes with over 500 questions (most in USMLE format). These quizzes provide students with the opportunity for a rigorous self-assessment before taking block exams that affect their grade.
Over the past decade I have worked with colleagues to develop case-based Problem Based Learning (PBL) sessions, and I am the senior author on 4 out of 8 of the PBL sessions used in our Med Pharm course. During the 2008-09 academic year I helped develop two Team-Based-Learning (TBL) sessions on coagulation disorders & autonomic pharmacology. In TBLs students complete an assigned reading before class, and during the session work as members of a team (of 6 students) to solve clinically relevant problems. Both PBL and TBL sessions foster active learning, the development of interpersonal skills and learning pharmacology in a clinical context, which are approaches that are believed to enhance long term retention (as compared to wrote memorization of facts).
In the Fall of 2005, following hurricane Katrina, the Baylor College of Medicine very generously invited Tulane to utilize their physical facilities & support staff to keep our Medical School open for the remainder of the 2005-06 academic year (in Houston). I relocated there in mid-September with a core group of administrators, faculty & course directors to organize and deliver a 1st & 2nd year medical curriculum using a mixture of faculty from Baylor, MD Anderson & Tulane. We lost 4 weeks of curricular time during the initial chaos. We also lost 1/3rd of our teaching faculty in December 2005 due to University mandated "faculty separations" related to financial exigency, so some of us suddenly found ourselves faced with new teaching responsibilities. The medical class relocated back to New Orleans in the summer of 2006 after repair of its buildings were nearly complete. There were many lessons learned during our "Baylor experience", including how generous Baylor & Texans in general, can be.
To provide additional student resources for formative assessment, I have developed a large database of interactive quizzes (over 500 questions on 39 different topics) that students can use for self-assessment prior to taking block exams. Recently I have begun working as a contributing editor for Harvard Medical School's Medpedia project to develop a wiki database on "concepts in medical pharmacology" that will help students identify major concepts in different system-related topics. This wiki, with which students can actively edit & participate, will also provide examples demonstrating the application of these concepts in a clinical context. The goals of this project are to aid students in knowledge construction, critical thinking, problem solving & contextual learning in an interactive environment.
In a collaborative project initiated by one of our (then) 1st year medical students (Niels Olson - class of 2009), we began making audio recordings of 2nd year Medical Pharmacology & Mechanisms of Disease lectures & posting both the audio recordings & lecture slide sets on a restricted server in the Fall of 2006. This became a wildly popular learning resource, and within a short period of time we had the majority of 2nd year lectures being recorded, uploaded & posted online. This project evolved into the eventual design of a “one-stop-shopping” website where current lecture media for the majority of the medical curriculum could be easily located & downloaded from a single page, and is currently managed by the Office of Medical Education.
I believe that having lecture media available 24/7 "should" have a positive impact on student learning. (A hypothesis currently being tested). In the Fall of 2007 I began a collaborative project with two Instructional Technologists in our School of Public Health (Bobbie Garner-Coffie & Vincente Bengoa) to conduct a pilot study using Tegrity Campus 2.0 for capturing & archiving Med Pharm lecture content in a key-word searchable video format. This media can be watched online, or downloaded to a computer (PC or Mac) or iPod for later viewing. Tegrity has report features that allow us to determine both the frequency and average duration that students view our hour-long lecture recordings. During a one-month time period our Med Pharm lectures were viewed 172 times for a total of ~91 hours, which averages to a viewing rate of ~30 minutes per time. My conclusion, similar to those reported by the company that developed Tegrity, is that the average student does not sit at home viewing lectures in their entirety. They view only those portions of lectures where they had incomplete notes, or did not fully understand a point being covered. The use of Tegrity for lecture recording expanded to other courses in the medical curriculum during the 2008-09 academic year and is now funded by the Dean's office.
Traditional classroom lectures are “teacher-centered” and promote passive learning. As a first step in implementing active learning strategies in the classroom, I collaborated with our faculty to develop a one-credit mini course on "Concepts in Pharmacology" in the graduate curriculum. In addition, I worked with two of our faculty (Drs. Agrawal & Beckman) to convert 7 traditional Medical Pharmacology lectures to "Just-in-Time-Teaching" (JiTT) sessions using "Peer Instruction". In JiTT students complete a reading assignment & a post-reading quiz on Blackboard by midnight before a class session (Novak et al., 1999). One of the questions asked is a short answer essay on “What did you find most difficult or confusing about the reading?” These responses are used to determine the areas to be focused on during class. Students come to class prepared with background knowledge of the material. Use of interactive Classroom Response System questions on the identified areas of difficulty transforms a traditional lecture into a class session focused mainly on student needs. Most class sessions included at least one question using the “Peer Instruction” method (Crouch & Mazur, 2001; Crouch et al., 2007) where students are asked to select (on their own) the best answer to a challenging question. After responses are collected (but not displayed), students are asked to debate which answer is "best" or most correct with their neighbors for 3-4 minutes, and then vote again - after which a histogram is displayed. This active learning strategy significantly increased class performance on questions from 63.3% (1st vote) to 89.4% (2nd vote)(n=20, p<0.0001). Further expansion of these techniques is planned for the 2009-10 academic year.
A METI Human Patient Simulation on the diagnosis & treatment of unstable angina & cardiac arrhythmias was developed for our 2nd year medical students. The outline for the simulation (case history & story line) was developed by Drs Krane, LeDoux and I. Based upon the case outline, I developed a METI HPS scenario to emulate the patient's presenting heart rate & blood pressure, and for simulating the symptoms of unstable angina with ST segment depression & associated changes in heart rate & blood pressure. The simulation included responses to drug administration (nitroglycerin, morphine, oxygen, metoprolol), simulation of various arrhythmias (bradycardia, AV block, VTach, VFib) and treatments (Cardioversion/Defibrillation, amiodarone, lidocaine & atropine). Dr. LeDoux played the role of the ER physician, and I coordinated the simulation & played the voice of the patient "Mr. Boudreaux" from a control room next door. We were able to get 180 medical students thru the simulation in small groups in a weeks time.
In December 2005, while living in Houston & directing the Medical Pharmacology course, I assumed responsibility for our pharmacology department’s doctoral and masters graduate programs. When classes resumed at the New Orleans downtown campus in mid-January of 2006, 25 (out of 40) masters students returned, along with 6 doctoral students. "Atypical" responsibilities during that semester included making trips back & forth between Houston & New Orleans to find rooms in our medical complex having acceptable air quality that we could use for teaching (most of the 1430 Tulane Ave building was still without complete power). We had an entire semester to "make up", so I had to restructure the graduate curriculum so that all previously scheduled graduate classes for the 2005-06 academic year could be completed during the Spring semester of 2006 & an extra Summer lagniappe semester in June-July of 2006. One component of this challenge was to find a way to simultaneously teach the complete Medical Pharmacology course at both the New Orleans campus (to our doctoral & masters students) & Baylor campus (to our medical students). Lectures on the two campuses had to be scheduled out of sync with each other, since our remaining teaching faculty could not be in two places at once. This was not a fun year for anyone.
During the summer of 2006, in response to student criticisms about our graduate curriculum, I initiated a series of major changes to the department’s graduate curriculum. These changes were based upon a “proven” design – that of the 2nd year medical curriculum which had been redesigned over the previous decade:
Graduate Resources Website url: http://tulane.edu/som/departments/pharmacology/gradresources/index.cfm
The Systems Biology Course was a newly constructed course, first offered in Spring 2007 for the 1st year doctoral students in the School of Medicine's newly created umbrella “Biomedical Sciences” (BMS) doctoral program. Although this course looked great “on paper”, it received some “negative” reviews in its end-of-course survey. The major criticisms of the course included: a) some lectures were excessive in length (90+ slides), b) there was excessive redundancy & duplication of material covered in different lectures, c) there was no communication between lecturers, d) no class notes were available before lecture, e) there were too many details to be remembered for exams, and f) there were not enough exams (e.g. 2 exams was not enough).
In the Summer of 2007, I was asked to take over as course director. After reviewing the survey results, a number of changes were made to address the concerns raised. These included:
For the 2009 academic year some additional adjustments to the course were made, including:
In 2010 we added the use of a Course Management System (Blackboard) for:
To facilitate the development of active learning strategies in our graduate curriculum, I developed a 1 credit hour “pilot” course for the Masters in Pharmacology students. The course consisted of seven JiTT sessions that had a pre-class reading assignment, a pre-class Blackboard quiz, and a class session focused on interactive CRS questions, including 3 questions at the end of each class session using the Peer Instruction method. The course grade was based upon performance on Blackboard quiz questions, and Peer Instruction questions. An end of course survey indicated a high level of student satisfaction, with a 4.6 out of 5 rating for “This course enhanced my learning” (1-5 scale). The lessons learned from this pilot project were utilized to implement & expand the number of active-learning JiTT sessions in our other graduate & medical courses (e.g. graduate course on Principles of Pharmacology & the 1st year Human Physiology courses).
In the summer of 2009 I initiated the development of a "pharmwiki" in collaboration with Tim Park (Class of 2011). This project is a learner-centered project that is creating an online interactive resource to explain concepts & key knowledge objectives in the field of Medical Pharmacology. During its initial year it has become the 2nd year medical class's 2nd most utilized information resource second only to lecture handouts. It has been constructed immediately before each systems block during the 2009-2010 academic year and contains:
Tulane University, New Orleans, LA 504-865-4000 firstname.lastname@example.org