Kathryn Chappelle, MA Shawn Blanchard, MD William Toffler, MD Anita Taylor, MAEd Orientations as Catalysts for Student Learning

The Truth About Orientations...  We see them as necessary, but not as important as “teaching”  They are sometimes a hassle or difficult to arrange  We often don’t recognize they are needed—until it’s too late!

2005 Ethnographic Essay: A Good Assignment Gone Bad  Worthy objective: real-life cultural experience  Reasonable standards: questions, write-up  Four-year history--some negative feedback  Excellent prior experiences, though some took “easy way out”  Instructions adjusted to address this  Objectives and standards included in written assignment posted on webpage  Assignment given in mid-quarter, later than usual

2005 Ethnographic Essay: Student Reactions / Damage Control  HUGE angst, resistance, accusations of “racism”  Steering Committee meeting to address concerns  Guidelines *reinterpreted*, not changed Where we went wrong...

Madeleine Hunter’s “Direct Teaching” Model 1) Objectives 2) Standards 3) Anticipatory Set 4) Teaching (input, modeling, checking for understanding) 5) Guided Practice 6) Closure 7) Independent Practice

Anticipatory Set is Key Positive “sets” enable learning  Liking instructors, relating to them personally  Believing in value of material  Seeing relevance of material to own situation  Being motivated: wanting to learn something Negative “sets” interfere with or prevent learning  “Non-physicians can’t teach me anything.”  “This is stupid, worthless, etc.”  “This would never work in real-life clinic.”  “I really don’t want to do this.”

How Orientations “ Help Create Learning”  Promote positive feeling tone (“set”)  Provoke interest (“set”)  Provide rationale (objectives)  Provide information (standards)  Provide open exchange (clarify, check for understanding)

“Catalytic” Learning Agents  Positive feeling tone: relationships and attitudes affect learner’s receptivity  Interest: a “hook” that intrigues, pulls students into assignment  Rationale:  Course/lesson objectives  STUDENT reasons to learn  Information: clear explanations, models, setting standards reduce anxiety  Open Exchange: respond to questions, misinterpretations and heard by all

Next Year: The Ethnographic Essay Orientation  Avoid “set-up” for negative responses by distributing challenging assignment on time  When first distributed, orient entire class  Provide “hook”: How many of you have ever lived in another country? (actual experience vs. book learning)  Explain history and objectives  Explain rationale for interview contents and legal precautions  Invite former students to speak to how students personally benefit  Allow time for questions/responses

Orientation in Principles of Clinical Medicine: A Two-Year Multidisciplinary, Longitudinal Course

Principles of Clinical Medicine: Orientation as Process  Overall course orientation for students  Written Exam/GOSCE orientation two weeks prior to exam  Mock GOSCE orientation for first-years by second-year students  Large group session orientations  “Check-ins” on assignments, course issues as they arise  Orientations for new faculty each quarter  Orientation/faculty development for preceptors annually

PCM Year 1: Introductory Course Orientation Feeling tone/relationships:  Introduce course faculty, administrators, and Steering Committee  Communicate multi-disciplinary development and contributions  Convey positive attitude toward course  Stress importance of student input Interest:  How students learned patient care prior to curriculum revision  Invite former student panels to speak to both classroom and preceptorship experiences

PCM Year 1: Introductory Course Orientation Rationale:  Provide course objectives, intensions of school  Address STUDENT point of view: how they will benefit  Increased skills in 3rd Year  OHSU grads sought by residencies Information: Take time to provide oral explanations of:  complex course structure  course materials  teaching methods  evaluation standards

PCM Year 1: Introductory Course Orientation Provide Open Exchange:  Include all students in same communication  Answer questions--check for understanding  Address real-time concerns  Correct real-time misconceptions

What We’ve Learned: PCM Orientation Pearls  Student and patient panels promote student “buy in”  Course leadership needs to be “on students’ side”  Too much orientation to evaluation “freaks students out”  Not enough orientation to evaluation “freaks students out”!!

What We’ve Learned: PCM Orientation Pearls  “In person” approach more effective than written orientation  Orienting students to process as well as content is important (e.g., “rules” of controversial issues sessions)  Administrative errors and lack of timeliness detract from student respect for course and content  Open forums in which students can ask questions and share concerns are well worth the time

Orientation Process in the OHSU Family Medicine Clerkship: A Five-Week, Required Third-Year Rotation

FMC Introductory Orientation: Anticipatory Set  Brunch provided for students  Round table check-in with whatever students wish to share about their current lives outside of school  Preceptorship  “What do you most want to get out of this clerkship?”  Students need to proactively ask for clinical experiences  Patient care time can include hospital, deliveries, home visits

“Checking In” Principle in Group Process  Talking about process is part of group norm  Enables diverse group to understand and appreciate nature of its diversity  Allows for discussion of how conflicts will be handled  Builds trust and relationships by increasing understanding

FMC Introductory Orientation: Course Components  Chairman’s Sessions (chair attends)  Patient Management Rounds (leader often attends)  Common Clinical Problem Sessions  OSCE and Videotaping Exercise  Final Examination  Explanations of assignments  Time for questions, clarifications

FMC Introductory Orientation: Evaluation Standards Provide an overall positive “set” toward course evaluation  New Dean’s Office cut-offs: satisfactory is satisfactory  Fairness of seven-year “norms”: no quota for honors  Encourage students to proactively work toward desired grades rather than complain afterwards Note: Very few grade challenges since we began openly discussing grades at orientation

FMC Orientation/Process: Midterm Feedback Sessions  Students encouraged to let us know early if there are preceptorship difficulties  Third week, preceptors fill out feedback forms  Students bring forms, individually “check- in” with Clerkship Director  OSCE feedback shared, students assigned learning issues assignments if appropriate

Orientation Process for AAFP National Conference

FMIG Anticipatory Activities for AAFP National Conference  Ask for early commitment to attend and give periodic reminders  Encourage students to apply for scholarships  Have forum for 4 th year students to tell of benefits of attending National Conference  Engage students in Program of Excellence application

FMIG Pre-Conference Orientation 7-10 Days Prior to Conference Agenda:  To introduce attendees from different classes  To share student experiences at past meetings  To confirm travel/housing plans  To set expectations  Attend business meetings, lectures and workshops  Share information with group at meals  To write or brainstorm resolutions

AAFP Conference Check-ins for Attendees  First evening: review schedule, opportunities  Daily lunchtime check-ins:  Share ongoing information and insights  Reemphasize attendance at business meetings and elections

Measurable Outcomes of Orienting Students to the AAFP National Conference  Scholarship awardees  Program of Excellence awards  Students elected to AAFP National Offices and appointed to AAFP Commissions and Committees  Resolutions authored by OHSU students

“Catalytic” Learning Agents  Positive feeling tone: relationships and attitudes affect learner’s receptivity  Interest: a “hook” that intrigues, pulls students into assignment  Rationale:  Course/lesson objectives  STUDENT reasons to learn  Information: clear explanations, models, setting standards reduce anxiety  Open Exchange: respond to questions, misinterpretations and heard by all

Group Exercise  Divide into small groups  Take a problematic lesson, activity, or course suggested by one participant and design an effective Orientation process to better “catalyze” students for learning  After 15 minutes, share strategies / ideas with large group