Wikis for collaborative learning, knowledge
construction, critical thinking, & contextual application
While I don’t have any
experience with creating formal lesson plans, I have been responsible for the
learning activities of many medical students and residents. Below is my first
shot at an 8-week “lesson plan” for my second-year family medicine residents. I
am not quite sure of the best way to format this lesson plan, but I will do my
best to lay out the content and intent for using the Wiki to facilitate knowledge
construction and collaborative learning between the residents and their patients.
Overview:
The Context behind the Lesson Plan
The second year of family
medicine residency (referred to from here on as “PGY2” for post-graduate year #2)
starts on July 1st and ends on June 30th every year. The
PGY2 academic year is broken down into 13 four-week blocks. The first 4-week
block of the PGY2 academic year at our residency program is dedicated to
orientation.
During Block 1 Orientation,
PGY2 residents learn about the specific requirements (outside of routine
patient care) that must be completed in order to progress into their last year
of residency. PGY2 residents are made aware of their requirement plan,
implement, and take-turns leading the collaborative PGY2 quality improvement
project for the clinic.
During the academic year, each
PGY2 resident is also scheduled for eight consecutive weeks (two blocks) of Family
Medicine Continuity Clinic. Thirty-two hours during the Family Medicine
Continuity Clinic block are dedicated to the quality improvement project.
PGY2
Quality Improvement Project Requirements: The PGY2 residents have chosen
“prenatal care” as their topic for their collaborative project this year. Prenatal
care is a series of preventative medicine visits that consist of health
education specific to pregnancy and health checks for the mom and growing baby.
The PGY2 residents have decided to implement prenatal “centering groups” for
their pregnant patient as the intervention for their quality improvement
project.
For more information about the
benefits of centering groups for patients, check out this link.
How
Family Medicine Doctors in Our Residency Program Take Care of their Continuity Patients: Family
medicine doctors in the military take care of pregnant women from the time that
they find out they are pregnant, deliver the baby, and then provide care for
both mother and baby afterwards. Family medicine residents see their pregnant
patients regularly to provide pertinent health education and monitor for any
complications throughout the pregnancy. The schedule for these prenatal visits
is based on how far along the pregnancy is (in weeks) for a minimum of 8
prenatal visits. Prenatal visits between the pregnant patient and the family
medicine doctor typically occur at the following intervals: 10-12 weeks
pregnant, 16-20 weeks, 24-28 weeks, 29-32 weeks, 33-35 weeks, 36-38 weeks, 39
weeks, (40, 41, and 42 weeks if not already delivered), and 6-8 weeks after
deliver (e.g. post-partum).
The aim of this lesson plan is
for PGY2 residents to collaborate in the creation of a prenatal care Wiki. Ideally,
the Wiki will also contain a discussion board that allows the patients to
interact with the Wiki content and ask their doctors questions regarding the
information provided prior to and after each centering visit.
Why Use Wiki for this Quality Improvement
Project? Wiki’s offer an online space that promotes knowledge
construction and collaborative learning in a user-friendly, easily edited
environment. Wiki content can be developed asynchronously, which is ideal for
PGY2 residents that are already constrained to “off-hour” times to work on
academic projects. Family medicine residents will gain exposure to and
experience with creating an online patient-doctor communication space. This is
new for many physicians, and thus the collaborative nature in developing the patient
education portal is preferred. Through collaboration, residents can revise and
add to the content throughout the year as they interact with subject-matter
experts and learn of new clinic or community-based resources to share with
their patients.
As millennials, the PGY2 residents already see
the educational value in sharing credible, online educational materials with
their patients. The PGY2 residents view the challenge of creating a Wiki as
very relevant to the clinical duties on this rotation, and value the learning
experience to bring to their future practice.
As the faculty facilitator for the PGY2
quality improvement project, I have recommended that the residents collaborate
to create a secure Wiki that includes the education material and community
resources that they wish to share with their centering group patients at each
of the 8 prenatal visits. The 8-week lesson plan will focus around the recommended
educational content for each of the 8 prenatal visits, and will assign weekly Wiki
contributions for each PGY2 resident to complete during their Family Medicine
Continuity Clinic rotation.
Lesson
Plan
Title:
Using Wikis to Enhance PGY2 Prenatal Education during Pregnancy Centering
Visits in the Family Medicine Residency Clinic
Target
Audience:
1. PGY2
Residents: There are six PGY2 family medicine residents. All six
residents will collaborate together to create a Wiki that describes pertinent “need
to know” information with links to resources for patients.
2. Patients: The
patients enrolled in the Family Medicine Residency Clinic pregnancy centering
groups will benefit from the online educational resources and frequent
communication with their doctors about their pregnancy-related concerns.
Curriculum Overview: PGY2 residents
will collaborate throughout the academic year to create a Wiki that contains evidence-based,
up-to-date educational materials for pregnant patients. The online space will
contain a discussion board managed by the PGY2 residents to facilitate online and
in-person communication with their patients throughout the continuum of their pregnancy.
The Wiki will serve as a common place for patients to learn from their doctors
and bond with other women in their centering groups in between group visits.
Women can explore pregnancy-related health topics on the Wiki, apply this
medical information to their current pregnancy experiences, share their
experiences with the other women in their centering group on the discussion
board, and build a sense of community and support within the group.
Learning Objectives:
·
Residents integrate technology
into their clinical practice in Family Medicine Continuity Clinic to improve communication
with and quality of care delivered to vulnerable population (e.g. pregnant
women).
·
PGY2 resident class collaborates asynchronously throughout the
academic year to research, lead, and implement a quality improvement project.
·
Residents create and manage an interactive, online space (e.g.
Wiki with discussion board) to share up-to-date health education and facilitate
meaningful discussions with their centering-group patients in between scheduled
prenatal group visits.
·
Residents reflect of their experiences
and generate recommendations for future iterations or interventions for this
quality improvement project.
Wiki Development Schedule:
Block 1 Orientation Month prior to start of 8-week lesson plan: (2 hours per week)
·
Week 1: Set up meeting times, decide
on collaborative versus leader-based approach, establish group
expectations/ground rules, discuss/brainstorm areas of interest for content, review
PGY2 rotation schedule, develop mini-milestones
·
Week 2: Play in the Sandbox
o Individual Assignment: PGY2 develops “sample” home page content
§ Topic: “Congratulations! You are pregnant.” Include relevant patient
information (prenatal vitamins, exercise, safety, foods/medications/activities
to avoid, when to seek emergency care)
o Develop a team “process” page
o Explore on Wiki: Collaborate while in-class to create a sample
home page on the process page
·
Week 3: Frame the Wiki
o Revise the Home Page
o Add Content Page tabs for assigned topics
o Add a secure discussion board
o Practice how to comment and post on a demo discussion board
·
Week 4: Multi-disciplinary
Collaboration
o OB nurses will be present
o Work with nursing staff to create the Content Page for 6-8 week
nursing visit
o Refine Home Page
8-Week Family Medicine Continuity
Clinic Schedule: (4 hours on Wednesday mornings)
·
Week 1: Research/Create/Revise your assigned “content” tab on Wiki (e.g.
10 to 12 week visit)
·
Week 2: Wednesday Morning Schedule
o 0800-0900: Respond to discussion posts from patients
o 0900-1100: Centering Group Visit, review new Wiki content with
patients
o 1100-1200: Prepare for next session
·
Week 3: Write/Revise the next assigned “content tab” on Wiki (e.g. 16
to 20 week visit)
·
Week 4: Wednesday Morning Schedule
o 0800-0900: Respond to discussion posts from patients
o 0900-1100: Centering Group Visit, review new Wiki content with
patients
o 1100-1200: Prepare for next session, schedule in-progress review
with faculty advisor
·
Week 5: Research/Write/Revise the
Wiki tab for next session (e.g. 20 to 24 week visit)
·
Week 6: Wednesday Morning Schedule
o 0800-0900: Respond to discussion posts from patients
o 0900-1100: Centering Group Visit, review new Wiki content with
patients
o 1100-1200: Prepare for next session
·
Week 7: Research/Write/Revise the next assigned “content tab” on Wiki
(e.g. 24 to 28 week visit)
·
Week 8: Wednesday Morning Schedule
o 0800-0900: Respond to discussion posts from patients
o 0900-1100: Centering Group Visit, review new Wiki content with
patients
o 1100-1200: Conduct end-of-rotation review with faculty advisor
o 1200-1300: Hand-over continuity of patient care to the next resident
on the Family Medicine Continuity Clinic rotation
Grading Criteria: This is a collaborative
activity. Ground rules, mini-milestones, and contributions will be mutually
decided upon by the residents during Block 1 Orientation. The PGY2 class will
hold regular meetings (on a schedule TBD during Block 1) to gauge progress. Facilitator
will be invited to these meetings, and will review the Wiki and discussion board
posts at least biweekly. PGY2 residents will not receive an individual “grade”
for this assignment. Each PGY2 resident will report/review their progress with
their faculty advisor at the mid-point and end-of-rotation. All centering groups
will be observed by a faculty per usual precepting standards and comments
provided to the resident at the end of the group visit. PGY2 residents will
send their centering visit notes for co-signature. Comments from the patients
about their interactions during the centering group with each provider are
already routinely solicited and will be provided to the resident for
self-reflection and improvement. In accordance with residency graduation
requirements, the PGY2 class will collaboratively present their Quality
Improvement Project at the hospital-wide research day in May.
Resources:
West, J.A. & West, M.L (2009). Using Wikis for Online Collaboration: The
Power of the Read-Write Web. San Francisco: Jossey-Bass.
Association of American Medical Colleges. “Pre-med
club lesson plans.” Retrieved from https://students-residents.aamc.org/choosing-medical-career/medical-careers/ways-explore-more/pre-med-club-lesson-plans/,
accessed on 08 April 2019.
I see a lot of application for a wiki to a Quality Improvement. I may be thinking of Quality Improvement differently, though. I understand Quality Improvement through the lens of Total Quality Management (TQM), which is to say process improvement (ASQ, 2019). I infer from the description here that the meaning in this context. When I was reading West's & West's (2009) description of wikis for Process Maps, I was thinking specifically about TQM and continuous improvement. I also see opportunity for the learners in this lesson plan to use Process Maps to identify non-value added steps, process bottlenecks, and the like. However, the Class Encyclopedia (West & West, 2009) approach you cite will also have value to patients, I believe.
ReplyDeleteIt seems there is a reasonable body of research into the use of wikis in medical education. Rasmussen, Lewis, & White (2013) give eight tips for using wikis in the context of medical education. Neve & Collett (2018) used learner wikis to retrieve qualitative evaluation data, for example. Varga-Atkins, Dangerfield, & Brigden (2010) described the use of wikis to develop professionalism in medical students. And
Best
--Les
ASQ (2019). Quality Glossary Definition: TQM. Retrieved from https://asq.org/quality-resources/total-quality-management
Neve, H. & Colette, T. (2018). Empowering students with the hidden curriculum. Clinical Teacher, 15(6), 494-499.
Rasmussen, A., Lewis, M. & White, J. (2013). The application of wiki technology in medical education. Medical Teacher, 35, 109-114. doi: 10.3109/0142159X.2012.733838
Varga-Atkins, T., Dangerfield, P. & Brigden, D. (2010) Developing professionalism through the use of wikis: A study with first-year undergraduate medical students. Medical Teacher, 32, 824-829. doi: 10.3109/01421591003686245
Les,
DeleteThank you for your comments and the references. I enjoyed looking through them. Yes, I believe we are speaking on similar terms with Quality Improvement and Total Quality Management. Our Family Medicine Residency Clinic (and Program) have assistance and systems facilitated by the hospital-wide Quality Improvement/Patient Satisfaction team. They already get assistance with process mapping and have access to systems to manage data. We generally follow Institute for Healthcare Improvement (IHI, 2019). If these resources were not already in place, I would definitely see using the Wiki to Process Map (West & West, 2009).
Alternatively, I tried envisioning using the Wiki for a different type of contextual application. Class Encyclopedia versus Service Learning Project. The residents rotate with other services (Obstetrics, Midwifery, Labor and Delivery, and do other activities in the community) and thus I see them potentially collaborating with other healthcare professionals or community-based resources to grow their Wiki to include information on these resources for their centering groups.
.
IHI (2019). Improving Health and Healthcare Worldwide. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
West, J.A. & West, M.L (2009). Using Wikis for Online Collaboration: The Power of the Read-Write Web. San Francisco: Jossey-Bass.
Wildcat,
ReplyDeleteI enjoyed reading your blog and lesson plan. I wish there had been something like that around through my pregnancies. I really see this as a collaborative knowledge construction with a contextual application. Students will be building a timeline of events (stages of pregnancy) with a resource bank. They will be creating understanding by referencing materials, online dialogue with patients, and creating an encyclopedia of information to pass down to the next PGY2 class.
I especially like that they would communicate with patients here. They will get to hone their knowledge and practice patient care in a new way, increasing their own knowledge, that of their peers, and the knowledge of the patient at the same time. I like your idea a lot. Thank you for sharing.
Vee
Vee - Thank you for your post. I would like to have a resource like this for my pregnancies too! I believe a real challenge in medical resident education is providing the freedom for them to use technology creatively. I believe that many of the PGY2 would like an online interface/dialogue with their pregnant patients, as the meaningful patient-physician relationships developed are typically very impactful and long-lasting.
DeleteWhile in many clinical situations, adding another means of patient communication would be daunting, I feel like in this collaborative group process the residents would actually see this as rewarding/worthwhile. Many PGY2 residents already spend a lot of time on providing prenatal education and communicating with their OB patients. The Wiki +discussion board technology may actually decrease time spent with the currently time-consuming processes.
Very interesting concept of incorporating wikis in a medical setting. What is even more intriguing is the idea that patients are part of the process. The resulting wiki will definitely be a treasure trove of valuable information for the residency students. I'm going to put thought into your concept and see how we could utilize for our aerospace medicine residencies that come to our institute as part of a rotation. The resident students include aerospace medicine physicians from the military services and from other countries.
ReplyDeleteGood job!!!!
OkieKCarrel - From the medical learner perspective, inheritance of an up-to-date "treasure trove" of lessons-learned and resources in residency is really a key to success. In working with different residency programs, it is interesting that often updates are being made to PDF documents that are still printed out and based down from one PGY class to the next. It seems that a Wiki with this information would be much easier to update and "pass down" to facilitate the success of the next PGY class. I am sure that having a Wiki for aeromedical residents for this use would be beneficial if it replaces the "hard copy" systems currently in place in many residencies.
DeleteHi Wildcat,
ReplyDeleteI believe your goal and purpose of using wiki are consistent. In your lesson plan, you are looking for a tool that allows members to collaborate and work together. "The aim of this lesson plan is for PGY2 residents to collaborate in the creation of a prenatal care Wiki."
I see you have two groups in your target audiences. Do you plan to introduce the wiki benefits for the users before they start using it? In addition, the Wiki development schedule is great. It includes details for each week. I have another question, are you going to work with both of them at the same time?
Best
Tariq