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Center for the Future of the Health Professions Oct. 2021 digest

This month, The Center for the Future of the Health Professions is posting another monthly op-ed column for 2021. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce, so they can effectively plan for a sustainable future and make the best use of available resources.

This month features a discussion around the occupational therapy (OT) profession in the U.S. Despite its long history in western medicine and healthcare, it is not a well-understood profession, even among interprofessional healthcare teams. This article will discuss the profession, why it is important to the occupational health of U.S. citizens, and where it is going. The author, Jyothi Gupta, PhD, chair and professor, department of occupational therapy, A.T. Still University (ATSU) in Mesa, AZ has extensive experience in academia and higher education in occupational therapy. She has expertise in successful accreditation, curriculum development, program development, faculty mentoring, and managing complex programmatic issues. She is also the coauthor of Understanding Policy Influences on Health and Occupation Through the Use of the Life Course Health Development (LCHD) Framework in the American Journal of Occupational Therapy (2020) and coauthor of the textbook Culture and Occupation: Effectiveness for Occupational Therapy Practice, Education, and Research (2016) by AOTA press.

Occupational therapy (OT) in the U.S. celebrated its centennial in 2017. Despite its long history in western medicine and healthcare, it is not a well-understood profession, even among interprofessional healthcare teams. Many reasons may be attributed to this lack of clarity as to what OT has to offer. Perhaps the word occupation makes people think it is ‘work’ therapy, and therapists help people get employment. This is understandable since the term ‘occupation’ commonly denotes a job or a profession. The Merriam-Webster dictionary also defines occupation as an activity in which one engages. The profession’s use of the term occupation refers to how we ‘occupy’ our time; in short, everything we do in our daily lives, such as self-care, domestic life, interpersonal interactions and relationships, and major life areas such as work and education (AOTA, 2020a). Secondly, given the broad scope of practice in diverse settings, the profession’s scope is often defined by practice that pertains to a specific location. For example, in most hospital settings, practice is focused on activities of daily living (ADLs), so much so that this practice focus defines OT. Essentially, occupational therapists (OTs) assist people with injuries and disabilities to adapt and function in their environment and maintain their quality of life through participating in meaningful and purposeful activities (AOTA, 2020a).

The fundamental belief of the profession is that everyday living and the multitude of occupations we engage in across our life span influences our health and quality of life. The philosophy and outcomes of OT are well aligned with the World Health Organization’s view of health as not merely the absence of a disease but the ability to participate in life activities (WHO). Occupation is, therefore, a health determinant, and the environment determines the access and opportunities to health-promoting occupations.

The profession’s broad scope of practice encompasses physical, mental, and behavioral health concerns. OTs practice in many diverse contexts through healthcare and education are the primary settings. According to the 2019 AOTA Workforce survey, the most common primary work setting for OTs is hospitals: 46% of OTs work in urban areas, 39% work in suburban areas, and the remaining 15% work in rural areas. The most common secondary work setting is skilled nursing facilities. Pediatric OTs practice 15% in the school system and 4% in early intervention programs. Historically, OT started to provide WWII veterans with activities to ‘occupy’ their time in mental institutions. It is unfortunate that today, despite the overwhelming need, only 2% of OTs in the U.S. work mental health (AOTA, 2020b).

OT education at ATSU

The OT department at ATSU’s Mesa, Arizona, campus was the first OT program in Arizona (1995) and offered the master of science in occupational therapy degree. At present, it is the only department in the state that provides the two entry-level degree options of a master’s degree and a clinical doctorate (OTD). It is also the only doctoral program in the country with an embedded public health certificate within the OTD curriculum. This motivation is to align the curriculum with the university’s mission, the compatibility between public health and OT, and the contribution ATSU graduates can make for population health, systems changes, and advocacy. The progressive curriculum at ATSU prepares graduates for current practice and introduces them to novel systems and community contexts where OT can make a substantial impact. Some examples of systems that can benefit from OT will be discussed below. The barrier to practice in these areas is payment for services.

Primary care settings

Efforts to contain healthcare costs and improve quality of care have changed reimbursement based on fee-for-service to health outcomes and care quality. Achieving the quadruple aim of improving population health, cost, the patient experience, and provider/care-team well-being require interdisciplinary care teams with the skills and knowledge to meet the wide variety of needs in primary care settings. Unfortunately, primary care providers do not yet fully understand OT’s contributions to achieving better health outcomes and improving quality of life for all (Tshuma, Gupta, Dahl-Popolizio, and Vohra; Beyond Flexner, 2020). Promoting daily life functioning with physical, cognitive, and behavioral impairments; lifestyle wellness and prevention; end of life preparation; behavioral health interventions, and chronic disease management are just a few examples. A 2016 study by health policy researchers demonstrated that increased healthcare spending was correlated with reduced hospital readmissions post-discharge with occupational therapy interventions (Rogers, Bai, Lavin, & Anderson, 2016). OT was the only profession to show positive outcomes. OTs are a cost-effective solution to enhancing health and quality of life for people with disabilities, chronic disease conditions, or age-related decline in functioning by keeping them safe in their homes. In the U.S., annual medical costs for non-fatal fall injuries are nearly $50 billion, and $754 million is spent on fatal falls (Florence et al., 2018). There is evidence that occupational therapy interventions save money by reducing the rate and risk of falls (Gillespie et al., 2012; Haines et al., 2004). OTs at community health centers can help with health promotion, prevention, and healthy lifestyle behavioral changes for their clients. This is yet a new opportunity.

Criminal justice system

The U.S. has the highest incarceration rate, and according to the Bureau of Justice estimates, the costs are more than $80 billion annually (Sawyer & Wagner, 2020). The OT profession has been slow to delineate the role of occupational therapy within criminal justice settings (Munoz, Moreton, & Sitterly, 2016). Occupational therapy can help correctional facilities, policymakers, halfway houses by developing programs for community reintegration and rehabilitating juvenile offenders to resume life occupations that will set them on a socially approved life trajectory.

OT during COVID-19

The pandemic propelled telehealth to the forefront, and like all other health professions, OTs were required to provide virtual services. Not all services can be provided in a virtual environment, more so for the pediatric population. The apparent benefit of telehealth is that OT services can reach people in remote areas. There is evidence that telehealth can be effective for remote home visits under particular contexts (Read et al., 2020). While telehealth will continue, reimbursement for virtual OT services and consumer preference may be the deciding factors.

According to the Bureau of Labor Statistics (BLS), the profession’s future looks optimistic, which projects OT to grow by 17% from 2020-30 (BLS, 2021). Despite the projected job growth rate, the profession also faces several threats. With the rising costs of healthcare and increasing demands of accountability by consumers of healthcare, the greatest challenge for the profession is inadequate research evidence. The profession lacks the research capacity and must prioritize building the next generation of researchers.  One potential is for entry-level OTD graduates to be scholar-practitioners and perform quality assurance in their places of work to produce evidence for the effectiveness of the services they provide. A secondary challenge is the acute shortage of qualified faculty. The profession must also differentiate outcomes of graduates who are master’s prepared and those with an entry-level doctorate. Factors that may impact faculty capacity building are the high cost of OT education, lack of understanding of the entry-level versus post-professional doctorates and their outcomes, and a lack of accessible PhD programs in rehabilitation sciences or related disciplines for working professionals. This can be seen as an opportunity to develop MS-PhD or OTD-PhD bridge programs to prepare the future generation of academics and researchers.

References:

American Occupational Therapy Association. (2020a). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

American Association of Occupational therapy (2020b). 2019 workforce & salary survey.

Bureau of Labor Statistics (n.d.). Occupational Therapy Handbook. Retrieved from https://www.bls.gov/ooh/healthcare/occupational-therapists.htm

Florence, C. S, Bergen, G., Atherly, A., Burns, E. R., Stevens, J. A., & Drake, C. (2018 ) Medical Costs of Fatal and Nonfatal Falls in Older Adults. Journal of the American Geriatrics Society, 66 (4), 693-698. DOI:10.1111/jgs.15304 external icon

Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Sherrington, C., Gates, S., Clemson, L. M., & Lamb, S. E. (2012). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, http://dx.doi.org/10.1002/14651858.CD007146.pub3

Haines, T. P., Bennell, K. L., Osborne, R. H., & Hill, K. D. (2004). Effectiveness of targeted falls prevention programme in subacute hospital setting: Randomized controlled trial. British Medical Journal, 328, 1–6. http://dx.doi.org/10.1136/bmj.328.7441.676

Merriam-Webster. (n.d.). Occupation. In Merriam-Webster.com dictionary. Retrieved September 23, 2021, from https://www.merriam-webster.com/dictionary/occupation

Muñoz, J. P, Moreton, E. M,  Sitterly, A. M (2016). The Scope of Practice of Occupational Therapy in US Criminal Justice Settings. Occup Ther Int, 23(3):241-54.

Read, J., Jones, N., Fegan, C., Cudd P., Simpson, E., Mazumdar, S.,  Fabi, & Ciravegna, F. (2020). Remote Home Visit: Exploring the feasibility, acceptability, and potential benefits of using digital technology to undertake occupational therapy home assessments. British Journal of Occupational Therapy, 83(10) 648–658.

Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2017). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 74(6), 668-686.

Sawyer, W., & Wagner, P. (2020). Mass incarceration: The whole pie. Retrieved from https://www.prisonpolicy.org/reports/pie2020.html

Tshuma, L., Gupta, J., S., Dahl-Popolizio, and Vohra,R. (2020). Better together: Occupational therapy on integrative behavioral health teams. Presented at Beyond Flexner, Virtual conference.

World Health Organization. (2006). Constitution of the World Health Organization (45th ed.). Retrieved from https://www.who.int/governance/eb/who_constitution_en.pdf

We have two new LibGuides to announce, both created by Laura Lipke, medical librarian liaison to A.T. Still University’s Kirksville College of Osteopathic Medicine (ATSU-KCOM).

DNP: Search for Evidence

ATSUKCOM Information Literacy Tutorial


Don’t forget your liaison librarians are here to help you with anything you see on our LibGuides, with your research projects, and using library resources. You can find ways to connect with them below.

Hal Bright, MLS, AHIP

University library director | ATSU-ASDOH, CPA, ATSU-MOSDOH liaison librarian

Samantha Maley, MLIS

Web & communications librarian | PA & AT liaison librarian

Adrienne Brodie, MLS

Liaison librarian for ATSU-ASHS & ATSU-SOMA

Medical librarian liaison to ATSU-KCOM

Laura Lipke MS, MLIS, AHIP

Over the past few months we have enjoyed a successful rollout of the Accruent EMS room booking software on the Mesa, Arizona campus. We’re greatly appreciative of all the positive feedback by those who are quickly becoming experts with this new system!

You can find a tutorial video, a how-to guide, FAQs, and any updates to EMS on our Request a room through EMS guide. 

Begin booking with EMS by simply logging into the ATSU Portal and searching for ‘EMS.’ Through EMS you also have the ability to search events by date, by location, by event type, or even by person. 

EMS tip #1

We’d like to offer a more efficient way to group bookings under the same reservation when your dates needed don’t follow a typical pattern (daily, weekly, monthly on the same date, etc.). This will save you a lot of time by not having to fill out the reservation information over and over again, and will make it easier to find all your bookings in the future in case you need to make more edits. 

  1. Create a reservation for your recurring event, starting with the first date you need a booking for. 
  2. Once you have created and submitted this reservation request, enter the Edit Reservation page.
    1. This can be found by clicking on the reservation under My Events.
  3. Scroll down to the bottom of the page to Bookings and select New Booking on the left side of the page.
  4. Now you may add another booking to the reservation without having to choose a date pattern. 
    1. Once you have entered your new booking information and selected a room, add the booking. EMS approvers will receive notification that a new booking has been added and needs approval.
  5. Repeat this process as many times as you need to create new bookings for one reservation. 

We hope this helps with the management of your future reservations! 

I wanted to say how great it is to see everyone’s face again in person as I meet and greet you in the hallways. The library staff in Missouri and Arizona are all expressing the same sentiment. It is wonderful to see students studying and hanging out in our facilities. The new furniture in Arizona is very popular and well used. The study rooms on both campuses are full almost all the time. It is great to see normality returning to campus.

One thing I wanted to mention, both the Missouri and Arizona campuses have anatomical models for student use. The Missouri campus models are located on the main floor of the library and up against the computer lab wall to the right (south). The Arizona models are available upon request and available during staffed hours Monday-Friday, 8:00 a.m.-5:00 p.m. We are working on a permanent place for them to live.

Orientations and introductory library instruction sessions have gone very well. I encourage you to book your librarian for every first year class as soon as possible so students are comfortable navigating PubMed, Still OneSearch and finding eBooks/textbooks on the library web site. Students have commented that these sessions have been incredibly helpful and we are hearing from 2nd year students they wish they had them in the beginning of their first year as well. We also offer clinical library resource sessions for students entering their clinical experiences.

As always, reach out to me with any suggestions.

Hal Bright, MLS, AHIP

University Library Director

The future of physician assistants is in the training

This month, The Center for the Future of the Health Professions is posting another monthly op-ed column for 2021. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce, so they can effectively plan for a sustainable future and make the best use of available resources.

This month features a discussion around the future of the education of physician assistants (PAs), particularly as it relates to recruiting, training, and placing PA students & graduates in our nation’s rural and underserved communities by Kim Devore, MS, PA-C, assistant professor; Michelle DiBaise, DHSc, PA-C, department chair & professor; and Tessa M. Tibben, DHSc, PA-C, assistant professor, Department of Physician Assistant Studies at A.T. Still University’s Arizona School of Health Sciences (ATSU-ASHS).

Twenty percent of Americans live in rural areas of the United States.1 These individuals tend to be older, with more significant health comorbidities, are mostly underinsured or uninsured, and are poorer than their urban counterparts.2,3 A rural health care crisis has emerged mainly based on lack of availability and accessibility; however, affordability, accommodation, and acceptability are also influential in this crisis.4 A 2018 Health Resources and Services Administration (HRSA) report revealed a health professional shortage of 66% for primary care and 62% for mental health services in rural or partially rural areas of America.3

Presently, 10% of physicians and 3.2% of physician assistants practice in rural areas.1, 5 This urban/rural gap is projected to widen by 23% by the year 2030, secondary to rural physicians aging into retirement and the reduced number of younger physicians replacing them within these communities.3 In line with this trend, one in five clinically practicing PAs are nearing retirement in the next decade.2

Alleviating the rural health care access crisis requires expansion of efforts beyond just physician recruitment to include recruitment of PAs. In 2019, the U.S. Bureau of Labor Statistics reported the number of PA jobs nationwide at 125,500 and a growth outlook of 31% between 2019-29.6 Moreover, PA programs provide a high-quality generalist medical education, priming the PA to practice patient-centered, collaborative primary care. Unfortunately, only 14.2% of all PAs practice family medicine, while 33% of PAs in rural communities practice family medicine.5 Most state legislation currently requires PAs to practice within their supervising physician’s scope of practice, further restricting how and where a PA can practice.7 Despite this, the increasing number of newly trained generalist PAs suggests that the PA workforce is well-positioned to help meet rural America’s growing primary care needs.2  

ATSU-ASHS’s Department of Physician Assistant Studies has a mission to recruit and train individuals from rural and underserved communities with the intent to increase access. The key to ATSU-ASHS’s PA program’s success in meeting its mission begins years in advance of the admissions process. Its partnership with over a dozen community health centers (CHCs) enables community leaders from rural, underserved communities to identify future PAs they believe have a heart for community health care. The ATSU Hometown Scholars program is designed to grant an automatic admission interview for any CHC-endorsed applicant who meets the minimum admissions requirements. Once selected to join the program, the student completes their didactic training at ATSU-ASHS in Mesa, Arizona, and returns to the endorsing CHC for 12 months of clinical training. Hometown Scholars has graduated 28 PAs in just the past six years, who now practice in their hometown, improving access to medical care. There are currently 17 more in the program.

Hometown Scholars is just one pre-admission strategy to meet ATSU-ASHS’s PA mission. Pipeline to Practice (P2P) is funded through a HRSA grant that partners with local undergraduate universities near ATSU-ASHS’s PA program CHC partners, recruiting future PAs with a heart to serve their local community. Like Hometown Scholars, P2P is designed to grant an automatic admission interview for any partner institution-endorsed applicant who meets the minimum admissions requirements. Moreover, like Hometown Scholars, the P2P student completes their didactic training at ATSU-ASHS in Mesa, Arizona, and returns to a CHC close to their endorsing institution for 12 months of clinical training.  ATSU-ASHS’s PA program faculty connect with these prospective students through presentations delivered during site visits to the region. Interested P2P candidates are associated with the local CHC to shadow PAs and other providers to learn more about healthcare careers. Often, these interactions lead to a Hometown Scholars endorsement.

The admissions process is another critical ingredient to ATSU-ASHS’s PA program’s success. Utilizing a rigorous multiple mini interview (MMI) process, students meet with several faculty, staff, and alumni across nine different interview stations. Topics discussed relate to underserved communities, social determinants of health, and PA practice ethics, allowing candidates to express their commitment to becoming a mission-match PA. Once accepted into the program, ATSU-ASHS’s PA program offers scholarships of up to $30,000 per year funded through a HRSA grant for economically or environmentally disadvantaged students. Students who otherwise would carry a lifetime of burdensome student debt are enabled to change the trajectory of their future and their community.

Once matriculated, PA students have several opportunities to work with underserved populations. Didactic clinical experiences during the first year include school physicals and COVID immunization clinics at Title I schools, intake interviews at substance abuse treatment facilities, health screenings at community outreach events, pre-and post-operative care at Mission of Mercy, and shadowing at urban area hospital emergency rooms. Students complete a minimum of eight experiences, but many will volunteer as often as possible. The experience in rural and underserved communities continues into the clinical year. Nearly two-thirds of the ATSU-ASHS’s PA program students complete their clinical training at a CHC campus. However, even the students who do traditional six-week rotations in the Phoenix area will be placed on rotations in rural or underserved locations.

ATSU-ASHS’s PA program is committed to recruiting, training, and placing graduates in our nation’s rural and underserved communities, working with the National Association of Community Health Centers. To date, the collaborative mission-focused efforts of the PA program have been very successful in meeting the needs of underserved communities. The program will continue to build recruitment funnels through Hometown Scholars and anticipates expanding success with the addition of the P2P program. However, barriers still exist in training and retaining graduates in rural areas. With the shortage of available providers board-certified in the specialty required for the rotation (i.e., board-certified pediatricians for pediatric rotations), ATSU-ASHS’s PA program does not have enough CHC partners to train all students in a single site for the entire clinical experience. Future solutions include improving state legislation to untether the PA from a specific physician and allowing the PA to practice at the top of their education, experience, and training. Additional innovations expanding the PA role include allowed eligibility for direct payment from public and private insurers and for all states and territories of the U.S. to create separate majority PA boards to regulate PAs. And although there is much work to be done, ATSU-ASHS’s PA program is moving the dial in the right direction.

References

1.         Nielsen, M, D’Agostino, D, Gregory, P. Addressing rural health challenges head on. Mo Med.

2017;114(5):363-366. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140198/

2.         American Academy of Physician Assistants. PAs in Rural locations ready to meet primary care needs. Published June 12, 2018. Accessed July 13, 2021. https://www.aapa.org/news-    central/2018/06/pas-rural-locations-ready-meet-primary-needs/

3.         Skinner, BA, Douglas, SO, Auerbach, DI, Buerhaus, PI. Implications of an aging rural physician workforce. N Engl J Med. 2019;38(4):299-301. DOI: 10.1056/NEJMp1900808

4.         Jolly, LE. Healthcare access barriers in rural America. Kentucky Journal of Undergraduate             Scholarship. 2019;3(1):1-21. Accessed July 13, 2021.

https://encompass.eku.edu/kjus/vol3/iss1/8/

5.         American Academy of Physician Assistants. 2021 AAPA salary report: Summary of national findings. Published May 2020. Accessed July 15, 2021. https://www.aapa.org/shop/salary-

report/summary-of-national-findings/

6.         U.S. Department of Labor, Bureau of Labor Statistics.  Physician assistants.Occupational Outlook

Handbook. Accessed July 6, 2021. https://www.bls.gov/ooh/healthcare/physician-

assistants.htm

7.         American Academy of Physician Assistants. State laws and regulations. Published 2021.

Accessed August 6, 2021. https://www.aapa.org/advocacy-central/state-advocacy/state-laws-

and-regulations/

The library is pleased to announce a new software for our Ficus Tech Room in Arizona, SPSS Statistics 27. The
IBM® SPSS® software platform offers advanced statistical analysis, a vast library of machine learning
algorithms, text analysis, open source extensibility, integration with big data and seamless deployment
into applications.

In addition to SPSS, Ficus also has three other specialized technologies for faculty, staff, and students to
use. Two technologies involve 3D printing, a 3D scanner, and OsiriX. The third technology is a self-
editing station. Our 3D scanner is using the software NextEngine. This software allows you to scan,
align, polish, and fuse 3D models. These 3D files can then be printed with the library’s 3D printer.

OsiriX is a software to view images produced by radiology equipment, such as MRI, CT, and ultrasounds. 
Its key features are displaying, reviewing, interpreting, and post-processing the images. Images can be
turned into 3D files and printed by the library’s 3D printer.

The self-editing station allows you to edit videos using Camtasia. Camtasia is a simple-to-use screen
recorder and video editor.

All room use needs to be reserved and approved by library staff ahead of time. Library staff will not be
experts in using the technologies, but can provide basic starting steps or tutorials for people to review. 
We recommend people review the tutorials before requesting Ficus. Ficus use should be limited to
using the software or computers for a specific project requiring the technology. Learning and tutorial
review should be completed on a personal device.


Learn more on the Ficus Tech Room LibGuide.

by Adrienne Brodie, MLS, liaison librarian for ATSU-ASHS & ATSU-SOMA

Interested in joining the podcast craze? The TLC has put together a curated list of healthcare education podcasts that discuss creative and practical tips to improve teaching practices and learning outcomes. For instance, Lomayesva et al. (2020) recently published an article which describes the role of podcasts in healthcare education as well as five in-depth recommendations from Yale School of Nursing and Yale School of Medicine for students and faculty.

Or are you already into the podcast trend and do you have a favorite educational podcast that we have not referenced? If so, please send your recommendations to tlc@atsu.edu.

Rubrics are beneficial for both students and educators. While using rubrics helps with assigning grades, the evaluation criteria also help students understand what is expected of them. However, as we explored in the TLC 2021 Spring Seminar Series: “Building Community in Your Classes,” educators may not be fully aware of their own assumptions or biases about their expectations for students’ performance. As a tool, rubrics can be used to promote equity and objectivity by clearly articulating expectations for student performance in a transparent way that is beneficial to all learners, especially students of color, first-generation students, and students who are English-language learners.

In the book chapter, “Beyond Fairness and Consistency in Grading: The Role of Rubrics in Higher Education,” Kiruthika Ragupathi and Dr. Adrian Lee review this topic and share best practices for creating and using rubrics.

Here are some other links to learn how to incorporate rubrics and align learning outcomes to rubrics within Canvas.

This month, The Center for the Future of the Health Professions will be posting another monthly op-ed column for 2021. Our columns represent strong, informed, and focused opinions on issues that affect the future of the health professions. As mentioned in the past, the center was developed to provide state, local, and national policymakers and health system stakeholders with accurate, reliable, and comprehensive data and research about the healthcare workforce, so they can effectively plan for a sustainable future and make the best use of available resources.

This month features a discussion surrounding the traditional classroom lectures for health professions students and the role of faculty, titled “Confessions of a recovering sage-on-the-stage performer” by Norman Gevitz, PhD, professor of history and sociology of health professions and senior vice president-academic affairs at A.T. Still University (ATSU).

If classrooms were judged on the basis of a Broadway show, and only 20% of the seats were filled for each and every presentation, the actors would be fired and the show would close. And yet, unless classroom attendance is mandatory, the lecture halls of health science universities are largely empty. Many students believe there is nothing to be gained by getting up from bed, their couch, or a desk chair to attend a 50-minute or longer live performance. If the lecture is recorded they can play it at warp speed, getting the gist of what’s being said, with little concern about what they might be otherwise missing.

The thing about lecture performances is that they are usually an extended soliloquy of something that is replicated more fully in a textbook. And unless the relevant textbook pages are written in a confusing way, the textbook alone can suffice for understanding the material. And especially now when the Internet offers a host of resources to answer any basic science or clinically-related question, the lecture—the hallmark of medieval learning—would seem to be irrelevant—but it’s not—and not to the credit of this form of content delivery.

Then what is the purpose of the lecture to faculty members and students? For faculty members, lecturing is the traditional means by which they can convey their erudition, the fruit of their years in graduate school and beyond. For those of us (myself included), it is also an opportunity to be on a stage, to have the eyes of the audience fixed upon you where one not only can educate—but frankly entertain. Faculty know students constitute a fickle audience whose criteria for giving their professors positive reviews may not accurately reflect students’ mastery of the material. And too often, faculty will adjust their sights and tailor their presentations to expressed student needs which is not necessarily learning, per se.  

In more than three decades in the classroom, some of the questions I’m most often asked (whether during a lecture, right after the class is over, or during office hours) are “what subjects will the test cover?” or “is this a question on the exam?” From the standpoint of a student, these are natural questions to ask. What these questions reflect is the large amount of content in your particular class or all classes they are currently taking, which often dwarfs what they were responsible for as undergraduates. To many students the volume of material and the expectations seem overwhelming. For these anxiety-ridden students, they yearn for the means to lessen the burdens of study, and are most happy to reward those faculty with glowing reviews who provide guidance or short cuts for them to do well on exams.

In a course syllabus, the student is usually provided a number of pages in a textbook to read, digest, and master during the period before the exam. The student has to create a prioritization list whereby she/he has to determine what topics “seem” more vital than others and to apportion to the various topics what limited time they have on the basis of their apparent importance. The lecture, and most particularly, the incorporated PowerPoint presentation, is one potential aid to students, for it is widely perceived as the instructor’s own perception of the relative importance of the subjects covered in the text. And indeed, students reward those professors with good reviews who are known to restrict their test questions to the PowerPoint or what they otherwise cover in the lecture while eschewing questions found solely in the textbook, making the latter source all but irrelevant. In my earlier teaching and assessment experience, I tried basing approximately one out of every four or five multiple-choice questions on the textbook rather than on the PowerPoint or lecture, as these textbook-based questions reflected stated learning objectives provided to the students. Not surprisingly, I found students as a whole did not generally do as well on these textbook-based questions and some of those students did not hide their dissatisfaction with my question choices in their end-of-course reviews of my teaching.

Over time, I grew increasingly dissatisfied with the lecture as my primary teaching tool. In looking at my exam results, particularly my essay question responses, I found a high percentage of students did not satisfactorily understand the material. Too many just barely passed. Are they really learning, or just regurgitating what I was presenting in the PowerPoint or in my lecture? Overall, I received good reviews for my “theatrics”—words like “engaging,” “humorous,” “doesn’t put you to sleep,”—but where early in my career I loved these reviews, now they were bothering me. Maybe I was good as an entertainer, maybe students were showing up, but were they actually leaning as much as I hoped. Part of the problem of being an entertainer-teacher is that while you may be getting them to show up or keeping them awake, students are not focusing on or thinking deeply about the content of the subject matter. Most importantly, my presentations were still a form of “passive” learning. They were sitting in their seats, focused on being “entertained,” expecting me to tell them all they needed to know. Laughter at my asides may have been one form of audience interaction but it is definitely not interactive learning nor is it active student learning.    

My self-questioning occurred in the years following my arrival at the Ohio University College of Osteopathic Medicine. There, the dean, not satisfied with the outcomes of a systems-based curriculum, charged the curricular dean and the faculty with coming up with a new curricular model. In fact, they devised two new curricula—one centered on a problems-based model pioneered by the Southern Illinois University College of Medicine and the second, a clinical presentation model pioneered by the University Of Calgary Faculty of Medicine. The “problem-based model” eliminated all lectures (unless requested by students on given topics) and the Calgary model reduced the number of lectures somewhat. Both models were focused on small-group learning sessions on given clinical presentations. In the problem-based model, the students devised their own learning objectives, in the Calgary model, the faculty provided the learning objectives. In addition to doing my usual lecturing in the Calgary-based curriculum, I was a faculty facilitator in both curricula.

At first, I wondered what my role was as a faculty member in facilitation. We were taught not to be content experts but rather facilitate group discussion making sure that all of the students were prepared and contributed to the analysis of the case. We were to intrude in the discussion only when it veered off course. Initially, I was demoralized because of my diminished role. But then it finally dawned on me. The students were all engaged, and were actively learning which was what I wanted to achieve as a professor. And it appeared to me that our students were obtaining better assessment outcomes. While I moved things along on occasion, I began to feel privileged at simply being a witness to students’ own progressive mastery of material.

Nonetheless, I decided to innovate. In both the problem-based and clinical presentation facilitations, when the students were finished with a case having completed all the learning objectives, having analyzed all the test results and imaging, and satisfied with the diagnosis they made, I added another element. I challenged the students, with me playing a patient with the agreed-upon diagnosis, and asked a student volunteer to explain to me, what I suffered from and how she/he was going to manage my condition. The first time I did this, the student, a little flustered, responded to my question “what’s the matter with me, doc?” by immediately saying “well, the good news is you are not going to die from this.” Our group erupted in laughter. Obviously, it was one thing to be analytical in the investigation and quite another skill, in relating clear information in an appropriate way to patients.

My second innovation was to transform the lectures I gave, which I started doing at Ohio but more regularly when I joined the faculty at the New York College of Osteopathic Medicine which had a problem-based curriculum and a systems-based curriculum, the latter curricula consisting of lectures only. In my 50-minute sessions, I “lectured” for five or ten minutes tops and then provided the students with a multi-layered problem, broken up into discrete parts. I allowed the students to discuss the problem in ad-hoc small groups, and after several minutes randomly pointed at a group to give me an answer. Since the question I devised had many possible answers, I went around the lecture hall, microphone in hand to get the answers from several groups, often questioning them why they selected that particular answer. Then I would ask the collective whole another question, and students would again break into their ad-hoc groups, and the process again would play out. Not only were students engaged by this but I found with each succeeding presentation more students came to class. I wasn’t getting 20% of the class, I was getting 75% of the class as the word spread. More tellingly, the assessment outcomes, as measured by the quality of their responses on scenario-based clinically-oriented multiple choice questions, improved significantly!

When each of these interactive class sessions were over, I witnessed the puzzled expressions of faculty members who were scheduled to present after I was finished who never saw so many students in the lecture hall and their visible disappointment that so many of these students were now on their way out the doors. Certainly, not all students liked what I was doing. In an end-of-block set of teaching evaluations, one student acidly remarked “I certainly believe Dr. Gevitz is the laziest professor in the medical school. All he does is give us problems which we are left to figure out. I’m sorry, but I’m paying hefty tuition dollars so professors can teach me exactly what I need to know.” Clearly, some students presented with opportunities for active engagement just want to be passive learners—but my experience is that if given the opportunity to participate (with others) in their own learning, most students will choose to do so. As faculty, I believe we need to ensure that our students have more of these types of active learning experiences.  

Have you initiated innovative learning activities you wish to share? Please consider submitting an essay to us for publication.       

After several backend linking updates, it’s now possible for remote users to add the library to their Google Scholar settings. For best results, we recommend using Chrome browsers on laptops and desktop computers while current students, faculty, and staff are signed in to the ATSU Portal. Want to try jumping right in to searching?  Try the linked options below or visit our new Google Scholar & ATSU guide for complete steps, links, and troubleshooting tips to get Google Scholar results connected to our ATSU Library resources.

Quick access test: Google Scholar search link with institutional ID

FAQs

Who should these links work for?”

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What about preceptors and alumni?”

  • These groups have access to different resources, but we don’t expect these link options to function for preceptors and alumni yet. Further investigation and testing is on-going. There’s a poll on the linked guide where you can indicate your feedback on this issue by voting anonymously about this topic.

Still have questions? Please visit the Google Scholar & ATSU guide for more information!

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