Instructional design - at the front lines

I attended a curriculum design dinner workshop last night hosted by the Division of Studies in Medical Education (am awake mostly because I have not had that much BUTTER on and in a meal for a long time and the system is not coping well....) It was good, but the attendance low so we did sort of a meta level chat about the processes they used in the workshop when they had a full complement of people who are designing courses present, and a lot of discussion about underpinning concepts and ideas.

This is not completely relevant to the total discussion had there (shocking? maybe not) but it made me think about two parallel methods of lecture design, having experienced both.

1) First Scenario. Get a request to teach the undergrads about, say fungal diseases. Two hours.

Process Timeline
Start: Info gathering. You are given an understanding that undergrad is "more about the basic sciences, and not so clinical.", and fungal diseases or therapeutics aren't really covered elsewhere. AAaaaaaaaaaaaaaaugh!!!!!!!!

Middle: Fresh off subspecialty fellowship exams, quickly tie together a vast wad of information, trying to "dumb down" the clinical, highlight interesting points that demonstrate big ideas, and looking up basic biology and pathophysiology to make sure you got that part right. Try to be innovative and interesting.

End: Realize they you probably need some objectives. Remembering the types of objectives you were familiar with in school probably have some drawbacks, take a brief look online for an easily findable resource on how to write objectives. Finding something that isn't medical but at least is written by a teacher, pick some verbs, and go back through the lecture, identifying what you are talking about as objectives.

Delivery: Being student centred, try to avoid apologizing for having so many slides. Give an interested, fast paced, enthusiastic tour of fungal diseases. The student try to hang on and in general like the lecture, but by afternoon don't remember anything... until the exam, when you get a flurry of queries about details on the slides.

Oh yeah,
Exam Questions: Get the request for question. Dread coming up with them. As deadline approaches, use objectives (which you now see problems with) to come up with questions. the distractors prove problematic, so change one to negative phrasing. Look for info on how to write medical MCQs but find difficulties in locating good stuff. Submit late because you are on service and it's crazy.

2) Scenario 2. Get request to do a lecture on HIV Infection. The coordinator supplies some background on students exposure to viral pathogenesis, therapeutics, and epidemiology.
Process Timeline:
Start: Dump your previous lecture, and while on a car trip think about what you really want the students- all medical personnel- to remember about HIV infection. Write objectives using a DSME supplied Objectives handout for help). Maintain the patient visit for the final part of the session because it reminds students that at the end of the day, they are responsible for people's health.
Middle: Arrange the talk by new objectives. Cut details that would change when they "get there" anyway. Leave in some clinical details (as cases) to provide a "hook" for memory. Build in interactive summary breaks. Write the exam question at the same time as the lecture-using a supplied item writing primer to remember the rules and get ideas for the stem from the templates.
Delivery: Comfortably paced, with pauses for interaction discussing and reinforcing content, global health philosophy, stigma. Tell anecdotes instead of detailed slides.

Starting with thinking about the student- what they really need as a takeaway, then writing objectives makes the trajectory so much cleaner, with strong direction and clarity of purpose....it is also easier, but is NOT the way most people do it. These scenarios are both exaggerated obviously, idealized and non. I would be interested in comments as to the idealized second approach, which is more reflective of what I am doing now (although I regress often)- as better teachers than me may have further help to suggest. Work In Progress. I also am challenged with mostly teaching nonpreclinical level, so it's a whole different set of issues.

I do think there comes a point when a light goes on for teachers in medicine, when they realize that they aren't there to bestow the whole content of their discipline, but are trying to engrave the rules of engagement, principles, and approaches in the primitive reflexes section of the brain (if I told you about my neuroanatomy lectures you'd know why neurosurg was never an option for me) . Of course, they need enough actual, factual knowledge to understand the rules of engagement and principles- a basic structure of understanding to hang the knowledge into.

As no one starts out deciding to waste several hours in prep, and bewilder 150-200 students, the question becomes one of achieving some consensus and commonality of purpose in teachers. Let's not "do unto others" as was done to us....unless it was really good. As we discussed last night- the final reassuring point is that students are smart. And good. And many can autoregulate- when they realize something is important they can acquire the knowledge. It just would be so great to get it right at the beginning and let them use that time to deepen their knowledge rather than acquire it!