Monday, September 14, 2015

This game is frequently used in medical education settings to poor effect.

What is "Jeopardy!"?

Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation.

Not that I don't think games can have an important role in education - far from it. Heck, I once worked on a presentation that turned our residency conference room into a giant Game of Life board with the residents as life-sized game pieces. It seems to me, though, that most of the time teachers insert games into their presentations just to do it ("They're games! They're fun!") and not after careful thought about using games as an instructional strategy to further their educational goals. Because, at the end of the day, that's what games should be when we use them to teach - a deliberately chosen instructional activity designed to reinforce knowledge and/or skills.

When we did that Game of Life board, for example, it was part of a longitudinal series we created as faculty development fellows on "The New Health Care System."* In preceding sessions, we had taught the residents about different types of practice models, staffing ratios, and even the debate about whether to invest in an electronic health record.** For the game session, the residents had to make a series of decisions about how they wanted to build their "practice," all the while encountering occasional calamities and successes, just like in the original Game of Life.

We used our modified Game of Life to reinforce previously taught concepts; participants had the opportunity to practice knowledge and skills that they had already received. Most of the time, this sequence - first provide new knowledge, then reinforce new knowledge - is the right way to structure interactive presentations. Provide your audience with new knowledge and/or skills, and then let them practice.

The problem with Jeopardy!, most of the time, is that the audience is not provided with the relevant knowledge being tested beforehand. I would have no quibble with PowerPoint Jeopardy! presentations if they followed other presentations providing the knowledge to be reinforced first, but usually that's not what happens. My observations are that medical teachers, instead, use Jeopardy! as a tool to teach new knowledge. I've been told that "the residents can learn from each other when they're wrong" and this game will "reinforce what they already know." Unfortunately, most learners will not learn effectively in this environment.


1. Most people learn best in low-stress, emotionally safe environments. One emotionally unsafe example is "pimping;" most personality types experience a high level of anxiety related to the potential embarrassment of answering "pimp" questions incorrectly. Medical Jeopardy! presents the same risk; while a few residents and students will thrive in this competitive environment, most will internally cringe at the risk of revealing their perceived ignorance. Anxious, uncomfortable individuals do not retain new knowledge as well as calm individuals.

2. Jeopardy! often involves a vast amount of information that may be only loosely related. Most learners will only walk away from an educational session remembering 3-4 key concepts. A typical Jeopardy! board has 30 squares on it; multiply this by 2 if you've also got "Double Jeopardy!" - and remembering 60 facts after any presentation seems unlikely to me.

3. Most of the time I see Jeopardy! played in teams; that is, with 3-6 residents on a team competing against each other. Having observed several of these sessions over the years, very few audience members get actively engaged in these sessions. It's easy for more anxious, less experienced, and/or more introverted residents and students to take a silent role, and observing instead of participating decreases the educational yield even more.

If the goal of the presentation is to teach (and not just "have fun!"), then games should reinforce new knowledge, not provide it for the first time. Every instructional strategy should intentionally reflect the educational goals of the presentation, and the level of problem-solving inherent in the game should align with the presentation's objectives. The Game of Life, which involves a lot of application and analysis, made sense for teaching about decision-making in new models of office practice. Jeopardy!, which is fundamentally a game of information recall, would work better to reinforce basic knowledge such as antibiotic coverage or musculoskeletal anatomy.

But the key word in that last sentence is "reinforce" - using Jeopardy! to introduce new concepts is a flawed approach that will leave most learners uncomfortable, overwhelmed, and unengaged.

* These concepts preceded the Patient-Centered Medical Home model, so I am definitely dating myself here.
** Again, dating myself. *sigh*

Saturday, April 18, 2015

How can social media help Family Medicine?

This post originally appeared on the AFP Community Blog.

I was thumbing through an issue of Family Medicine (the Society of Teachers of Family Medicine's journal) when I came across "Twitter Use at a Family Medicine Conference: analyzing #STFM13." I knew that this article was on its way; its lead author, Dr. Ranit Mishori, had contacted me to ask for some of my thoughts about using Twitter at conferences several months ago.

The study authors examined every tweet with the #STFM13 hashtag related to the 2013 Annual STFM conference from 3 days prior to the conference, during the conference, and for 3 days after the conference. They found that nearly 70% of the tweets were directly related to session content, about 14% were more social, and the remainder related to logistics and advertising. They also grouped the top reasons attendees gave for tweeting into four categories: information sharing, networking and connectedness, advocacy, and note taking.

Several of my comments made their way into the article about why I tweet at conferences. Tweeting allows me to simultaneously take notes and share interesting facts with the Twitter-verse. It's easy to read through my tweets when I get home and review what I learned along with the action steps I need to take. I also enjoy the dialogue and camaraderie that happens during the conference on Twitter; it's great to respond to other people's comments and factoids as well as see their responses to mine. By enabling supportive, meaningful dialogue among conference attendees, Twitter helps us to engage more deeply with the conference content.

Upon reading the article, I saw my Twitter handle (@SingingPenDrJen) named as the top tweeter for the conference. I was both a little proud and a little dismayed; it's nice to be an "influencer," but maybe I'm tweeting too much? Outside of what the article terms "social" tweets (which are not the majority of my tweets), I try to only tweet session content that is new, insightful, and/or practice changing. I'll definitely be more mindful of what I tweet at the next conference I attend.

Only a small percentage of STFM 2013 conference attendees were on Twitter; just 13% of conference attendees tweeted at least once, and over half of the total number of tweets were sent by 10 people. Many of the people sitting next to me in conference sessions asked me about tweeting and why I do it. When I offered to assist them with getting on Twitter, most politely declined, usually with comments about "I don't have the time" and the how intimidating new technology is ("I can't even figure out my EHR!" one person said).

I'd love to see more family docs on Twitter and other social media sites, but I'm not sure how realistic that is. From 2012 to 2013, the number of tweeters at the STFM conference didn't budge much. The diffusion of innovations theory postulates that a critical mass of early adopters have to embrace a change before the majority will follow suit; are we still waiting for that critical mass, or will this particular theory end up not applying to family docs and Twitter, with a significant number of docs not ever using it?

Spreading the word about the positives of an online presence may be a step in the right direction. A recent article in Family Practice Management reviews several social media platforms and discusses benefits of having a robust online presence. The article describes using social media to provide office updates and patient education. Perhaps equally valuable is proactively managing your online presence, so that patients see more than just third-party website patient reviews of you when they put your name into a search engine. At the end of the article is a list of simple, practical starting points for getting online in ways that benefit both patients and docs.

I hope to see more articles exploring how we as family docs connect and communicate online. Keep the replies, retweets, and Facebook posts coming!

Thursday, April 16, 2015

Not like other doctors

I've now been in my new position for about 8 months. (When does "new" no longer apply?) The toughest part of moving for me is having to build new relationships with patients, and over the past few weeks I'm finally looking at my daily schedules and recognizing some names.

I think my patients are starting to feel that sense of comfort as well, and several of them have made a similar comment to me. The context always seems complimentary:

"You're not like any doctor I've ever known!"

One patient followed this comment by saying, "If you weren't wearing a white coat, I'd never guess you were a doctor."

I graduated from medical school in 2003, yet I've never heard these comments before, not until this most recent move. Is there something different about the physicians in this area whom I'm being compared to? Have I changed, somehow, in ways I haven't recognized?

I have gotten a lot more comfortable in my own skin as a doc. I still rely on my doctor-patient communication training to make sure the visit stays focused on the patient's needs, but I worry less about "sounding like a doctor." I feel free to inject some of myself into these interactions, which feels much more comfortable than earlier in my career; I was guilty of imitating how I felt a "good" doctor would act instead of being genuine with patients.

While I appreciate the implied compliments, part of me worries about these "not like other doctors" statements. Perhaps I don't look professional enough, or act professionally enough. Maybe I'm putting too much of my personality into these encounters. Maybe my patient interactions cross that invisible doctor-patient boundary line of appropriateness. Is there some inherent "doctor"quality that I am lacking?

And, if so, how do I figure out what it is?