Patricia Hudes, M.S.I.T., Faculty Development Director, has supported several of our faculty in incorporating the Audience Response System (ARS) to lectures, small groups, Team-Based Learning, and review sessions.

The Audience Response System (ARS), also known as "clickers", is a wireless technology that allows students to anonymously respond to a question posed by the teacher during a learning session. A summary of the responses is immediately displayed, providing feedback to both the teacher and students on the level of understanding. The literature on ARS discusses its advantages, including active learning, feedback, increasing attention span and motivation. ARS has a variety of potential uses including content review, embedded practice, pre- and post-tests, quizzes, and team/group work exercises.

The Vanderbilt Center for Teaching, Nashville, TN, has created a website with extensive and comprehensive information on Audience Response Systems, which they call "Classroom Response Systems (CRSs)."

On this page, you will find an excellent CRS Teaching Guide, including:

• What Is a CRS?
• Videos
• Terminology
• Types of Questions
• Types of Activities
• Examples
• Why Use a CRS?
• Challenges in Using a CRS

On this page, you will find "a bibliography of articles on classroom response systems (CRSs). Most of the articles present some form of research on the effectiveness or impact of CRSs on student learning. The first group of articles are not discipline-specific; the later articles are grouped by discipline."

If you only have time to read one article, related to medical education utilizing the Audience Response System, we recommend the following:
Clickers: the Use of Audience Response Questions to Enliven Lectures and Stimulate Teamwork (PDF file), Frazier Stevenson, M.D., University of California Davis School of Medicine. JIAMSE, IAMSE 2007 Volume 17 2 106.
Abstract: "Health science educators are under increasing pressure to reduce traditional lecture time and build more interactive teaching into curricula. While small group exercises such as problem based learning achieve that aim, they are highly faculty intensive and difficult to sustain for many faculties. The commercial availability of easy to use audience response systems (ARS) provides a platform for increasing instructor interaction and engagement with learners. This article details my recent experience with ARS, and suggests its uses to increase lecture interactivity, build student teamwork, provide formative feedback, and energize both faculty and students."

Clickers on NPR
Every Monday, All Things Considered (a program on NPR) has been airing its new series called All Tech Considered to explore the sometimes daunting-always changing-world of technology. On March 2, 2009, they did a segment called "In Search of Answers, Teachers Turn to Clickers." Read or listen to the story online.

"Audience Response System: Making Your Teaching More Interactive" Wednesday, August 5, 2009--12:15-2:30 p.m. White Hall, Boonshoft School of Medicine, WSU View more information and register.

Adding ARS questions to a PowerPoint is as easy as inserting a new slide! At the BSOM we use TurningPoint technology; you can download their software for free:

TurningPoint website

Arthur Pickoff, M.D., Pediatrics and Community Health, developed a capstone integrated clinical session for the Renal course that has been a big hit with our second year students. The three-hour session is conducted in a highly interactive manner, within the setting of the main lecture hall. Students are asked to volunteer (sometimes they are called on) and asked to discuss the various clinical and laboratory findings presented in the case, and are encouraged to try their best to come up with a differential diagnosis, and to interpret the laboratory data. They then generate a problem list and discuss likely diagnoses. The students are allowed and encouraged to "consult" with fellow students to answer the posed questions and thus learn that turning to peers for help in solving a clinical problem is both "OK" and encouraged. The students gain confidence in their ability to work through a real clinical problem and the integrated session reinforces concepts taught during the Renal course.

Video of a Session -- (QuickTime file)

To view this movie, download free QuickTime Player.

Login information:
Username: faculty
Password: whitehall08

Paul Koles, M.D., Pathology Education, presents clinical-pathologic exercises for diagnosis on the Year 2 website. Three cases are posted each month, December through May. Students study these cases and try to solve the differential diagnosis, using any references they find useful. The cases are designed to develop clinical reasoning skills while reinforcing concepts of disease pathogenesis, morphologic pathology, interpretation of imaging studies and laboratory data, and correlating the history and physical with diagnostic data. Student participation is optional and varies, historically 10-20% of the second-year class submit diagnoses. Books are awarded at the end of the year for the 3-5 students who diagnose the most cases correctly.

Case of the Month for December, 2008 (PPT file)

WSU Center for Teaching and Learning offers Elluminate, a web conferencing system made for higher education. This tool enables faculty to narrate a PowerPoint presentation online live and permits students to participate in the session with two-way audio, text messaging, a shared whiteboard, polling and more. This can also be an effective tool for live meetings and discussions whenever participants are not able to be in the same location.

• Center for Teaching and Learning: Getting Started Using Elluminate
• Elluminate live training
• Elluminate website
• Evidence-Based Resources for Design and Development of Classroom and E-learning Training, by Ruth Clark, Ph.D.

Michael Markus, M.D., Internal Medicine, developed Megamix, a web-based tool that allows students to practice integrative skills and diagnostic thinking during the Year 2 Respiratory Course. Megamix is based on clinical application of the basic science (pathology, physiology, pharmacology and microbiology) curriculum. Three clinical scenarios are presented, and the student is guided to check specific areas of history, physical examination, and laboratory or other investigative studies. After the information is gathered to the student's satisfaction, a question posing several different courses of action is asked. All cases involve a minimum of thirty options and clinical decisions. Each choice has consequences in further treatment, diagnosis, and the eventual recovery or worsening of the patient.

Michael Markus, M.D., Internal Medicine, implemented Muddy Waters, a web-based tool that allows students to anonymously address questions to faculty. It is based on the "Muddiest Point" assessment technique, in which students identify the least clear concept in a lecture. Muddy Waters is used as a tool to:

1. provide an anonymous forum in order to encourage questions,
2. provide access to faculty outside of the classroom, and
3. clarify content and identify weak spots in the curriculum

Muddy Waters is an online link on the years one and two courses websites. Currently, five courses provide the Muddy Waters link. This is how it works:

• Students click on the link and anonymously submitted their questions.
• Questions are relayed to the course director who answers or forwards them to appropriate faculty.
• Answers are posted at the Muddy Waters website within 1-2 days.

Paul Koles, M.D., Pathology Education, uses case-based format optional review sessions in which students work as pairs to observe, explain, and diagnose. The reviews are attended by 10-60% of the Year 2 students depending on the time of the year and how comfortable they are with the course concepts being reviewed. These optional reviews are offered for 90 minutes on the last Thursday before the Monday exam, to all Year 2 courses except for The Mind and the Clinical Decision Making courses.

Cases will be posted soon.

Paul Koles, M.D., Pathology Education, implemented a creative and effective way to enhance our students' skills on providing helpful peer feedback. Year 2 students have several Team-Based Learning (TBL) sessions throughout the year. Peer Feedback is part of the TBL grading system, in which students provide quantitative scoring of teammates' behavior in twelve domains, and it also includes qualitative comments. Students' qualitative feedback was not, in general, helpful to teammates in identifying strengths and weakness as members of a team. Dr. Koles started in 2007 to grade the Peer Feedback for its degree of helpfulness to teammates. The results have been very positive: qualitative comments have been more descriptive, specific, relevant and useful to the receivers.

Peer Feedback samples will be posted soon.

Marvin Miller, M.D., Pediatrics, shared with our faculty how to present visual data à la Edward Tufte. Tufte writes, designs, and self-publishes his books on analytical design, which have received more than 40 awards for content and design. Tufte is Professor Emeritus at Yale University, where he taught courses in statistical evidence, information design, and interface design.

Dr. Miller's presentation had three objectives:

1. improve graphical presentations
2. critically evaluate the graphical presentations of others
3. identify the limitations and shortcomings of PowerPoint presentations

Download Dr. Miller's Presentation

Edward Tufte's website

Sparklines Software

There are two new add-ins for Microsoft® Office that create sparklines (mini-graphs) to visualize numerical data in dashboards, spreadsheets, reports and presentations created with Excel, Word and PowerPoint: Bissantz Sparkmaker and BonaVista MicroCharts. Read product review article about these add-ins.

Paul Koles, M.D., Pathology Education, encourages and supervises the participation of our Year 2 students in the BSOM Regional Postmortem Examination Service. One to four students participate in an autopsy with Dr. Koles for three to four hours, serving as a review of normal anatomy and pathology observed in the deceased. The schedule is unpredictable, but usually about twelve to twenty students per year see their first autopsy in this manner.

Pathology Education Website

Regional Postmortem Examination Service brochure (PDF file)

Our school has successfully implemented Team-Based Learning (TBL) in several courses since 2002. We are the first medical school to institute TBL throughout its pre-clinical curriculum.

Education in the health professions is placing greater emphasis on active learning: learning that requires applying knowledge to authentic problems; and that teaches students to engage in the kind of collaboration that is expected in today's clinical practice.

Team-Based Learning is a strategy that accomplishes these goals. It transforms passive, lecture-based coursework into an environment that promotes more self-directed learning and teamwork, and makes the classroom come "alive."

TBL can dramatically enhance the quality of student learning by:

• Enhancing problem-solving skills
• Replacing or reducing lecture time
• Ensuring that students are prepared and on time to class
• Creating a remarkable amount of energy in the classroom
• Promoting teamwork

• Introduction
• Articles - Application
• Articles - Theory
• Books
• Clinical Vignettes
• Modules
• Posters
• Testimonials
• Video Demonstrations
• Websites