December 2, 2016

I trust that you had an enjoyable and safe Thanksgiving. Susan and I enjoyed the holiday with three of our four grandchildren, our daughter and son-in-law, and my brothers and their spouses. It was a wonderful interlude, and our three granddaughters sure are growing up fast (they’re now 3, 5, and 7 years old)! We hope that your holiday was just as special.

But wait—we are not yet done with the holiday celebrations. Yesterday we had our Annual Holiday Luncheon, but for the first time, it was held in our new building. We had a wonderful turnout of over 700 faculty, staff, and students on the Northeast (Grand Forks) Campus. And later that evening we had a Holiday Reception in the Gorecki Alumni Center on the UND main campus for our Grand Forks full-time and clinical faculty, staff, alumni, and colleagues who are so essential to our educational, research, and service programs. Over a hundred people turned out for a marvelous time.

Susan and I will be traveling to our three regional campuses next week for similar Holiday Receptions. Here is the schedule and details of the events on tap:

  • Southeast (Fargo) Campus
    Tuesday, Dec. 6, 2016
    6:00 p.m.–8:00 p.m.
    Avalon West
    Sheyenne Room
    2525 9th Ave. S.
    Fargo, ND
  • Northwest (Minot) Campus
    Thursday, Dec. 8, 2016
    6:00 p.m.–8:00 p.m.
    Holiday Inn Riverside
    Aegean/Ionian Rooms
    2200 Burdick Expressway East
    Minot, ND
  • Southwest (Bismarck) Campus
    Friday, Dec. 9, 2016
    6:00 p.m.–8:00 p.m.
    Courtyard Marriott
    Lewis and Clark Room
    3319 N 14th St.
    Bismarck, ND

Susan and I would love to see you at one of the receptions. Please RSVP if you are able to attend to http://www.med.und.edu/events/holiday-2016/.

As discussed in prior E-News columns, we held our debriefing following the recent Association of American Medical Colleges (AAMC) annual meeting this past Tuesday. Here is a summary of the comments from the people who attended the AAMC meeting (including two medical students). Two themes were consistent: the networking opportunities were perhaps the best part of the meeting; and on a related note, virtually all medical schools are facing similar challenges, but the meeting (and especially the networking opportunities) allow different institutions to share their unique and novel approaches to these common issues.

Many agreed that the highlights of the meeting were the presentations at the plenary sessions. Three plenary speakers were especially noteworthy, as I mentioned previously: Dr. Darrell Kirch, the president and CEO of the AAMC, whose talk “In Search of Community” was based on his earlier comments here at the Gala Dinner the evening of the official opening of the new building. He stressed the importance of communities of involved stakeholders—including teachers, learners, and donors—to tackle many of the challenges of health education. Then historian Doris Kearns Goodwin gave a wonderful analysis of four great presidents and the qualities that they shared—Lyndon Johnson, Franklin Roosevelt, Teddy Roosevelt, and Abraham Lincoln. Finally, surgeon and author Dr. Atul Gawande shared a moving recollection of a small-town Ohio family that struggled with major healthcare issues.

Four other important themes ran through the attendees’ observations from the meeting:

  • The role of women in medicine—It is clear that progress in equity has been made (for example, the percentage of female medical school deans in the United States has gone from 0 percent in 1980 to 16 percent now), but there still is much work to do (the percentage of female medical school deans still is only 16 percent).
  • The importance of resiliency—Many students and practitioners feel stressed, time-pressured, and anxious. For example, it has been reported that the percentage of physicians who are satisfied with their work/life balance has plummeted from 50 percent to 40 percent in only four years! Various proactive approaches to addressing these issues were discussed and merit consideration here at the SMHS.
  • Faculty development—A variety of novel approaches to encourage and support academic and clinical faculty development were discussed.
  • Strengthening service learning—We have pioneered a robust approach to interprofessional education, but a second-year medical student who attended the meeting discussed a program at another medical school where the interprofessional student group is required to complete a group project to improve health in their local community. This idea really resonated with our discussion group and will be forwarded for further consideration here at the SMHS.

There were a variety of other interesting reports that we discussed, but the major themes are listed above. In summary, the AAMC annual meeting is a really positive experience for the administrators, faculty, staff, and students who attended. If any of our volunteer community faculty members or legislators is interested in attending, the next meeting is scheduled for early November 2017 in Boston. Just let my office know, and we can provide contact information.

Joshua Wynne, MD, MBA, MPH
UND Vice President for Health Affairs
Dean UND School of Medicine and Health Sciences

________________________________________

Recent Educational Policies to Review

Standards of Capacity (for medical students)

View all of the School's Policies and Procedures.

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Leisa Baldwin

     Medical Billing Technician

Leisa Baldwin began employment as a medical billing technician at the Center for Family Medicine in Minot on December 1. Her supervisor is Becky Bina.

Patricia Offerdahl

     Front Desk Clerk

Patricia Offerdahl began employment as a front desk clerk at the Center for Family Medicine in Bismarck on November 21. Her supervisor is Donna Baumgartner.

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WebEx training is on December 8

WebEx is a Web-conferencing platform system, designed specifically for holding online meetings. An online meeting is an alternative to a face-to-face meeting or a telephone conference. Meeting participants log in to a meeting from any computer with an Internet connection. This allows people to meet and collaborate via Web conference across geographically dispersed locations.

Training on WebEx for faculty and staff will be held from 10:00 to 11:00 a.m. on Thursday, December 8, in Room W203.

Vicki Thompson
IT Support Specialist

(701) 777-9349

Zen in 10

Zen in 10 focuses on stretching, breathing, and having fun with coworkers. Go back to work with less stress, more energy, and better body functioning.

Sessions are from 10:40 a.m. to 10:50 a.m. on Tuesdays and Thursdays, and are held in the following locations at the SMHS in Grand Forks.

  • Dec. 6: W201

  • Dec. 8: Auditorium

  • Dec. 13: E224

  • Dec. 15: W201

Services provided by Kay Williams, Certified Yoga and Relax and Renew Instructor®.

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Johnson elected as vice chair for national physical therapy commission

Beverly Johnson, PT, DSc., GCS, CEEAA, was elected to be vice chair of the 10-member Physical Therapy Panel of the Commission on Accreditation in Physical Therapy Education (CAPTE) at its meeting in November. Johnson is assistant director of clinical education and an associate professor in the Department of Physical Therapy at the University of North Dakota School of Medicine and Health Sciences.

The Commission on Accreditation in Physical Therapy Education is an accrediting agency that is nationally recognized by the U.S. Department of Education and the Council for Higher Education Accreditation. CAPTE grants specialized accreditation status to qualified entry-level education programs for physical therapists and physical therapist assistants.

The commission is a group of 31 individuals with varied backgrounds who are charged with determining whether a program meets the standards of quality in physical therapy education, developing the evaluative criteria for quality, and setting policy and procedure for the physical therapy accreditation process. Members of the commission must have served as on-site reviewers to be eligible for appointment. Johnson has been an onsite reviewer and team leader for many years before her appointment to the physical therapy panel of CAPTE. 

As a commissioner, Johnson reviews physical therapy education programs to assure the programs meet quality education standards developed by the commission.  

“Dr. Johnson is recognized nationally as a leader in physical therapy clinical education,” said David Relling, PT, PhD, associate professor of physical therapy and chair of the Department of Physical Therapy at the UND School of Medicine and Health Sciences. “Election as vice chair on the PT panel is a confirmation of Bev’s effective leadership and comprehensive knowledge of physical therapy education.”

Johnson earned her Bachelor of Science in Physical Therapy, Master of Science in Sport and Exercise Science, and minor in Education from UND; she earned her Doctor of Science in Physical Therapy (Geriatrics) from Rocky Mountain University of Health Professions in Provo, Utah. She received certifications as a geriatric clinical specialist (GCS) through the American Board of Physical Therapy Specialties and as a certified exercise expert for the aging adult (CEEAA) through the Academy of Geriatric Physical Therapy, a component of the American Physical Therapy Association.

“Involvement with national leaders in the educational and physical therapy professions has been a rewarding and humbling experience,” Johnson said. “I feel blessed to remain passionate about a profession I entered 40 years ago. It is an honor to give back to the profession and the department and also to represent the University at the national level.”

Medical Student Council “Giving Tree”

Hello All,

The Medical Student Council is working with the Northeast Human Service Center on a holiday project. We have set up a gift donation tree in the entrance of the School and ask that you consider giving to this great program.

The gifts will benefit two programs at the Northeast Human Service Center. The first one is for senior citizens, age 55 and over, who are volunteers in the Foster Grandparent Program. These are low-income men and women who donate 15 hours or more per week working with children in schools, Head Start programs, healthcare facilities, or nonprofit child care centers. The second is for children in foster care in the county of Grand Forks. Foster parents do not get extra funds during this time to purchase presents, so this can be an added hardship for these families. All of the recipients and their families are very appreciative of the kind donations.

If you would like to give a gift, please do the following:

  1. Select a tag from the tree
  2. Purchase a gift (~$20)
  3. Wrap the gift and attach the tag to the outside
  4. Leave the gifts under the tree by December 14!

Please contact me if you have any questions or concerns at brooke.m.lentz@und.edu. Thank you for your thoughtful contributions. Happy holidays!

Brooke Lentz, MS I
Student Council Secretary

Sponsor/Exhibit at the 2017 Dakota Conference

2017 Sponsor/Exhibitor Registration Now Open
June 13–15, 2017
Holiday Inn Riverside, Minot

On behalf of the Dakota Conference Planning Committee, you are invited to sponsor the 2017 Dakota Conference. Space is limited, so register now! We have additional options this year for sponsors. Choose the level that suits your needs!

Two ways to register:

Sponsor registration deadline is 11:59 p.m., CST Wednesday, March 1, 2017.

The Dakota Conference is Coordinated and Facilitated by
Center for Rural Health, University of North Dakota (UND) School of Medicine and Health Sciences (SMHS)

Supported by

Questions?
Contact Kylie Nissen or (701) 777-5380.

Social Media—Health Matters

On our Facebook page, Dean Wynne answers questions about pancreatitis and about the effectiveness of drinking cranberry juice to ward off urinary tract infections in his latest Health Matters column, which can be found in the Grand Forks Herald every other Monday. Please submit any general health-related questions to healthmatters@med.und.edu.

You can also get the latest SMHS news by following the School on Twitter

UND Today—"Staying power"

The School's tops-in-nation ranking for producing family medicine physicians helps meet North Dakota healthcare initiatives by keeping doctors in state.

More information about this and other UND news can be found in UND Today, UND's official news source.

"Public Health Law: A Tool to Address Emerging Health Concerns"—CDC Grand Rounds

The Centers for Disease Control and Prevention's (CDC) Public Health Grand Rounds is a monthly webcast created to foster discussion on major public health issues. Each session focuses on key challenges related to a specific health topic, and explores the latest scientific evidence and the potential effect of different interventions. The Grand Rounds sessions also highlight how the CDC and its partners are already addressing these challenges and discuss the recommendations for future research and practice. December's presentation is "Public Health Law: A Tool to Address Emerging Health Concerns." All of the webcasts are archived for later viewing.

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ER Corner: Outcomes—Healthcare Education’s First Aim

In the last ER Corner, I told you about a triple aim for healthcare education: (1) the identification of real-world, behavioral outcomes; (2) the generation of measurable, behavioral objectives that operationalize those outcomes, and (3) the creation of assessment items that directly measure the objectives. These three aims are the core principles of instructional design, and failure to attend to all three in the correct sequence can result in fundamental flaws in instruction that can lead to a corresponding failure to learn.

In this week’s ER Corner, I will discuss the first, and most critical of the triple aims: specifying/classifying learning outcomes. This will also be the subject of a workshop on this topic at noon on Wednesday, December 14. See below for a link to information about the workshop and how to register and attend in person or online.

In my last column, I provided an overview of learning outcomes, suggesting that there were two aspects of specifying outcomes that are critical to our discussion: (1) outcomes refer to real-world behaviors that demonstrate what knowledge looks like when demonstrated in the real world, and (2) outcomes are classified according to an instructional taxonomy. Classify outcomes correctly (and first!) and you can achieve perfect alignment of teaching strategies and assessment (i.e., the desired learning). Misidentify one outcome for the other, or fail to recognize that what we actually want to teach is really two different outcomes (and thus requires different teaching and assessment strategies), and no amount of teaching expertise can make up for the error.

Robert Gagné, the founder of instructional design as a field, realized in 1969 that most of the errors teachers make can be traced to two errors I’ve just described. Based on a detailed analysis of the evidence in education, psychology, and communication, he wrote the seminal volume The Conditions of Learning in 1965, which delineates a taxonomy of five different classes of learning outcome, or varieties of learning, as he called them. While these are akin to Bloom’s taxonomy, there are important differences. Whereas Bloom focused only on cognitive skills, Gagné subdivides Bloom’s cognitive skills into cognitive skills and intellectual skills, arguing that there are important differences.

Gagné’s cognitive strategies focus on internal control processes that learners select and apply to help them manage their own learning (e.g., rehearsal, elaboration), whereas his intellectual skills rely on knowing what or how to do things (much like Bloom’s taxonomy). Intellectual skills are further subdivided into a hierarchy, from most to least complex: problem solving, rule-using, defined concepts, concrete concepts, and discriminations. He also added three other domains, or varieties of learning: motor skills (the physical movements required in skills such as those involved in hitting a baseball), attitudes (beliefs or feelings such as those involved in empathy, compassion, altruism), and verbal information (facts and propositions such as drug names or names of tools).

Why do we need these five different varieties of learning in the first place? What difference do they make in our instruction?

We need them because outcomes are the tail that wags the dog in good instructional design. Each requires its own set of teaching and assessment strategies. Take using an ultrasound wand during pregnancy: there are physical movements (pressure, grip, etc.), intellectual skills (knowing where to place the wand, what pattern to use, how long to do it, recognizing what the image is showing), verbal information (the names of anatomical locations and features of the fetus), and attitudes (patient interaction, delivery of difficult news). While it is true (and desirable) that each of these can be taught and assessed separately, if we do not first consider which of these outcomes are involved and which of them we want to teach under this circumstance, we will either ignore a necessary outcome (and thus not develop any teaching or assessment for it) or conflate two or more different outcomes and select the wrong strategies and assessment.

A common example of this latter error is when we mistake rules (one of Gagné’s intellectual skills) for verbal information, and vice-versa, as when teaching “when performing an ultrasound for purpose x, the wand should be placed in position y with z pressure.” Having already classified this as a rule, I know that this is a real-world application of a skill, not verbal information, which then guides the design of my objective (e.g., “Given an ultrasound wand and a simulated or real patient, the learner will be able to demonstrate a standard ultrasound exam using the transducer on the patient to generate 2-D images of the developing fetus that meets the standards in use at _____ hospital or clinic.” And because I have my outcome and objective aligned, it is impossible for me to generate the wrong assessment. In this case, it would involve a real or simulated patient in a real or simulated environment, and the actual procedure itself: “tell the student to ‘perform a standard ultrasound on the patient to generate a 2-D image of the developing fetus for a first-trimester pregnancy.’ ”

However, if I did NOT first classify my outcomes, I might then generate an objective that could be interpreted as either verbal information or a rule, which might then lead to an assessment item appropriate for verbal information such as a true-or-false item that asks the learner to “tell me how to perform a standard ultrasound to produce a 2-D image of the developing fetus for a first trimester pregnancy,” to which the student could parrot back a memorized answer. We would have no evidence that they can actually perform the skill.

This may seem obvious, but it is not always so. Even if we develop the right objective for the end, there are still prerequisite outcomes that are necessary. If a student fails the exam, was it because he or she did not know the motor skills, the names and labels involved, or the rule for what to look for and how to classify resulting images? Likewise, each different kind of outcome requires its own teaching strategies. For example, attitudes are learned through strategies such as modeling and role play and are ultimately assessed by observation of the choices people make regarding the object or environment in which the attitude can be observed. Yet, more often than not, we try to teach and assess attitudes by using strategies that align with verbal information (e.g., telling people what specific attitude they should have and why they should have it or asking them to answer multiple-choice items).

If you want to learn more about and gain practice in specifying learning outcomes, come to the AEIS Workshop on Outcomes on December 14. For more information on attending this workshop in person, participating live from another campus, requesting a workshop on your campus, or to set up a consultation with Education Resources for teaching or education scholarship assistance, contact Shae Samuelson at (701) 777-6150. Stay tuned for the next ER Corner and its associated workshop, which will focus on how to write a good objective based on outcomes!

Richard Van Eck, PhD
Associate Dean for Teaching and Learning 
Founding Dr. David and Lola Rognlie Monson Endowed Professor in Medical Education

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Request for Proposals from the Great Plains IDeA-CTR Network

Jonathan D. Geiger, PhD, Chester Fritz Distinguished Professor in the Department of Biomedical Sciences at the University of North Dakota School of Medicine and Health Sciences, was selected to serve on the leadership team for the Great Plains IDeA-CTR Network, a collaboration involving nine institutions in four states—Nebraska, North Dakota, South Dakota and Kansas.

The Great Plains IDeA-CTR Network was created by a $20 million grant from the National Institutes of Health to the University of Nebraska Medical Center in Omaha. Funding is provided through the Institutional Development Award (IDeA) program and the NIH's National Institute of General Medical Studies. It will focus on developing early career researchers into independent scientists and increasing the infrastructure and other resources needed to support clinical/translational research (CTR) around the region.

The following are two requests for proposals from the Network:

If anyone has questions, they can contact Jonathan Geiger at jonathan.geiger@med.und.edu—UND’s institutional coordinator for this grant.

USDA GF Human Nutrition Research Center seeks study participants

The United States Department of Agriculture Grand Forks Human Nutrition Research Center is seeking participants for two research studies.

  • Fish for HEALTH! 
    Are you interested in cardiovascular health? Would you like to eat more fish? The USDA Human Nutrition Research Center is seeking men and women, ages 20–70, to determine whether eating rainbow trout with different omega-3 levels reduces heart disease risk markers. Receive up to $500 for completing the study.
  • Acute Effects of Fats on Satiety & Energy Needs
    Women on contraception: are you satisfied when you eat? The USDA is looking for female participants, ages 18–50, to join our study to assess how dietary fat affects energy metabolism and feelings of fullness after eating. Receive up to $530, or a 13-month individual membership, or a 9-month family membership at Choice Health & Fitness, to be paid at the conclusion of the study.

For more information, and to see if you qualify, check out our website, or contact Vanessa Thyne, Biological Laboratory Technician, Dietary Prevention of Disease Research Unit, Grand Forks Human Nutrition Research Center, (701) 795-8493.

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F. A. Davis Collection and JAMAevidence now available

Thanks to the generosity of the Department of Physical Therapy, SMHS Library Resources is able to offer two new resources to UND students, staff, and faculty.  

The F. A. Davis PT Collection provides full text access to physical therapy books and cases, as well as over 400+ physical therapy videos. The F. A. Davis PT Collection is an extension to AccessPhysiotherapy, an online physiotherapy resource available since 2014 that offers full-text books, videos, images, self-assessment tools, and a cadaver dissection tool. 

JAMAevidence is also now available! JAMAevidence includes the textbooks: User’s Guides to the Medical Literature, The Rational Clinical Examination, and Care at the Close of Life along with education guides on evidence-based medicine (EBM) concepts, a glossary of more than 900 EBM terms and definitions, calculators, worksheets, critical appraisal forms, and audio files.

Both resources are from McGraw-Hill Education and thus are available for use with the Custom Curriculum tool.

Both the F. A. Davis PT Collection and JAMAevidence are available both on campus and off campus via the library’s website

Kelly Thormodson MLIS
Interim Director
Health Sciences Library

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