from Lecture to Interaction (Case Study)

Introduction
When faculty members experiment with technology enhancements, there is often a ripple effect where thoughts about technology lead to thoughts about pedagogy, which then lead back to new ideas about technology.

Educational Need
This was the case for William Kettyle, head of MIT Medical Department and Assistant Professor of Medicine in the Health Sciences and Technology Division, when he explored innovative directions for his endocrinology class. Kettyle’s challenge was to sustain student engagement in a course that met once a week for three hours. Kettyle: “the class [could be] an ordeal or adventure … or whatever one wants to think about a 3-hour class, but 3 hours of lecture [was] not acceptable.”

In order to move away from lecture format and towards more opportunities for student participation, Kettyle introduced a panoply of teaching modalities designed to vary the in-class experience: the creation of student working groups that would function as a diagnostic unit, the invitation of guest patients to provide first hand information about a particular illness or disease, and the introduction of an in-class ‘clinical encounter’ between the student groups and guest patients. In addition, Kettyle invited specialists/colleagues to co-teach and share their expertise and knowledge.

With assistance from Jim Cain of OEIT, Kettyle became interested in exploring technology as a way to support his pedagogical experiments, and he introduced into his class three augmentative devices: flash drives, classroom clickers (personal response systems), and wikis.

Technology Implementation
Flash Drives
The flash drives were 1-gigabyte USB devices distributed at the beginning of the semester. The drives contained the entire course material archive that students would use during the class, and thus provided a comprehensive and ultra-mobile resource.

Clickers
Kettyle also designed a teaching tool called a ‘quickie’ and introduced clickers as a way to gauge student performance and understanding. Quickies were a series of short medical vignettes intended to assess one’s knowledge in a particular disease area. The diabetes quickie portrayed the case of “six patients, all of whom have blood sugar of 380… which is way too high…and they got there in six different ways… and they are going to get out of there six different ways.” Using clickers, Kettyle was able to quickly determine whether the students grasped the basic concepts of diabetes.

“With [the] clickers you can say, is this ice cream gluttony, is this type 1 diabetes, is this type 2 diabetes, or is this a laboratory error?” Kettyle did not record individual responses but he recorded how the class collectively performed on a question. The results were used to tailor subsequent class sessions to address any deficiencies in understanding.

Clickers also served to trigger lively dialog on difficult questions. “There often shouldn’t be a right answer. There can be many right answers. You see where [there is] consensus and reasonable, well-meaning people, can disagree about what’s most important... [which in turn leads to] conversation, and that’s a wonderful use of the clicker.”

Wikis
In the spring of 2007, Kettyle met with OEIT to explore using a wiki in order to facilitate collaboration. The introduction of a wiki would add yet another way for the students and faculty to engage with each other.

Kettyle’s class already had an online portal giving access to a data repository. But “…it seemed to me that a wiki could offer an interactive place in addition to [the] data warehouse. OEIT was incredibly responsive. They set up a meeting…and showed me a bit about wikis. They set up a sandbox and I began to play around with it.”

Kettyle devised a ‘wiki-quickie of the week’, a question posed to the class which individuals would then respond to. One of the first of these was an assignment to “generate a mnemonic to keep track of the control mechanism of the hypothalamus and the pituitary”. The students responded with an array of creative mnemonic solutions posted to the wiki. Kettyle also uploaded an atypical scan of a thyroid and asked students give explanations as to its cause. The responses revealed that students collectively arrived at consensus on the critical issues and casual factors.

However, some applications of the wiki did not work very well. Kettyle had students write one-minute papers at the end of class demonstrating what they did or did not understand of the topics covered that day. In this instance, the wiki was less beneficial than using paper. Paper allowed the responses to remain anonymous, therefore encouraging students to respond with complete candor and not worry about the impact on their grades.

William Kettyle	Jim Cain

Next Steps
In discussions with OEIT’s Jim Cain, another idea came to Kettyle. “There are three or four courses offered at the same time – at the medical school – to the basic same group of students. The overlap is probably 80% but not 100%. They’re studying cardio-vascular, physiology, respiratory, and endocrine... in fact there are patients who have all four of those things.” From this was born the idea of doing collaborative sessions. Kettyle sees potential in the wiki as a way to coordinate among the four courses and make shared information dynamically available to all participants. He is considering adding video, with discussions and lists of findings that integrate the information within various contexts.

Used this way, the coordination and collaboration offered by the wiki gives rise to a patient-centered perspective: “People [who] die of diabetes and have heart disease, often have kidney disease, and insulin and glucose problems, so let’s put it together and teach to the patient as opposed to a specific issue.” By leveraging its collaborative capabilities, technology innovations can offer the potential of a better-integrated medical education.

Kettyle’s work follows an evolutionary path: experimenting with a number of technologies, gathering evidence of student engagement or lack therefore, and then adjusting based on what the evidence suggests. Furthermore, successes and failures serve to promote reflection, which subsequently gives rise to new ideas.