Linkage of Three Threads of Change to Conceptual Frameworks

Chapter Two. First, the visuals of each framework are provided in Figure 3.3 (Mishra & Koehler, 2006) and Figure 3.4 (Cooke, et al., 2010) for ease of reference and as a

refresher from Chapter Two. Following each figures is a written explanation linking the various changes to corresponding components of each framework. Then, as a visual summary, Table 3.2 charts all study focus areas and their related components from framework.

Figure 3.3 Technological Pedagogical Content Knowledge (TPACK)

Technology and the TPACK Framework

The three technology changes examined in this study connect to multiple components from the Technological Pedagogical Content Knowledge (TPACK) framework.

 Lecture Recordings: the move to record all lectures relates to the technology and pedagogy intersection of Technological Pedagogical

Knowledge (TPK). The lecture recording itself is the technology and the pedagogical changes are seen on the student side with how they may receive lectures. Prior to this change students could only see and hear a lecture live. While now that is still an option, they can also (or as an alternative), watch the lecture asynchronously with the recording. Content isn’t the focus here as the topics and material of the lectures didn’t change (as a result of this adoption). All content continued to be presented in the auditoria, only the reception method began to vary for students after lecture recordings were introduced.

 Computer Based Exams: the move to computer-based exams occurs at the three-way intersection of technology, pedagogy, and content at Technological Pedagogical Content Knowledge (TPACK). The exam software was the technology change, and an enhanced ability for

instructors to tag their questions with categories to improve performance reports for students relates to both content and pedagogy. This convenient, automated, and more robust analysis by both instructors and students, was not possible in the past.

 Virtual Microscopy: the move from traditional microscopes to virtual microscopy affects technology, content, and pedagogy, so also occurs at the three-way intersection of Technological Pedagogical Content

Knowledge (TPACK). It required new knowledge to use the technology (for both instructors and students), new content with a move from wet

slide preparations to digitized slides, and new pedagogy where instructors moved from teaching students with various preparations to show the same histological reference in their microscopes, to all student having access to all digitized slide examples. It also provided the means to expect pre- session preparation by the students.

Pedagogy and the TPACK Framework

Pedagogical changes that were studied (the shift towards more student-centered and active learning environments) focus primarily on Pedagogical Content Knowledge (PCK). Instructors look at the best ways to teach particular content areas with more student interaction and incorporate case-based or problem-based learning in the

classroom, or encourage self-study to be done in teams between sessions. Other changes, such as the use of Audience Response Systems (ARS), reach the interactive classroom goal with the addition of technology and reach the full combination of Technological Pedagogical Content Knowledge (TPACK). What had been primarily a one-way instructor-focused lecture in the past, has become much more student-centered and participatory.

Content Integration and the TPACK Framework

The integration of first-year course content is another robust case of the studied changes as it touches all domains in both frameworks. This integration initiative relates to all components of the TPACK framework and all four goal areas from the Carnegie framework. These content-integration curriculum changes leveraged technology, and included changes to both teaching approaches, and content.

Next follows Figure 3.2 showing the table on the Carnegie Foundation’s Recommendations from the 2010 book, Educating Physicians: A Call for Reform of Medical School and Residency. Then after refreshing on the table, an explanation follows to describe how changes being studied link to those recommendations.

Technology and the Carnegie Framework

The three technology changes examined in this study connect the Standardization and Individualization goal from the Carnegie framework:

 Lecture Recordings: The adoption of lecture recordings relates to Standardization and Individualization from Carnegie because the school has standardized by requiring almost all large lecture content to be recorded. Yet, students can individualize their experience by going to lecture live and/or watching on their own time outside of the school. Students can choose to view or review as much or as little and as often as they’d like. Students can also make use of tools within the player to speed up, slow down, and pause lectures for further customization based on their preferences.

 Computer-Based Exams: The adoption of computer-based exams applies to Standardization and Individualization from the Carnegie framework because questions are now standardized to be formatted like those on Unite Stated Medical Licensing Exam (USMLE) Step exams and the scoring and category reports can be individualized for students. Scoring reports provide students not only with exam grades but also their per-exam as well as longitudinal performance data within the various tagged

categories. Students are able to see their performance in a topic area or category not just per exam but throughout their multiple modules and

courses. With category tagging, students can see their strengths and those areas in need of further development.

 Virtual Microscopy: From the Carnegie framework, Virtual Microscopy allows for Standardization and Individualization. All students are able to study the same (standardized) microscopy specimens simultaneously. Students also have an ability to study this content asynchronously, progressing through content at their own pace, and making their own annotations (individualization). With this change also came the feasibility for self-study and mandatory pre-work to be assigned by instructors and completed by students prior to their lab discussions.

Pedagogy and the Carnegie Framework

From the Carnegie framework, these changes to teaching approaches link primarily to Habit of inquiry and Improvement as well as Professional Formation. Conducting smaller group discussions on cases or exercises to solve allows for student- centered problem-based learning. It also aims to foster student curiosity in an effort to develop critical reasoning skills in a collaborative environment which will be needed in their clinical careers.

Content Integration and the Carnegie Framework

As content became integrated, different teaching methods and technological tools were used for the delivery or acquisition of this content. Aptly, the biggest connection to a component from the Carnegie framework is Integration, yet the content integration initiative also touches the other three components. From Carnegie’s Standardization and

Individualization, the first-year integrated course hits Standardization because several first-year courses came together to form one integrated course with modules that follow a similar flow. The format for the course module sites in the Learning Management System (LMS), syllabi, and other learning materials were all standardized. This integration links to at least part of Carnegie’s Individualization goal because although students move as a cohort unit through each of their pre-clerkship classes, outside of the classroom

individual students are able to review flipped-classroom content, lecture recording, and self-directed learning materials at their own pace.

Containing the lecture time to mornings only throughout the week also allowed for self-study and self-directed individualized and team learning activities. These activities can occur during the free afternoons where interactive doctoring courses, such as Introduction to Clinical Medicine (ICM) and Integrated Problems (IP) are not already scheduled. Even with these afternoon classes, students still have three four-hour

afternoons protected away from classes so they can focus on self-directed learning activities. These afternoons aim to foster their curiosity and enhance their critical thinking skills, and link to Carnegie’s Habits of Inquiry and Improvement. Finally, although many of the Professional Formation recommendations were already happening in the curriculum prior to the implementation of the integrated course, students have opportunities to provide feedback and suggest changes to further enhance the course through Student Advisory Committee meetings. Student involvement fosters a

collaborative learning environment with a focus on continuous improvement, which are also Professional Formation components. The content integration change initiative was

the most robust as it involved all components for each of the frameworks.

Next follows Table 3.3 linking each component from the three primary threads of study to each framework.

Table 3.3 Study Threads & Framework Components Study Thread &

Adoption timing Subjects

Conceptual Framework: TPACK Knowledge Area Carnegie Recommendation Areas Technology  Lecture Capture Recordings (2006)  Computer Based Exams (2010 pilot, 2012 all pre-clerkship courses)  Virtual Microscopy (2007) All 1st _{& 2}nd year module directors and instructors Lecture Recordings: Technological Pedagogical Knowledge (TPK) Exams: Technological Pedagogical Content Knowledge (TPACK) Virtual Microscopy: Technological Pedagogical Content Knowledge (TPACK) Standardization and individualization Pedagogy Student-Centered & Active Learning Environments (ongoing adoption) 1st _{& 2}nd _year module directors and any Pedagogical Content Knowledge (PCK) with opportunities for Technological Pedagogical Content Knowledge (TPACK) Habits of inquiry and improvement Content Implementation of the PrISM course: integration of first- year curriculum content (2015) – based on 2nd year DRx creation (2008) PrISM Module Directors and instructors, plus DRx Module Director and instructors for a historical comparison Technological Pedagogical Content Knowledge (TPACK) Standardization and individualization Integration Habits of inquiry and improvement Professional formation