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Innovations in Education_ The Brewsters

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					  Innovations in Education:
   The Brewsters:
The Who, What, When, Where,
       Why and How
         Jeffrey Spike, PhD
       Thomas R. Cole, Ph.D.
          UTHSC-Houston
         February 24, 2012
    Why did we create the Brewsters?
• Everybody wants more or better ethics teaching
• But no one knows how
• The Brewsters are a pedagogical breakthrough
• This approach involves a "choose-your-own-
  adventure" style of active learning where students
  make choices about ethical and professional
  dilemmas.
• This project was launched in the Fall of 2011 with
  755 students from 6 health professional schools. It
  has recently been converted into an e-reader and
  will soon be available for other institutions to use.
 Academic Deans on Professionalism
• Negative: Prevent cheating and plagiarism, address lack
  of professionalism.
• Also: Great concern social networks spreading gossip
  and violating confidentiality on unprecedented scale.
• Primary concerns were of behaviors, not lack of
  education as much as lack of discipline or appreciation
  of the importance of joining an established profession
  guided by a set of values or ideals.
• Sometimes called “identity formation”
• Challenge: change your identity/self-image to that of a
  professional, guiding maturation with mentoring
  (requires innovative pedagogy plus faculty development)
             What is the Brewsters?
An introduction to inter-professional ethics for health
    science students that consists of both fictional narrative
    and fact-based instructional materials.
It is modeled after “Choose Your Own Adventure” books
    and is meant to be fun and entertaining as well as
    informative and educational.
The story follows members of the Brewster family through
    their encounters with students, physicians, dentists,
    dental hygienists, nurses, an epidemiologist, and
    researchers.
It unfolds in three acts: (1) Professionalism; (2) Clinical
    Ethics; and (3) Research Ethics.
Each act is followed by 20 pages of instructional materials
  How does ‘The Brewsters’ Work?
In each act, students can choose which character
  they would like to be. They can, for example, be
  a medical student or a patient, or, in another act,
  they can be a researcher or a patient.
They are faced with multiple decisions along the
  way, and each decision takes them to a different
  point in the story. (For example, if they make
  Choice A, they will be directed to page X. If they
  make Choice B, they will be directed to page Y.)
After they finish each act, they read the
  corresponding instructional materials.
         Who are the Brewsters?
• Central characters are from “a typical American
  family” (i.e. a bit dysfunctional, but not all that out
  of the ordinary)
• Meant to test their ability to listen empathically to
  people with problems, and not be judgmental
• The parents are Wayne and Sheila (not a great
  marriage) and the kids are Walter, in med school,
  Stephanie a teen who wants birth control pills, and
  little Cindy with (psychosomatic?) stomach aches.
• When his mother Gloria gets cancer, poor Wayne
  joins the sandwich generation
             A major innovation
• This same story is used in all six schools. So our students
  in every school will learn the basics that are being taught
  to the students in the other schools. It breaks down
  academic silos.
• The story also reinforces the value of inter-professional
  education respect, cooperation, and teamwork.
• Can be used for undergraduate education too: for
  example, if pre-meds were to learn some of their ethics
  side-by-side with other clinicians in training (e.g. nurses
  studying to be nurse practitioners) they might better
  appreciate the humanistic importance of their expertise.
• Contrast that to the hidden agenda of large pre-med
  science courses whose goal is to wash out or otherwise
  discourage students. (Surviving such courses is more a
  test of competitiveness than compassion.)
  The Brewsters as retrovirus designed
    to attack the hidden curriculum
• Think of it as an antidote to a system geared to
  produce high test scores, which inadvertently
  sends the message that how you get them isn’t
  as important as that you get them
• EBM: So, is it an effective antidote?
• No one book can change the lessons learned
  from a hidden curriculum that starts in high
  school and continues through residency (see the
  recent stories on ‘airplane notes’ and ‘recalls’)
• But it’s a start. Here’s some early data…
 Average Score by School (out of 30)
• School of Dentistry (n = 124) 27.47
• Graduate School of
  Biomedical Sciences (n = 109) 26.55
• Medical School (n = 240) 26.71
• School of Nursing (n = 224) 25.07
• School of Public Health (n = 39) 23.56
• School of Biomedical
  Informatics (n = 19) 23.21

Out of the 755 students, 53.0% of them (400 students)
 earned a 90% or greater on the post-test.
             Evaluations (143 total)
Average rating, based on a scale 1-5; where “1” is Strongly
  Disagree and “5” is Strongly Agree
• When reading the stories, the “choose your own adventure”
  learning method was easy to follow: 4.49
• “Choose your own adventure” is an interesting method of
  presenting information: 4.42
• Reading the instructional materials after each act increased my
  knowledge of basic terms in health professional ethics: 4.26
• I enjoyed the self-paced aspect of this learning activity: 4.33
• The time it took to complete this learning activity was just right:
  3.87 (average time reported was 4 hours)
• This educational activity provided an adequate introduction to
  health professional ethics: 4.28
• This educational activity enabled me to see ethical issues beyond
  my own health profession: 4.18
    Limitations of Study/Warnings
• Only an introduction to the issues and terminology,
  but IN NO WAY is sufficient for a professional ethics
  education. It must be followed up with some more
  detailed support in each year of school.
• Is best way to INTRODUCE the subject, because it is
  engaging, interactive, and narrative based. But is
  only an introduction. So the quality of the overall
  ethics education will be judged by how well your
  curriculum follows up…
• Will not replace anything already there, but is
  inserted prior to what’s already there, to generate a
  higher level of interest and comprehension in that
  material…

				
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