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Dr. Beth Barron, MD

Associate Professor of Medicine, Columbia University Irving Medical Center

Dr. Barron teaches the Foundations of Clinical Medicine Tutorials course which occurs during the second and third semester of medical school. The course is focused on teaching clinical skills such as patient interviewing, communication, physical examinations, note writing, and oral presentations. All teaching in this course is normally held in small groups led by faculty and occurred in person. Faculty train actors to portray patients presenting with medical concerns. Students come to the medical center to interview and examine the patients and are brought to the hospital bedside with faculty members to meet volunteer patients to practice these skills. 

When the pandemic hit, Dr. Barron and other faculty soon realized the need to radically alter their teaching strategies. Students were no longer allowed to participate in in-person learning and were not able to visit the hospital. Recognizing that their old model, simply put, was obsolete, Dr. Barron and the teaching team quickly adapted and devised ways to deliver course content to their students in the remote learning environment. Read on to learn more about what Dr. Barron did in her courses, what lessons and experiences she is carrying forward, and the advice she has for other instructors at Columbia. To learn more about Dr. Barron’s innovations, watch her video for the Voices of Hybrid and Online Teaching and Learning initiative.

Leverage the Online Modality to Encourage Peer Learning 

During the remote teaching period, patient interviews were transitioned from live, in hospital and in the simulation center to Zoom. Standardized patients were still trained to portray the cases we had previously planned, and we were able to quickly create more. Faculty members met four students in a Zoom room with the trained actor. Students would take turns interviewing the patient and providing each other feedback about their history taking process and communication skills. They would verbally brainstorm the physical exam maneuvers they would want to do in this scenario and students were still able to submit a note summarizing the encounter for evaluation after the session. There were a number of unexpected benefits to this model. Faculty, students and standardized patients had rich discussions about communication and history taking skills with peers learning from each other. We were able to tailor the difficulty of the interviews to the students’ level, not possible during live patient interviews. Discussions regarding differential diagnosis and medical reasoning could occur in real time with pausing of interviews and group discussions.  

Design Engaging Asynchronous Learning Opportunities

In the fall, we were allowed to return to campus for some live, in-person events in a limited manner. This led to the need to consider even further innovations in the way we teach this course to maximize the learning occurring during these sessions. One solution was to find ways to improve the learning of our in-person sessions. Prior to the pandemic, we would assign pre-work to be completed before each session. In the past, the pre-work was deemed “optional” by students leading to valuable live time being consumed with educating on the basics. Students had told us that the prior assigned pre-work was not very engaging or efficient. We worked to improve our pre-session work to ensure that students were as ready as possible to participate when they did get the chance to be live in person for interview sessions and physical exam sessions. We designed interactive, multi-modal online modules and online clinical cases, which led to a much higher level of preparedness for the in-person sessions. The online cases allowed students to work in teams to contribute to the care of virtual patients and share ideas and strategies.  Advantages to this innovation included empowering students to take more ownership of their education, allowed students to work at their own pace, created more consistency in teaching and more integration with other courses.  

Truthfully, the pandemic led to a number of lessons learned. We saw the value of direct feedback in the Zoom interviews and have increased the amount and quality of feedback our students receive from peers, faculty and standardized patients. This has led to each session being capitalized as much as possible, maximizing the learning. We also saw the benefits of creating pre-work that students would find engaging. Creating the online modules and cases was time intensive in the beginning but now those resources exist and can be used repeatedly.  Students revisit the modules frequently, even when they enter the clinical years. The online modules showed us how well students could work together in teams sharing ideas, strategies and suggestions with much less guidance from faculty than we ever would have imagined. Asynchronous learning allows the students to work at their own pace and to take more ownership of their learning, something we definitely want to encourage.    

Dr. Barron shares innovations in her courses.

Advice for Instructors and the Future of Teaching at Columbia 

Provide learners with purposeful, useful, and timely feedback.

I would encourage other instructors to think of ways of maximizing effective feedback for their learners.  Perhaps our learners do not need to practice something 100 times; they just need a few times with direct, purposeful, and useful feedback. Also, consider reviewing the homework assigned to the learners. Is it engaging, useful, time-efficient, and delivered at the right learning level? If not, see if there are ways to adapt. Technology is so readily available now, and compelling materials can be created.  

Partner with students to work together toward their learning goals.

Moving forward, I would hope to see the schools think more deeply about the attitudes we wish to foster in our students and adapt our learning and assessment strategies to these. If we would like to see more self-direction, teamwork, collaboration, curiosity, and ownership of their learning, then perhaps our old models of teaching and assessment are not as useful. I would also love to see more partnerships with students where we are listening to their needs and adapting to their best learning strategies. Students and faculty have the same goal – for each student to reach their highest capability in their field of study. Can we find a way to be more adaptable to achieve this?