LCOM & Department News

Putting the Active in Learning – Med Students Bring First-hand Insight to Curriculum

August 7, 2018 by Michelle Bookless

As the Larner College of Medicine at the University of Vermont works toward a curriculum that is 100 percent lecture-free by 2019, faculty aren’t the only ones helping move the transition forward; medical students are playing a critical role in creating active learning curriculum as well.

Eric Schmidt, M.D.'18, answers questions from Class of 2021 medical students during an active learning session he developed and taught

A bold pledge – to go 100 percent lecture-free – catapulted the Larner College of Medicine at the University of Vermont into the medical education spotlight. Thanks to a September 2016 Associated Press article, more than 150 media outlets, including the Washington Post, National Public Radio and the New York Times, covered the College’s push to transform its entire curriculum to an active learning approach, garnering the attention of medical schools and educators around the country.

Innovation was not a new concept at the Larner College of Medicine, however. The Vermont Integrated Curriculum had won wide acclaim and the school had been incorporating active learning methods since well before it opened its first active learning classroom in 2014. In fall 2016, the College was at about 50 percent active learning; since then, that number has grown to 67 percent, thanks to the tireless work of dedicated faculty and support of a newly created Office of Active Learning. But faculty aren’t the only ones helping move the transition forward; medical students are playing a critical role in creating active learning curriculum as well.

Student-faculty collaboration and input is key to the success of the transition, says UVM Professor of Pathology and Laboratory Medicine Rebecca Wilcox, M.D., course director for Nutrition, Metabolism, and Gastrointestinal Systems (NMGI). “We think of active learning as the best thing for this generation [and] we really need to have people in this generation designing it,” says Wilcox. “As a course director, I know what objectives I want [to achieve] and what is important for them to learn during the course, but the students help me ‘get it’ at the student level.”

One of those students is Liz Carson ‘19, who first became involved as a representative for the Student Education Group (SEG). SEG student representatives act as liaisons with faculty to “provide a unified point of view, and to appropriately bring pertinent education issues to the attention of faculty and course directors.” More recently, Carson took on an even more hands-on role in helping with the active learning switch, incorporating it into the research portion of her year-long pathology fellowship. Medical students accepted into the pathology fellowship defer graduation for a year for the opportunity to do four months of surgical pathology, two months of autopsy, several month-long elective rotations, and one month of research. An experienced outdoor guide and wilderness medicine teacher, Carson immediately knew she wanted to focus on medical education for her research project. She approached Wilcox, former chair of the College’s Active Learning Task Force, whom she says is a “real educational innovator,” to be her mentor and help her develop a project that would combine her two passions – pathology and medical education. 

Carson’s project had two main objectives – first, take a class that’s still lecture-based and turn it into an active learning module; second, present the module using two different active learning classroom methods to determine which works best for students and faculty.

To start, Carson worked with Wilcox to identify areas in the first-year curriculum that students struggle with and create an approach that would help reduce the difficulty with which they learn and apply the concepts and information. “We had a few different ones to choose from and we settled on [metabolic liver disease] because Dr. Wilcox is really good at identifying what students struggle with,” Carson says. “[That’s] really advanced,” she adds. “You have to be really good at teaching to be able to pick up on…aspects of these diseases that year after year students struggle with.”

Metabolic liver disease is covered in a series of lectures taught by Steven Lidofsky, M.D., Ph.D., a UVM hepatologist and professor of medicine. Lidofsky had already laid the groundwork for transitioning his lectures into an active learning session by condensing approximately 2.5 hours of lecture into four pre-learning video modules totaling 36 minutes in length. In active learning, students use self-paced pre-learning modules to gain foundational knowledge prior to their in-classroom session.

Carson reviewed Lidofsky’s videos as if she was a first-year student, then picked out teaching points she felt were the most salient based on her recent experience in clinical clerkships and taking the first two out of three United States Medical Licensing exams. Then, she, Lidofsky, and Wilcox collaboratively developed a clinical scenario and patient profile for the classroom-based learning that would follow the videos they’d watched the previous night.

Clinical scenario and patient profile in hand, Carson created a module that can be used in a versatile way – a non-linear Powerpoint that can act as an interactive application to deepen the students’ conceptual understanding of the information presented in Lidofsky’s videos. “I wanted to create a patient assessment ‘video game’,” she says. “[It’s] a great way to apply learning to a clinical context – to virtually walk through seeing a patient, asking them questions, ordering lab tests, interpreting the lab tests, and coming up with the assessment and plan.” 

Her inspiration came, in part, from an extremely versatile pharmacology module she used in an optional session during her first-year Neural Science course. The module allowed students to learn in a group format or independently.

Carson’s module features a clinical vignette featuring a 19-year old female UVM student presenting at a health center with vague, non-specific symptoms. Students are asked to use the knowledge gleaned from Lidofsky’s videos to make choices, such as what diagnostic tests they should order for the woman, which will lead them down different paths within the application. Still, regardless of which path they choose, all students will be presented with the same key takeaway points – information they’ll most likely face during USMLE and more importantly, in the practice of caring for patients.

In addition to creating the interactive module, Carson worked with Wilcox and UVM Associate Professor of Pathology and Laboratory Medicine Ronald Bryant, M.D., to compare the effectiveness of different active learning methods. “There’s a lot in the literature that supports active learning in general,” notes Carson, “but there are not many papers that compare different active learning methods and recommend which ones you should use for which types of information.”

For instance, a small-group session approach, which requires a class of 120 students to break into groups of 10-12 students per faculty member, provides students with an intimate environment and extended facetime with clinical faculty. However, small-group sessions are resource intensive and expensive to run – at least 8 faculty members (who are also busy clinicians) need to be free on the same day, at the same time. Additionally, Carson notes that student evaluations show these sessions can breed stress and anxiety among students who feel that their peers, who are being taught by a different faculty member, may be getting different or more information than they are.   

In the large-group format, the entire class of 120 meets in the same room with one to two faculty members and one to two teaching assistants (TAs) as proctors. During the classroom session, students can work through problems and cases at their own pace either as a group or on their own, asking faculty and TAs questions as needed. With less faculty needed to facilitate, it’s less expensive and easier to schedule. But is it as effective as a small-group session? That’s what Carson set out to determine.

To compare the two formats, Carson had half of the first-year students attend the class in a small-group format and the other half in a large-group format. Students were then asked to fill out a LimeSurvey Carson created with the help of the University of Vermont Teaching Academy through which Carson would gain insight about the effectiveness of each session based on four parameters: student preparedness for the session; student perceptions of the session’s learning effectiveness; learner knowledge assessment upon completion of the session; and short-term (ten days) knowledge retention.

Through the survey and working with UVM Statistician, Alan Howard, to comb through the results, Carson learned that in terms of student preparedness, there was no significant difference between the two formats. The same rang true with the students’ perception of learning effectiveness – students in both groups felt the sessions met the stated objectives and most had no difficulty completing the activity during the in-class session. This trend continued for the remaining parameters – statistically, Carson saw no significant difference between the two formats.

Regardless of the results, she remains interested in researching the comparative effectiveness of different active learning methods and is hopeful that not only will faculty use her interactive application as a template for creating other case-based sessions, but that her application will continue to be used for the NMGI course in the years to come. Wilcox believes it can and will. Essentially, says Wilcox, anyone – teaching assistant or clinical faculty, it doesn’t matter if they’re a liver expert or not – could use Carson’s tool to facilitate an active learning classroom session.

Fortunately for the College, Carson is one of many medical students who have contributed to changes in medical education and active learning.

Eric Schmidt, M.D.’18 was one of those students. In 2014, he and his classmates were the first to access the newly-renovated Larner Classroom. Most of their active learning classes followed a “team-based learning” approach, which sparked Schmidt’s interest in the role of academic clinicians in medical education and active learning methodologies.

When Schmidt was determining the focus of his fourth-year scholarly project, he reached out to Wilcox, the director of his favorite first-year course, for guidance and ideas.

His timing was perfect. Wilcox and her NMGI faculty were in the process of transitioning the few remaining lecture-based classes to active learning, so she suggested that Schmidt, like Carson, take on a session taught by Lidofsky, who had already created a series of seven-minute videos that condensed his old hour-long lecture into short, condensed chunks of the most important information and key points students needed to know before class. Schmidt’s objective was to build upon Lidofsky’s work to create a flipped-classroom session featuring clinical cases, and then deliver that to first-year medical students.

During the session, Schmidt advanced through a Powerpoint that presented students with clinical scenarios he had created. The students were then prompted to discuss the information available to them and analyze it based on what they’d learned from the videos the night before, in order to reach a conclusion about what the patient’s diagnosis was or what their next step might be – for example, to order an additional lab test. After group discussions about each slide’s scenario, Schmidt requested students present their conclusions and takeaways to the class. The ensuing conversations shed light on which concepts students were still struggling with, which Schmidt then addressed.

The session was a success due to the close student-faculty collaboration between Schmidt, Lidofsky, and Wilcox and Schmidt’s “near peer” insight – first-hand knowledge that he’d retained and understood material better when he and his classmates could apply what they were learning to clinical case studies. And as a peer teacher, he was more credible, because he had “recently taken the NMGI exams and tests, such as [USMLE] Step 1 and Step 2.” The students recognized that the content they were learning was “high yield,” says Schmidt.

As the College steadily works toward its goal of a 100 percent active learning based curriculum by 2019, it will continue to look toward both faculty and students like Schmidt and Carson to continue the push ahead.

“[Our students] come [to medical school] with a wealth of ideas about how to improve medical education, and we invite their energy and enthusiasm into the process,” says Senior Associate Dean for Medical Education, William Jeffries, Ph.D. “Not only do they propose ideas, they work with faculty to implement them, and then rigorously evaluate the results. Resulting scholarly projects inform the national conversation.”


Past Department Highlights

Congratulations to Jessica Crothers, M.D., Assistant Professor Pathology and Laboratory Medicine, on achieving the Notice of Special Interest Team Science award from NIAID for: "Effects of the gut microbiota on oral vaccine response in adults and children." (10/2023)

Nicole BouffardCongratulations to Nicole Bouffard on being awarded the "Scientific Research Staff Award" for 2023. This was presented to Nicole at the September 21, 2023, LCOM Research Excellence Award Ceremony. This is a great honor for Nicole and the Department of Pathology and recognizes her contributions and importance to the department and MIC. (10/2023)

Congratulations to Brian Cunniff, Ph.D., Assistant Professor Pathology and Laboratory Medicine, on being awarded a $1.6 million R01 grant by the National Institute of General Medical Sciences to study the role of mitochondrial trafficking in regulating cell migration, a key feature of metastatic tumors. (9/2023)

Congratulations to Yvonne Janssen-Heininger, Ph.D., Professor Pathology and Laboratory Medicine, on becoming a University of Vermont Cancer Center Program Co-Leader, Cancer Cell. (9/2023)

Congratulations to the following pathology members on receiving research support funds in April 2023. Recipients were: John Kennedy, M.D., $6520 for morphologic and immunohistochemical re-evaluation of renal cell carcinomas exhibiting papillary architecture, with emphasis on tumors demonstrating "type 2" morphology. Yvonne Janssen-Heininger, Ph.D., $15,000 for a joint initiative between RBP, UVM Cancer Center, and faculty in the Department of Chemistry. Megan Tarte $745 for Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Disease ConferenceAlbert van der Vliet, Ph.D., $14,400 for Redox processes in macrophage activation in IPF. (9/2023)

Congratulations to the following faculty members on their promotions: Vikas Anathy, Ph.D., to Professor with tenure, Bronwyn Bryant, M.D., to Associate Professor, John DeWitt, M.D., Ph.D., to Associate Professor, Sarah Nowak Ph.D., to Associate Professor, and Christi Wojewoda, M.D., to Professor. (6/2023)

Bei Zhang, M.D., M.S., Ph.D., MLS(ASCP), associate professor of pathology and laboratory medicine, did an educational scholarship session titled "Activate Students Learning Outside Classroom." at the 8th International meeting of the Association of Biochemistry Educators. Dr. Zhang also conducted two additional workshops with other ABE members titled "Linking Clinical Presentations to Their Biochemistry: A novel ABE Clinical-Biochemistry Curricular Treat Mapping Educational Tool.", and "Getting to Clerkship and Beyond: Crafting Biochemistry Learning Objectives that Connect and Integrate Basic Science Concepts with Clinical Application." (5/2023)

Congratulations to Dr. Maureen Harmon, M.D., associate professor of pathology and laboratory medicine, and Dr. Amer Abu Alfa, M.D., assistant professor of pathology and laboratory medicine for being recognized by medical students for their professionalism. Dr. Harmon was recognized for social responsibility and Dr. Abu Alfa was recognized for compassion. (5/2023)

Congratulations to Mary Cushman, Ph.D., M.Sc., professor of medicine and pathology and laboratory medicine, on being named a University Distinguished Professor of Medicine, Hematology/Oncology Division, and Pathology and Laboratory Medicine. (5/2023)

View the story Mammograms of a study by Sarah Nowak, Ph.D., assistant professor of pathology and laboratory medicine, and researchers at the UVM Cancer Center showing data that fewer women being screened for breast cancer. (4/2023)

vandervliet-habibovic420x280A new study by Albert van der Vliet, Ph.D., professor of pathology and laboratory medicine, and a team of University of Vermont (UVM) researchers is honing in on why people with asthma often have worse symptoms if they are obese. This new research demonstrates that the gene DUOX1 likely contributes to the connection between obesity and asthma.  The research was published ahead of print in the American Journal of Physiology-Lung Cellular and Molecular Physiology and was highlighted as an APSselect article for March 2023. Albert van der Vliet, Ph.D., was the senior author on the paper, along with department of pathology and laboratory medicine coauthors Aida Habibovic, lab research technician;Litiele Cruz, Ph.D., visiting scholar; Vikas Anathy, Ph.D., associate professor; University Distinguished Professor Yvonne Janssen-Heininger, Ph.D.; and additional team members and authors from UVM. Read the full LCOM News story LCOM News (4/2023)

Congratulations to Bronwyn Bryant, M.D., Assistant Professor of Pathology and Laboratory Medicine, for having your proposal, Consequential Validity of Entrustable Professional Activities in Pathology Residency Training selected to receive a Frymoyer Scholars Program project of $48,000 to be funded July 1, 2023 through June 30, 2025. (4/2023)

Congratulations to Martin Chang, M.D., Ph.D., on accepting the new role as Vice Chair for Faculty Affairs. (4/2023)

Congratulations to Joanna Conant, M.D., on becoming the new Pathology Student Fellowship Director starting July 1, 2023. (4/2023)

Congratulations to The Cunniff Lab, on receiving funding to support research focused on malignant mesothelioma. The funding was from The Butler Family Foundation Fund for Cancer Research at the University of Vermont Cancer Center. The Butler Fund was established by the Butler family in memory of two loved ones lost to mesothelioma. (03/2023)

Congratulations to the following recipients that received pathology research support funding. Nathaniel Shannon in Brian Cunniff's, Ph.D., lab was awarded $1800 towards the cost of travel to the 2022 Annual Meeting of the Society for Redox Biology and Medicine (SfRBM). Litiele Cruz, Ph.D., and faculty mentor Albert van der Vliet, PhD., were awarded $2622 for her project "Characterization of Laminin Oxidative Modifications by Peroxidasin in Pulmonary Fibrosis"Nels Olson, PhD., MPH., $14,582 for the purchase of an Agilent BioTek 405 TS Touch Microplate Washer, Model 405 TSRS. Ashley Volaric M.D.Joanna Conant M.D., and David Seward, M.D, Ph.D., were awarded $13,680 for their project, "The Effect of Epstein Barr Virus Latency on Cellular DNA Methylation Profile of Diffuse Large B Cell Lymphoma". (3/2023)

A number of faculty and students from the pathology and laboratory medicine department presented research at the American Heart Associations Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health (EPI/Lifestyle) Scientific Sessions 2023 in Boston February 28 - March 3. Students presenting were Maggie King, a master in science pathology degree student who was mentored by faculty scientist J. Peter Durda, Ph.D. pathology and laboratory medicine.  Maggie presented on "Complete Blood Count Analysis in the Risk Underlying Rural Areas Longitudinal (RURAL) Cohort Study with a Point of Care Instrument." Her study is supported by NHLBI. And second-year medical student and 2022 Cardiovascular Research Institute Summer Research Fellow Megan Zhou, mentored by pathology and laboratory medicine associate professor Nels Olson, Ph.D. Megan presented on  "Coagulation Factor IX and Incident Diabetes Risk: The Reasons for Geographic and Race Differences in Stroke (REGARDS) Study." Also, pathology and laboratory faculty members that were coauthors of presentations given, assistant professor Margaret Doyle, Ph.D., and University Distinguished Professor of pathology and laboratory medicine, Russell Tracy, Ph.D. (3/2023)

Congratulations to Dr. Bei Zhang, M.D., Ph.D., MLS(ASCP), associate professor of pathology and laboratory medicine, for being selected for a Distinguished Scholar Award by the Association of Biochemistry Educators for her submission entitled "Activate Students' Learning Outside Classroom". Dr. Zhang will be presenting this submission at the 2023 Association of Biochemistry Education Conference. (3/2023)

Congratulations to our 2023 Gender Equity Award Nominees. Gender Equity Champion Award nominee, Debra Leonard, M.D., Ph.D., Chair and Professor Pathology and Laboratory Medicine. Our departmental nominees for The Polaris Award for Outstanding Mentorship- an award for informal or formal mentorship for women or gender diverse college community members, Rebecca Wilcox, M.D., Pam Gibson, M.D., Yvonne Janssen-Heininger, Ph.D., and Christi Wojewoda, M.D. (2/2023)  

Congratulations to Dr. Scott Anderson, M.D., on being selected to receive the Association of Pathology Chairs 2023 Margaret Grimes Distinguished Achievement Award in Graduate Medical Education. This award was made in recognition of Dr. Anderson's outstanding contributions to graduate medical education and his stature as a nationally recognized leader in pathology education. (2/2023)

Congratulations to Dr. Yvonne Janssen-Heininger, Ph.D., Dr. Kelly Butnor, M.D., Dr. David "Bebo" Seward, M.D., Ph.D., and Dr. Sharon Mount, M.D., on their news story in The Charlotte News, on their "giant steps in cancer research." Read the full article here:   Humble Superstar (1/2023)

Congratulations to Dr. Elizabeth Bundock, M.D., Ph.D., Chief Medical Examiner of Vermont and clinical assistant professor of pathology, for her appointment by the American Board of Pathology, to the Test Development and Advisory Committee for Forensic Pathology 2023. (1/2023)

Dr. Beri Zhang, M.D., Ph.D., MLS(ASCP), associate professor of pathology and laboratory medicine, presented a panel, at the Snow Season Education Retreat, titled "The Pearls and Pitfalls of Publishing in Medical Education", with three clinicians Dr. Hale, Dr. Halle, and Dr. Rideout. (1/2023)

Congratulations to Dr. Bronwyn Bryant, M.D., assistant professor of pathology and laboratory medicine on her Awards for  Teaching and Educational Excellence, Learner Assessment, conferred at the Teaching Academy Induction and Award Ceremony on January 11, 2023. (1/2023)

Albert in JapanCongratulations to Dr. Albert van der Vliet, Ph.D., pro-fessor of pathology and laboratory medicine, for being selected as an Invited Fellow to Tohoku University in Sendai, Japan, to participate in research in the laboratory of Takaaki Akaike, M.D., Ph.D., professor of environmental medicine and molecular toxicology. The invitational fellowship relates to a Tohoku University initiative that allows Tohoku faculty members to host invited researchers to promote collaborative research in the host lab for up to three months. The objective is to promote joint publications and expand international collaborations. Dr. van der Vliet's visit coincided with a medley of scientific meetings and symposia collectively termed  Redox Week In Sendai 2022 and held October 27-November 1, 2022. The events brought together leading scientists from around the world in the specific research fields of nitric oxide biology, polysulfur biochemistry, and biology. Van der Vliet was co-organizer and speaker at one of the symposiums, and Yvonne Janssen-Heininger, Ph.D., and Brian Cunniff, Ph.D., both professors of pathology and laboratory medicine, also participated as invited speakers. Additional Japanese federal funding supports the exchange of invited researchers, graduate students, and post-doctoral scholars to collaborate on research. Read more about the  redox research collaboration  between UVM and Tohoku University. (01/2023) 

Congratulations to Dr. Douglas Taatjes, Ph.D., professor of pathology and laboratory medicine, and director of the Center for Biomedical Shared Resources, at the UVM Cancer Center's recent annual scientific retreat he and Dr. Alan Howe, Ph.D., professor of pharmacology, were chosen from a group of five cross-disciplinary teams that competed for $25,000 in seed funding. They were chosen by a vote of the membership. Each team had 30 minutes to develop an idea with an actionable research plan that aligned with one of several proposed Cancer Center initiatives to address research relevant to the populations of Vermont and northern New York. The funds were awarded for the "Spatialomics and Precision Medicine Pipeline" project. This will be co-led by Dr. Taatjes, Ph.D., and Dr. Howe, Ph.D. (12/2022)

DebraDr. Debra Leonard, M.D., Ph.D., was the invited speaker for the Women in Cytometry reception at the 2022 International Clinical Cytometry Society Annual Meeting in Montreal on October 23. Dr. Leonard presented a talk titled "Leading from Within". Dr. Nicholas Haslett presented a poster at this same meeting. (10/2022)

Congratulations to Dr. Yvonne Janssen-Heininger, Ph.D., on her Lung Cancer Discovery Award from the American Lung Association. Read the full article here: VermontBiz (10/2022)

Larner Medicine profiles Dr. Yvonne Janssen-Heininger, Ph.D., and her research. Read the full profile here: Probing Oxygen's Mysteries (10/2022)

Research News see the news on UVM vaccine trials on eradicating polio and lead investigator Dr. Jessica Crothers, M.D., Read the full article here:  Research News (10/2022)

Congratulations, to Dr. Laura Greene, M.D., professor of pathology and laboratory medicine and assistant dean for admissions, who recently accepted an appointment as program director of the Pathology Residency Program, effective July 1, 2023. Thank you to Dr. Scott Anderson, M.D., professor of pathology and laboratory medicine, who as served as the program director since 2009. (10/2022)

Congratulations, to Dr. Jason Brazelton, M.D., for being named Physician of the Year by the Vermont Medical Society. "Dr. Brazelton's thoughtful and collabrative approach has improved care in our community and Porter's Medical staff has been incredibly fortunate to work with him." (09/2022)