Be that someone. #BeThe1To.

This tweet by Dr. Sue King, our Director of Elementary and Secondary Education, about a young boy named Patrick Turner really got to me:

Oh my ~ so heartbreaking! The pressure we are putting on kids is inexcusable! https://t.co/9tTj96WAtH

— Sue King (@sking58) February 8, 2018

I looked-up to Catherine. She was the oldest of my cousins, the wise one. The voice of reason that kept us in check when our plots and plans the rest of us were making were about to take a not-so-good turn. The smart yin for our reckless yang.

About 15 years ago, Catherine took her life. Several years later her husband Thierry did the same, orphaning their grade school aged son Hamelin. Both (unbeknownst to me) had battled anxiety and depression for years. She is buried in a plot next to my grandmother in the tiny village of Chalou-Moulineux, about two hours south of Paris, in the heart of the grain-belt of France.




The cemetery is right up the road from my grandparent's house, a place filled with countless childhood memories, my Happy Place. Here's their house, with the deep red shutters and entry gate:




Hypertension is often referred to as the "Silent Killer". The same can be said of suicide.

I'm no therapist. I'm not a counselor. I'm not a social worker. I'm a Dad, husband, teacher and paramedic. I see the effects of stress, anxiety and depression at school, at home and in the back of the ambulance. At times they seem almost inescapable. What strikes me most is their manifestation at school.

At school. The place where elementary school kids ran off the bus to enter. The place where young hands jumped up in the air excitedly, wanting to get picked to clap erasers or empty the pencil sharpener at the end of the day. The place where the overall vibe was joy.

Something happens between elementary and middle and high school to many (if not most) students. No longer do they race into the building. No longer is it a competition to earn the right to do classroom "chores". No longer are the halls filled with joys and excitement.

Don't get me wrong; high school halls are not macabre passageways connecting classroom crypts. But there is a much different vibe with the older kids. Sure they have mellowed-out. Some have found their "It" or their "Why". Others are still finding their way. And some are drowning.

Drowning in personal anguish. Personal demons. Hell at home. Hell in the cafeteria. Hell in school in general. Or all the aforementioned. These are the kids that need an ear. These are the kids that need a homeroom teacher with a keen eye for something askew. These are the kids that need someone to reach out and ask about their day. These are the kids that we may not teach but see in the hallway every day. And one day something is off, amiss.

Kids can be under so much pressure from parents, themselves, teachers, coaches, recruiters, colleges, and employers. This stress can be so overwhelming that it becomes difficult for them to function or to even enjoy life. They need someone to turn to. Someone to talk to. Someone to talk it out with. Someone to confide in. Someone to listen. Someone to care.

I wish Catherine, Thierry and Patrick Turner had had someone in their corner that could have stopped them.

Be that someone. #BeThe1To

Case Study: Days 1 through Day 5

I greeted students at the door and invited them to grab a seat wherever they felt comfortable in the classroom (#flexible seating, arranged in a circle around the room).

#flexibleseating - why not be comfortable when learning?

While they were filling out #IWishMyTeacherKnew slips, I took attendance and asked students their preferred name/nickname/pronunciation. I then pointed up to this banner and read it out loud to set the tone for the semester:

Student-made banner (from @medicalaxioms on Twitter)

I requested a volunteer and walked them out into the hallway. I asked the student to "play unconscious" and lay on a blanket I set out in the middle of the classroom (see classroom picture above). When we returned to the classroom, I gave the class this task:

Brainstorm, to the best of your abilities, causes for concern and/or questions surrounding this scenario. Here is what they came-up with in their stated order, in their exact words:

Next, I asked them as a group to determine 1) what they thought their highest priority concerns were and/or 2) which of these concerns could be accomplished or determined without delay. The seven circled concerns reflect that (above).

Next, I asked them to prioritize these seven concerns in a logical order.

Once this was done (with some guidance and input from me) we started diving into each of the seven concerns, in order. Each of these is accompanied by hands-on demonstrations by students:

Scene safety: awareness of dangers in the form of weapons, assailants, traffic (if on the highway), used hypodermic needles, etc. We all need to go home in one piece at the end of our shift.

Scene survey: looking for clues such as flipped-over rug (suggesting a trip & fall), a ladder (suggesting a fall), overturned or smashed furniture (suggesting an assault), pills or bottles on the floor (suggesting overdose or intoxication).

Skin color:

• Pale —> shunting blood from the skin to the core
• Flushed —> distributing blood to the skin
• Cyanotic —> profoundly hypoxic, only have minutes to act
• Jaundiced (yellow) —> dysfunction
• "Normal"

Level of Consciousness (AVPU):

• Alert: eyes open & tracking
• Verbal: eyes open & patient responds to verbal stimulus
• Pain: only responds to verbal stimulus
• U: unresponsive/unconscious

Circulation:

• pulse (carotid):
• yes —> fine
• no —> initiate AED and immediate chest compressions
• control massive external bleeding:
• direct pressure
• elevation
• pressure points (brainstorm common pulse locations prior)
• tourniquet

Airway: patient MUST have a patent airway

Breathing:

• yes & adequate —> fine
• no and/or inadequate --> airway adjunct:
• oropharyngeal airway (OPA) for no gag reflex
• nasopharyngeal airway (NPA) for gag reflex

The end result of this portion of the case study is that students are able to assess life-threatening conditions within 30 seconds of patient contact.

Next up: History & Physicals (H&Ps)!

Spring Break - Teacher Style

I have a confession to make. I'm sitting on a cruise ship re-reading "Teach Like A Pirate" by Dave Burgess and reading "Hacking Assessment" by Starr Sackenstein for the first time. I'm thinking about my students and our anatomy and physiology classes.

I can't help it. I'm supposed to be switching-off for Spring Break; phones are powered-down and in the room safe. We have been lounging by the pool, boogie boarding on the FlowRider and tomorrow we will be zip-lining. This is supposed to be vacation.

This IS vacation. I choose to read education books. I choose to think about my classes; our failures, our successes and ideas for improvement. I can't help it.

I think about a former student's email from a few weeks back in which he told me that our class helped him develop and cultivate his love of trauma care. He is currently deployed as a Combat Infantry Medic in Afghanistan, shouldering much more responsibility than he could have ever imagined while in high school. I am grateful that his fellow soldiers are safer in part to a spark that was lit in our classroom.

I think about the student whose favorite class this is. Every night she monopolizes the conversation at the dinner table talking about all she learned in our class that day. I think about wanting to meet her high expectations every single day, provide her with an awesome and engaging experience and not disappoint her.

I thin about a freshman student a few years ago. Great kid, got to know her well. We spent plenty of lunches talking about life, school, things that were upsetting her as well as her successes and her plans for the future. She didn't say goodbye the last day of school; she just left. She later told me that saying goodbye would have been too tough.

I think about the students going through unimaginable turmoil at home. Or in school. For some students school is their only sane and safe haven. For some school is Hell. Some hate school so much that our class is the only reason they get out of bed in the morning. Some students hate home so much they cry at the thought of having to spend a break or a summer away from school.

I feel guilty if I am not in school, having to sick-out. I feel as though I am letting these students down. I feel guilty if a lesson turns-out crappy. Or even just decent. I want our 75 minutes together to be exceptional. That's a lot of pressure I put on myself. A lot of pressure.

I'm always thinkings of ways to improve our classroom experience together. I'm thinking about shaking-up our class. I'm thinking more and more about centering the class solely on case studies and dissection and putting very little emphasis on the low-level stuff (I've already flipped the low-level stuff to micro video lectures). How cool would that be to teach an anatomy and physiology class almost 100% on case studies?

We could bring the unconference EdCamp experience into our classroom. Students could brainstorm their medical interests and conditions, form groups around similar topics, research all they can about their topic and present it to their peers for critique and questions. This means that all three classes (on the block schedule) would be learning different things at different times. What a logistical nightmare. How cool would that be?

It's a lot to ponder over Spring Break as I watch the moonlit waves roll by.

#flipclass flash blog: essential practices

#flipclass flash blog prompt: key instructional practice/pedagogical belief that is essential to flipped classroom

As a paramedic (and any clinician in an acute setting), it is essential to develop the ability to size-up a situation (even before arriving on the scene, using dispatch/911 intake information), quickly assess the situation, determine life-threats to ourselves and the patient(s), mitigate those threats, collect objective and subject data (History and Physicals or H&Ps), formulate a differential diagnosis, create and implement a treatment plan and then continuously reevaluate the efficacy of the plan.

It is for those reasons that one of my favorite instructional/learning practices is the use of Case Studies in our classroom. Time and time again my students tell me one of their favorite parts of our class was the case studies. How it works: I pick a scenario/medical issue and pre-program a student volunteer out in the hallway with the answers to some basic questions. We then enter the room and the "patient" acts in character. The job of the rest of the class is to ask questions and/or perform a hands-on assessment as appropriate in a logical manner to figure-out what the "patient's" issue is. The "patient" does not offer-up any information that is not directly asked for.

Total detective work. All higher-level thinking. And practical too. Win-win.

Canvas Roll-Out

It has been a few weeks since the beginning of the semester in our A&P courses. I rolled-out an introduction to Canvas LMS which included the following:

• how to access Canvas from a desktop or laptop
• how to access Canvas using the mobile app for phones and tablets
• where to find my contact info, daily summary of everything we did in class as well as the suggested homework, and modules
• how to navigate between modules
• how to progress through modules in a linear fashion

We used a laptop cart with one laptop per student. The roll-out was fairly smooth, with hitches mostly like the typical user name or password issues. Our course did not appear on the dashboards of several students either on the web version or the app. It was simply because the course was not favorited. Once starred, the course appeared. Homework that night was to get into Canvas, play around and start to get familiar with the module set-up.

Some students were already familiar with Canvas, as there are a handful of teachers in our building who started using it last year. I encouraged my students to get familiar with it, as our teacher websites (hosted by SchoolWires) were going to fall pretty much by the wayside. In addition, most colleges and universities use some sort of LMS like Canvas or Blackboard. About two weeks ago, I received this tweet from a former student:



All-in-all it was a fairly easy roll-out and students were quite receptive.

Asynchronous Learning

Setting-up asynchronous flipped mastery is coming along nicely. I have organized our first unit (Introduction to A&P) activities around several core concepts. I decided to go with the 1.1, 1.2, 1.3 numbering system for each concept, with the integer portion correlating to the "reference book chapter" and the fractional portion referring to the sequential order throughout the unit.

For each given concept students have a several assignments to choose from:

• a book assignment w/ accompanied guiding questions
• a Visible Body assignment w/ accompanied guiding questions
• a video assignment
• a fourth "other" activity

Once those assignments have been completed, students will take a practice quiz on Canvas. Anatomy lends itself nicely to these automated quizzes as it is generally low-level recognition and memorization. After an 85% proficient has been earned on the practice quiz, students will then be eligible to take the corresponding paper quiz in class.

The time-consuming portion of setting-up these assignments and formative assessments has been aligning all three/four assignments with each concept in such a manner that students can easily find resources on Canvas. So, for example, concept 1.5g is blood pressure. Book reading assignment 1.5g is parallel to video assignment 1.5g, practice quiz 1.5g and real quiz 1.5g.

Now that alignment is complete, I need to import last semester's classes Canvas modules into this semester, tweak the assignment/activity titles to match concept alignment. Should be good to go then. Stay tuned...

Flipped Mastery Journey

Background

Last year I tried-out 20% Time with my first semester students, with mixed results (that’s a previous blog post). Although 20% Time benefited some students, it left me with less in-class instructional time than in previous semesters. At the same time, district teachers were allowed (and encouraged to) access our newly-adopted LMS, Canvas. Several of us teachers and coaches had been granted access to the sandbox version in October prior to going live in January(ish). Up until January I had not had (or made) the time to jump into Canvas. Well, now I was forced to figure-out a way to finish teach this course with limited time.

Why flip?

I did not NEED to finish the course; I WANTED to. You see, I view completion of this course as not exactly a necessity or an endpoint, but more of a jumping-off or starting point in a clinical path. I want my students to be well-prepared for a future in clinical medicine. This means getting a jump on not simply the low-level anatomy, but more so the higher-level thinking required in clinical decision-making. For example obtaining accurate H&Ps (History and Physicals), developing differential diagnoses, forming clinical impressions and treatment plans and evaluating their efficacy. It is the clinical aspect of medicine that must be taught and explored in the classroom; it is most difficult, I would argue impossible, to learn on one's’ own. Anatomy boils-down to memorization. Physiology involves the interconnected relationships of phenomena occurring in the body. Clinical decision-making is the utilization of both to chart a course for the treatment of the patient. We NEEDED to get past the low-level anatomy and REALLY spend good, high-quality classroom time on clinical stuff. That is why I started flipping lectures to videos.

How I started flipping

I started by recording the remaining of the traditional sage-on-a-stage anatomical Google Slides lectures using the free Chrome Store app Screencastify. I first heard of Screencastify in a “Chromebook for Education” class I completed in the Spring of 2016. Great class, facilitated by Tom Mcgee. It is easy to use and can record via webcam, active tab capture or entire desktop capture. In addition, there is a preview feature (box within a box) that enables preview while recording. Annotation is possible with pen tools and the use of a stylus. Lastly Screencastify integrates well with Google Drive, allowing you to instantly playback the video as it saves to your Drive in the background. Like it? Give it a title/file name from within the app (it will name it as such on your Drive). Don’t like the way it came out? Hit the trashcan icon and re-record.

I assigned the flipped lectures as homework and briefly went over the more difficult aspects at the beginning of each class. Most students liked the lectures, while some missed the interaction with me and the dialogue that always accompanies our lecture discussions. Yet others were used to multiple years of note-taking. Something else was missing.

Intro to Flipped Mastery Learning

But aren’t teachers supposed to teach? What are teachers going to do during class if students are watching lecture videos for homework? Good point. How about the higher-level thinking stuff that we struggle to get to because we get so bogged-down with the low-level stuff?

Enter Flipped Mastery. FM takes the ownership of learning low-level content and places it squarely in the lap of the students. FM does not necessarily refer to the flipping of lectures into homework, but rather the flipping of responsibility of learning low-level content to the students. I will admit I thought flipping was simply the making and viewing of videos. But after lots of reading (especially Flip Your Classroom: Reach Every Student in Every Class Every Day by Jonathan Bergmann and Aaron Sams) and asking questions of my Twitter PLN, I not only learned that FM was more than videos, but a way of helping students demonstrate mastery while learning asynchronously.

Asynchronous learning

Instead of assigning nightly homework and assessing all students at the same time, it actually makes more sense to allow students to learn the material at their own pace and be assessed once they have mastered the material. Some students have after-school sports activities or part time jobs. Or simply want to relax after school. We differentiate learning. Why not differentiate the way students utilize their time? While some students may learn the material quickly on their own and are assessed in class, other students may need more personalized 1:1 help or alternative assignments until they master the material. It really is dumb to expect students to learn material at exactly the same pace. Why not have set checkpoints to keep them on track?

Thoughts on implementation

I think that asynchronous learning will work-out pretty well for my students, especially during dissection labs. I usually have seven lab groups with 4-5 students per group. Typically one dissects, a second assists and third takes pictures and/or videos as needed. Roles rotate every day we dissect (which is almost every day or every other day). There is significant down-time for the third and fourth lab group members. Why not have them productively use their time by completing asynchronous assignments, complete remedial learning opportunities or be assessed if they have mastered content and are proficient? I am excited to try this out with them.