Teaching portfolio

I am an enthusiastic medical teacher and educational researcher with considerable experience in teaching at both the undergraduate, postgraduate, and continuing medical educational levels, and with supervision of Bachelor’s, Master’s and PhD projects. I have practical experience with course and curriculum development and am also deeply involved in medical education on a strategic and political level. I am well-founded in medical educational theory and my research is focused on virtual reality simulation training of surgical technical skills and applying the principles of directed, self-regulated learning and cognitive load theory to training. In both my teaching activities and educational research, I have a strong emphasis on student-centered activities, hands-on experience and application, and simulation-based training.

Teaching experience


Undergraduate

Emergency Medicine Summer School. CAMES, Herlev Hospital. International medical students (Bachelor & Master). Class lectures (16 h) and simulation-based, hands-on training (32 h). English. Aug. 2015; Aug. 2017.

Clinical course in Otorhinolaryngology. University of Copenhagen and Dept. of Otorhinolaryngology—Head & Neck Surgery, Rigshospitalet. Medical students (Master). Teaching assistant (62 h). Danish. Nov. 2012–Mar. 2013.

Mastoidectomy. Dept. of Otorhinolaryngology—Head & Neck Surgery, and the Simulation Centre, Rigshospitalet. Medical students (Bachelor & Master). Class lectures (6 h) and individual hands-on, VR simulation training and supervision of exercises (150+ h). Danish. Sep. 2013–[current].

 

Postgraduate

Basic Statistics for Health Researchers. Department of Biostatistics, Faculty of Health and Medical Sciences, University of Copenhagen. PhD students. Instructor (12 h). Danish. Feb.–Mar. 2017.

How to get clinical research published—knowing the peer review process. Graduate Programme in Clinical Research, the PhD School, Faculty of Health and Medical Sciences, University of Copenhagen. PhD students and research year medical students. Class lectures (10 h) and group work and exercises (16 h). Course director. English. Oct. 2016; May 2017.

Applied medical statistics using SPSS. Graduate Programme in Clinical Research, the PhD School, Faculty of Health and Medical Sciences, University of Copenhagen. PhD students and research year medical students. Class lectures and demonstration (60 h) and group work and hands-on exercises (120 h). Danish/English. Jan. 2016–[current].

 

Continuing medical education and specialist training

Copenhagen Otology & Neurotology. Basic and Advanced Ear Surgery and Implant Course. Dept. of Otorhinolaryngology, Rigshospitalet, Copenhagen, Denmark. International trainees in otology. Class lectures and hands-on VR simulation training (5 h) and development of course material. English. Sep. 2017.

The Middle Ear. The National Board of Health, Denmark. Residents in Otorhinolaryngology. Class lectures and demonstration (5 h) and hands-on, VR simulation training exercises (35 h). Danish. Jan. 2013–[current].

Directed Self-Regulated Learning in surgical technical skills training. AMEE Conference, Barcelona. Medical educationalists. Workshops with seminar-style lectures, group exercises and discussion (3 h). English. Aug. 2016; Aug. 2017.

 

Supervision

PhD students: Susanne Irene Scott, MD: ‘Quality of Life after primary Transoral Robotic Surgery (TORS) for early stage oropharyngeal squamous cell carcinoma’. Co-supervisor (robotic surgical skills training). Apr. 2017–Apr. 2020 [exp].

Pre-graduate research students: Primary supervisor, Mads Juhl Jørgensen, medical student: ‘Otoscopy simulation and assessment’. Feb. 2017–Nov. 2017 [exp]; Lisette Hvid Hovgaard, co-supervisor, medical student: ‘Validity evidence for procedural competency in robotic surgery for the vaginal cuff closure procedure, establishing a credible pass/fail standard’. Feb. 2017–Jul. 2017 [exp].

Post-graduate research training: Co-supervisor Kristine Aabenhus, MD: ‘Hearing results after tympanoplasty are stable short-term: a prospective database study’. Jun. 2014–Jul. 2016.

Master’s theses (primary supervisor): Fahd Al-Shahrestani: ‘Metrics and assessment in mastoidectomy: a systematic review’, Feb. 2016–Jan. 2017; Niels West: ‘Final-product assessment of initial performance in virtual reality mastoidectomy’, Jan.–May 2014.

Bachelor’s theses (primary supervisor):  Andreas Frithioff: ‘European status on temporal bone training’, Jan. 2016–Jan. 2017. Sebastian Roed Rasmussen: ‘Using Secondary Task Precision to Assess Cognitive Load in Surgical Simulation’, Jan.–May 2014.

 

Other teaching experience

Course for junior doctors in appointment committees. The Danish Association of Junior Doctors. Medical doctors. Danish. (9 h). Apr. 2016–[current].

Course in career paths for medical doctors. The Danish Association of Junior Doctors. Medical doctors. Danish. (24 h) Dec. 2015––[current].

Introduction course for union representatives. The Danish Association of Junior Doctors. Medical doctors. Danish. (12 h) Sep. 2015––[current].

Mathematics and theory of science. Gribskov Gymnasium. High school students. Danish. (200+ h). Aug. 2008–Jun. 2009.

Academic tutor for 1st year medical students, University of Copenhagen. (100+ h). Aug. 2007–Jan. 2009.

Examples of teaching resources and materials


Introducing a pre-course assignment, ‘clickers’, and more hands-on exercises in a course

For the 3-day course ‘Using SPSS for applied medical statistics’ for PhD-students in the Graduate Programme in Clinical Research, I have introduced a new pre-course assignment with the purpose of ensuring that course participants had installed the necessary software for the course and explored the software to get some basic hands-on experience with simple problem solving. Also, previous course evaluations had rated the subjects during the last course day low and I therefore: 1) introduced a new format for the demonstration of the homework assignment using a combination of a multiple-choice quiz using a ‘clicker’ system (to identify key issues of difficulty for repetition) and oral student presentations; 2) developed an explorative, hands-on exercise on ‘date and time handling’; and 3) added more hands-on and group exercises to allow repetition of key topics and application of skills to new data sets.

Portfolio material: Reflections based on colleague supervision (2 p), pre-course assignment (1 p), selected group exercises for repetition (1 p), summary of the evaluations of the October 2016 course (after the changes were implemented) (2 p).

 

Modifying simulator instructional design to consider cognitive load

In a research study, I demonstrated that a complex surgical procedure such as mastoidectomy induces a substantial cognitive load on the learner even when the procedure is practiced in a virtual reality (VR) simulation environment. Excessive cognitive load can lead to suboptimal learning, and cognitive load theory proposes that the extrinsic component of cognitive load, which can be imposed by a poor instructional design, can be reduced by worked examples and problem completion exercises. I therefore re-designed the instructions in the Visible Ear Simulator to integrate worked examples and problem completion exercises. In a randomized trial, I compared these modified instructions with the traditional instructions and found that the integration of part-tasks in the modified instructional design increased the learners’ cognitive load and lead to a poorer performance.

Portfolio material: Examples of traditional and modified instructions and effect on performance (1 p) and overview of traditional and new instructions (2 p).

 

Inductive teaching in otology

During ‘Introduction to University Pedagogy’ in February 2015, I developed a teaching session on the diagnostics and treatment of ear disease in relation to hearing loss. The intended audience were pre-graduate medical students in the clinical course in otorhinolaryngology. The session was opened with a case setting preamble, followed by a short introduction to the conduction of sound and group work on cases provided as handouts. After this, common reasons for hearing loss and the diagnosis were introduced using an inductive approach and applied in further discussion of the cases.

Portfolio material: Selected slides (2 p) and handouts (2 p).

Teaching evaluations and recommendations


Student evaluations of the PhD courses ‘Applied medical statistics using SPSS’ and ‘How to get clinical research published—knowing the peer review process’ from the fall 2016 are provided as examples because I taught more than 90 % of the sessions during these courses. For ‘Applied medical statistics using SPSS’ >75 % of the students rated the teaching as ‘above average’ or ‘excellent’ and the specific comments commended the pedagogical approach to the subject and the emphasis on hands-on experience. For the new course, I developed, ‘How to get clinical research published’, evaluations demonstrate that the course addressed a student need, balanced lectures and hands-on exercises well, and that the teachers were well-prepared with substantial knowledge on the subjects. In the academic year 2008–2009, I taught mathematics at a high school, and the recommendation, I received from the principle, emphasizes the level of teaching and my students’ high performance at the subsequent exams.

Formal pedagogical training


Supervision of BSc and MSc students. Institute for Science Education, University of Copenhagen, Denmark. Mar.–Apr. 2017.

Professional postgraduate teacher training [Universitetspædagogikum]. Institute for Science Education, University of Copenhagen, Denmark. Aug. 2016–Aug. 2017.

Introduction to University Pedagogy. Institute for Science Education, University of Copenhagen, Denmark (3 ECTS). Feb. 2016.

The PhD-student as supervisor – leadership education. PhD-course. Graduate School of Clinical Medicine, University of Copenhagen (3.6 ECTS). Oct.–Dec. 2015.

 

Participation in workshops and scientific sessions at the AMEE conference on medical education, meetings of the Danish Society for Medical Education (DSMU), the International Conference on Surgical Education and Training (ICOSET), and the Öresund Symposium on clinical skills training, including:

Supervision in the clinic. Danish Society for Medical Education, Copenhagen (4 h), Dec. 2015.

Clinical Skills Training – the changing face of surgical education. 12th Öresund Symposium, Copenhagen (6 h), Dec. 2015.

Competency based training for better surgical care in the 21st century. International Conference on Surgical Education and Training (ICOSET), Copenhagen (9 h), Nov. 2015.

Professional Identity Formation – between pre- and postgraduate medical education. Danish Medical Association, Odense (6 h), Nov. 2015.

Career guidance and recruitment of junior doctors – how and why? Danish Medical Association, Hindsgavl (6 h), May 2015.

Assessment of competency. Danish Society for Medical Education, Vejle (6 h), May 2014.

Clinical Skills Training – professional performance. 10th Öresund Symposium, Copenhagen (6 h), Dec. 2013.

Professional Identity and Faculty development in simulation education: why, whom and how. Danish Society for Medical Education, Aarhus (6 h), Nov. 2013

Simulation-based healthcare instruction and Using Theory in MedEd. The AMEE Conference, Prague (12 h), Aug. 2013.

Administration and management of education


Head of workgroup, revision of the Regional Internship curriculum, under the council for postgraduate medical education in Eastern Denmark, Apr.–Jun. 2017.

The Committee on Postgraduate Medical Education, Danish Junior Doctors’ Association. Member. Nov. 2015–[current].

Danish Society for Medical Education Member of the Board. Nov. 2015–[current].

Course secretary for the specialist training courses in Otorhinolaryngology, the National Board of Health. June 2014–[current].

The Council for Postgraduate Medical Education in Eastern Denmark. Substitute member. Feb. 2014–[current].

The Health Care Educational Council, the Capital Region of Denmark. Substitute member. Nov. 2013–[current].

The Graduate Programme in Clinical Research, the Graduate School of Health and Medical Sciences, University of Copenhagen. Member of the Steering Committee. Nov. 2013–[current].

Study Board for Medicine, Faculty of Health and Medical Sciences, University of Copenhagen. Member. Feb. 2009–Feb. 2010.

The Educational Strategic Council (KUUR), University of Copenhagen. Member. Feb. 2008–Jun. 2009.

The Educational Committee, Dept. of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen. Jan. 2008–Jan. 2010.

The Academic Council, Faculty of Health and Medical Sciences, University of Copenhagen. Substitute member. Jan. 2008–Jan. 2009.

 

Organization of several half-day scientific symposia for PhD students in the Graduate Programme for Clinical Research on: academic presentation (Jun. 2016), public speaking (Sep 2015), the increasing expenses of the national health system (Jan. 2015), haemostasis and bleeding (Jun. 2014), and scientific speed-dating (Aug. 2014); and members of the Danish Society for Medical Education: ‘Evidence-based medical education – status and implementation’ (symposia, Aug. 2016).

At the Simulation Centre, Rigshospitalet, I am involved in developing evidence-based, VR simulation training in otoscopy and robotic surgery, together with research year students, PhD students, and faculty.

Course director for ‘How to get clinical research published—knowing the peer review process’ including course management, curriculum design, recruiting lecturers, and developing course programme and material.

Pedagogical development and research


Course design or planning and organization of teaching

Developing a new PhD course on the peer review process

For the graduate programme in Clinical Research at the PhD school, I developed a new 2-day course on ‘How to get clinical research published—knowing the peer review process’ including course description, curriculum, and recruiting co-teachers. During the course, I introduce the subject of peer review by supplementing the traditional lecture format with integrated, interactive online activities such as word-clouds for facilitating discussion, and by testing current knowledge and presumptions with a quiz. The participants get hands-on experience with a systematic approach to peer reviewing by several exercises that gradually introduce different key areas of the peer review. Finally, the participants review peer students’ scientific papers in smaller groups leading and complete a review as a homework assignment, followed by a “masterclass” session on the final course day. where participants’ view shift into the role of the journal editor. For course evaluation, participants provided a small review of the course.

Portfolio material: Course description (1 p), course program (1 p), homework and masterclass assignment (2 p), evaluations (5 p).

 

Implementing evidence-based VR simulation training in specialist training in Otorhinolaryngology

In 2011 and 2012, we introduced a newly developed VR simulator during post-graduate specialty training in otorhinolaryngology at the national course on ‘The Middle Ear’. This pilot indicated that VR simulation training improved participants’ performance in subsequent dissection during the course, and in a research study, I established that 2-hours of VR simulation training improved the dissection performance by 52 %. Further examinations of the learning curves of novices in another study, suggested a new training paradigm consisting of distributed practice with blocks of three repetitions of which the first repetition could be directed by the simulator’s integrated tutor-function, guiding self-directed learning. Based on these results, we have now implemented VR simulation training as an integral part of the national specialist training course and the new training program is offered to all residents.

Portfolio material: Poster with an overview of the new training program and results (1 p), overview of the learning curves (1 p).

 

Self-assessment in VR simulation training of mastoidectomy

A key problem in self-directed surgical skills training is that the performance of novices plateau at an insufficient level after just a few practice sessions: In a study on the learning curves of virtual reality (VR) simulation training of the mastoidectomy procedure we found a plateau after just 9 repetitions at a score of 16 out of the maximum 26 points, which is expected for a safe and optimal performance. Inadequate self-assessment skills of the learners seem to be part of the explanation for this plateau and in an ongoing research project, we are investigating the effect on performance of structured self-assessment. In addition to quantitative data on the effect on performance and cognitive load, and as part of my main project for professional postgraduate teacher training [Universitetspædagogikum], I am investigating, by individual interviews, if the structured self-assessment supports the learners’ perception of cognitive engagement in the training and explore the learners’ experience with the structured self-assessment such as the usefulness of the itemized rating tool and supporting videos, to which extent they referred to the videos during their training, and if the structured self-assessment helped them understand the specific sub-goals of the procedure.

Portfolio material: Introduction (1 p), semi-structured interview guide (1 p).

 

Educational research

My PhD thesis ‘Virtual reality simulation training of mastoidectomy—studies on novice performance’ aimed to increase the evidence-base of VR simulation training of mastoidectomy, and, by studying the final-product performances of novices, investigated the transfer of skills to the current gold-standard training modality of cadaveric dissection, the effect of different practice conditions and simulator-integrated tutoring on performance and retention of skills, and the role of directed, self-regulated learning. Based on the results on the studies included in my PhD-thesis we have implemented a new, evidence-based training program in mastoidectomy. I am currently researching competency-based VR simulation training of mastoidectomy based on expert sampling of performance with the objective of further improving performance by investigating the role of distributed practice, cognitive load, directed self-regulated learning and fidelity.

I have published 13 peer-reviewed papers on VR simulation training of mastoidectomy, assessment of mastoidectomy performance, directed self-regulated learning and cognitive load in surgical technical skills training (see publications).

I have presented on a range of educational topics such as virtual reality simulation training, technical skills training in surgery, cognitive load, and directed, self-regulated learning at national and international conferences on medical education (e.g. IMSH, AMEE, ICOSET, Danish Society for Medical Education) with submitted oral presentations and as invited speaker and workshop facilitator (see presentations).

I have contributed to international health care educational journals as peer reviewer (Medical Teacher, Journal of Surgical Education, and Advances in Health Care Education) and as associate editor (Journal of Educational Evaluation of Health Professions).

Reflections on my pedagogical activities


I think that hands-on participation and deliberate practice leads to the most successful learning experiences. My teaching is therefore student-centered with emphasis on specific learning activities such as simulation-based training, exercises and problem-solving, and application to everyday issues. The majority of my formal teaching activities have involved PhD courses at the Faculty of Health and Medical Sciences, University of Copenhagen, and surgical skills training at the Simulation Centre at Rigshospitalet. Regardless of the setting, my approach to teaching involves combining technology, demonstration and application, and individual hands-on training: at the PhD school, I have integrated small, online quizzes using mobile technology to fuel discussion and integrated pre-course assignments that are used throughout the courses and then approached from different angles and perspectives; and in my development of virtual reality (VR) simulation for surgical skills training in temporal bone surgery, I have applied the principles directed, self-regulated learning, distributed and deliberate practice, and cognitive load theory, and researched the effects on learning of different approaches to instructions, support, feedback, and organization of training. My goal—and reasons for this approach to teaching—is to develop independent learners, who will seize every opportunity to learn and improve their skills, adopt new technology in health care, and become outstanding doctors, surgeons and researchers.

My students describe me as enthusiastic and attentive, and from their evaluations of my teaching, they value my hands-on and student-centered approach to teaching because they consistently report that they take home not only theoretical knowledge but, importantly, also skills they can apply to their own practice. I actively use my natural enthusiasm in my teaching and supervision because I find it encourages students’ involvement with the subject and promotes deep learning. This is, however, mutual: I get most inspired in teaching and research when interacting with the individual student and I appreciate the close collaboration when supervising students’ projects. I have supervised students on all levels and a number of different projects, and it is important for me that the students own their specific project. My role as a supervisor is to guide the student through the process and contribute with my knowledge and experience. This mentoring approach has successfully led to several of my students publishing their projects in peer-reviewed scientific journals.

In collaboration with students and other faculty, I am currently involved in developing new simulation-based skills training for other procedures such as otoscopy and robotic surgery, building on my experiences from temporal bone surgical simulation and using a systematic and scientific approach: basing the project on a theoretical framework, defining key research questions, collecting and analyzing relevant data and outcomes, evaluating, and using this to inform implementation into curriculum. A successful example of this, consequential to my PhD project, is the integration of evidence-based VR simulation training into the Danish national specialist training course in temporal bone surgery. This has been recognized by educational stakeholders in the Danish Society for Otorhinolaryngology—Head & Neck Surgery and I was therefore invited to incorporate VR simulation training into the Copenhagen international course in basic and advanced ear surgery and implants together with developing the core dissection manual, and also to develop an online learning platform for structured continuing medical education in otorhinolaryngology starting with a quiz-based course structured along the European specialist curriculum.

Evidence-based education and implementation into postgraduate and continuing medical education is imperative and I am therefore also deeply committed to advancing medical education at the strategic and political level. I have through the years contributed to various educational councils, committees and organizations, and positively influenced policy and practice. As a board member of the Danish Society for Medical Education, I am implicated in symposia and seminars, promoting evidence and best practice medical education. Recently, in the council for postgraduate medical education in eastern Denmark, I have headed the workgroup revising the regional curriculum for medical internship, hopefully succeeding in inducing structured assessment of competency and systematic feedback for all trainees.

I am constantly developing as a teacher based on literature and evidence, my own experience with teaching and supervising, and from systematic student and peer feedback. I regularly take the role of the learner, participating in courses, educational conferences, and similar opportunities, learning more on pedagogics and didactics, getting useful insights I can apply in my teaching practice. During professional postgraduate teacher training I have been inspired to explore inductive teaching and flipped-classroom further. I think such approaches are aligned with my teaching philosophy and can positively contribute to my students’ learning, and I look forward to applying these principles in my future teaching.