SSN TEACHER HANDBOOK Welcome back to the Student Success Network (SSN)! A Little History SSN was started in 1991 by Dr. Mindy Fullilove. SSN is based on the Medical Scholars Program (MSP), started at the University of California at San Francisco. MSP uses small study groups or workshops to promote achievement among minorities. The intent of SSN is to avert all failures in the first year class, and like MSP, our goal is to be preventive, rather than remedial. Our Mission Our teachers are second year medical students who guide first year students on their path through medical school. Our program is dedicated to teaching first year medical students the critical organizational and conceptual skills to assimilate medical knowledge. We strive to create an environment that is collaborative. Format of the Handbook The intention of this handbook is to pass down tips from SSN teachers from past years. The handbook is composed of two sections: General Teaching Principles and Workshop Specific Teaching Suggestions. The General Teaching Principles section will offer ideas for organization and presentation essential for effective teaching. The second section, Workshop Specific Suggestions will address the specific courses in SSN: Anatomy, Histology, Neural Science, Science Basic to the Practice of Medicine (SBPM), and Tutoring. This section offers workshop specific pointers for class organization and presentation. Included in the handbook are examples from old SSN worksheets as well as comments by former teachers and students.

SECTION 1: General Teaching Principles

Effective Teaching Active Environment


Start with an Overview

Create a Framework

Ask Questions

Learn to Facilitate

An effective teacher is a master of organization and environment. An organized lesson and an active environment help students understand the material and later apply knowledge. This section describes basic principles essential for achieving organization and creating an active environment. The first half of the section reveals two keys to organization: starting with an overview and creating a framework. The second half of the section describes question-based sessions and facilitation techniques, two components of an active environment. Both sections include examples, many from actual SSN worksheets, and comments from SSN students and teachers.

I. Start with an Overview Providing an organized overview of each lesson is critical. Students must understand the basic components of a topic before they can learn the details or problem solve effectively. Charles Reigeluth and Faith Steini use a zoom lens analogy to describe this principle: focus first on the city then the neighborhood, the building, the house, the window, and then the characters in the house. In other words, begin with the city; start with “the big picture”. In the following example, the topic “Protein Synthesis” is reviewed: Protein Synthesis Question 1: You have designed a protein that improves learning and memory. In order to translate it in bacteria, what must you include on the coding strand? If you were translating in an eukaryote, what changes would you make? Although this type of question is excellent, students can’t answer questions until they have some basic knowledge. In this example, the teacher jumps into the details of protein synthesis without providing an overview of the major steps in protein synthesis. The student is lost, and the question becomes confusing. If the teacher first gives an overview of protein synthesis and the steps in protein synthesis, the question is clearer and the detailed steps in protein synthesis memorable. For example, the teacher could have started the class with the diagram below:




Protein Synthesis (Translation) 1. Initiation 2. Elongation 3. Termination Protein

Note how the presentation orients the reader to protein synthesis. Immediately, the reader is aware that protein synthesis follows transcription, and that protein synthesis is composed of three steps: initiation, elongation, and termination. Presenting “the big picture” first; providing a basic summary of the material will enable students to grasp major concepts and prevent students from becoming lost in the details. As one student wrote, a teacher’s “thoughtful and well organized summaries” made him stand out from his peers.

II. Create a Framework Just as an overview of the major points is important, so is a framework for those points. Learning is faster and easier when topics are learned as parts of a whole rather than as independent concepts. One student cited the ability to connect and integrate material that is “unclear or spread out over several chapters” as a characteristic of an outstanding teacher. What are essential components of a framework? A framework provides a structure to organize information. It shows connections between topics and contrasts differences. Above all, it simplifies information. By revealing relationships between units of knowledge, a framework makes learning easier. Take the following example from SSN Histology Worksheets: The Eye The eye can be divided into three layers: 1. The outer layer contains the cornea and the sclera. The cornea consists of a stratified squamous, non-keratinized epithelium, and acellular Bowman’s membrane, transparent and avascular regularly arranged collagen fibrils and keratocytes, Descemet’s membrane (a thick basal lamina of the corneal endothelium), and a single layer of flattened hexagonal cells called the corneal endothelium. The sclera is the white outer coat of the eye, which is formed by dense regularly arranged connective tissue. The eye muscles attach to the sclera. In between the cornea and the sclera is the limbus. The aqueous humor from the outer chamber of the eye drains through an endothelial canal called the canal of Schlemm in this region. Reading this paragraph takes effort and wastes time. The teacher retyped the book’s definitions without organizing the information and creating a framework. As one student commented, “When SSN is just a repeat of a lecture, it doesn’t help.”

Now, look at another example:

The Eye

Cornea The Outer Layer

The eye can be divided into three layers:

Sclera The Middle Layer Uvea The Inner Layer


1. The Outer Layer (Corneasclera) contains the cornea and the sclera. a. Cornea Anterior

Posterior Limbus sclera.

From anterior to posterior, the cornea consists of: the stratified squamous, non-keratinized corneal epithelium the acellular Bowman’s membrane the stroma (transparent & avascular regularly arranged collagen fibrils & keratinocytes) the thick basal lamina of the corneal endothelium, called Descement’s mb the corneal endothelium, a single layer of flattened hexagonal cells The limbus forms the junction between the cornea and the

b. Sclera: The sclera is the white outer coat of the eye, formed by the dense, regularly arranged connective tissue. The eye muscles insert on the sclera. In this region, endothelium-lined channels merge to from the Canal of Schlemm. This example uses the same information, but the organization differs. At the beginning of the example, an overview of the material to be covered in the section is presented. Then, a framework is created, and the information is structured as a path through the eye: the information about the cornea is structured to resemble physically, the layers of the cornea. Just as in the eye, the limbus is placed between the cornea and the sclera. This presentation helps the student remember the individual components of the eye as well as their relationship to each other. Tables and diagrams can provide literal structures to frame key information. In both cases, similarities and differences become obvious. Take this example about Referred Pain:

Complete the following table: Referred Pain Spinal Level T1-T2

Nerve Cardiac Accelerator Thoracic Splanchnic Greater Splanchnic Lesser Splanchnic Least Splanchnic

T1-T4 T6-T9 T10-T11 T12 L1-L2

Lumbar Splanchnic Pelvic Splanchnic


Region Referred

Point of Origin Heart


Flank and Inguinal

Posterior Thigh and Leg

Lower ureter, Rectum

The table outlines key points about referred pain, and effectively compares and contrasts information. This exercise of comparing and contrasting material aids learning. Similarly, this diagram from a SSN Histology worksheet eases the memorization of numerous details by revealing relationships between these details. Complete the chart: Connective Tissue



This format provides a structure to organize the details, showing the connections between pieces of information. The example below, from an SSN worksheet on metabolism, reveals relationships among the degradation and synthesis pathways. By integrating material spread across many chapters, it simplifies complex metabolic pathways.


Fatty Acid Urea

Glycogen Glucose 1P HMP Shunt





Acetyl CoA

Glucose Glycolysis





As shown, a framework can be created in a paragraph or shown in a table, a diagram, or a picture. Even a mnemonic is a framework, devising a relationship between details, as idiosyncratic as that relationship may be. Frameworks such as tables, diagrams, or pictures, can, as one student said “get the large amount of material under control.” Showing relationships between pieces of information, through a framework, is an important step for learning the vast amount of material in medical school.

III. Ask Questions “What we learn to do, we learn by doing.” Aristotle Having been students for most of our lives, we would all rather sit passively and listen to a lecture because it’s easier. We hope we will remember something, anything. We think we can learn it later if we just take good notes, if we just write down all of the answers. Unfortunately, we have to learn the material now because there isn’t enough time. There is too much material to be inefficient; to listen passively. The learning process begins with acquisition and retention. Application, or retrieval and use, is the next step in the process.ii Only through application can the ultimate goal of proficiency, or the ability to integrate and synthesize be achieved. Thus, SSN workshops are based on the idea that practice produces competence.iii SSN workshops are based around worksheets with questions. As one teacher said, the worksheets “facilitate learning and teaching.” “Students love the [worksheets] and they really help us [to concentrate] on the more important topics and [avoid] tangents,” said another teacher. For SBPM and Neural Science workshops, questions that demand interpretation and thought are emphasized more than basic recall. Students find these types of questions to be more useful than detail or straight recall questions. “The questions on worksheets were extremely helpful,” remarked one student. “[They] helped me focus on what was important [and] were not straight recall questions, but required some interpretation/application.” For Histology and Anatomy, questions are directed at critical details that must be memorized. Histology teachers create practice questions for microscope slides at each session that one student found “key to see how much studying I had to do.” Anatomy teachers create worksheets with questions and quiz students in lab by tagging structures. Lastly, Practice Practicals in both Anatomy and Histology are provided. One student commented that “the worksheets and the practice practical were incredibly useful during my reviews exams.” Based on the idea that active practice yields mastery, questions are asked on worksheets and in sessions. As Professor Stephen Yelon said, in his book Powerful Principles of Instruction: If you were to ask me for the most powerful of all the principles, I would say active appropriate practice. It is a straightforward idea that is often ignored…this is where you can make profound changes in your teaching…You will find that your students can perform.”iv

IV. Learn to facilitate “Not only is there an art in knowing a thing, but also an art in teaching it.” Cicero Worksheet based workshops are most effective in a small group environment. Ideally, small groups facilitate learning through providing an open and interactive environment.v In a small group, students are more comfortable participating in the problem solving tasks. With over one hundred first year medical students, it is difficult to create a small group environment. SSN has employed strategies including breaking students down into to groups of two or three. These groups collaborate to answer questions and then report back to the class. The success of a small group session depends, in large part, on the teacher. The role of the teacher is to facilitate; to foster and guide There are several tactics a teacher can use to be an effective facilitator. They are as follows: 1. 2. 3. 4. 5. 6. 7.

Set the ground rules Start with an Overview Create a Framework Encourage Participation Clarify and Summarize Be Supportive Act as a gatekeeper

Each of these tactics is presented in some detail on the following pages.

1. Set the ground rules Set the ground rules on the first day. Define the objectives of SSN, explain the small group format, and establish the role of the first year student and the second year teacher. The Objectives of SSN To teach students the skills to succeed in medical school. To ensure that all students pass the first year of medical school. To emphasize teamwork and collaboration in the learning process.

Explain that SSN is for all students; the goal of SSN is not to ensure that a few excel, but that everyone passes their first year of medical school. Reinforce that the SSN Workshop is not another lecture. It is an interactive learning session. Define your role as a coach, rather than lecturer. Your role is not to make the first year students learn the material, but rather to facilitate this learning. If you must lecture, keep it brief: the attention span for an average person at a lecture is about eight or nine minutes.vii Specify the role of the first year student. Tell the first year students that it is their role, for example, to: Prepare for each session. Participate in each session. Respect their classmates. Work as a team. Describing the basic goals of SSN and the expectations of the first and second year student is important. Only through defined expectations can students with different personalities and levels of knowledge work together and gain from collaboration. 2. Start with an Overview Orient students to the material before the questions are tackled. This basic overview will help students to remember the details. 3. Create a Framework Use a framework in your worksheets: ask students how parts fit into a whole, or how ideas compare or contrast; ask students to complete diagrams and tables. During class, after a given question is answered, define the topic’s place in the “big picture”, the overall framework.

4. Clarify and Repeat Summarize key points after worksheet problems are answered or after students ask questions. According to former students, outstanding teachers are methodical and repeat key ideas and principles. For even more effective reinforcement, restate the same material in different ways; approach the problem from a distinct perspective. The best teachers “explained things differently than the syllabus,” stated one student. 5. Encourage Participation Questioning techniques are paramount for this tactic. As mentioned, one method to encourage participation is to break students into groups of two or three to answer the questions. Then, ask these groups to report back to the class. Another method is to call on students. But, this method can be intimidating for students, and it can be uncomfortable for teachers. One tactic to decrease anxiety is to ask a student to summarize material that has just been reviewed. Alternatively, as in Anatomy lab, ask an instant recall question about a structure that has just been explained. 6. Be Supportive Be approachable. Introduce yourself at each class and learn the names of the students. Create a supportive environment: sit in a circle. If errors are made, don’t react negatively. Establish a “safe” environment; explain that mistakes are critical for the learning process. Congratulate students for trying to answer the questions. 7. Act as a gatekeeper How does a teacher handle an obscure question asked by a student about an SSN problem? Clarify and repeat the key points of the SSN problem. If the student’s question goes beyond the scope of the problem, ask the student to save the question for the end of class.

Conclusion “I thought that SSN was incredibly helpful in getting me used to the type of questions asked and the level of knowledge expected by the professors. I think SSN is a valuable asset for the students. I appreciate all of the time and effort that the instructors put into their review.” First Year Medical Student The SSN teachers, the second year medical students, have an enormous impact on the first year students. The first year students watch, listen, and imitate the SSN teachers who guide them on the path that is medical school. As an SSN teacher, you will have a powerful influence. Consider these selected words from Brian Harlin, SSN SBPM Coordinator in 1995viii, as you embark on your year of teaching: First and most importantly, feel good about what you are doing. It takes a lot of time and energy to make SSN work, and everyone you help is not going to thank you for it every time you help them. Know that your labors are providing support for a lot of people who are going through a difficult experience. It does take a lot of time and effort to make the program work…and to make a good worksheet…Plan ahead and be well prepared. It is much more pleasant and enjoyable to do a workshop that you are well prepared for, than to try to wing it, and the workshop will be much more valuable for the first years to attend. But…it doesn’t take forever to prepare…Prepare well so that you know the material, but remember, it’s all in the book. Your main role is to support the first years in their quest for knowledge. You don’t have to know everything. You just have to be able to help them learn it for themselves. Erring on the side of being over-prepared is probably the best at first, but make sure that you don’t make SSN so labor intensive that you resent doing it. Don’t hesitate to contact previous participants in SSN. As third and fourth years, we may not have the time and flexibility of schedule to participate in the daily running of the organization. But, most of us have greatly enjoyed our involvement in the organization and want to continue to be of use to it. Lastly, feel good about what you have done. Even if the workshop didn’t go as smoothly as expected, you have done something great. It is not how many questions that have been answered correctly that makes SSN so great, it is that the people, like yourself, have shown the first years concern and support at a time that they, as well as we once, needed it. Just by preparing and showing up at the workshops, you do this. Take comfort in the fact that attendance will drop as the year progresses; people are learning how to fish for themselves. Know that for every person that attends, there are many more that take comfort in the fact that the workshops exist if they need them.

Thank you for your commitment to learning, sharing, and teaching. Good luck! Reigeluth C and Stein F. “The elaboration theory of instruction.” In C. Reigeluth Instructional design theories and models: An overview of their current status (p.335-382). NJ: Lawrence Erlbaum, 1983. ii Schmidt H. Tips for effective lecture presentations, Handout, 1998. iii Yelon S. Powerful Principles of Instruction (p.188). NY: Longman Publishers, 1996. iv Yelon S. Powerful Principles of Instruction (p.208). NY: Longman Publishers, 1996. v Schmidt H. Facilitating Small Group Discussion Sessions: Basic Guidelines, Handout, 1998. vi Ibid. vii Harlin B. “Teaching Wisdom”—General, Handout, 1995. viii Ibid. i