Harvard Macy Community Blog

Fostering the ongoing connectedness of health professions educators committed to transforming health care delivery and education.

Appreciative Advising: Advising with the Student in Mind

The American Association of Colleges of Osteopathic Medicine annual conference was packed full of thought-provoking sessions, including an interesting discussion on appreciative inquiry (specifically appreciative advising).

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Developing Leaders Through an International Collaboration: Introducing sanokondu

Many health care systems are faced with increased demands for safe and effective health care delivery as well as easier access to affordable health care services. These developments have resulted in the need for reform to the socioeconomic, political and medical educational agendas of several countries around the world. Central to these agendas is the need for leader and leadership development in medical training programs and integrating leadership education into the curricula of these diverse programs. Over time, educational frameworks have emerged in different countries to address this need for physician leadership education and many of them describe leadership using concepts like professionalism, communication, collaboration, advocacy and scholarship. Still, the process of reform and the implementation of leadership education proves to be difficult to achieve in the formal training programs of physicians. In this blog post, we introduce readers to sanokondu which is an international collaboration aimed at developing leaders within medicine globally.

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Designing Better Surveys for Education and Research

Health professions educators are increasingly engaged in educational scholarship. Many times, a survey is suggested as a way to collect data for scholarly activities related to teaching, learner assessment, program evaluation, and research, to name just a few. However, survey design is both an art and a science, and poorly designed surveys are unlikely to provide credible data. In this blog post, I offer six principles to guide the design and development of high-quality surveys in health professions education, with the ultimate goal of helping readers design better surveys for collecting better data.

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Medical Education and Global Health

As the Harvard Macy Institute and the field of health professions education have developed over the last 25 years, there has been a parallel growth in funding and scholarship within the equally multidisciplinary field of global health. Education and global health increasingly interconnect, and herein I discuss some of their fruitful crossings and lay out a vision of where the overlap between the two fields may lead.

 

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Microresistance

You have heard of microaggressions—“everyday subtle put downs directed towards a marginalized group which may be verbal or non-verbal and are typically automatic.” When these actions happen, whether in or out of the classroom, we’re often at a loss for how to address them.

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Reflections Across the Career Continuum, One Year Post-Harvard Macy

In 2018, Cathy Grossman and Lekshmi Santhosh completed the Harvard Macy Program for Educators in the Health Professions. They were frequent seat mates in the back row. While there, they discovered they were both Pulmonary and Critical Care trained – but at different places temporally in their careers. They were also both clinician educators, however Lekshmi was in her fellowship while Cathy was a decade out of fellowship. We thought it would be interesting to ask them some questions about their experience and how they were both able to apply their new knowledge at their home institutions, at two distinctly different points in their careers.

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Behind the Curtain with Vinny Arora & Nirvani Goolsarran: Bridging Leaders

Josiah Macy, Jr. Foundation Faculty Scholar and 2018 Scholar Vineet Arora, M.D., recently accepted the new Associate Chief Medical Officer-Clinical Learning Environment role at the University of Chicago Medicine. Vineet previously worked in graduate medical education to improve the clinical learning environment for residents and fellows by aligning institutional priorities with the work that trainees do on a daily basis. She is expanding this work to the whole health system, in her role as a “bridging leader.” She recently completed the Program in Health Professions Educators with Nirvani Goolsarran, an Associate Internal Medicine Program Director at Stony Brook University Hospital who is also a bridging leader in quality and education and active in the growing bridging leader community. We thought it would be interesting to ask them some questions about bridging leaders and how they were able to apply their knowledge gained at the course to these new roles.

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Scholar Testimonials of the Leadership and Innovation in Health Professions Course, Melbourne, Australia 2019

Our fourth iteration of the Leadership and Innovation in Health course was successfully held in February 2019 at Monash University, Melbourne, Australia.

The Harvard Macy Institute, in collaboration with the Monash Institute for Health and Clinical Education brought together faculty and scholars from across Australia and internationally to share their expertise and innovative responses to global health care and education challenges.

The response from our scholars was overwhelmingly positive with many enthusiastically providing testimonials to celebrate their successful learnings from the course, and their anticipated changes to their practice from these learnings.

We are proud to welcome another group of motivated health care professionals to the Harvard Macy Institute global community of practice.

Click here to learn more about our course and register your interest for Leadership and Innovation in Health, Melbourne, Australia, February 10-14, 2020. 

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Peer Instruction-A Med Ed Pearl from the 2019 Annual CGEA Conference

At the 2019 Central Group on Educational Affairs Conference in Grand Rapids, Michigan, Irina Overman and Brenda Roman from the Wright State University Boonshoft School of Medicine shared their experiences with Peer Instruction (PI). PI is a learner‐centered instructional approach developed at Harvard University by Eric Mazur and a straight forward method for encouraging active learning.

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Health Systems Science: The future of medical education and the solution to improving health care

This is an exciting time in medical education – as educators we have realized the importance of medical education reform and are in the process of rethinking how we educate our learners. There are many exciting innovators and innovations – but none with more potential and direct applicability than the implementation of Health Systems Science into medical education curricula.

What is Health Systems Science? Also known as the Science of Health Care Delivery, it refers to the critical competencies that are necessary for us to deliver the highest quality value-based health care in a manner that is both patient and population centered. It is how we can operationalize the education necessary to meet the Triple Aim of health care. Many of the hot topics currently being addressed in both the undergraduate medical education and graduate medical education spheres already encompass some Health Systems Science competencies. These competencies include population health (social determinants and healthcare equity), value-based care, health care policy and economics, interprofessional skills, informatics, and health system improvement. 

Why is Health Systems Science so important? In order to move beyond Flexner and truly embrace the continuum of medical education, we need to start thinking about foundational knowledge and clinical knowledge in a synthetic fashion and move away from the traditional 2+2 medical education model.  We have an opportunity to truly integrate the foundational sciences and clinical knowledge that our learners need, to use pedagogical approaches that will facilitate the integration of their foundational and clinical learning, and to ensure our students acquire the knowledge and skills necessary to be excellent physicians. Threads now incorporated into many curricula such as clinical reasoning, leadership, professionalism, and reflection are all critical subcompetencies of each of the Health Systems Science competency domains. Health Systems Science is the scaffolding upon which competency based medical education will thrive and ensure that our future physicians have the knowledge and skills to meet the needs of their patients. 

What are some early outcomes of Health Systems Science? As with any change in approach to medical education, innovative change without program evaluation impedes meaningful dissemination. Some of the early outcomes that speak to the importance and value of Health Systems Science have been the adaptation and implementation of the components of Health Systems Science into Undergraduate Medical Education programs. Some examples include:

1) Design of curricular frameworks for Health Systems Science

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F.O.C.U.S.E.D on Improving on the Dental Education

It is 5 pm on a Friday in the pre-doctoral dental clinic at your institution. A procedure has taken 5 hours, when it seemingly could have taken 90 minutes. Frustrated and exhausted, the student cannot seem to apply the content that they have learned in the classroom into real life. As an instructor you can’t help but think “What could we, as dental educators, have done to prevent this?”

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Pedagogy and Discharge Instructions: Do We Practice What We Preach?

“OK, so we think you have pleurisy. Your D-dimer was negative. You should take ibuprofen, rest and stay hydrated, then follow-up with your primary care physician. Any questions?”

My daughter reached for her discharge papers as she slid off the exam table and we thanked the staff as we made our way out of the urgent care part of a local emergency department.

She was eighteen at the time, a college freshman studying sociology. She called me to tell me she had been experiencing two days of pleuritic chest pain and felt a little short of breath. Because our logical, medical brains turn into parent brains when our child is sick, I dropped everything I was doing to go and see her. She looked fine, the pain was probably just musculoskeletal; she is a ballet dancer and these minor aches and pains are common. But, I thought, “What about a pulmonary embolism?” “Not likely” I thought, “but I’m here so let’s go get it checked out”.

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Technology in education: Transforming how we connect and build our learning communities

Working through the online pre-course materials for the Harvard Macy course “Health Care Education 2.0 – Transforming your Teaching for the Digital Age” we could not help but wonder if technology has evolved to the point that courses such as this might soon be delivered in an entirely online format. As a busy health professions educator, perhaps this thought has occurred to you as well, as you pack your suitcase for yet another flight, set your away message again, and put your projects, clinics, patients or meetings on a temporary hold to attend professional conferences or courses. If you teach in the classroom, then you may have received similar feedback from your own students such as our favorite, “Next time, can this session just be available online? I prefer to watch lectures at night on 2x speed.”

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The Role of Emotionality in Teaching and Learning

Emotion and learning have been viewed largely as separate entities, often with the role of emotions in learning (e.g. anxiety) as hindering. However, recent research has pointed to the interdependence between emotions and learning, suggesting that emotions are important, and perhaps even central to the cognitive learning process. Biologically, emotions are powerful motivators of learning because they activate brain mechanisms (e.g amygdala) that originally evolved to manage our basic survival. When reflecting on past educational experiences, the best teacher most quickly recalled is usually one with whom an emotional bond existed. To maximize student understanding and transfer of educational experiences into real-world skills and careers, medical educators must find ways to leverage the emotional aspects of learning by:

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Can we be Consciously Unbiased?

Implicit biases are associations between different concepts that develop over time, and influence us outside of our conscious awareness. The topic of implicit bias has entered mainstream conversation, and is the subject of discourse and debate. Some believe that implicit biases can be eliminated, and individuals can become consciously unbiased. Others suggest that implicit biases are impossible to change, and that attempting to recognize or manage biases is an exercise in futility.

Can we break our biased habits?

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A Millennial Learner’s Journey to Becoming a Physician Assistant

Growing up, I was often surrounded by health professionals as I accompanied my mother and brother to numerous medical appointments. I was immersed in the healthcare field starting at a very young age and that inspired me to work as a healthcare professional. The physician assistant profession was created in the mid-1960’s to ultimately expand the primary care workforce and address the shift of physicians training to provide specialty care. Over the last forty years, physician assistants have demonstrated that they are effective partners in a changing health care environment and have the ability to fill provider gaps and new roles in interprofessional team-based delivery systems. As a cohort, millennials aspire to have a career that allow us to be mission-driven, have good work-life integration, and experience personal happiness as well as professional success. These are just some of the reasons I - in addition to many other millennials - am drawn to pursuing a career as a physician assistant. In this blog post, I articulate the goals I have developed for my upcoming physician assistant training.

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Behind the Curtain with Senthil Rajasekaran: Developing a Global Competency Framework for Universal Health Care

Recently, Senthil Kumar Rajasekaran was invited by the World Health Organization (WHO) to be a part of a small working group of health professions education experts to develop a global competency framework for universal health coverage. As an alumnus of the 2013 “Leading Innovations in Healthcare and Education” course – who has also served as course faculty - we thought we would sit down with Senthil and ask him some questions about this meeting, his participation, the team’s recommendations and to learn about the global competency framework as it applies to health professions education 

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The Role of "Instructor Talk" in the Classroom

You can impact student success simply by the way you speak in the classroom! Instructor Talk is a term coined by researchers who looked at the impact non-content related language had on student success. Non-content language is the little things we say to students during a class session that foster a positive learning environment. Just by switching up how we talk to students can impact their perceptions. For example, switching from, “I have extended the deadline for the project” to “I have extended the deadline for the project to give you additional timeor from “We will begin today discussing . . .” to “To get you prepared, we will begin today discussing . . .” can help.

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Digital Storytelling: Bringing the Power of Narratives to Life

Digital storytelling refers to the use of real-life experiences, stories and adventures combining narrative with digital content. This can include images, sounds, and videos to create a short movie, typically with a strong emotional component to help engage learners in learning. Digital storytelling is a powerful medium for teaching because it can increase engagement and retention of learning, and has been used in medical education.

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The Power of Interprofessional Education

The pager on my hip beeped at 1:22 am with a call from the ICU. The nurse on the other end asked if I would please come down and pronounce a patient who had passed away. “I’ll be right there,” I responded, put down the admission note I was writing, and set off toward the ICU. This was my first inpatient medicine rotation as an intern, so I was embracing this task with a mix of overconfidence and not knowing what I didn’t know. I was also trying not to disturb my senior resident who was either addressing some important tasks or sleeping. Hitting the wall plate to open the double doors to the ICU, a nurse behind a desk pointed in the direction of one of the patient rooms. As I approached the room, I realized that I didn’t actually know how to pronounce a patient and had never been taught how to do so in medical school.

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