Harvard Macy Community Blog

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

#MedEdPearl January 2020: About Learner Feedback: The Gift No One Likes to Give but Really Should

Let’s be honest about one thing: No one likes giving constructive feedback to learners. Even with the brightest learners, the process can be quite daunting and, at times, repetitive. Yet, we find ourselves seeking support from colleagues and other experts in the field to find fresh ways to deliver effective feedback. This #MedEdPearls highlights the SPIKES protocol as a tool for learner feedback. In 2011, the tool was adapted by Thomas and Arnold to identify parallels between giving feedback and delivering bad news to patients. Additionally, they found the structure of the SPIKES protocol served as a buttress of support for medical professionals newer to the role of instructor. Consider the use of SPIKES the next time you deliver feedback:

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Mastering 2020

I was recently asked by a colleague: “What are your goals for 2020?” As I began to write down the long list of possibilities and to articulate my answer, I started thinking about the question a little more deeply. What is a goal? And, do I really define myself by them?

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Virtual Communities of Practice in Health Professions Education

The Harvard Macy Institute Podcast aims to connect our Harvard Macy Institute community and to develop our interest in health professions education topics and literature. Our podcast is hosted by our Program for Educators in the Health Professions course faculty Victoria Brazil, and will feature interviews with health professions education authors and their research papers.

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#MedEdPearls December 2019: Is There A Transformational Book for Educators?

This #MedEdPearls highlights the Ignite session that focused on the book “Make It Stick” and was facilitated by Deb Hagen Moe and Carrie Bowler at The Generalists in Medical Education - #TGME19. The session highlighted how the principles in the book have both empowered learners and faculty and led to curricular innovations within Pathology programs at the Mayo Clinic. 

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Reflections of a Facilitator: Why I Come Back Each Year, or How My Life is One Big Kolb Cycle

As this year's Harvard Macy Program for Educators in Health Professions course drew to a close, celebrating the 25th anniversary of the Harvard Macy Institute, I spent some extra time reflecting on what I learned this year, and why I keep coming back. The answer, I realized, surprised me.

I first came to the course in 2013 as a scholar. Like many others, I was in awe of the learning environment, and overwhelmed by the work. I spent long days and nights trying to keep up with the readings and assignments, and faced the humbling experience of having my project, which I had worked so hard on, get (significantly) revised by the new information I was taking in. When I left, I was physically and emotionally drained, yet I couldn't wait to come back. What was wrong with me?

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My Medical Education Mantra: Small is OK! Imperfect is Better than Nothing!

In June 2019, a postcard came in the mail from my past self. At first, I was confused to receive a photo of Boston, where I live, but I recognized my own handwriting with my favorite blue super-fine pen. It was my 6-month follow-up postcard that I had written at the Harvard Macy Institute Program for Post-Graduate Trainees.

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November #MedEdPearls: Trust Me – I’m a Doctor

Competency based medical education (CBME) is an outcomes-based time-independent concept that is informing curricular innovation across the country and beyond. The roll out of Entrustable Professional Activities (EPAs) has incited discussion about workplace-based assessment in the context of entrustment.

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Making People Think at Grand Rounds

I recently had the opportunity to present at the Dell Medical School Palliative Care Grand Rounds. I was fresh from attending the Harvard Macy Institute Program for Educators in the Health Professions, and more fully aware of the significant learning benefits of an interactive lecture. I now had evidence that there are better ways to present material that would help people learn. Plus, I had experience as a learner that engaging, interactive lectures were just way more fun. Now I just had to figure out how to create one…

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#HMIchat August 2019: Developing Leaders: Busting Myths and Lifelong Learning

Despite numerous calls for an increase in physician leaders and leadership development in medical education, a 2018 systematic review found significant gaps exist in (1) understanding the best ways to teach leadership, (2) assessing and understanding the value of leadership training, and (3) overall reporting of curricula design. Participants in the August #HMIchat explored myths of leadership and leadership development, shared crucial advice, passed on resources, and discussed innovative ways to teach and develop leadership skills both in and beyond medical education. The chat was rich with ideas and resources to help us become better leaders.

 Here is a recap of some of the common themes and ideas shared by our community.

What are some common myths about leadership?

  • Leaders cannot show vulnerability; they must have all the answers… be the smartest in the room (@joshuadhartzell)
  • Everyone has the same access to leadership opportunities. Reality: There remains incredible bias and sponsorship is one way to work to create equity in leadership (@SusanHingle)
  • You have to be an extrovert to be a leader (@KFabsMD)
  • Leaders can only lead after they have “done their time” (@DrJRMarcelin)

As we discussed these myths, @Javeedsukhera remarked how “many myths related to leadership perpetuate gender and racial biases...make us question our leadership skills and competencies because we don’t ‘look’ like leaders.” In busting these myths, the #HMIchat turned to the critical value of personal mentors, coaches and sponsors in developing leaders, especially for women and minorities.

What are some common myths about teaching leadership:  

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Education as a Catalyst for Health Care Transformation

Improving community and population health is in the core mission statement of many medical schools. However, physician training happens within the same system that has led the United States to disproportionately spend on its healthcare system. While wealthy countries like the U.S., tend to spend more per person on health care and related expenses than lower income countries. However, the U.S. spends more per person on health than comparable countries. Health spending per person in the U.S. was $10,224 in 2017, which was 28% higher than Switzerland, the next highest per capita spender.  The all-encompassing social determinants of health, politics, and vested financial interests heavily influence policies affecting population health. It would be useful for us to take a moment reflect upon the problem.

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Interprofessional Education: Who is buzzing at your planning table?

For the past two years, I have been deeply involved in interprofessional education and collaboration efforts at Cleveland Clinic. As an instructional designer by training, I strive to engage all stakeholders any time I am designing educational programming. This is particularly important when your audiences are from a number of professions, with a wide range of expertise level and diverse views on the need for learning.

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October #MedEdPearls: Resources to ease MCQ test writing anxiety

School is back in full swing, and it is a good time for refreshing multiple-choice question (MCQ) exams. Download the following one-page guide for 5 basic steps of item writing.

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Removing the Sage from the Stage: Blending Case- and Problem- Based Learning in Graduate Biomedical Research Education

Though those trained in business, law, and medicine are no strangers to active learning techniques in the classroom, scholars in graduate biomedical research programs are still frequently taught using passive lecture-based techniques. This is challenging for many pre-doctoral and master’s level students, who will spend the bulk of their training years conducting inquiry-based research. They are inherently curious and learn best through hands-on techniques. I say this as an individual for whom a single case-based course during my graduate biomedical research training not only vastly improved my educational experience as a student, but also dramatically changed my views on what biomedical research education was and could be.

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“Good job, read more:” Making positive feedback truly positive

When I see “good job, read more” on a learner’s assessment form, I chuckle because I have most certainly received that feedback before, as have many other health professional trainees. To some educators, this appears to be effective reinforcing feedback, but a larger number of educators cringe on seeing that phrase, because neither did it take much effort to write those four words, nor does this feedback help a learner improve and grow.

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Jumping down the rabbit hole: Questions to chase in medical education

For some time now, I have been contemplating the kinds of questions we ask in health professions education (HPE). These ruminations began in 2010 when I was working on a paper about my medical school’s efforts to implement an educational innovation. Truth be told, I had a real problem. My study was supposed to be an evaluation of the innovation’s implementation; however, the data highlighted all the workarounds we constructed to make the innovation fit within our contextual constraints. How could I evaluate our implementation of the innovation when I was no longer confident that what we had implemented was still an exemplar of the original innovation?I found myself asking questions like: Why do we value this innovation? Why is our implementation an example of the innovation at work? How much can I change the innovation before I turn it into something else?

I started searching the literature to find insights into these questions. Surely other HPE scholars have had similar concerns. Surely I would not be the first to venture down this rabbit hole. Right

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September #MedEdPearl – Small Group Instructional Diagnosis

Even though it seems classes just started, it is time to prepare for mid-semester evaluations. Unlike evaluations at the end of the semester, mid-semester evaluations are great tools to provide feedback to the instructor in time for adjustments to be made. This semester, consider a SGID—Small Group Instructional Diagnosis. A SGID is a short, 20-minute formative assessment activity that involves having a trained facilitator meet with student focus groups to discuss what’s working, what needs improvement, possible changes to the course, and how students see they are meeting course learning objectives. 

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Inclusive Health Professions Education

Inclusive Learning

On April 5th, 2019, I had the pleasure of attending a workshop, “Building an Inclusive Classroom,” sponsored by the Vice Provost for Teaching and Learning at Stanford University. The guest speaker was Sherryl Broverman, PhD, from the Duke Global Health Institute and Duke University Department of Biology. Everything that follows is credited to her and represents a tiny glimpse into her outstanding presentation.

The workshop started with the class divided into groups of 5-7 individuals that were given arts and crafts supplies and asked to complete a creative task. When finished, we compared our work between the tables and noticed striking differences. Dr. Broverman set the stage for our discussion by asking, “How do we organize our classrooms so that teaching activities, student performance, and evaluations don’t codify and reinforce existing privilege and social capital?”

Some students did not understand the prompt that described the assigned task.

Some groups were given more supplies than others. They completed more intricate and interesting crafts than groups with less resources.

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The Art of Education: The Harvard Macy Institute’s Art Museum-based Health Professions Education Fellowship

A foundational principle of the Harvard Macy Institute (HMI) is to build and nurture collaborations to foster cross disciplinary learning and problem solving. Early collaborations begun with the plans described in the 1994 successful grant submission to the Josiah Macy Jr. Foundation, which laid the foundation for our 26 year collaborations with faculty at the Harvard Medical School, the Harvard Graduate School of Education and the Harvard Business School. The Macy Foundation’s assumption was that neither institution would be as successful working in isolation as they would be in partnership. This blog post tells the story of another fruitful collaboration - one in which health professions educators and museum educators collaborated to design a new fellowship, sponsored jointly with the Cambridge Health Alliance and now part of the HMI course portfolio.

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4 steps to revitalize a tired post-graduate curriculum

Since as early as the 1880s, psychologists studying human memory generated “forgetting curves” which attempt to illustrate memory retention over time. It is thought that adults retain less than 30% of lecture-based content which diminishes over time, and yet this is still a commonly used platform for teaching in medical education. At my institution, our radiology residents receive nearly two hours of dedicated teaching each day, at least half of which is lecture-based didactics. I vividly remember sitting through those 45-minute lectures as a resident, often after lunch, struggling to pry my eyes open. 

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ACGME 2019 Faculty Development Requirements

The Accreditation Council for Graduate Medical Education (ACGME) updated Common Program Requirements (CPRs) for faculty development in July 2019. Moving forward, all core faculty who educate, supervise, and evaluate trainees will be required to participate in at least four (4) faculty development areas annually: as educators; in quality improvement and patient safety; in fostering their own and their trainees’ well-being; and, in patient care based on their practice-based learning and improvement efforts.

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