Harvard Macy Community Blog

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

The “Heron 8” – 3 Things and 5 Communities – Even More Relevant During COVID-19

 One may ask what the “Heron 8” is and why the relevance especially in this time. In simple mathematic terms, the “Heron 8” encompasses what we all need in our life’s journey – 3 things and 5 communities to thrive. The summation of these constructs is 8. The suffering is acutely seen in the patients I care for  in my professional life as an Emergency Physician in a busy inner-city Emergency Department. An Emergency Department that cares for patient’s primarily of lower socioeconomic status who are predominantly people of color. People who look like me.

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July 2020 #MedEdPearls:The HyFlex Option - Designing Course Delivery in a Time of Known Unknowns

In HyFlex courses, students can decide for each and every class meeting, group activity, assignment and assessment whether to sit in the classroom, join via videoconference in real-time, or complete online activities later. The HyFlex model offers institutions and programs the flexibility to deliver educational experiences as safely as possible and enhances their ability to pivot to remote teaching and learning quickly, if needed.  

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Promoting Wellness for Educators During Uncertain Times

Helping yourself

 

Develop structured daily routines: This includes setting wake up and sleep times, mealtimes, and exercise times. Practice sleep hygiene by setting bedtimes and liming screen time prior to going to sleep.  

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Building a Culture of Caring in the C-suite

 

As a novice healthcare manager, I recall the shock I felt after my supervisor screamed at me for no apparent reason. She then called another colleague and told him how horrible she felt but she never apologized to me. As I progressed to C-suite leadership, I realized I had the power to model the behaviors I wanted to see. The Joint Commission Sentinel Event on Harassment warned of behaviors that can undermine a “culture of safety.” Disruptive behaviors such as verbal outbursts, uncooperative attitudes, refusing to complete assigned duties, and intimidating behaviors such as physical threats undermine the safety of our team and our patients. Since the #MeToo movement and resulting Time’s Up and Time’s Up Healthcare campaigns, we are beginning to see more research on the types of harassment that create unsafe work environments for our patients and employees. Most recently, Dr. Esther Choo and colleagues published “Sexual Harassment between Health Care Workers and Safety Culture,” identifying cases of sexual harassment and their impact on staff and patient safety. There seems to have been little progress made toward the national high reliability healthcare system we strive to become but we have the power to change this.

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The Harvard Macy Institute Podcast: Silver linings – Leadership and Innovations for Health Professions facing the COVID-19 pandemic

The COVID-19 pandemic has been a challenging time for healthcare and for health professions educators. But there are opportunities for innovative approaches to our clinical and educational work, and for reflection on the systems of training and workforce development. The pandemic has brought a sharp focus on leadership and change.

In episode #4 Victoria Brazil speaks with Professor Liz Armstrong, Director of the Harvard Macy Institute, about ‘silver linings’ – the opportunities for innovation and creativity – from the challenges of the COVID-19 pandemic. Liz describes the plans for running the June Leaders program online, and how interactivity and small group work are being supported. She tells us about a preliminary exercise the scholars have completed – focused on their own ‘silver linings’ – and how (paradoxically) ‘staying at home’ seems to have fostered more community, collaboration and patient focused care. And finally – Liz and Vic ponder on broader issues of change and innovation in healthcare, and take lessons from Elon Musk and SpaceX !

Watch out for new episodes this year which will be announced on our blog and our Twitter, LinkedIn, and Facebook social media channels.

Did you know that the Harvard Macy Institute Community Blog has had more than 220 posts? Previous posts have included interviews with Alice Fornari, Louis Pangaro, and Victoria Brazil!

 

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Harnessing the Power of Zoom for Teaching and Learning

 

How do I engage learners in a remote, online, or virtual environment? This is a question rolling around in the minds of many health professions educators who have over the last few months made significant pivots given the COVID-19 pandemic. Zoom, among other web conferencing technologies, has become an essential tool for educators, learners, and peers to connect and facilitate synchronous learning experiences. However, integrating Zoom alone is not enough. To create significant learning experiences, consider the three tips offered below!

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June 2020 #MedEdPearls: Out of Our Comfort Zone and Into the Fire: Ideas for Engaging Students Virtually

Martin & Bolliger describe Moore’s three types of interaction in effective online courses: (1) learner-to-learner interaction, (2) learner-to-instructor interaction, and (3) learner-to-content interaction and provide strategies to increase engagement.

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Finding and Defining Your Legacy

As an undergraduate student at Louisiana State University, I was acknowledged for outstanding humanitarian services in the tradition of Dr. Martin Luther King, Jr., which encouraged me to continue to work towards supporting, motivating and encouraging others to pursue their dreams and careers.  


As a graduate student, I enrolled in a required course entitled, “Time Management.” I was a little disturbed at having to take such a course with all of the more important courses I felt I should spend my time completing. However, this course turned out to me the most impactful courses I have ever taken. I thought the course would teach me how to manage my time to be a more effective student and future professional. Additionally, I devoted the semester to reading and applying information about the type of legacy I would leave and how I would impact the people in my life and the world around me. I would spend hours thinking about the different roles I possess, such as a sister, a daughter, a mother, and an aunt.

Our assignments and class discussions were always so rich and reflective. We had to ponder what we want our legacy to be and think strategically how we could accomplish these goals. For many years I grappled with my legacy, until 2014 when I made a career change in order to move back to Louisiana from Iowa where I was employed at the university level as the Director for the Center for Improving Teaching and Learning at Des Moines University. My new position in at the Louisiana State University School of Veterinary Medicine opened up new opportunities for me to work with diversity and inclusion efforts for the School of Veterinary Medicine and the profession as a whole.

I realized that the work I was about to embark upon would be the legacy I had been grappling to find. I created a nonprofit institute, the Institute for Healthcare Education Leadership and Professionals (iHELP) to work with supporting diversity and inclusion efforts in healthcare. The first iHELP initiative is the creation of the National Association for Black Veterinarians (NABV). The purpose of the organization is to work collaboratively with other organizations to support and ensure research-based methods are implemented to increase diversity and inclusion in the veterinary medical profession and in colleges of veterinary medicine. The charter president (Dr. Renita Marshall) and Vice President (Dr. Tyra Brown) were featured in an article that discusses the lack of diversity in the profession which speaks volumes about the need to increase the number of Black people in veterinary medicine. 

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What my former career as a pipefitter has taught me about medicine so far

“That’s just a little blue-collar ingenuity, my friend” said “Junior” as we all sat there dumbfounded. I was the foreman of a pipefitting crew at a large semiconductor plant in Oregon. Junior was a traveling pipefitter from Florida and a veteran of the trade. For the past two days, we had been racking our brains attempting to rig a difficultly large spool of pipe so that we could make a weld. Our attempts had all failed. But how? We were all certified in rigging and had done this thousands of times. Junior joined our crew earlier that day. When he saw that we were struggling, he walked over, nonchalantly, and changed our approach in a way that none of us had seen before. It worked. We had been too focused on approaching the problem from a single perspective – we were unable to take a step back and reassess our methods.

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Students as Partners: Working with students to co-create medical school curricula

As they listen to lectures, work through group learning activities, and study, students may recognize discrepancies in content, flow of material, repetitions, and more. Obtaining student feedback can be very helpful in guiding curriculum design. Students can provide formative feedback to faculty – for example, if a student did not feel that they learned from a particular lecture, they can offers suggestions for how to improve. In turn, faculty can acknowledge student feedback and respond to it, thus closing the feedback loop (as we see in Kern’s 6 Steps to Curriculum Development). If changes were suggested, the faculty member can respond to the class to explain why they could or could not make that change – which students will appreciate!

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May 2020 #MedEdPearls: Back to Basics with the Plus/Delta During COVID-19

As educators, we must remember to go “back to basics,” in times of uncertainty or when we experience new teaching and learning challenges. Adult learners desire to give and receive feedback about their learning experiences. Educators navigating the transition to online teaching and learning can utilize this in their favor. Although varied methods can be utilized, one simple, efficient, translatable, and free way to do so is to implement the “Plus/Delta Debriefing Model” (Plus/Delta) as part of routine educational quality improvement.

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Empowering Residents How to Teach: One Minute Preceptor on the Wards

Not that long ago, I remember being thrust into the role of a senior resident on wards and being responsible for the educational experience of medical students. I was still trying to figure out how to manage patients - how was I going teach the medical students? How could I be supportive of their learning? It was overwhelming and I remember wishing someone would provide me with additional guidance.

Years later, after finishing a Masters in Medical Education, I gained some tools that allowed me to understand how being a good teacher was an art and a learned skill – not something that comes innately. I wanted to impart some of the skills I had learned to the senior residents in our program so they did not feel as lost as I did all those years ago. Furthermore, residents at our program had expressed a need for guidance in teaching medical students. Thus, I challenged myself to start a curriculum for internal medicine residents focusing on the “One Minute Preceptor” – an educational technique that could be useful for them when teaching on the words.

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Art as Antidote: Fostering Empathy, Self-Knowledge, and Resilience in the Art Museum

This past spring, my palliative care colleagues and I sat down in front of Kara Walker’s artwork titled The Jubilant Martyrs of Obsolescence and Ruin at the High Museum of Art in Atlanta, Georgia. For thirty minutes, we slowed down, turned off our cell phones and pagers, and looked slowly and intently at this 58-foot massive cut-paper work. Like the other works of art we studied in the museum, our docent facilitator began the conversation by asking us the following question: What is going on in this artwork?  Some saw a scene of incredible violence. Others saw a satiric commentary on the American Civil War.  One remarked on figures representing different races and identities. Another commented on gender and sexuality portrayed in the work. With each comment, the facilitator asked: What do you see that makes you say that? Our eyes sharpened and our language became more precise with each passing comment.  For example, when a participant was asked to clarify her remark on different eras of American history portrayed in this image, she honed in on the figure in the upper right of the artwork who appears to be wearing a suit. To her, he represented an African American figure from the Civil Rights era more than from the Civil War. The facilitator acknowledged and paraphrased her comment, and then continued: What more can we find?

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Promoting collaborative and teamwork competency in medical students

The medical practice landscape has changed towards a more team-oriented and inter-professional approach. Physicians are expected to function as effective members of multidisciplinary teams, as the patient case mix has increased in complexity, chronicity and age. Developing collaborative skills in medical education is essential as medical students will enter a dynamic world of team-based medical practice. Therefore, teamwork training is a requisite in medical school to nurture appropriate competencies in the physicians of the future. The literature recommends beginning collaborative and teamwork training at the start of medical training, using implicit team learning (e.g. problem based learning and team based learning activities where students work interdependently to achieve learning outcomes while teamwork/collaboration is influenced by the facilitator) for early students and progressing towards more explicit team learning (e.g. clinical simulation activities where students work interdependently and are given explicit instruction and practice in teamwork/collaboration with the goal of improving their performance) as students advance.  

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April 2020 #MedEdPearls: Mastering Adaptive Teaching in the Midst of COVID-19

The current coronavirus outbreak is forcing all educators to rapidly adapt to a new method of teaching - online. While many educators may have mastered their teaching domains in the classroom, virtual teaching will certainly challenge their mastery of adapting to this new learning environment. With the help of faculty development colleagues, we can remain nimble during times of rapid transition. How do we as medical educators stay resilient and step courageously into this unfamiliar territory?

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The Harvard Macy Institute Podcast: What’s Next for Systems of Assessment in Educational Settings

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.

Podcast #3 explores Four big issues for assessment in health professions education in discussion with Louis Pangaro, and guest comments from  Sharon Mickan and Martin Pusic. This discussion was originally prepared for the 2020 Systems Approach to Assessment in Health Professions Education course in Boston, where both Lou and Martin were expected to participate as faculty. However, due to the COVID-19 outbreak, the course was postponed and rescheduled for October 18th through October 22nd, 2020 (the Systems course will now be offered annually in October). 

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#MedEdPearl March 2020: Learning style preferences across a spectrum of learners

Have you ever encountered a cohort of learners who are all exactly the same? Likely not.Diversity in learning style preferences is increasing! A learning style preference is a desired or default set of cognitive, psychological, and social characteristics that learners exhibit in educational environments. In education, it is sometimes important to introduce desirable difficulty so learners are challenged to make concepts stick.

However, preceptors must be mindful of the myriad interactions with learners and modify their teaching styles accordingly to the learning style preference encountered (2). To illustrate, try this simple activity: Using a pencil, print your first and last name. Now repeat this same task but switch hands. What did you experience? While using your non-dominant hand, you probably experienced increased anxiety and decreased confidence and automaticity, and the task required increased time, concentration, effort, and attention while the quality of your handwriting decreased. By not attending to learning style preferences, it is akin to forcing learners to write with their non-dominant, non-preferred hand (3).

This pearl is a first of three devoted to the application of learning styles research in medical education.

How do you recognize learning style preference in your learners? Share your thoughts on Twitter at #MedEdPearls!

  1. Grasha A. 1994. A Matter of Style: The Teacher as Expert, Formal Authority, Personal Model, Facilitator, and Delegator. College Teaching, 42(4), 142-149.
  1. Vaughn L., Baker R. 2001. Teaching in the medical setting: balancing teaching styles, learning styles and teaching methods. Medical Teacher, 23(6), 610-612.
  1. Grasha I. 2010. The dynamics of one-on-one teaching. College Teaching, 50(4) 139-146.

 

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The Challenge of Giving and Receiving Feedback in the Operating Room

Verbal feedback from senior surgeons represents an essential part of surgical training. As an organizational psychologist who has spent time observing and measuring communication in the operating room (OR), I have observed a great deal of feedback from surgeons to surgical residents, students or more junior team members; most were constructive and expressed respectfully. However, in some cases, I observed feedback that seemed unsupportive and challenging to interpret, such as: “No, no, you should do this like this and not like this [showing how to handle an instrument], as I already told you twice. You are still working like an intern.”

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Growth mindset and medical education: What is the connection?

“Stop!” the attending blurts out as the trainee was about to make a miscalculated maneuver with her surgical instrument. The resident’s stomach flips as she realizes her potential error and readjusts. The attending, likewise, breathes a sigh of relief as the surgery is turned back on course.

As medical educators, we have all experienced high stakes moments like this one. But what is the best way to debrief this encounter? And how do we turn the “fight or flight” inducing stomach-churn into an educational opportunity? Sure, we can give feedback, and we should. However, to the learner, this experience may feel like a “mini-fail” and lead to feelings of guilt or shame, and possibly avoidance of similarly challenging scenarios in the future. Can we redirect a trainee’s learning trajectory just as we redirected the surgery? I think we can, with a secret ingredient called “growth mindset.”

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So I have this consult...Using the consult as a means of teaching and learning

I remember being a first-year physician in training, picking up the phone, and calling consults. I remember calling consults even if I found I did not always understand the question we had for our consultants. It bothered me at the time, but I was so busy, and asking why sometimes seemed like more energy than I could muster.

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