Harvard Macy Community Blog

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

Deploy team science principles to mend “silos” in academic medicine

Though it is difficult to predict the future, it is safe to say that collaborative, cross-disciplinary approaches to complex societal problems are here to stay. This is evidenced by team science, a collaborative and cross-disciplinary approach that has accomplished biomedical breakthroughs once considered impossible. Making the most of the opportunities that team science has to offer may seem fraught with the challenges of adapting from a solo-investigator culture to one of collaboration; however, new advances become possible through this methodology.

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Dear Native English Speakers, Please Make Sure Your English is Understandable

What do the AMEE Conference, Reddit, and popular programming languages - such as Java - have in common? If you answer that they are all based on English, you are correct. Though they are international, their medium of choice, like many other things, is English. The landscape of academia is also English-based, as English publications are far more numerous that those of other languages.

Therefore, native English speakers may naturally feel more at ease communicating with an international audience. However, this BBC article describes why non-native speakers can be more effectual English communicators in these settings, and native speakers should step up their game.

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#HMIchat September 2018 - How Do We Use and Foster Curiosity and Creativity as Educators?

I arrived home from Basel energized and inspired by AMEE 2018. The conference’s fringe sessions were the inspiration for this month’s chat, which aimed to answer the question, “How to use and foster curiosity and creativity as educators?

Many students enter medical school with open minds and a thirst for knowledge. Unfortunately, that insatiable curiosity can fade somewhere along the path of medical school and residency. This brings to mind a few questions. First, what factors in our own training programs can lead to that loss of curiosity? And secondly, and maybe more importantly, is it possible to relight that flame, or to guard against it ever going out? I personally love the idea of arts and humanities courses for medical students. Atipong Pathanasethpong (@atipongpath) told us about Khon Kaen University’s art classes for first year medical students. Such an innovative idea!

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Challenging Assumptions: Your own, your tribe’s, and your community’s

The Harvard Macy Institute Program for Educators in Health Professions is an ideal place to develop and practice new teaching skills consistent with the current knowledge of experiential learning theory, as well as a place to enhance scholarly expertise and explore organizational leadership. As I found, it is also a place to recognize your personal potential and to help others find theirs by identifying ideas, commitments, and even biases, that knowingly or unknowingly hold us back. Ultimately, this allows us to transform into better versions of our educator and leader selves.

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Behind the Curtain with Louis Pangaro: How the RIME Framework was born

Recently, Louis Pangaro received the 2018 National Board of Medical Examiners Hubbard award. Lou is known for his work developing conceptual frameworks for assessment and developed the RIME framework for clinical assessment of learners in medical education. As Lou is one of the course directors for our ‘Systems Approach to Assessment in Health Professions Education’ course, and a leader in medical education assessment of learners, we thought we’d ask him to explain the RIME Framework, and how it came to be.

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#MedEdPearls September 2018 - A different approach to questioning

Looking for a quick, engaging activity for your course? Try a slightly different approach to using questions that facilitates peer instruction, promotes deeper learning, and allows for knowledge application. Similar to Team-based Learning, this activity can also give student teams an opportunity to provide rationale for their responses while also providing you feedback on how well students are understanding the material.

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The Role of Formal Training in Medical Education: New Pathways to Medical Education

Since my early years in medical school I have understood that teaching was one of the skills a physician should have. Teaching patients, families, and multi-disciplinary teams is a daily and complex activity. What shall we say then about teaching prospective doctors? Is it a higher calling, an inherent talent impossible to be taught and learned? Or is it a teachable skill itself?

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Disrupting Health Professions Education…What we learned from this month’s #HMIChat

We had a lively discussion during this month’s #HMIChat about disruptive innovation focused on health professions education. We discussed many sustaining innovations as well, and highlighted the difference between the two. For those interested in reading more check out the pre-reading for the chat. Obviously, the @HarvardMacy and #MedEd community at large is eager to innovate, whether it be sustaining or disruptive and quite frankly we need both types!

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Behind the Curtain with Victoria Brazil: How hard can it be?

At the 2018 Program for Educators, faculty member Victoria Brazil led a professional development session for course faculty intended to prompt reflection on our career trajectories. Victoria asked a series of six questions to our faculty members, and we thought our Harvard Macy blog readers would enjoy hearing Victoria’s answers to the same questions.

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#MedEdPearls August 2018 - Questioning to assist in Supervision Levels and Entrustable Professional Activities (EPAs)

What levels of supervision are required for physician trainees? This month’s #MedEdPearl focuses on faculty supervision levels using a prospective, summative entrustment scale that fosters physician trainee progression toward autonomy.  As trusting propensity is an important component in supervision and entrustment, ten Cate and colleagues have developed an easily understood model for communicating aspects of entrustment through level of supervision for trainee assessment. The model describes elements of progression and decision-making that can foster autonomy in the learner.  As a complement to ten Cate's model, the #MedEdPearls team offers the following questions to quickly assess the required level of supervision for a learner while encouraging learner growth.

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Pushing the Envelope: Ways Technology Can Extend the Limits of Possibility in Medical Education

The technology landscape has changed a great deal even since my first Harvard Macy blog post back in 2015. As computing power increases exponentially, we are seeing many of the technologies that were previously thought to be science fiction coming to fruition. Artificial intelligence, machine learning, neural networks, blockchain technology, augmented reality, virtual reality, and 3D printing are now making their way into common language outside of our higher education walls. Ever increasing attention has been given to technologies like augmented (AR) and virtual reality (VR), with new companies popping up every day and existing companies scrambling to expand their capabilities utilizing these technologies. In 2017 alone, venture capitalists poured over $3 billion dollars investing in AR and VR startups and the global healthcare AR/VR market is expected to hit $15 billion by 2026. Virtual and augmented reality headsets are free falling in price and rapidly hitting the consumer market with the HTC Vive and Facebook’s Oculus Rift falling from $800 in 2017 to $399-499 in 2018. Mobile based AR is rapidly gaining popularity as our everyday devices are now being supported by Apple’s ARkit and Google’s ARCore. Bringing these technologies to mobile devices will have huge implications in education and learning.

This post is not intended to be exhaustive, but rather a snapshot and examples of what technological capabilities are out there. Regardless of the technology, the adage ‘Content is King’ strongly resonates. One must remember that the technology will never make up for poor content or pedagogy. Although there is strong buzz around these technologies, I encourage everyone to be critical and see how the technology can actually add value or capabilities to the educational content without being the educational content itself. The best way to evaluate this is to ask yourself, ‘Could this content be made meaningful without this technology?’ For example, a virtual patient in VR may be cool, but are the interactions with the patient the same that could be had with much lower technology like a laptop or mobile device? In some instances, technology can actually add unnecessary cognitive load and detract from the learning experience.

This blog will detail technological advancements in the consumer and educational realm, and how medical educators are starting to use this technology to augment and, in some instances, replace existing learning experiences.

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#HMIchat July 2018 - What Image or Song Would You Choose?

For those of us in the United States, it was a special holiday version of #HMIchat on July 4th— a 24 hour asynchronous chat (no synchronous sessions this time)! Because July 1st marks the beginning of a new academic year here in the US, the focus was medical education goals for the 2018-2019 academic year. Personal, professional, and institutional medical education goals were all welcomed.

Despite the holiday, our @HarvardMacy community showed up to share & help! We shared goals such as: create a curriculum that is both sustainable and malleable, complete graduate training, learn about various education strategies, increase habits of self-care, and develop new research interests. Many of us struggle with how to move forward with a new goal. Fortunately, our community members shared several wonderful resources—here are just a few:

Great book for curriculum building, shared by Lonika Sood.

Great book for presenting the evidence in medical education, shared by Teresa Sörö.

How to write great multiple choice questions, shared by Teresa Sörö.

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Procedural Competency and Procedural Proficiency

Practice doesn’t make perfect. Perfect practice makes perfect.

  • Vince Lombardi

Teaching procedural skills to novice providers can be challenging. Maintaining procedural skill and advancing from competent to proficient can be even more difficult. Simple practice and the ‘See One, Do One, Teach One’ model may not be sufficient. This blog covers how to practice a more perfect procedure.

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Feedback PLeaSe! A #MedEdPearl from #IAMSE18

The Feedback PLeaSe model has three phases: Preparation, Listening, and Summarizing.  During the Preparation phase, the faculty facilitator announces the intention to conduct face-to-face feedback sessions, discuses effective behaviors, and provides a model to use when giving feedback. In the Listening phase, the presenters at the conference suggested using a model called the STAR model. STAR is an acronym that reminds learners that effective feedback is Specific, Timely, Actionable, and Received. Those providing feedback can use the STAR model to give one positive observation and one area for growth. The receiver is encouraged to listen while the facilitator takes notes to send at a later date. Finally, in the Summarizing phase, the receiver demonstrates active listening by giving a short verbal synthesis of key points of the observations.

During the session at the conference, the presenters shared anecdotal data from their experiences using the Feedback PLeaSe model. Additional qualitative and quantitative data is available in their article. They also led an excellent faculty development activity. During the activity, participants formed small groups and received a realistic scenario, assumed roles, and practiced conducting a face-to-face feedback session.

How do you prepare learners and faculty to provide effective feedback? Share your strategies at #MedEdPearls.

REFERENCES

Szarek JL. Medical Science Educator April Article Review http://www.iamse.org/medical-science-educator-april-article-review-from-dr-john-l-szarek/

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Seriously? A Board game?

Candy land. Monopoly. Life. Scrabble. Risk. These are the games that we played as children, but they often engaged us in a way that is the foundation for learning. Engagement, after all, is a crucial precursor to learning since it allows educators to gain a learner’s attention. Games, however, do not need to be built for fun – they can be serious too.

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Choosing Not to Learn: The Case of the Missing Students

Bella didn’t show up for her assigned clinics. Instead, without informing anyone, she joined her classmates in other clinics that were more interesting to her. Another time, Bella didn’t show up in any clinic at all (as confirmed by faculty). When Dr. Harvey confronted her on her attendance, she lied.

 Charles seemed to show interest in the specialty and engaged well with the patients. Then one day he didn’t show up at work. Afterwards, he emailed Dr. Harvey to explain that he had decided to self-study instead of see patients. Later, Dr. Harvey heard from an administrator that Charles had returned his hospital badge and submitted his feedback days before the usual end of the rotation date.

 On the last day of the rotation, Dr. Harvey held a meeting with the students. He wanted to understand why they were absent so frequently, seemed disinterested, and didn’t notify him of schedule changes.

 Bella said the greatest learning value came from seeing standardized patients and doing simulations, followed by attending lectures and tutorials. To her, seeing real patients had the lowest learning value. She further believed that observing faculty deal with ‘patient administrative matters', such as completing insurance forms, was not useful for her future career.

 Charles said he was focused on passing the summative exam at the end of the rotation. He saw attending patient clinics as optional.

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#HMIchat June 2018 - What are We Really Teaching? Exploring The Hidden Curriculum.

Missed out on the June #HMIChat about the promises and perils of the hidden curriculum? In this post, we recap the key points from the conversation and further enhance our learning on the topic. 

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What Can YOU Design?: Innovative Thinking in Medical Education

The American Association of Colleges of Osteopathic Medicine annual conference was packed full of thought-provoking sessions, including an interesting discussion on Design Thinking.

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What every healthcare manager should ask before hopping on the integration bandwagon

It’s rare to read past a healthcare headline these days without encountering the word “integration” in some phrase or other, from vertical or horizontal integration; to clinical, economic or data integration. And the word’s ubiquity makes sense. Everything about U.S. healthcare is complex, from the problems it’s required to solve and the fragmented “system” through which care is funded and delivered, to the regulations intended to promote care quality, cost effectiveness and access. So it’s intuitive that industry managers pursuing ambitious goals would strive to get people, processes and resources working in alignment toward them. 

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We are all Leaders: What are you waiting for?

We are all leaders! Health care professionals, whether nurses, pharmacists, physicians, physical therapists, or others, are all leaders at different times. Health care is complex, and all of us must be humble enough to recognize that there are times when we should let someone else lead. While not all of us will take on formal leadership roles such as deans, department chiefs, or program directors, all of us will lead in some capacity. We will, at a minimum, lead our own clinical teams and, of course, our patients. Despite the fact that we are all going to be leaders, there remains a paucity of education dedicated to leadership development for entry level positions and, in particular, graduate medical education. While there are resources for those assuming titled leadership positions, for many who are leading on a daily basis there is a gap in leadership training. Moreover, we should not wait until people are put in positions of leadership to develop their leadership skills. This so-called accidental leadership (the leadership skills we learn simply by taking part in our jobs) development model needs to change.

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