For those of us in the United States, it was a special holiday version of #HMIchat on July 4^th— a 24 hour asynchronous chat (no synchronous sessions this time)! Because July 1^st 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.

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.

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/

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.

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.

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. 

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

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. 

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.

Based on my date of birth I am a millennial. Although I am in no way an expert, I grew up using technology and am comfortable utilizing it in my teaching. What more did I really need to know? Prior to taking the Harvard Macy Institute 2.0 course, a friend cynically asked me: What are you really going to learn from a technology education course? How to do a PowerPoint presentation? Do you really think you are going to get something out of it? Reflecting back on those words after finishing the course I would confidently answer: That, and much, much more. 

Flipping the classroom with team-based learning (TBL) is becoming common practice in medical education.  Key to its success as a learner-centered teaching strategy is its scalability to large classrooms through the employment of high-performing learner teams, requiring less faculty time/numbers compared to other learner-centered strategies such as problem-based or case-based learning.  Individual learners are motivated to come to class prepared by both a readiness assurance process (i.e., quiz) and team accountability.  Class time is then focused on application of knowledge through problem solving and clinical reasoning. 

Compared to traditional teaching strategies such as lecture, TBL not only significantly increases knowledge scores¹, but also offers opportunities for developing and measuring competencies of contemporary healthcare such as professionalism, communication, team work, and even team reflexivity². As a pedagogical framework, TBL further facilitates integration of additional teaching strategies³ to optimize learning, retention, and teaching satisfaction.  As an opportunity for scholarship, there is a dearth of flipped classroom literature reporting measurement of outcomes other than knowledge gains.  So why not flip for TBL?

Check out the TBL Collaborative, MedEdPortal, or the following resources to get started!

1. Fatmi M, Hartling L, Hillier T, Campbell S, Oswald AE. The effectiveness of team-based learning on learning outcomes in health professions education: BEME Guide No. 30. Med Teach. 2013. Nov;35:1608-1624. Doi: 10.3109/0142159X.2013.849802. https://www.ncbi.nlm.nih.gov/pubmed/24245519
2. Schmutz JB, Kolbe M, Eppich WJ. Twelve tips for integrating team reflexivity into your simulation-based team training. Med Teach. 2018. Apr:1-7. doi: 10.1080/0142159X.2018.1464135.https://www.ncbi.nlm.nih.gov/pubmed/29703126
3. Domans D, Michaelsen L, van Merrienboer J, van der Vleuten C. Should we choose between problem-based learning and team-based learning? No, combine the best of both worlds! Med Teach. 2015. Apr;39(4):354-359. doi: 10.3109/0142159X.2014.948828. https://www.ncbi.nlm.nih.gov/pubmed/25154342 

Leah Sheridan, PhD, is a medical educator in physiology. Leah currently holds a position as Associate Lecturer at Ohio University Heritage College of Osteopathic Medicine. Leah’s areas of professional interest include teaching effectiveness, assessment for learning, and pedagogy. Leah can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

The adage coined by Sir William Osler that “medicine is learned by the bedside and not in the classroom” remains a founding principle of medical schools internationally. In recent decades, changes in the healthcare environment have seen an erosion in time spent by the student at the bedside: rapid patient turnover; shorter-than-ever hospital stays; and increased community care have all limited the exposure to stark physical findings of disease which were so commonplace in centuries gone by. In addition, an explosion of technological aids and simulated learning environments are transforming teaching opportunities and the term “bedside” is not as unilateral as it perhaps once was. 

For students to leave medical school with excellent diagnostic and clinical examination skills remains as essential today as it was in Osler’s time. How we can ensure this is cultivated in a challenging new era is an important focus for medical education. How can technology be used to our advantage to enhance medical education? What areas can it be applied effectively to? How can we ensure traditional bedside teaching does not suffer in an era where time by the bedside can be challenged?

Let’s start with a mental exercise. Rank your motivation for the following activities:

(A) Brushing your teeth

(B) Filing your taxes (knowing you’re not getting that refund)

(C) Eating your favorite candy

Got your ranking? Hold on to it, and we’ll revisit that in a moment.

Most of us are familiar with Newton’s first law of thermodynamics: an object in motion will stay in motion, and an object at rest will stay at rest until acted upon by an outside force. What if we thought about motivation in the same way rather than our more common framework of having or not having motivation? If we thought of motivation as an object experiencing accelerating and decelerating forces, would we change the way we think about our actions or inactions? In what ways would we think about our students’ motivations? Our colleagues? Would it give us a more effective framework to identify and impact those positive and negative forces?

The April HMI chat focused on learning analytics, with a rich discussion on the exciting potential for these tools as well as some caveats regarding their use. This is an exciting new area in technology enhanced education. Many interesting questions and multiple engaging discussions happened during synchronous and asynchronous chats.

Like a tree that falls in the woods, yet no one hears it; a silent scream is the muting of voices and rejection of alternative perspectives to maintain a single monolithic reality.                                 K. Beard

Several years ago, I visited a family member who had undergone a partial nephrectomy. As I entered Randy’s (fictitious name) room, I immediately saw what I interpreted to be signs of distress. Randy’s mouth was open, yet he uttered no words. His eyes had a fixed downward gaze, and his facial expressions portrayed a hint of fear that coalesced with discomfort. The image, coupled with the rapid yet shallow rise and fall of his chest, pushed me out of my comfort zone. Was I interpreting these cues correctly? I whispered, “Are you ok?” Randy’s response solidified my suspicions.

This blog reflection is co-authored by Mobola Campbell-Yesufu and Christina Cruz

The March #HMIchat focused on health equity and social determinants of health. We kicked off the first synchronous hour with excited and engaged health professions educators sharing what health equity means to them. Over the course of the next 23 hours, including both synchronous sessions, we shared our experiences, challenges and future directions in teaching health equity. With almost 100 participants sending 500 plus tweets on this topic, we amassed a veritable treasure trove of teaching pearls during the chat. Here are the highlights:

Burnout is a serious epidemic affecting medical students, residents, and practicing physicians. This past January, Mohammad Zaher authored an insightful blog discussing the current state of well-being in health care. This current blog will build on these ideas with a focus on medical trainees. In addition, I will discuss practical solutions that can be implemented at your institution to improve trainee well-being.

Burnout is defined as a work related syndrome of depersonalization, emotional exhaustion, and decreased sense of personal accomplishment. Studies have shown that burnout begins in medical school, and intensifies during residency. Furthermore, approximately 50% of practicing physicians meet criteria for burnout. Burnout has grave personal consequences for medical trainees, including decreased quality of life, higher rates of depression, and suicidal ideation. Professionally, burnout affects patient safety, physician turnover, and patient satisfaction. Given these undesirable outcomes, increasing efforts to target burnout and improve physician well-being are an important focus at many training programs. Experts and evidence have suggested a combination of individual and organizational approaches to target burnout. Read on to explore the problem of burnout in medical trainees and get ideas about interventions you can implement at your own institution.

This blog was co-authored by Gary L. Beck Dallaghan, Ph.D. and Michael Ashley, B.S.

In 2014, the Association of American Medical Colleges issued recommendations for essential activities every graduating medical student should be able to perform unsupervised. The guiding principles underscoring the development of these skills included patient safety and enhancing confidence of stakeholders regarding new residents' abilities. These activities are meant to be a foundational core and should complement specialty-specific competencies.

Englander and colleagues mirrored their conceptual framework of the core entrustable professional activities for medical students on that being used by residency training programs. This entailed systematically reviewing published graduation requirements, program director expectations for entering residents, and tasks residents perform without supervision. This helped them develop 21 distinct entrustable professional activities (EPAs) that are considered observable and measurable units of work that represent a variety of competencies expected of medical professionals. More than 100 unique educators representing the continuum of medical education settled on the 13 current EPAs.

A main learning component of skills and competencies is feedback.   As instructors, when a learner makes a mistake, we jump to the conclusion we know why the learner erred without inquiring about the learner’s thought-processes. “Frame-based” feedback is a strategy to avoid this feedback error and to teach more effectively and efficiently. In an excellent article* about frame-based feedback the authors suggests three quick steps to provide effective feedback while avoiding our own cognitive biases: 1) Provide initial and specific feedback on what you observed; 2) Inquire as to what the learner’s ‘frame of mind’ was; 3) match teaching points with the learner’s frames.

While no one wants to make a mistake and no one wants their mistake pointed out to them, without constructive feedback the learner loses opportunities to improve. As we continue to move toward milestones and competencies in assessment for medical education, we should focus on providing formative feedback to our learners.  

 
Reference:

Rudolph J, Raemer D, Shapiro J. We know what they did wrong, but not why: the case for 'frame-based' feedback. Clin Teach. 2013 Jun;10(3):186-9. doi: 10.1111/j.1743-498X.2012.00636.x