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

Our best intentions and goals as health professions educators can be easily undone or reinforced by the hidden curriculum.

As the intern completed her presentation on rounds, she said, “Dr. Campbell, this is Ms. Williams’* third admission in three weeks. She is clinically stable and can be discharged today but I’m worried she will soon be back in the hospital.” Imagine with me two possible scenarios: the first where the team discounts the intern’s fears and pushes for a quick discharge; the second where the team stops to explore what non-medical issues might be contributing to the patient’s readmissions, and works with the social worker to connect the patient with resources that help address those issues. What lesson does the intern learn from scenario one versus scenario two? Which hidden curriculum is at play in each scenario?

#HMIchat February 2018 co-authors: Leslie Sheu (@lesliesheu), John Mahan (@MedEdMahan), Larry Hurtubise (@hur2buzy)

"I think to be an entrusted educator means that learners respect you, but also are not afraid to be themselves and be honest to you about their questions and needs." - Lindsey Smith (@DrLindseyMSmith)

We were thrilled that trust was the topic of this month’s #HMIchat, and were astounded to learn that this chat brought together 118 medical educators from around the world (including physicians, physician assistants, nurses, and researchers) across multiple specialties (including medicine, surgery, emergency medicine, ICU, physiatry, and pathology, to name a few).

We came out of the chat reinvigorated with thoughts on how to improve our own work and entrustability as educators, ideas on how to study or think about trust in a broader context, and ways to challenge our current framework. We thought we would frame our key take-aways around the 5 factors of trust (watch this video by Justin Kreuter (@kreuterMD) for a great summary!):

The following blog was co-authored by: Atipong Pathanasethpong and Rosawan Areemit

Academic dishonesty plagues universities around the world, from the US to Taiwan to Australia and beyond. In this blog we would like to discuss ways to address it by employing educational concepts and frameworks to shape a culture and environment that reward honesty and reduce incentives for dishonesty. 

The medical education environment offers a variety of opportunities for dialogue education learning tasks.  Dialogue education is an intentional design framework that fosters communication, reflection, and community in the learning environment.   Using this framework, educators can structure dialogue with students through learning experiences or “tasks” designed to assess prior knowledge, introduce new content, give learners a chance to practice, and thenhelp them integrate the new knowledge or skill (Vella, 2000).   Jane Vella’s concept of learning task design includes what she refers to as the 4 I’s: 

My heart sank as I quickly scanned the list of speakers at the conference. I recognized the names of faculty whom I respected and admired, many of whom are local, state, and national leaders in their fields. What business did I have speaking at such a conference? Surely one of them would attend my talk, detect a fatal error, and spread the word that I had advanced this far in my career by chance alone and didn’t deserve my merits. Does this story seem familiar to you? If so, you may be suffering from “perceived fraudulence,” otherwise known as “impostor syndrome.”

Authors: HMI Chat team

 This #HMIchat moderated by Jeff Wong (@jwonguprcmeded) and Mark Stephens (@mbstephensmd), from Penn State Hershey (@PennStHershey), in January 2018 focused on #DesignThinking in medical education (#MedEd) and health professions education (#HPE). This topic especially hit home with the HMI Chat team (@teresasoro @kreutermd and me (@erhall1)) given #DesignThinking is grounded in “abductive logic” which facilitates a growth mindset of “what might be” rather than “what might have been.” The @HarvardMacy #HMIChat community wholeheartedly embraces a “what might be” approach and imagines the possibilities as we wrestle with hot topics in medical education with subject matter experts and international colleagues. 

During my attendance at the Harvard Macy Institute Health Care Education 2.0 course, I was surprised when we were asked to participate in a mindfulness exercise every morning. I must admit that I wasn’t comfortable with the idea of spending time focusing on my breathing when I could be utilizing that time to work or learn. As the course carried on, I began to realize how we, as professionals, can be so focused on outcomes that we lose track of the journey, and how it affects us. 

While healthcare providers, with their rigorous selection process and training, are expected to be resilient under significant physical and emotional stress, the numbers say quite the opposite. Levels of burnout (exhaustion of physical or emotional strength and lack of motivation) among healthcare providers are increasing every year, and have reached nearly 60% in some disciplines. Rates of provider distress (burnout, anxiety, depression, and suicide) are higher than the general population. These numbers have implications beyond the affected healthcare provider, as studies have associated providers in distress with inferior quality of care, increased errors, decreased patient satisfaction, and even increased patient mortality. 

Reflective Practice:  Your BEST Professional Development Tool

With the start of a new year and scores of self-improvement resolutions underway, what better time to think about resources to help attain your goals and avoid barriers that might impede success in your self-improvement efforts.

Harvard Macy is a community of educators and leaders dedicated to transforming healthcare education. In addition to being a top course in research, teaching, and learning in health professions education, Harvard Macy is itself a community of practice – a group of people who share a craft and/or a profession – and thus a prime opportunity to grow your professional network. 

What can you do to embrace networking while a Harvard Macy scholar? Here are 8 tips to consider: