Harvard Macy Community Blog

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

Educators have bought-in to the flipped classroom. But are our learners following suit?

I was flying to join my wife in San Diego, California while she was attending a conference on ocean planning. For those of you not familiar with ocean planning, it is the process of analyzing ocean resources and ocean use. The most important thing about it is that the people who do it usually have conferences in beautiful, often warm and always ocean-adjacent locations. I sat in my seat and reached for the airline magazine. The first article was about medical education and how many medical schools were switching to this new concept of the “flipped classroom.” It highlighted the University of Vermont as well as Harvard Medical School, and how they changed the old model of sitting in a large auditorium, listening for hours on end to someone who had incredible amounts of expertise and information, because they had found learners had trouble committing this information to long-term memory and applying it to new settings. How could this be? The lecture format is the tried and true educational experience. The idea of the “sage in the stage” started with the very advent of universities as far back as 1050 AD. This was the “way it was done.” Why then were these medical colleges completing overhauling the way they teach medicine?

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Use Instructional Design support to leverage your teaching experience

If you have not yet worked with an instructional designer, it may be worth exploring such a resource at your institution to leverage your teaching with the help of relevant technology to enhance the educational experience. With remarkable advancements in educational technologies over the last decade, most, if not all, educational interactions taking place today incorporate some form of digital interaction for students, staff and faculty. As of fall 2016, there were over 6.3 million students taking at least one distance education course, comprising 31.6% of all higher education enrollments. And specifically in nursing education, 82.9 percent of nursing students report that the use of technology enhances their learning, and 79.6 percent say that technology helps them better prepare for future careers. These technologies appear in many forms during the educational career of a health care professional -  whether it is the use of a learning management system (LMS), creating and interacting with video tutorials, participating in simulated scenarios, using different assessment tools, participating in peer evaluations …and the list goes on. Gaming tools and mixed reality applications are not far behind! As indicated by the recent 2019 Horizon Report, “mixed reality and artificial intelligence are forecast to be important to teaching, learning and creative inquiry in the future.”

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Peer Observation #MedEdPearls from #IAMSE19

At the 2019 IAMSE conference in Roanoke, Virginia a collaborative group of Central Group on Educational Affairs and Southern Group on Educational Affairs members facilitated an interactive workshop on implementing a Peer Observation of Instruction program. The process proposed is similar to the findings reported by Adriane Bell, Holly Meyer and Lauren Maggio this month in Teaching and Learning in Medicine. They found that most peer observation programs are voluntary and provide formative feedback with the sole purpose of teaching improvement. They also found that most programs use a three-phase process with a pre-observation meeting for goal setting, direct observation of teaching, and a post-observation meeting with feedback. The IAMSE workshop leveraged the Peer Observation of Teaching Handbook by Lori Newman, David Roberts, and Richard Schwartzstein.

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Implementing Collaborative Learning Methods

After reflecting on the two years we spent at the Harvard Macy Institute Program for Educators in the Health Professions course as learners and teachers, it became more apparent that health professions educators cannot just talk about collaborative learning methods. Instead, we must figure out a way to incorporate these pearls into our everyday practice to promote effective teaching and learning throughout the medical education continuum. During our time at the course, we have seen that by weaving collaborative learning methods into the delivery of education, knowledge is fostered, teamwork is promoted, and a true excitement for learning new concepts occurs. One challenge that may impede us from implementing collaborative learning methods into our own teaching strategies is lack of time; however, to be the change agents that healthcare needs, we have a duty to better prepare our learners for their future role as healthcare providers. How do we do this? The answer may not be that difficult. In fact, by using collaborative learning methods, you may find that students develop a deeper understanding as they practice synthesizing and applying healthcare concepts.

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Reflections on creating an Anatomy case-based e-learning module

A close look at history reveals that for centuries the format of lecture delivery has remained consistent. In the Middle Ages a lecturer usually read from notes while students listened attentively, took notes and tried to retain the content and later disseminate the notes. Fast-forward to the twentieth century; in the 1970’s with the discovery of slide films and overhead projectors, lecturers’ projected handwritten notes and drawings on slides to supplement their talks. In 1990 the birth of PowerPoint allowed educators to create slide shows. In all these scenarios, the delivery of the content and receipt of the information happened at the same time. This mode of delivery of content is called synchronous learning. In today’s E-learning era, synchronous learning morphed into on-line chats and video conferencing. An additional huge step forward was the birth of online learning management systems that allowed larger PowerPoint decks to be offered online. In these scenarios the content delivery and receipt of the information did not happen synchronously. The learners were responsible for pacing their own learning, a method of content delivery called asynchronous learning.

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Collaboration at its Best: Psychiatry Trainees Reflect on their Experience in the Harvard Macy Program for Post-Graduate Trainees

As five Psychiatry trainees, we had the exciting opportunity to meet one another at the 2018 Program for Post-Graduate Trainees: Future Academic Clinician-Educators, co-sponsored by the Harvard Macy Institute, the MGH Institute of Health Professions, Boston Children’s Hospital, and the Icahn School of Medicine at Mount Sinai. We quickly realized that we all shared the same passion and zeal for medical education, working with trainees, and collaborative work! This enthusiasm resulted in the spontaneous decision to collaborate on a combined "Harvard-Yale" project for the annual American Psychiatric Association Meeting.

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Teaching First, Technology Second: Using Learning Theory to Make it Work (Easily)

Many of us have a love/hate relationship with technology, and it often involves standing in front of a bunch of intelligent students while technology fails us. As educators, how can we prevent this from happening? A recommendation is to choose your instructional strategy first, investigate the theory behind the strategy second, and then pick the technology that affords you benefits you would not get with the old methods. In this blog post, I offer strategies for doing this, and provide a short list of common strategies related to theory, then matched with technology benefits.

 

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Appreciative Advising: Advising with the Student in Mind

The American Association of Colleges of Osteopathic Medicine annual conference was packed full of thought-provoking sessions, including an interesting discussion on appreciative inquiry (specifically appreciative advising).

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Developing Leaders Through an International Collaboration: Introducing sanokondu

Many health care systems are faced with increased demands for safe and effective health care delivery as well as easier access to affordable health care services. These developments have resulted in the need for reform to the socioeconomic, political and medical educational agendas of several countries around the world. Central to these agendas is the need for leader and leadership development in medical training programs and integrating leadership education into the curricula of these diverse programs. Over time, educational frameworks have emerged in different countries to address this need for physician leadership education and many of them describe leadership using concepts like professionalism, communication, collaboration, advocacy and scholarship. Still, the process of reform and the implementation of leadership education proves to be difficult to achieve in the formal training programs of physicians. In this blog post, we introduce readers to sanokondu which is an international collaboration aimed at developing leaders within medicine globally.

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Designing Better Surveys for Education and Research

Health professions educators are increasingly engaged in educational scholarship. Many times, a survey is suggested as a way to collect data for scholarly activities related to teaching, learner assessment, program evaluation, and research, to name just a few. However, survey design is both an art and a science, and poorly designed surveys are unlikely to provide credible data. In this blog post, I offer six principles to guide the design and development of high-quality surveys in health professions education, with the ultimate goal of helping readers design better surveys for collecting better data.

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Medical Education and Global Health

As the Harvard Macy Institute and the field of health professions education have developed over the last 25 years, there has been a parallel growth in funding and scholarship within the equally multidisciplinary field of global health. Education and global health increasingly interconnect, and herein I discuss some of their fruitful crossings and lay out a vision of where the overlap between the two fields may lead.

 

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Microresistance

You have heard of microaggressions—“everyday subtle put downs directed towards a marginalized group which may be verbal or non-verbal and are typically automatic.” When these actions happen, whether in or out of the classroom, we’re often at a loss for how to address them.

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Reflections Across the Career Continuum, One Year Post-Harvard Macy

In 2018, Cathy Grossman and Lekshmi Santhosh completed the Harvard Macy Program for Educators in the Health Professions. They were frequent seat mates in the back row. While there, they discovered they were both Pulmonary and Critical Care trained – but at different places temporally in their careers. They were also both clinician educators, however Lekshmi was in her fellowship while Cathy was a decade out of fellowship. We thought it would be interesting to ask them some questions about their experience and how they were both able to apply their new knowledge at their home institutions, at two distinctly different points in their careers.

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Behind the Curtain with Vinny Arora & Nirvani Goolsarran: Bridging Leaders

Josiah Macy, Jr. Foundation Faculty Scholar and 2018 Scholar Vineet Arora, M.D., recently accepted the new Associate Chief Medical Officer-Clinical Learning Environment role at the University of Chicago Medicine. Vineet previously worked in graduate medical education to improve the clinical learning environment for residents and fellows by aligning institutional priorities with the work that trainees do on a daily basis. She is expanding this work to the whole health system, in her role as a “bridging leader.” She recently completed the Program in Health Professions Educators with Nirvani Goolsarran, an Associate Internal Medicine Program Director at Stony Brook University Hospital who is also a bridging leader in quality and education and active in the growing bridging leader community. We thought it would be interesting to ask them some questions about bridging leaders and how they were able to apply their knowledge gained at the course to these new roles.

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Scholar Testimonials of the Leadership and Innovation in Health Professions Course, Melbourne, Australia 2019

Our fourth iteration of the Leadership and Innovation in Health course was successfully held in February 2019 at Monash University, Melbourne, Australia.

The Harvard Macy Institute, in collaboration with the Monash Institute for Health and Clinical Education brought together faculty and scholars from across Australia and internationally to share their expertise and innovative responses to global health care and education challenges.

The response from our scholars was overwhelmingly positive with many enthusiastically providing testimonials to celebrate their successful learnings from the course, and their anticipated changes to their practice from these learnings.

We are proud to welcome another group of motivated health care professionals to the Harvard Macy Institute global community of practice.

Click here to learn more about our course and register your interest for Leadership and Innovation in Health, Melbourne, Australia, February 10-14, 2020. 

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Peer Instruction-A Med Ed Pearl from the 2019 Annual CGEA Conference

At the 2019 Central Group on Educational Affairs Conference in Grand Rapids, Michigan, Irina Overman and Brenda Roman from the Wright State University Boonshoft School of Medicine shared their experiences with Peer Instruction (PI). PI is a learner‐centered instructional approach developed at Harvard University by Eric Mazur and a straight forward method for encouraging active learning.

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Health Systems Science: The future of medical education and the solution to improving health care

This is an exciting time in medical education – as educators we have realized the importance of medical education reform and are in the process of rethinking how we educate our learners. There are many exciting innovators and innovations – but none with more potential and direct applicability than the implementation of Health Systems Science into medical education curricula.

What is Health Systems Science? Also known as the Science of Health Care Delivery, it refers to the critical competencies that are necessary for us to deliver the highest quality value-based health care in a manner that is both patient and population centered. It is how we can operationalize the education necessary to meet the Triple Aim of health care. Many of the hot topics currently being addressed in both the undergraduate medical education and graduate medical education spheres already encompass some Health Systems Science competencies. These competencies include population health (social determinants and healthcare equity), value-based care, health care policy and economics, interprofessional skills, informatics, and health system improvement. 

Why is Health Systems Science so important? In order to move beyond Flexner and truly embrace the continuum of medical education, we need to start thinking about foundational knowledge and clinical knowledge in a synthetic fashion and move away from the traditional 2+2 medical education model.  We have an opportunity to truly integrate the foundational sciences and clinical knowledge that our learners need, to use pedagogical approaches that will facilitate the integration of their foundational and clinical learning, and to ensure our students acquire the knowledge and skills necessary to be excellent physicians. Threads now incorporated into many curricula such as clinical reasoning, leadership, professionalism, and reflection are all critical subcompetencies of each of the Health Systems Science competency domains. Health Systems Science is the scaffolding upon which competency based medical education will thrive and ensure that our future physicians have the knowledge and skills to meet the needs of their patients. 

What are some early outcomes of Health Systems Science? As with any change in approach to medical education, innovative change without program evaluation impedes meaningful dissemination. Some of the early outcomes that speak to the importance and value of Health Systems Science have been the adaptation and implementation of the components of Health Systems Science into Undergraduate Medical Education programs. Some examples include:

1) Design of curricular frameworks for Health Systems Science

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F.O.C.U.S.E.D on Improving on the Dental Education

It is 5 pm on a Friday in the pre-doctoral dental clinic at your institution. A procedure has taken 5 hours, when it seemingly could have taken 90 minutes. Frustrated and exhausted, the student cannot seem to apply the content that they have learned in the classroom into real life. As an instructor you can’t help but think “What could we, as dental educators, have done to prevent this?”

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Pedagogy and Discharge Instructions: Do We Practice What We Preach?

“OK, so we think you have pleurisy. Your D-dimer was negative. You should take ibuprofen, rest and stay hydrated, then follow-up with your primary care physician. Any questions?”

My daughter reached for her discharge papers as she slid off the exam table and we thanked the staff as we made our way out of the urgent care part of a local emergency department.

She was eighteen at the time, a college freshman studying sociology. She called me to tell me she had been experiencing two days of pleuritic chest pain and felt a little short of breath. Because our logical, medical brains turn into parent brains when our child is sick, I dropped everything I was doing to go and see her. She looked fine, the pain was probably just musculoskeletal; she is a ballet dancer and these minor aches and pains are common. But, I thought, “What about a pulmonary embolism?” “Not likely” I thought, “but I’m here so let’s go get it checked out”.

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Technology in education: Transforming how we connect and build our learning communities

Working through the online pre-course materials for the Harvard Macy course “Health Care Education 2.0 – Transforming your Teaching for the Digital Age” we could not help but wonder if technology has evolved to the point that courses such as this might soon be delivered in an entirely online format. As a busy health professions educator, perhaps this thought has occurred to you as well, as you pack your suitcase for yet another flight, set your away message again, and put your projects, clinics, patients or meetings on a temporary hold to attend professional conferences or courses. If you teach in the classroom, then you may have received similar feedback from your own students such as our favorite, “Next time, can this session just be available online? I prefer to watch lectures at night on 2x speed.”

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