July 2024 #MedEdPearls: FORTify your faculty through neural synchronization

I am a runner. That is an overstatement. But on my off-service days, I enjoy starting the day with a run through the city, and my gift to myself is listening to delectable music. When I run, I notice my feet and shoulders pace with the beat of the song I am listening to. In the psychology literature, this is referred to as neural synchronization: the alignment of neural oscillations between different brain regions.

This alignment is not limited to discrete brain regions in oneself but can also occur between individuals. In my role as a faculty developer, I have often utilized frame of reference training (FORT) as a technique to develop a shared mental model and improve the accuracy and reliability of workplace-based assessments. In the FORT exercise, raters are first provided with a standardized assessment tool, and subsequently practice identifying good, average, and poor performances as defined by this standard. A successful FORT exercise provides raters with a common reference standard that should be used in performing learner evaluations. The goal of the exercise is to improve accuracy and reliability of performance ratings.

In medical and health professions education, FORT has been demonstrated to improve faculty skills in distinguishing between learner skill levels, and performance expectations in clinical skills and lectures. FORT can be so easily applied that a study by a group of anesthetists in Germany successfully trained high school students in addition to medical students and anesthesia faculty to deliver much-needed Basic Life Support training to other high school students with impressive inter-rater reliability. 

While research as yet does not directly link neural synchronization to FORT, the functional synchronization theory suggests that coordinated activity emerges across multiple levels, from neural to behavioral. FORT may facilitate the synchronization of neural patterns, mental models, and overt performance assessments.

Felt by faculty to be a useful exercise, FORT has its benefits and challenges. A study evaluating faculty perceptions of FORT revealed several interesting observations.

Benefits:

• Deliberate practice: Getting a group of faculty in one room to practice a tangible skill in workplace-based assessment improves the muscle memory of using the assessment tool.
• Importance: Provides an opportunity to review evidence to support the importance of specific clinical skills.
• Alignment: Distinguishing the range of performance levels through observation of varying performances can help discern a “good” performance from a “mediocre” one or a “poor” one.
• Direct observation: Emphasizes the danger of relying on proxy information to make a judgment on learner bedside performance.

Challenges:

• Content and delivery: Role playing or observation of encounters that appear inauthentic can create dissonance.
• The tedium of learning:  Attention spans of learners at all levels are diminishing, and research shows learner engagement drops significantly after 6 minutes in an online course.
• Groupthink: Premature closure can occur when a perceived expert vocalizes an opinion.
• Behavior vs. tool: It can be challenging to evaluate a learner’s performance while also learning the lexicon associated with a new assessment tool.

Suggestions for Success:

• Create high quality durable material to reduce the long-term cost burden and provide a more authentic appearance.
• Optimize time, with brief trainings delivered during departmental faculty meetings.
• Diversify the team to include those with divergent views, or ask the faculty to take an opposing stance in each scenario.
• Disseminate the assessment tool prior to the FORT exercise, or host the exercise sometime after the tool has gone live, which may allow an opportunity for faculty to discuss practical concerns.

Next time you are dancing to the beat of music, consider where you might need faculty re-alignment, or where deliberate practice may be beneficial to your faculty in preparation for assessment. How might you tackle the challenges of rater training at your institution?

#MedEdPearls are developed monthly by the Health Professions Educator Developers on Educational Affairs. Previously, #MedEdPearls explored topics including a generational approach to growth mindset, reflective journals, and questioning and learner engagement.

Shanu Gupta, MD is Associate Professor of Internal Medicine and Program Director for the Academy of Distinguished Educators at the University of South Florida Morsani College of Medicine. Shanu’s areas of professional interest include faculty development, professional development and hospital medicine. Shanu can be followed on Twitter or LinkedIn.

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