Harvard Macy Community Blog

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

Returning To The Bedside

The COVID-19 pandemic devastated communities across the globe, leaving socioeconomic and health disparities in its wake. Despite these hardships, we, as health professions educators, remained true to our mission of caring for sick, promoting science, and advocating for voiceless. Even though I cared for patients in a non-surge area, it was still a crazy time. In what seemed like a blink of an eye, things changed. Incident command centers quickly arose to deal with COVID-19. In what seemed like overnight, we shifted to virtual learning environments to maintain the educational mission to our learners. In one of the few times in modern history, attendings and learners were on the same level in terms of COVID-19. During this uncertain time, as a hospitalist, I also transition from bedside rounding with the entire team, to bedside rounding with only the intern or resident primarily responsible for the patient.

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#MedEdPearls June 2022: Are We Underestimating Our Influence?

When we think of influence, we tend to think about how we can affect someone’s character, development or behavior. Yet, we underestimate how we influence others indirectly or without knowing it. As leaders or educators in health professions education, how do we employ influence we have positively in trainee/educator relationships?

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Reversing the Vertical Integration Pendulum

Quoting the philosophy attributed to Socrates, “I cannot teach anybody anything, I can only make them think.” When medical school curricular leaders push for change, we must ponder the question: How do we best revise medical school curricula to spark our students to think? Most curriculum revisions can be broadly categorized into one of two categories: instructional methods (pedagogical) reform or content reform.

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Podcasts for Teaching and Learning: Are you Late to the Party?

Eighty million Americans listen to audio podcasts weekly—almost the same amount of people who watch the Super Bowl every year. If you have a phone, tablet, or computer, you can access over sixty-three million free podcast episodes anytime, anywhere. 

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How Lessons from the COVID-19 Pandemic Can Improve Support for Breastfeeding Parents and Other Caregivers in Health Professions Education

There has been a dramatic increase in telemedicine and online remote learning during the COVID-19 pandemic. This shift normalized clinical care and education in spaces outside the confines of the hospital, office, or classroom. Parents who pump breastmilk at work have long known that clinical and educational tasks can and often must be done in unconventional spaces while expressing breastmilk at the same time.

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The Harvard Macy Institute Podcast Season 3 Episode 5: Leading Up Leading - A Preview of the HMI Leading Innovations Course

Nearly 30 years ago, our Director Elizabeth Armstrong envisioned the opportunity to partner with organizational change and innovation leaders at Harvard Business School to launch the Harvard Macy Institute Leading Innovations Course. Year after year, this course helps scholars develop strategies for leading change within the complex systems of health care delivery and education. In this episode, we recount the history and conceptual underpinnings of the course, and take a granular look at the activities for the week including how scholars can best prepare.

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#MedEdPearls May 2022: Counseling and Remediating the Struggling Medical Educator

Why do you teach? When are your most enjoyable moments as a medical educator?

The final stretch of the medical academic year often involves faculty performance evaluations and student remediations. Most faculty performance reviews tend to be positive and arguably future-focused with collaborative goal-setting processes. However, what happens if a faculty member receives a poor outcome?

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An Educators Challenge: Maintaining Academic Integrity During Remote Proctoring

The COVID-19 pandemic forced healthcare to rethink and re-envision how remote learning should be administered. The disruption of traditional in-class instruction had many instructors struggling to rapidly pivot to deliver content and evaluate knowledge and skills remotely. Few resources were available to prepare educators for this shift, particularly when it came to remote assessment. Summative and formative examinations had been conducted with online software programs even before the pandemic, typically synchronously and in-person in a classroom environment. During the pandemic, faculty were expected to provide a robust remote proctoring process while maintaining academic integrity, which was a significant and novel challenge. 

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The Harvard Macy Institute Podcast S3 E4: Better Academic Writing with Lorelei Lingard

The Harvard Macy Institute Podcast aims to connect our Harvard Macy Institute community and to develop our interest in health professions education topics and literature. Our podcast is hosted by our Program for Educators in the Health Professions course faculty Victoria Brazil, and will feature interviews with health professions education authors and their research papers.

Most of us would like to ‘write better,’ but few of us make intentional efforts to improve. Lorelei Lingard is internationally known for her efforts to help health researchers and clinical scholars become better writers. In this podcast we talk about her Writers Studio courses and her book “Story, not Study”, 30 Brief Lessons to Inspire Health Researchers as Writers.

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TikTok for Celiac Disease and Gluten-Free Diet Education

Adolescents with celiac disease are always seeking new and innovative ways to learn about the gluten-free diet and manage the social and emotional elements of living with this chronic disease. Prior to the COVID-19 pandemic, the Boston Children’s Hospital Gluten-Free Diet Education Class for patients with newly diagnosed celiac disease was held in-person in a clinic conference room with approximately 2 to 5 families attending each class. The classes are 90 minutes and highly interactive with a skilled dietitian. When the COVID-19 pandemic struck, all nutrition education classes for celiac disease were quickly transitioned to a virtual zoom format.

The virtual format allowed for higher enrollment, which meant shorter wait times to get into the class. Zoom also removed barriers like long commutes and high parking fees, which previously prevented some families from attending the classes. However, some adolescents who attended remote school for most of the day reported it was challenging to sit for another 90 minutes in front of the screen and wanted new and fun ways to learn. Their specific ask: TikTok.

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#MedEdPearls April 2022: Optimizing the Clinical Learning Environment for the Learner and the Teacher

‘Lately, I have been feeling inadequate – both as a clinician and as a teacher… I think I need to give one up for my own sanity…’ Does this sound familiar? It can feel as though there is so much opportunity to teach, yet not enough time to do so as we take care of our patients.

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The Harvard Macy Institute Podcast S3 E3: Inclusive Teaching with Jeremy Amayo

Increased global attention to diversity, equity, and inclusion necessitates inclusive teaching in health professions education.” The opening line of this article by Jeremy Amayo and team set the scene for a wide-ranging discussion of principle and practical strategies to help teachers be more inclusive – in the classroom, in the clinical environment, and in the online learning environment.

Jeremy Amayo is an Assistant Professor and the Director of Ultrasound Education at the Emory University School of Medicine. He is also a Physician Assistant in the Division of Critical Care Medicine at Emory Healthcare.

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Seeing Beyond the Images: Can Art Reframe Medicine?

As a radiologist, I am a physician whose responsibility and expertise is to carefully review medical imaging (e.g. radiographs, CT, ultrasound, MRI, PET) to detect abnormal findings or deem a medical imaging test “normal.” Since high school, my love of science and technology has been intertwined with appreciation for, creation of, and education in the visual arts. Radiology has been the perfect career combining visual skills, deductive reasoning, and understanding the intersections of anatomy, physiology, and disease. Participating in the Harvard Macy Institute Art Museum-based Health Professions Education Fellowship has not only exposed me to techniques highlighting similar skills that are cultivated in radiology practice but also to push emotional boundaries farther. This experience has also introduced me to my co-fellows - other passionate educators connecting, innovating, and working together to change the future of medicine and medical education.

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For the Love of Medicine

Several years ago, while precepting 3rd year medical students, I realized I was trying very hard to minimize their exposure to the parts of the job that can be cheerless. I wanted to protect them. I wanted them to have the most positive interaction with medicine they could during medical school. Unfortunately, however, from the moment we start our path to becoming physicians, it is easy to find ourselves dwelling on the negative. Whether it is bad feedback, a low score on an exam, a tough interaction with a patient, or hearing about patients’ lack of access to care, the negative experiences tend to carry more weight than the positive. Recently, after attending a particularly discouraging lecture, I knew it was time to put a plan into play that had been brewing in my mind for years.

With encouragement and collaboration from colleagues, we began an evening storytelling session which a colleague appropriately titled “For the Love of Medicine.” This is a para-curricular, voluntary activity for medical students where physicians on our faculty and in our community share brief but specific stories from their careers. This purpose of each story is to highlight why choosing a career in medicine is so rewarding.

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The “Non-Traditional” Student is now “Traditional:” The Circuitous Route to Medical School and Why it Matters

Now, in 2022, I am a second-year medical student at Wayne State University School of Medicine. Diversity, in both patient population and medical school student body, is one of Wayne’s strengths. Still, I recognize that I fall within a uniquely well-represented but seemingly under-supported group of outliers: the non-traditional medical students.

Who is a non-traditional medical student? 

Anecdotally, we may be known as “the weird ones who always sit in the front row and never come to social events.” Generally, students are considered non-traditional if there was at least a two-year gap between completing an undergraduate degree and medical school matriculation. First-generation medical students or students who come from low socioeconomic backgrounds often self-identify as non-traditional as well. The average age of medical school matriculants is 24 years old, suggesting a shift towards more non-traditional student acceptances.

What value do non-traditional students bring to medical education?

Non-traditional students bring valuable life experience to medical school. For example, students with prior career experience may exemplify team spirit and a growth mindset that all students can learn from. Older medical students may have the lived experience of navigating the healthcare system that can be valuable for all learners.  

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#MedEdPearls March 2022: Performance Reviews Reconsidered - Elevating Outcomes Through Humanized Systems

How do we do this? One solution is to recalibrate “performance reviews” as future-focused, collaborative, goal-setting conversations—those that will motivate individuals (humans) to envision a future beyond traditional outcomes measures—to wonder and dream. Modernizing the performance review “system” is an important step for taking our organizations to a new level from the ground up.   This may mean elevating and redefining metrics for performance, beyond strictly business or work-related units of measure like RVU calculations or faculty work load.

What could this look like? Scholars are increasingly examining the psychological needs of workers including, autonomy, competence, and relatedness, among others, and during a pandemic, these needs were heightened, yet often blurry. So now, more than ever before, we have an opportunity to pay attention to the messages we send, or don’t send, in our performance conversations.

Asking better questions during our reviews is an investment that helps people feel and be seen. Bringing better questions to performance conversations is also “power agnostic”—anyone can enrich performance outcomes through questions and conversations that matter. 

Connecting as humans, not machines or cogs, we can interrupt our everyday biases, and pursue clarity and focus around additional needs, roles, and dialogues--such as mentor, advisor, sponsor, or coach--which only expands the possibilities of promising results.

 

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Striking a Chord?

So how does music impact us? It has the capacity to make us feel all types of emotion such as elation, sadness, joy, fear, and exhilaration. Through a variety of functional imaging studies, we have developed our understanding of the brain’s response to music and the areas of the brain involved in the different components that comprise music. It can impact our heart rate, blood pressure, serum cortisol and activates the reward systems in our brain, elevating our mood. There is a growing body of literature and health professionals who recognize the importance of the humanities in medicine. The humanities provide opportunities for us to question what we do and why, and to rediscover meaning in our work. We can reflect on our experiences, listen with new ears, and see with a different lens. A number of papers related to music in medicine have been published, but overall this is a discipline that has had limited attention compared to visual art or narrative medicine for example.

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Descending the Staircase: Reflections on Being Human

This past August as I was exiting my third floor classroom at the University of Washington School of Medicine I could hear a noise coming up the staircase. The sounds were weird, and it took me a second to identify them. There were voices and lots of them. As I descended the stairs and the voices grew louder, the excitement of the gathering was almost palpable. I reached the bottom of the stairs and waded in to a happy throng of second year medical students. There were joyful greetings and high fives all around. It was only their second gathering as a class, and it had been nearly a year and a half since I had seen them together. Despite our masks, the power and emotions of interacting face to face were overwhelming.

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Zoom for Introverts

When the hospital world abruptly moved from auditoriums and conference rooms to Zoom rooms, I disliked everything about the new technology. I struggled to get the links to open, my headphones working, and my microphone muted at the right times. Teaching on Zoom was the worst! Showing up to teach to a large group, all learners with their cameras off, was like talking into a black hole. Were they even there? Was I talking too fast or too slow? What was the point of it all?


But then a question would pop up in the chat box, followed by another. Sometimes learners would even respond to my attempts to engage the group! On many Thursday afternoons I teach the fellows like always, and I notice that the chat function helps the quieter learners speak up. As a person who has always been nervous about speaking, especially in large groups, it turns out it is much easier to put my thoughts and questions into written words and chat them to the group as a way to start than to raise my hand and talk. Asking all the learners to share their answer in the chat box gives me a way to engage the whole group, not just the most extroverted and confident few. While there do not seem to be any large studies examining chat as a way to engage quiet students, others have noted this phenomenon both in medical education and in other scientific discipline teaching. There is also a solid body of literature showing that when educators pause for 3-5 seconds after asking a question, learner engagement increases.

Virtual teaching has given me the opportunity to be thoughtful about engaging the whole group, not just the loudest, fastest responders. One strategy I found particularly effective as a learner during the Harvard Macy Institute Program for Educators in Health Professions is the “Zoom Waterfall”: ask a question, then ask all participants to type an answer in the chat box, but not hit send until instructed. Having the time to pause and think before someone jumps in with a verbal answer made me feel more engaged in the material, and it was exciting to see the range of responses from a huge group flash by.  As I continue to develop skills to keep a virtual classroom engaged, I am excited to try this out. 

What virtual teaching strategies have you found helpful to encourage quiet learners to participate?  Comment below and join the conversation.

Did you know that the Harvard Macy Institute Community Blog has had more than 295 posts? Previous blog posts have explored topics including designing programmatic assessment structures to support learning, engaging students virtually, and being together, when apart

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#MedEdPearls February 2022: Retooling the Facilitator Toolbox for Learning

In the shift to the Learning Paradigm and a flipped classroom approach, learners acquire prerequisite knowledge before attending an in-class session with peers while faculty assume a guide/facilitator role. This facilitator role requires tools for educators to skillfully foster effective verbal and nonverbal communication with learners. Topperzer et al. (2021) indicate that thoughtful questions (tip 10) can be posed to stimulate thinking, guide discussion, and encourage bidirectional communication and engagement with learners. The authors outline question categories (specific, clarifying, open, probing, and confrontational) with examples that facilitators can use to promote learner reflection.

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