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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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Virtually Uninterrupted: Implementing a Virtual Geriatrics Curriculum for Residents during the COVID-19 Pandemic

Encompassing 240 beds across multiple care units, VA Bedford is one of the largest long-term care facilities in the VA healthcare system. Normally the geriatrics rotation at VA Bedford took place on the Geriatrics Evaluation and Management Unit, a 24-bed inpatient subacute rehabilitation and skilled nursing unit specifically designed to manage older Veteran patients in need of post-acute or community-dwelling veterans in need of complex geriatrics care.

Prior to the pandemic onset, residents came from 3 internal medicine and family medicine residency programs and rotated on two- or four-week blocks. Two residents, working under the supervision of an attending physician, are typically on rotation at any one time. To fulfill geriatrics training requirements, the residents participated in patient care and regularly structured didactic, active-learning, and self-directed experiences.

We thus sought to maintain a core geriatrics education program while adhering to restrictions imposed by the need to minimize exposure and transmission of SARS-CoV-2, the causative agent of COVID-19. From the onset of the pandemic in March 2020 until October 2020, several months following a surge in the U.S. Northeast, we converted the geriatrics rotation at VA Bedford to a fully virtual non-clinical GME experience.

Our overarching goal was to deploy the original curriculum, including its learning objectives and provided educational resources, virtually so that even with COVID-19 restrictions residents could complete the rotation with core tools needed to care for older adults. The topics covered fell under the major themes of geriatric syndromes, comprehensive geriatric assessment, and serious illness and end of life conversations.

We structured the rotation as much as an intensive graduate course as a clinical rotation, with the expectation that the resident would put in vigorous effort to engage with the material. We provided an orientation packet that detailed the curriculum, a robust set of educational resources, a guide for self-directed learning, and a schedule of daily learning activities, all accessible either on a shared website or in a physical binder. Learning sessions were typically conducted via video conferencing using secure Skype or Microsoft Teams platforms. Both have features that enable video conferencing and include a range of built-in tools that allow for screen sharing, file sharing, breakout rooms, and slide presentations. These video communication platforms created an interactive virtual environment that enhanced engagement between the instructor and learners.

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The Cognitive Load of COVID-19

 

While the evolving pandemic provides unique learning opportunities, it also poses numerous educational barriers. How learning is prioritized at individual institutions will vary greatly depending on the local needs of patients, providers, hospital systems, and the community. Effort explicitly devoted to learning may be proportionately reduced during a crisis, yet, even in severely affected areas, learners maintain important roles in the workplace. For example, an emergency medicine resident must triage patients with respiratory syndromes, a nephrology fellow will help initiate dialysis for a critically ill patient, and a medical student may assist an overstretched infectious disease consult team.

Even in this time of crisis, we remain obligated to teach learners and to provide strategies to help them learn. However, considering the stress the COVID-19 pandemic imposes on all stakeholders, we cannot assume that usual methods of teaching will be effective without some adjustments. Cognitive load theory (CLT), developed by John Sweller, provides an educational framework based on cognitive psychology that can inform workplace teaching and learning during the pandemic.

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Book Review: The Do-It-Yourself Mentorship Playbook

Are you looking for better mentorship? Are you waiting for your mentee to start carrying their fair share? Are you tired of spending time figuring out how to get ahead in academic medicine instead of actually getting ahead? If so, read on.

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Pandemic Pandemonium – Finding Constancy During the COVID-19 Era

As health professions educators, teachers, family, friends and as humans… we are still reflecting on 2020 and working towards a better 2021 and beyond. Many of us find comfort in academic medicine with a predictability of caring for patients, teaching trainees, and promoting self-learning. But how many of us expected to navigate a full-blown pandemic? Raise your hand if you graduated from your training feeling “if there is a pandemic, I am ready!”

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Co-facilitating Small Group Learning Environments: Creating Meaningful Connections at a Virtual Conference

Virtual conferences appear to be the new reality. Although this format offers a number of advantages such as better accessibility for learners and the possibility to have speakers from all over the world without the need to travel, the main difficulty lies in creating “real” connections and networking opportunities. This is paramount for a conference such as the Harvard Macy Institute Program for Educators in the Health Professions, which offers a number of small group activities where interaction and connection amongst scholars is essential to have fruitful discussions. In this blog we offer our tips for co-facilitating in virtual environments.

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“Unmasking” in the Era of COVID-19

This joint narrative reflection weaves through the experiences of three female physicians, practicing internationally during the COVID-19 pandemic. It uses the metaphor of the ubiquitous masks we now all wear to explore the boundaries between caregivers and patients and the unanticipated “unmasking” that has taken place across technological platforms, in hallways and patient spaces. The focus is on the commonality of experience of clinical caregivers in these extraordinary times, despite the diversity of social and cultural settings. Most importantly we describe what has been uncovered and what other health care providers might take away from this once-in-a-life-time experience.

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Designing Programmatic Assessment Structures to Support Learning

Among the myriad disruptions the COVID-19 pandemic has caused, medical educators are thinking about how they can ensure students moving through adapted curricula are progressing appropriately, and are motivated as they learn in this new environment. We recently published a 12-tips article: Twelve tips for embedding assessment for and as learning practices in a programmatic assessment system. This paper provides practical advice for schools to consider to help students learn from assessments and to learn with the goal of becoming excellent physicians. We encourage educational leaders and students to utilize evidence-based assessment practices to support these learning goals.

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Guest — marlynbradley

PLC, HMI, Inverter, Microcontr...

Beautifully explained. An incredible blog post
Saturday, 09 January 2021 6:06 AM
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Hematology Oncology Collaborative Videoconferencing (Heme/Onc COVID) Learning Initiative: Unleashing the Potential of Trainees as Leaders in Medical Education

Arriving on the US west coast in January of 2020, the SARS-CoV2 pandemic impacted all aspects of life, including medical practice and education. Medical trainees were among the first to assume roles of direct and consultative care providers for patients suffering from SARS-CoV2. At the same time, structured in-person didactics - a cornerstone of medical education and trainee development - were placed on hold. Standard educational models struggled to overcome the challenges imposed by Center for Disease Control and Prevention’s recommendations on social distancing. This was compounded by frequently changing provider schedules due to continually evolving patient, hospital, and community needs. This new environment fostered feelings of isolation and fear of the unknown among trainees who were on the frontlines of the battle against COVID-19. In this setting, a clear need arose for a novel shared medical education platform capable of rapidly disseminating SARS-CoV2 content rooted in cross-disciplinary medical expertise.

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Defining a Framework for Health Science Education Innovation

Over the past several months, we have seen how innovation in health science education (HSE) plays a critical role in health and science discovery as our community continues to address challenges presented by the COVID-19 pandemic. During this time, many of our colleagues have demonstrated the courage to take risks, experiment, fail, and try again—often resulting in an improvement on their original ideas. HSE innovation moves us beyond the common, incremental changes and quality improvement initiatives commonly seen within our organizations. To continue advancing health and science through education innovation, it is important to define a framework that helps us better understand what HSE innovation means. 

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Guest — Charlie Cooped

Thank you!

I remember being introduced to the importance of assessing the health impact of medical educational innovation when I attended one... Read More
Thursday, 17 December 2020 6:06 PM
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Mentors without Borders: A Global Community of Mentors, Scholars and Leaders in Health Professions Education

 Fifteen ‘mentors’ participated in this world café workshop: Nearly 35 participants attended and rated the format highly. During the process of debriefing and reflecting on what worked well and how the workshop could be improved, the group members decided to continue the working relationship and transform into a community of mentors and collaborators. We have worked together since September 2019, publishing papers on speed mentoring and career development for educational leaders and scholars and working on 2 more. We learn from each other and mentor each other.

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Guest — Andrew Ong

Hi from singapore

This is something I would really love to be involved in. Greetings from Singapore
Wednesday, 09 September 2020 12:12 AM
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Students as Partners: Working with students to co-create medical school curricula

As they listen to lectures, work through group learning activities, and study, students may recognize discrepancies in content, flow of material, repetitions, and more. Obtaining student feedback can be very helpful in guiding curriculum design. Students can provide formative feedback to faculty – for example, if a student did not feel that they learned from a particular lecture, they can offers suggestions for how to improve. In turn, faculty can acknowledge student feedback and respond to it, thus closing the feedback loop (as we see in Kern’s 6 Steps to Curriculum Development). If changes were suggested, the faculty member can respond to the class to explain why they could or could not make that change – which students will appreciate!

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Natasha Louise Yates

Students are just the start...

Well done on a great blog and conversation starter. I agree that it is helpful for students to be engaged with their curriculum d... Read More
Monday, 18 May 2020 6:06 AM
Senthil Kumar Rajasekaran, MD

Suggestions

Hi Natasha, Thank you for your comments and it was a delight to work with Sarina. Below are my thoughts: 1. It is a great idea to ... Read More
Tuesday, 19 May 2020 4:04 PM
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Building New #MedEd Communities with Old Friends

It started with a Twitter post. To celebrate #HMICommunity Day, Holly Gooding (Educators ’10) shared a photo from the rooftop of the Grady Hospital parking deck in downtown Atlanta, the gold dome of the State Capitol building gleaming in the background on a sweltering summer day. Lynda Goodfellow (Educators ’16) recognized that backdrop as the same one from her own office and reached out to Holly. Over coffee in the Georgia State University (GSU) Student Center, where she serves as Associate Dean for Academic Affairs, Lynda updated her former project group facilitator on the success of her HMI project. Lynda had just welcomed her inaugural class of interprofessional faculty into the Lewis College Teacher Scholar Academy at GSU. Wait a minute, thought Holly. That sounds similar to Linda Lewin’s (Educators ’97) Woodruff Health Educators Academy at Emory University, Holly’s new academic home. Could it be that both Linda and Lynda were transforming interprofessional education in Atlanta using Harvard Macy Institute principles?

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Virtual Communities of Practice in Health Professions Education

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.

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Education as a Catalyst for Health Care Transformation

Improving community and population health is in the core mission statement of many medical schools. However, physician training happens within the same system that has led the United States to disproportionately spend on its healthcare system. While wealthy countries like the U.S., tend to spend more per person on health care and related expenses than lower income countries. However, the U.S. spends more per person on health than comparable countries. Health spending per person in the U.S. was $10,224 in 2017, which was 28% higher than Switzerland, the next highest per capita spender.  The all-encompassing social determinants of health, politics, and vested financial interests heavily influence policies affecting population health. It would be useful for us to take a moment reflect upon the problem.

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The Art of Education: The Harvard Macy Institute’s Art Museum-based Health Professions Education Fellowship

A foundational principle of the Harvard Macy Institute (HMI) is to build and nurture collaborations to foster cross disciplinary learning and problem solving. Early collaborations begun with the plans described in the 1994 successful grant submission to the Josiah Macy Jr. Foundation, which laid the foundation for our 26 year collaborations with faculty at the Harvard Medical School, the Harvard Graduate School of Education and the Harvard Business School. The Macy Foundation’s assumption was that neither institution would be as successful working in isolation as they would be in partnership. This blog post tells the story of another fruitful collaboration - one in which health professions educators and museum educators collaborated to design a new fellowship, sponsored jointly with the Cambridge Health Alliance and now part of the HMI course portfolio.

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4 steps to revitalize a tired post-graduate curriculum

Since as early as the 1880s, psychologists studying human memory generated “forgetting curves” which attempt to illustrate memory retention over time. It is thought that adults retain less than 30% of lecture-based content which diminishes over time, and yet this is still a commonly used platform for teaching in medical education. At my institution, our radiology residents receive nearly two hours of dedicated teaching each day, at least half of which is lecture-based didactics. I vividly remember sitting through those 45-minute lectures as a resident, often after lunch, struggling to pry my eyes open. 

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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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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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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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