In February of 2021, our monthly Harvard Macy Twitter Chat (#HMIChat) celebrated 5 wonderful years of engagement, learning, and building community worldwide. The aim has always been to connect Harvard Macy Institute scholars around the world, to continue the conversations, and learn from and with each other. The result is more than 62 chats and over 40,000 tweets. Since 2016, #HMIChat has been curated by Elissa Hall, EdD, Justin Kreuter, MD, and Teresa Soro, MS and under their leadership our chat has grown into a known and respected learning experience in the health professions education social media space.

Despite numerous calls for an increase in physician leaders and leadership development in medical education, a 2018 systematic review found significant gaps exist in (1) understanding the best ways to teach leadership, (2) assessing and understanding the value of leadership training, and (3) overall reporting of curricula design. Participants in the August #HMIchat explored myths of leadership and leadership development, shared crucial advice, passed on resources, and discussed innovative ways to teach and develop leadership skills both in and beyond medical education. The chat was rich with ideas and resources to help us become better leaders.

 Here is a recap of some of the common themes and ideas shared by our community.

What are some common myths about leadership?

• Leaders cannot show vulnerability; they must have all the answers… be the smartest in the room (@joshuadhartzell)

• Men are better leaders than woman (@alexandralw2)

• Everyone has the same access to leadership opportunities. Reality: There remains incredible bias and sponsorship is one way to work to create equity in leadership (@SusanHingle)

• You have to be an extrovert to be a leader (@KFabsMD)

• Leaders can only lead after they have “done their time” (@DrJRMarcelin)

As we discussed these myths, @Javeedsukhera remarked how “many myths related to leadership perpetuate gender and racial biases...make us question our leadership skills and competencies because we don’t ‘look’ like leaders.” In busting these myths, the #HMIchat turned to the critical value of personal mentors, coaches and sponsors in developing leaders, especially for women and minorities.

What are some common myths about teaching leadership:  

I arrived home from Basel energized and inspired by AMEE 2018. The conference’s fringe sessions were the inspiration for this month’s chat, which aimed to answer the question, “How to use and foster curiosity and creativity as educators?”

Many students enter medical school with open minds and a thirst for knowledge. Unfortunately, that insatiable curiosity can fade somewhere along the path of medical school and residency. This brings to mind a few questions. First, what factors in our own training programs can lead to that loss of curiosity? And secondly, and maybe more importantly, is it possible to relight that flame, or to guard against it ever going out? I personally love the idea of arts and humanities courses for medical students. Atipong Pathanasethpong (@atipongpath) told us about Khon Kaen University’s art classes for first year medical students. Such an innovative idea!

We had a lively discussion during this month’s #HMIChat about disruptive innovation focused on health professions education. We discussed many sustaining innovations as well, and highlighted the difference between the two. For those interested in reading more check out the pre-reading for the chat. Obviously, the @HarvardMacy and #MedEd community at large is eager to innovate, whether it be sustaining or disruptive and quite frankly we need both types!

For those of us in the United States, it was a special holiday version of #HMIchat on July 4^th— a 24 hour asynchronous chat (no synchronous sessions this time)! Because July 1^st marks the beginning of a new academic year here in the US, the focus was medical education goals for the 2018-2019 academic year. Personal, professional, and institutional medical education goals were all welcomed.

Despite the holiday, our @HarvardMacy community showed up to share & help! We shared goals such as: create a curriculum that is both sustainable and malleable, complete graduate training, learn about various education strategies, increase habits of self-care, and develop new research interests. Many of us struggle with how to move forward with a new goal. Fortunately, our community members shared several wonderful resources—here are just a few:

Great book for curriculum building, shared by Lonika Sood.

Great book for presenting the evidence in medical education, shared by Teresa Sörö.

How to write great multiple choice questions, shared by Teresa Sörö.

Missed out on the June #HMIChat about the promises and perils of the hidden curriculum? In this post, we recap the key points from the conversation and further enhance our learning on the topic. 

I’ll discuss each of these more in depth below. 

The first theme called attention to the importance of healthy interpersonal relationships. This discussion highlighted inter-professional relationships and the importance of trust and rapport between those working in the CLE. The necessity of clear and supportive communication strategies was also underscored here, ensuring the creation of safe learning environments that celebrate successes and foster a growth mindset culture within learning and work spaces. Designing learning environments in which there are communal, inter-professional work spaces or lounge spaces was a suggestion to encourage this community culture.

A second point of discussion was on the engagement of all stakeholders in the assessment and optimization of the CLE. This included patients and their families, inter-professional colleagues, and learners. In particular, the point on empowering learners resonated throughout the discussion as a valuable asset in improving the CLE. Speaking as an OBGYN resident, residency is a unique time in one’s medical career when we are gradually learning to take on more independence while still operating under a more experienced supervisor and teacher. We are truly entrenched in the CLE every day, and empowering learners (whether medical or nursing students, residents, registrars, or other trainees) to reflect on the strengths and weaknesses of these environments is not only beneficial in the CLE QI process, but could also be beneficial for the learners’ sense of ownership over their continued learning. Co-production and co-leadership are buzz words that have been frequently cited in this capacity; concepts that restructure traditional decanal leadership into something more ‘horizontal’. These concepts can, of course, be applied to other stakeholder engagement as well, patients and inter-professionals included.

There were also some branching conversations around the various spaces in which we learn in medicine – consideration to in- versus out-patient settings, academic versus community hospitals, and time and workload pressures in different settings – and the cultures and climates that are so engrained within those spaces. There were some interesting discussions around the importance of ‘in-situ’ versus simulation center simulation and how best to integrate reflection and coaching into the learning environment.

Finally, there were a couple resources for assessment and diagnosis of the CLE that were frequently cited throughout this discussion.

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.

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:

#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!):

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. 

Jonathan Foo, Margaret Hay, Stephen Maloney

Cost and value are so pervasive in our day to day decision-making, that it often slips by unnoticed. The December #HMIChat brought the concepts of cost and value in medical education out of the dark and kicked it around like an old wallet – yielding an insightful and passionate discussion touching upon the themes of understanding value in the context of contemporary teaching and learning practices, applying cost and value deliberately with appropriate measurement, and developing a common language for cost and value.

Guest Moderator Dr Lauren Licatino reflects on last month’s #HMIchat about what value Social Media can bring to Medical and Health Profession Education. The chat was rich, with lots of discussions and a large amount of both scientific and practical tips emerged.

The Caffe Nero on Longwood Avenue couldn’t have been a more perfect place to reflect with Teresa Soro and Elissa Hall on the October #HMIChat I moderated, and not just because of the great lattes. October’s chat on “Learners-as-Educators” discussed how to develop health professions learners at every level into teachers themselves. I love the pay-it-forward nature of this idea, that everyone has something to contribute to and to inspire the next generation of learners. It had been at Caffe Nero that I decided--as a trainee--to dedicate my career to medical education, so returning there to talk about this topic resonated deeply.

During AMEE 2017 there were a few recurring concepts. One of them was Equity and how we, within health professions education, can both be more aware of our own biases and promote equity in health professions education. The subject resonated with a lot of us HMI alumni that attended the conference and we decided to see what our HMI community thought via our September Tweet Chat.