Harvard Macy Community Blog

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

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Pre- COVID-19 pandemic, many faculty members arrived to committee meetings late, perhaps rushing from clinic or a prior meeting across campus that ran over the expected time. The entry door was at the front of the room, near the presenter, so each late attendee disrupted the speaker and participants as they sifted through the attendance sign in sheet and collected document copies. At the end, meeting attendance documentation sometimes indicated high absences from voting-members of the committee, with sometimes barely over half of the voting members having attended. This might have been due to distance to travel or inconvenience of work flow to get to another part of campus. The meeting room was arranged with traditional small rectangular tables in rows facing the speaker at the front of the room, so questions from the group were directed at the speaker. The questions sparked limited group conversation, as a committee member at the middle or back of the room was often speaking to the back of the heads of the attendees at the front of the room. Extroverts tended to contribute verbally the most, and interaction among the attendees was difficult due to room arrangement. The video feed to/from another campus produced a small image that was difficult to see. Most frequently, non-faculty members such as education coordinators or institutional support staff who attended the meeting seated themselves at the back or around the outer edges of the room.

Our committee transitioned to teleconference, and embraces the technology as we continue to navigate the COVID-19 pandemic. Faces fill the virtual meeting screen, most with video, some without. Unlike the previous year, attendance rates of voting members vastly increased. Faculty join from more diverse locations: clinical settings, their own offices across campus, their home office (sometimes joined by a pet or child), their car while making a long commute (audio only for safety), and from undisclosed locations (with virtual backgrounds). As noted in online classes, the different locations spark small talk in the faculty meetings about an item in the bookshelf, the cat making an appearance, and even the virtual backgrounds that may represent an attendee’s “happy place” like a favorite vacation spot or movie background. The virtual format can reach larger faculty audiences, allows for work/life integration, encourages egalitarian conversation, as all attendees have an equal space at the virtual table, and all faces with videos on are displayed, instead of the backs of heads. Those arriving late do not disrupt the meeting discussion, and attendance is easier to document. Turn-taking is encouraged, as only one member can effectively have their microphone active at a time. Introverts, those participating from public locations, or those who are multitasking can write questions or comments in the chat and have them answered. Participants across campuses have an equal space on the screen and can participate with audio more easily. Participants from our Resources such as links and files are shared real time in the chat or through dynamic screensharing. Meetings are more regularly recorded for later reference or to share with those who could not attend.

The move to holding our curriculum committee meetings by teleconference was prompted by a need to maintain continuity of faculty governance during the COVID-19 pandemic, and there have been recent investigations into the overuse of teleconferencing. However, in the case of our once monthly curriculum committee, the virtual format allowed meeting participation and engagement to thrive. 

What have been your experiences with the transition to virtual meetings? Comment below to join the conversation!

 

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#MedEdPearls January 2022: Earthquakes of Thought as a Metaphor for Change Possibilities

Dr. Lara Varpio challenged educators and thought leaders in health professions education (HPE) to rethink the impossible during her Generalists in Medical Education plenary talk entitled “When the Earth Moved Under Our Feet.” In reflecting on changes in health professions education during the COVID-19 pandemic, Dr. Varpio suggested that there were “earthquakes” in our thinking—seismic events that shook the very foundations of our core as educators and thought leaders. She helped the audience reflect on changes to our normal every day practices that we once knew to be true. Speaking of change…

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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 Harvard Macy Institute Podcast S3 E1: Connecting Scholarship to Practice in Health Professions Education with Lara Varpio and Subha Ramani

Scholarship in health professions education is often based on paradigms and methodologies unfamiliar to clinician educators. This risks a ‘disconnect’ – where educators may be looking for randomized controlled trials, and scholars are providing theoretical frameworks and thematic analysis!

In this episode Lara Varpio and Subha Ramani discuss their scholarly work in health professions education and how they have made that work rigorous and useful to practitioners, while also educating their readers and challenging some positivist norms.

Lara Varpio is Professor, Center for Health Professions Education & Department of Medicine and Associate Director of Research, Center for Health Professions Education at the Uniformed Services University of the Health Sciences in Maryland. Subha Ramani is Associate Professor of Medicine, Harvard Medical School, and an internal medicine physician at the Brigham and Women’s Hospital in Boston. She is senior faculty with the Harvard Macy Institute.

We had an interesting discussion on the cultural contexts in which this scholarship is placed and look forward to more ‘bidirectional’ influence of non-Western perspectives on knowledge and ‘ways of knowing.’ Subha and Lara provided excellent advice to those early in their scholarship journey – being clear on goals, engaging in scholarship for the right reasons and the importance of collaboration. Many thanks to them for their time and expertise!

 

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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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#MedEdPearls December 2021: Universal Design for Learning in Health Professions Education

As health professionals seek to prepare a diverse workforce, it is essential that unnecessary barriers to learning be removed. By incorporating Universal Design for Learning (UDL) principles during the curriculum development process, we can provide flexibility and allow learners to customize their learning experiences to meet their individual needs. In his article Twelve tips for Designing an Inclusive Curriculum in Medical Education Using Universal Design for Learning (UDL) Principles

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The Harvard Macy Institute Podcast S2 E11: New Horizons in Healthcare and Implications for Health Professions Education

Health professions educators must remain attuned to the ways in which healthcare is delivered if we want to produce graduates who are ‘work ready.’ This is an enormous challenge when healthcare technology and systems evolve at a rapid rate. 

So, what is on the horizon of health delivery? What changes in practice can we anticipate? What will be the impact of technology? Changing workforce roles? changing consumer expectations? And how will COVID-19 continue to influence care delivery?

In this episode of the Harvard Macy Institute podcast, we spoke with Ann Somers Hogg about the top trends to watch in healthcare delivery. Ann-Somers is a senior research fellow at the Christensen Institute where she focuses on business model innovation and disruption in healthcare, including how we can transform a sick care system to one that values and incentivizes total health. Prior to joining the Institute, Ann Somers spent eight years at Atrium Health.

We talked about technology, personalised medicine, ‘health coaches,’ mental health apps, companies that are ’healthcare aggregators,’ telehealth trends and exemplars such as the Health Design lab at Jefferson Health. We conjectured about what this all means for health professions education and look forward to more of these conversations.

 

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Finding the mental space to learn: A case for dedicated academic half days

At programs who use noon conference or morning report model, trainees are expected to attend the teaching sessions unless there is a patient emergency. However, it is difficult to ignore pleas for pain medications or a diet order for patients who had a procedure cancelled and who have been fasting since midnight the night before. These are not ‘emergencies’ but I think most of us would struggle with the idea of leaving anyone in pain for an hour. When I have previously worked in hospitals with this model, I have rarely attended a lecture which did not necessitate me leaving early, arriving late or answering a call during the session.

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The Harvard Macy Institute Podcast S2 E10: Trends and Disruptions in Teaching Perspectives with Dan Pratt and Amanda Dumoulin

In his book Five Perspectives on Teaching, Dan Pratt describes perspectives as ‘something we look through, rather than at as we go about the business of teaching. He eschews the idea of simplistic ‘best practices,’ and invites a ‘plurality of the good’ in teaching - recognizing our perspectives and thoughtful about how they shape our teaching formats.

 Do these perspectives change over time? Are the influences on them internal or external? What is the effect of a massive disruption such as the COVID-19 pandemic?

Dan gave us a precis of the five perspectives and the Teaching Perspectives Inventory - a freely available instrument for educators to help identify their dominant and back up perspectives. In reviewing data from Harvard Macy Institute Scholars, Amanda offered some insights into trends observed over time, and some dramatic shifts during the pandemic. After some initial shifts towards a transmission perspective, developmental and nurturing perspectives are on the rise again. Food for thought! We reflected on the role of technology and culture in shaping teachers’ perspectives and practice.

 

Please click here for the episode - Happy listening!

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#MedEdPearls November 2021: Disclosure – What Happens after Medical Errors are Encountered?

Two decades ago, medical errors were brought into the spotlight with the Institute of Medicine’s report To Err is Human. This report highlighted the alarming rate of medical errors and can be credited to the numerous efforts undertaken to improve the safety of health care delivery. After a medical error occurs, patients expect disclosure of the event. What exactly does the process of disclosure entail? Galagher provides a simple assessment of disclosure that includes three elements:

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The Harvard Macy Institute Podcast S2E9: “Glocalisation” for health professions education

Healthcare and health professions education is increasingly global and interconnected. This has many benefits, but risks ignoring important cultural and contextual differences in the settings where education is delivered. In this episode Sawsan Abdel-Razig tells us about ‘glocalisation’ - combining the terms globalisation and localization to describe the adaptation of international standards to local needs and cultures. We explored this concept through her work in the United Arab Emirates, where she works as chair of medical education at the Cleveland Clinic Abu Dhabi.

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Utilizing Technology to Address Gaps in Medical Education

There are some reasons why I think that we are in the golden age of addressing gaps in medical education through technology:

  • High-quality modules and curricula are widely available online:

One of the most important roles of a medical educator in this age of technology is that of a content curator, rather than a content creator. This is because so many high-quality modules are being created and shared online by national experts that educators aim should be to curate an educational experience for their students rather than create them from scratch.

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October 2021 #MedEdPearls: Embracing a Scholarly Approach

How many times have you heard the following: “You should write that up!”? While mentioned by colleagues and mentors with positive intent, suggestions such as these are usually mentioned after implementation of an educational initiative. Educators who take the time to develop novel or unique experiences for trainees or colleagues would be wise to consider how it could be shared with others as scholarship during the development stage, before it is implemented. 

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The Harvard Macy Institute Podcast S2 E8: A Curious Case of the Phantom Professor with Bas Uijtdehaage and Lauren Germain

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 features interviews with health professions educators about their scholarly work.

S2 E8 podcast is a conversation between Vic Brazil, Sebastian (Bas) Uijtdehaage, and Lauren Germain about why student evaluations of teaching (SETs) can appear ‘mindless,’ and about the inadequacies of many student evaluation systems in educational institutions.

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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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The Harvard Macy Institute Podcast S2 E7: Welcoming new scholars into the Harvard Macy Community of Practice

The Harvard Macy Institute Podcast is hosted by our Program for Educators in the Health Professions course faculty Victoria Brazil. This episode features a conversation with Program for Educators course directors Liz Armstrong and Holly Gooding and program manager Todd Fowler, in a discussion welcoming new course scholars into our worldwide community of practice.

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The Harvard Macy Institute Podcast S2 E6: Digital presence with Traci Wolbrink

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 features interviews with health professions educators about their scholarly work.

S2 S6 podcast is a conversation between Vic Brazil and Traci Wolbrink about ‘digital presence’ – how to establish and manage our online identities, including the overlap of personal and professional identities. It’s a fun ‘meta’ experience – a podcast recorded ‘live’ during the 2021 HMI Transforming Teaching for the Virtual Environment course.

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September 2021 #MedEdPearls: A Recipe for Designing Motivating Learning Experiences to Enhance Learner Performance: Lessons Learned from the 2021 International Association of Medical Science Educators (IAMSE) Annual Conference

During his plenary at the June 2021 IAMSE annual conference entitled “Top Ten Ways an ID [Instructional Designer] can help you Define the New Normal,” Dr. Atsusi Hirumi reminded us that learner motivation is as important as ability (i.e., skills and knowledge) and opportunity in determining performance.

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A Clinician’s Reflection on Teaching without Training

Over the years, I have been fortunate enough to teach Nurse Practitioner (NP) students in both clinical and classroom settings. Teaching, especially regarding topics about which I am passionate, can be incredibly rewarding. However, I have found that doing so without training as an educator can also be tremendously challenging. 

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Behind the Mask: Lessons in Professional Identity Formation

Medical students are constantly molding and reshaping their sense of identity in response to multiple internal and external forces coupled with their evolving understanding of what it means to be a physician. It is normal for students to struggle with their professional identity at any given point in time during their educational journey. Much of the identity work that takes place during medical school takes occurs through the informal processes embedded within the hidden curriculum. In this setting, students are told one thing in the formal learning setting while observing something completely different in the clinical environment. This juxtaposition contributes to identity conflict, particularly if a student is trying to be accountable to multiple influences that don’t align. 

With this in mind, helping medical learners explore their professional identity formation (PIF) is a central responsibility in medical education. To facilitate this, we have adapted the use of mask making in the specific context of examining PIF in medical education. Human beings are biologically conditioned to respond to faces. Masks, therefore, evolve from a longstanding and fundamental human need to explore meaning and belonging, navigate transitions and ensure survival. As such, the act of mask making represents both process (constructing the mask) and product (the mask itself). Mask-making, therefore, is a unique modality to foster reflective expression and professional growth.

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