Harvard Macy Community Blog

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

Burnout: Addressing the epidemic in Medical Trainees

Burnout is a serious epidemic affecting medical students, residents, and practicing physicians. This past January, Mohammad Zaher authored an insightful blog discussing the current state of well-being in health care. This current blog will build on these ideas with a focus on medical trainees. In addition, I will discuss practical solutions that can be implemented at your institution to improve trainee well-being.

Burnout is defined as a work related syndrome of depersonalization, emotional exhaustion, and decreased sense of personal accomplishment. Studies have shown that burnout begins in medical school, and intensifies during residency. Furthermore, approximately 50% of practicing physicians meet criteria for burnout. Burnout has grave personal consequences for medical trainees, including decreased quality of life, higher rates of depression, and suicidal ideation. Professionally, burnout affects patient safety, physician turnover, and patient satisfaction. Given these undesirable outcomes, increasing efforts to target burnout and improve physician well-being are an important focus at many training programs. Experts and evidence have suggested a combination of individual and organizational approaches to target burnout. Read on to explore the problem of burnout in medical trainees and get ideas about interventions you can implement at your own institution.

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Exploration of Program Director Perspectives on Core EPAs for Entering Residency

This blog was co-authored by Gary L. Beck Dallaghan, Ph.D. and Michael Ashley, B.S.

In 2014, the Association of American Medical Colleges issued recommendations for essential activities every graduating medical student should be able to perform unsupervised. The guiding principles underscoring the development of these skills included patient safety and enhancing confidence of stakeholders regarding new residents' abilities. These activities are meant to be a foundational core and should complement specialty-specific competencies.

Englander and colleagues mirrored their conceptual framework of the core entrustable professional activities for medical students on that being used by residency training programs. This entailed systematically reviewing published graduation requirements, program director expectations for entering residents, and tasks residents perform without supervision. This helped them develop 21 distinct entrustable professional activities (EPAs) that are considered observable and measurable units of work that represent a variety of competencies expected of medical professionals. More than 100 unique educators representing the continuum of medical education settled on the 13 current EPAs.

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#MedEdPearls March 2018 - "Frame-Based" Feedback

A main learning component of skills and competencies is feedback.   As instructors, when a learner makes a mistake, we jump to the conclusion we know why the learner erred without inquiring about the learner’s thought-processes. “Frame-based” feedback is a strategy to avoid this feedback error and to teach more effectively and efficiently. In an excellent article* about frame-based feedback the authors suggests three quick steps to provide effective feedback while avoiding our own cognitive biases: 1) Provide initial and specific feedback on what you observed; 2) Inquire as to what the learner’s ‘frame of mind’ was; 3) match teaching points with the learner’s frames.

While no one wants to make a mistake and no one wants their mistake pointed out to them, without constructive feedback the learner loses opportunities to improve. As we continue to move toward milestones and competencies in assessment for medical education, we should focus on providing formative feedback to our learners.  

 
Reference:

Rudolph J, Raemer D, Shapiro J. We know what they did wrong, but not why: the case for 'frame-based' feedback. Clin Teach. 2013 Jun;10(3):186-9. doi: 10.1111/j.1743-498X.2012.00636.x

 

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Teaching about Health Equity and Advocacy? Consider the Hidden Curriculum

Our best intentions and goals as health professions educators can be easily undone or reinforced by the hidden curriculum.

As the intern completed her presentation on rounds, she said, “Dr. Campbell, this is Ms. Williams’* third admission in three weeks. She is clinically stable and can be discharged today but I’m worried she will soon be back in the hospital.” Imagine with me two possible scenarios: the first where the team discounts the intern’s fears and pushes for a quick discharge; the second where the team stops to explore what non-medical issues might be contributing to the patient’s readmissions, and works with the social worker to connect the patient with resources that help address those issues. What lesson does the intern learn from scenario one versus scenario two? Which hidden curriculum is at play in each scenario?

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#HMIchat February 2018 – Let’s talk about trust - of the educator

#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!):

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Discouraging Academic Dishonesty using Cognitive Science Concepts

The following blog was co-authored by: Atipong Pathanasethpong and Rosawan Areemit

Academic dishonesty plagues universities around the world, from the US to Taiwan to Australia and beyond. In this blog we would like to discuss ways to address it by employing educational concepts and frameworks to shape a culture and environment that reward honesty and reduce incentives for dishonesty. 

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#MedEdPearls February 2018 - Dialogue-Structured Learning Tasks

The medical education environment offers a variety of opportunities for dialogue education learning tasks.  Dialogue education is an intentional design framework that fosters communication, reflection, and community in the learning environment.   Using this framework, educators can structure dialogue with students through learning experiences or “tasks” designed to assess prior knowledge, introduce new content, give learners a chance to practice, and thenhelp them integrate the new knowledge or skill (Vella, 2000).   Jane Vella’s concept of learning task design includes what she refers to as the 4 I’s: 

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You Belong Here: Shaking Off Impostor Syndrome and Embracing Leadership

My heart sank as I quickly scanned the list of speakers at the conference. I recognized the names of faculty whom I respected and admired, many of whom are local, state, and national leaders in their fields. What business did I have speaking at such a conference? Surely one of them would attend my talk, detect a fatal error, and spread the word that I had advanced this far in my career by chance alone and didn’t deserve my merits. Does this story seem familiar to you? If so, you may be suffering from “perceived fraudulence,” otherwise known as “impostor syndrome.”

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Design Thinking in Health Professions Education - reflections on our January #HMIChat

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. 

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Well-being in Healthcare: Where are We Today?

During my attendance at the Harvard Macy Institute Health Care Education 2.0 course, I was surprised when we were asked to participate in a mindfulness exercise every morning. I must admit that I wasn’t comfortable with the idea of spending time focusing on my breathing when I could be utilizing that time to work or learn. As the course carried on, I began to realize how we, as professionals, can be so focused on outcomes that we lose track of the journey, and how it affects us. 

While healthcare providers, with their rigorous selection process and training, are expected to be resilient under significant physical and emotional stress, the numbers say quite the opposite. Levels of burnout (exhaustion of physical or emotional strength and lack of motivation) among healthcare providers are increasing every year, and have reached nearly 60% in some disciplines. Rates of provider distress (burnout, anxiety, depression, and suicide) are higher than the general population. These numbers have implications beyond the affected healthcare provider, as studies have associated providers in distress with inferior quality of care, increased errors, decreased patient satisfaction, and even increased patient mortality. 

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#MedEdPearls January 2018 Reflective Practice

Reflective Practice:  Your BEST Professional Development Tool

With the start of a new year and scores of self-improvement resolutions underway, what better time to think about resources to help attain your goals and avoid barriers that might impede success in your self-improvement efforts.

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Maximizing your Networking Time at Harvard Macy

Harvard Macy is a community of educators and leaders dedicated to transforming healthcare education. In addition to being a top course in research, teaching, and learning in health professions education, Harvard Macy is itself a community of practice – a group of people who share a craft and/or a profession – and thus a prime opportunity to grow your professional network. 

What can you do to embrace networking while a Harvard Macy scholar? Here are 8 tips to consider: 

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Taking Care of Y-O-U in the New Year

 

Blog co-authors: Kristina Dzara and Beth Pegg Frates

As we enter 2018, the field of health professions education is embracing the notion that we must encourage wellbeing and resilience, and work to empower ourselves, our colleagues, and our learners to prioritize self-care.

A busy schedule with multiple time demands can make the goal of effective work-life integration seem elusive – if not impossible. But it is possible when you are equipped with effective tips and tools that guide you to practice routine exercise, restful sleep, stress resilience, and healthy eating. Certainly, there is no magic pill for a healthy lifestyle. In this post, we offer a few strategies you can implement today. Even small changes have the ability to impact your life in a big way.


 1) Stress: Stress is “an innate survival response in which certain hormones are released, increasing blood flow to the brain or heart. The stress response leads to an energy surge, enabling a person to flee dangerous situations. Ongoing stress, however, can sap energy and damage health.” Some stress is good for us, and in fact can help us get in a work zone. Yet, when the tensions run high at work, we can benefit from an “in the moment” stress reduction technique that works. Here is an easy suggestion:

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#HMIchat December 2017 – Cost and Value in Health Professions Education

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.

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#MedEdPearls December 2017 Sharing Stories

What’s your story: the power of narrative medicine?
Inspiration for this #MedEdPearls goes to @annieweisman1 & @dmullinsdms from their recent storytelling workshop at The Generalists in Medical Education.

 Storytelling is a communication method that has stood the test of time.  Its use in medical education is seen across the continuum to engender motivation to learn on topics across a diverse spectrum: empathy, well-being, professionalism, reflection, etc. 

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#HMIChat November 2017: Social Media in Medical and Health Professional Education

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.

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The Ultimate Goal of Medical Education

Medical education is, broadly, how we educate physicians to care for patients. Sometimes it can be difficult to see this ultimate goal in our very busy everyday life. As I tend to my busy clinical and educational activities, I find myself stopping and reflecting upon my educational tasks. Am I truly working in the best interest of my faculty, learners and ultimately the patients we serve?

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Next-Levelling Your Conference: Attendees as Co-Producers of Knowledge

What was your role during the last academic conference you attended? One common answer is “an attendee,” which means that you were there but doesn’t provide details regarding what you actually did. Another common answer is “a participant,” which is only a bit more telling because now it suggests that you were taking part in something. These common answers are widely used, but somehow they only convey that someone goes somewhere and does something. From these terms, we simply cannot deduce exactly what roles the conference organizers, speakers, facilitators, and attendees fulfill.

Higher education has been facing the same problem - the terms “teacher” and “student” imply that one teaches and the other studies. But this leaves the details of roles and expectations to each person’s interpretation. For this reason, there have been attempts to employ terms that are better at defining the nature of the relationship. Metaphors such as “client,” “customer,” “partner,” and “consumer” have been used. These metaphors imply different roles and expectations for every party in the educational system and also how they relate to each other.

These terms are equally applicable to academic conferences. A client means you pay the organizers for a professional service. A customer means the organizers have to please you to get your money. A partner means you partially bear the same set of responsibilities as the organizers. With these definitions in mind, think back again to your role at the last conference you were in: Were you a client? A customer? A partner? Or a consumer?

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#MedEdPearls November 2017: Converting Teaching into Scholarship

Ten Steps to Convert Basic Teaching into Publishable Scholarship

The purpose of scholarly teaching is to move beyond basic teaching, which is routine and non-changing.  Scholarly teaching is informed by pedagogical literature as well as student evaluations, peer evaluation, and self-reflection.  The Scholarship of Teaching and Learning (SoTL) goes beyond scholarly teaching by  disseminating  research findings to impact educational practice beyond one’s classroom walls and serves to bridge the gap between teaching and research roles of the academic. 

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#HMIchat October 2017: “Learners-as-Educators

 

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.

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