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.

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.

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. 

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.

Practicing communication, with good feedback, helps us get better at our jobs in healthcare. This is especially important for ‘high stakes communication’ (but really is there any other kind 😊). In this episode of the HMI podcast, Vic speaks with Laura Rock about her recent paper: Communication as a High-Stakes Clinical Skill: "Just-in-Time" Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill.

Her key messages are about the power of rehearsal with feedback for better communication, and the need to practice the actual words we will use. We highlight that this approach appropriately elevates the status of communication as a critical skill, along with other procedural skills. Laura describes strategies like the use of scripts, and developing the ‘microskills’ of communication, as well as recognising the fundamental role of recognizing and responding to emotions in both patients and learners.