Medical Education Grand Rounds

Topics

Addressing Health Disparities: Can Equity Pedagogy Help?

Presented by Catherine R. Lucey MD, Executive Vice Dean, Vice Dean for Education, The Faustino and Martha Molina Bernadett Presidential Chair in Medical Education, Professor of Medicine, University of California San Francisco

Course description/learning objectives: Despite years of attention, progress toward achieving health care that is equitable and patient centered has been slow. To improve health outcomes for minority patients, educational environments for learners, and research environments for scientists, health professions education programs have used new approaches to recruit more diverse learners to our environments. Realizing the benefits of diversity requires educators to eschew a colorblind philosophy and instead embrace the principles of equity pedagogy.  Designing curriculum, assessment strategies, and learning environments for optimal inclusivity and equity of opportunity will lead to improved student outcomes and ultimately to better health care. Following this session, participants will have an understanding of the obligation of medical education to prepare a workforce that is prepared to counter health disparities; will understand what equity pedagogy is and how it can be used to counter structural racism and the inequitable learning environment of medical school; and will understand the impact and consequences of inequitable learning environment on medical student achievement.

Addressing Medical Student, Resident, and Physician Wellbeing

Presented by Lotte Dyrbye MD, MHPE, FACP, Professor of Medicine, Professor of Medical Education, and Consultant in the Division of Primary Care Internal Medicine, Associate Chair for Faculty Development, Staff Satisfaction, and Diversity for the Department of Medicine, Director of Faculty Development for Mayo Clinic School of Graduate Medical Education, and Co-Director of the Department of Medicine Program on Physician Well-being, Mayo Clinic, Rochester, Minnesota

Course description/learning objectives: During this presentation, Dr. Dyrbye will review the prevalence, drivers, and consequences of burnout among trainees. Additionally, she will review evidence-based individual and organizational strategies to mitigate the risk of burnout.  Following this session, participants will be able to explain the prevalence of burnout and potential contributors, describe the consequences of burnout, and identify individual as well as organizational strategies to enhance trainee well-being.

Beyond ‘Communication Skills’: A Rhetorical Approach to Teaching and Learning Team Communication

Presented by Lorelei Lingard, PhD, Director, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, University of Western Ontario

Course description/learning objectives: Communication is not only descriptive; it is constructive of our realities. On healthcare teams, communication shapes attitudes towards the team’s work, relations among team members, and the coordinated actions that constitute care delivery. Research in the past decade has mapped recurrent patterns of healthcare team communication, with critical implications for how we think about ‘communication skills’ and how we teach it to, and assess it in, our trainees. This presentation emerges from research that takes a rhetorical perspective on team communication, emphasizing what communication does, the way it shapes understanding and action in social settings. Four key claims about communication will be introduced, and the research underpinning each reviewed: (1) language is not self-evident: interpretation is (almost) everything; (2) communication problems aren’t just a matter of individual ‘skill’; they emerge from rhetorical situations; (3) meaning emerges not only from spoken discourse, but also from silence, (4) changing team communication habits is an intrinsically relational activity. By the end of the presentation, participants will be able to list these four claims, discuss their implications for teaching and assessing communication in health professional trainees, and recognize some limitations to the traditional approach to ‘communication skills’ training in the context of preparing for the complex communicative environment of teamwork.

Clinical Education: Controversies, Uncertainties, and Practicalities

Presented by Cyril Grum, MD, Professor, Department of Internal Medicine and Senior Associate Chair, Undergraduate Medical Programs, University of Michigan Medical School.

Course description/learning objectives: This interactive discussion seminar will focus on controversies, uncertainties, and practicalities in clinical education.  Dr. Grum brings 25 years of experience with clinical education as an Internal Medicine Clerkship Director.  We will explore some of the struggles of our times and hope to bring a better understanding, if not a road forward, on some of these issues. By the conclusion of this session, participants will be able to: discuss details and challenges of clinical education with an experienced clerkship director; describe similar or different challenges in clinical education at UVa; and draw conclusions about how controversies (such as patient confidentiality vs. student access to patient charts), uncertainties (such as grading approaches and problems with feedback), and practicalities (such as faculty teaching bonuses; keeping outpatient clinics efficient that have student learners) can be addressed effectively.

Cultural Competence: How Do We Know Our Graduates Have Achieved It

Presented by LuAnn A. Wilkerson, EdD, Senior Associate Dean for Medical Education, David Geffen School of Medicine at UCLA.

Course description/learning objectives: Patient-centered care has a long history in medicine since the landmark paper by Kleinman, Eisenberg, and Good, Culture, Illness, and Care in 1978. In more recent years, it has been promoted as one approach to cultural competency. By eliciting and responding to the concerns, beliefs, needs, and preferences of an individual patient, the physician demonstrates awareness and respect for cultural differences and engages the patient in determining aspects of the care. In this session, we will examine the use of an Objective-Structured Clinical Examination (OSCE) as one way of assessing patient-centered care (PCC) and providing feedback to students on cultural competency. By the end of this session, participants will be able to describe critical attitudes and skills essential to a PCC approach to cultural competency, explain ways to integrate the assessment of PCC into an OSCE examination both with a single case and with embedded items, and list how to provide feedback to students on the results of PCC assessments.

Designing, Directing and Assessing Learning Experiences

Presented by Thomas Viggiano, MD, MEd, Consultant, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic; Barbara Woodward Lips Professor, College of Medicine, Mayo Medical School; Associate Dean for Faculty Affairs, Mayo Medical School; and Professor of Medicine and Professor of Medical Education, Mayo Medical School.

Course description/learning objectives: During this session, participants will review the theory of outcome-based education and explore applications of learning science to designing and assessing learning experiences. After completion of this session, participants will be able to apply the theory of Outcome-based Education to designing effective learning experiences; design and direct active learning experiences that enhance learner’s retention, application and transfer; and assess whether learners have achieved the desired learning objectives.

Engaging the Digital Learner: How has growing-up digital impacted learning?

Presented by Curtis L. Whitehair, MD, Associate Medical Director, Regional Physiatry; Program Director, MedStar GUH/NRH PM&R Residency Training Program; and Assistant Professor of Clinical Rehabilitation Medicine – Georgetown University School of Medicine.

Course description/learning objectives: There has been a lot written about the Digital Native, Digital Immigrant and Digital Wisdom or Literacy as it pertains to the learners of today. Most of this literature originated in the early 2000’s concerning how K-12 pedagogy would react to this new Digital Native. Much has been learned about them over the last decade, but these new learners are rapidly approaching medical school and residency training. This presentation will focus on understanding the today’s learner or generation so that educators can start to appreciate the impact this may have on their teaching style, pedagogy and curriculums of the future. By the end of this session, participants will be able to discuss current literature on those born in the digital age, explore the generational and demographic differences between learners and teachers of today and describe how the young digital age learners are processing information in the rapidly changing digital time.

EPAs and entrustment based decision making

Presented by Th.J. (Olle) ten Cate, PhD, Professor of Medical Education and Director of the Center for Research and Development of Education, University Medical Center Utrecht, The Netherlands; Adjunct Professor of Medicine, University of California San Francisco

Course description/learning objectives: EPAs have become a new, but already frequently used framework for the planning of teaching and assessment in clinical training, both in graduate and undergraduate medical education and increasingly in other domains. This GR will update the audience on the backgrounds and practice of these innovations. Following this session, participants will be able to explain what EPAs are, how they may be identified and applied in workplace curricula and understand what the implications are of a move from traditional assessment of trainees in the clinical environment to entrustment as a foundation of assessment.

Facilitating a midcourse correction: Remediation in Medical Education

Presented by Adina Luba Kalet, MD, MPH, FACP, FAAPP, Professor of Medicine and Surgery, New York University School of Medicine.

Course description/learning objectives: Remediation in medical education is the act of facilitating a correction for trainees who started out on the journey toward becoming an excellent health professional but have moved off course. The emerging focus on remediation is a direct consequence of the fact that assessment of clinical competence and professionalism in medical training has become more sophisticated and ubiquitous. Initially, educators focused on the struggle to find effective and respectful means to work with individual trainees who don’t meet standards, the vast majority of whom will become practicing professionals. More recently, scholars have begun framing remediation as an anticipatable consequence of mis-match between individuals and institutional assessment culture suggesting the need for proactive individual tailoring of medical education. But ultimately, justifiable competence judgments need to be made. Society allows and expects the medical profession to regulate ourselves, and we must do so as a routine part of medical education. In this talk Dr. Kalet will assert that effective faculty development for remediation is an institutional capacity building process, which requires both individually and institutionally focused approaches. She will propose a set of specific competence areas for individual faculty development and briefly discuss attributes of teachers and theories of learning, and teaching strategies that impact on the ability to remediate effectively. In particular, she will focus on the importance and specifics of developing judgment, facilitation skills, emotional intelligence and courage, and attitudes consistent with effective remediation work. She will conclude by proposing the need to organize these activities so that they are aimed at creating a community of practice in remediation, which is integrated with other important communities of practice (e.g. education and workplace) to inform and be informed by these related activities to ensure the most “competent” health care systems possible. By the end of the session participants will assert that conducting remediation of trainees and colleagues is the responsibility of all medical educators; lay out a framework for both understanding medical competence and identifying and working with individuals who veer off course; discuss faculty’s attitude and skill barriers to engaging effectively with trainees and colleagues who are “not competent;” and argue for the importance of viewing faculty development in remediation as an institutional capacity building activity.

Flawed self-assessment: On the failures of incompetence to recognize itself

Presented by David Dunning, PhD, Cornell University.

Course description/learning objectives: In this talk, Dr. Dunning will discuss the problem that poor performers often fail to have the expertise to recognize their own poor performance. As a consequence, they express marked confidence in their judgments and decisions even when those decisions are faulty. He will further discuss the problems this phenomenon has for self-assessment and learning. Following this session, participants will be familiar with common errors in self-assessment, based on current psychological and medical research and will be able to discuss ways to circumvent these difficulties in self-assessment, to enhance self-knowledge and competence.

Getting beyond “I know one when I see one”: Setting defensible learner performance standards for high stakes decisions

Presented by Larry D. Gruppen, PhD, Professor, Department of Medical Education, University of Michigan Medical School.

Course description/learning objectives: We assess learner performance to make decisions, such as competence, promotion, remediation, certification, commendation, etc. To make these decisions, we must set standards or cutpoints for assessment data, but setting standards is both complex and political. This session will address both the techniques and the politics of setting defensible standards for decision making. Following this session, participants will be able to: decide when it is worthwhile and necessary to set defensible standards for learner assessments; select among alternative standard setting methods; be able to organize and conduct a reproducible standard setting meeting; and accommodate the political aspects of standard setting.

Getting Started: Developing and Implementing Effective Interprofessional Education

Presented by Scott Reeves, PhD, MSc, PGCE, Director, Center for Innovation in Interprofessional Education, Professor of Social and Behavioral Sciences, Editor-in-Chief, Journal of Interprofessional Care, University of California, San Francisco.

Course description/learning objectives: This talk will focus on how faculty and clinical preceptors can provide opportunities for interprofessional education toward effective team-based, patient-centered care. Following this session, participants will be able to define IPE and describe its principles, describe the strategies for developing an effective IPE activity, and offer a range of ideas and approaches for the successful delivery of an IPE activity.

Hidden In Plain Sight: The Untapped Potential of Written Assessment Comments

Presented by Shiphra Ginsburg, MD, MEd, PhD, FRCPC, Professor, Department of Medicine (Respirology); Scientist, Wilson Centre for Research in Education, University of Toronto.

Course description/learning objectives:  This session will focus on enhancing narrative evaluation of medical students’ clinical performance across the curriculum. By the end of the session, learners will discuss the value of written assessment comments; list the complexities involved in analyzing language; describe their own use of assessment language in a new way.

How Do Attendings and Residents Develop Trust in Their Trainees?

Presented by Patricia S. O’Sullivan, EdD, Professor of Medicine and Director of Research and Development in Medical. 

Course description/learning objectives: Education in the Office of Medical Education, University of California San Francisco School of Medicine
Trust is a gateway to allowing trainees to expand their responsibilities. In a qualitative study, we explored how attending physicians trusted their trainees. In a mixed methods study, we applied the same model for trust to residents supervising interns. These two studies provide insight as to how trust develops and highlights what supervisors can do to develop trust in their trainees. At the end of this presentation, participants will be able to: describe a model for trust formation; compare and contrast how attendings and residents form trust in their trainees; and identify strategies that clinical supervisors can take to develop trust in their trainees.

Intelligent Virtual Agents in Healthcare: Transforming Education and Practice

Presented by Frederick Kron, MD, President & Founder of Medical Cyberworlds, Inc., and Visiting Assistant Research Professor of Family Medicine, University of Virginia School of Medicine.

Course description/learning objectives: This discussion is intended to bring nurses and physicians up-to-date about a variety of interactive, virtual agents that are increasing popping up in healthcare. Lecture attendees will become conversant with state-of-the-art technologies used in agent creation; develop a conceptual framework to help match up available technologies with real-world needs; recognize the challenges of innovation; and develop strategies that anticipate future developments.

Improving Learning Environments: What do we know and how can we do it?

Presented by David M. Irby, PhD, Professor Emeritus of Medicine, University of California, San Francisco.

Course description/learning objectives:  Educators, researchers, and accreditors have all highlighted the importance of the learning environments (LE) in health professions education; yet, there is little uniformity about definitions and measuring instruments.  This presentation reports on the results of a 2018 national consensus conference convened by the Josiah Macy Jr. Foundation titled: Improving Learning Environments for the Health Professions.  Dr. Irby chaired this conference and will share a new framework for understanding LEs as well as specific examples of interventions designed to create a positive environment for learning.  Following this session, participants will be able to: identify the key elements of the learning environment; describe strategies used to improve the learning environment; and articulate a vision for an optimal learning environment.

Leadership in Medicine: Talking the Talk and Walking the Walk

Presented by Presented by Hilary M. Haftel, MD, MEd, Clinical Associate Professor of Internal Medicine, Pediatrics, and Communicable Diseases, University of Michigan Medical School, and Linda Waggoner-Fountain, MD, MEd, Associate Professor of Pediatrics, Pediatrics Residency Director.

Course description/learning objectives: Dr. Hilary Haftel, with colleague Dr. Linda Waggoner-Fountain, will engage attendees in a discussion about the challenges of developing leaders in medicine and medical education. While this is a broad and deep topic, Drs. Haftel and Waggoner-Fountain have helped to create a national program in educational leadership development that can apply across all disciplines looking to train the next generation of leaders. Please join us to discuss leadership development across health care and please also bring your own experiences – whether in the context of support or challenges. At the conclusion of this session, participants will be able to: discuss methods to apply leadership principles across the continuum of medical education; identify individuals’ characteristics and contexts that demonstrate evidence of potential or existing leadership; and discuss and evaluate leadership as “state or trait” – e.g., are leaders born or do they step up to become leaders under certain conditions.

Medical Education and the Soul of Medicine

Presented by Fitzhugh Mullan, MD, Murdock Head Professor of Medicine and Health Policy at George Washington University and 2014 recipient of the Anne L. Brodie Medical Education Scholar Award.

Course description/learning objectives: This session is jointly presented by the Center for Biomedical Ethics and Humanities Office’s Medical Center Hour and the Office of Medical Education’s Medical Grand Rounds series.

Medutechnication: Integrating Technology into Bedside Teaching

Presented by J. Scott Wieters, MD, Assistant Professor of Emergency Medicine, Baylor Scott &White Healthcare/Texas A&M Health Science Center College of Medicine

Course description/learning objectives: Information is doubling and technology is developing at dizzying speeds. Current learners are voting with pads, smartphones, and laptops as the preferred media of information transfer as they socialize electronically on various media platforms. Are you equipped to effectively instruct the next generation of healthcare professionals?  Following this session, participants will be able to:  develop efficient methods of information curation; incorporate technology and social media into their instructional design; and create Free Open Access Medical Education.

Opportunities and Challenges of Competency-Based Assessment

Presented by Kevin Eva, PhD, Hon. FAcadMEd, Associate Director and Senior Scientist, Centre for Health Education Scholarship; Professor and Director of Education Research and Scholarship, Department of Medicine; Faculty of Medicine, University of British Columbia; and Editor-in-chief, Medical Education.

Course description/learning objectives: Having recently undergone a rigorous self- and external assessment of our program here at UVa SOM, this is an excellent time to discuss future directions. In this talk, we will discuss the movement toward competency-based assessment and the intended/unintended consequences that come with it. The opportunities arise from being explicit and broad in focus, increasing emphasis on observation, and using assessment as a pedagogical intervention. The challenges the field continues to struggle to overcome include reliability problems, reliance on subjectivity, and difficulty in defining specific competencies. Following this presentation, participants will be able to: examine the literature regarding the adequacy of defining performance as a series of independent competencies; discuss the role of context and the implications for whether or not humans can be expected to make absolute judgments about competence; and consider how we might use a competency-based assessment framework to deliver feedback in a manner that promotes receptivity and quality improvement.

Realizing the Promise of Outcomes-based Medical Education through Developmental Assessment

Presented by Eric S. Holmboe, MD, MACP, FRCP, FAoME(hon), FRCPSC(hon), Senior Vice President, Milestone Development and Evaluation, Accreditation Council for Graduate Medical Education.

Course description/learning objectives: The transition to outcomes-based medical education (OBME) has been challenging. Most countries have developed competency frameworks to guide this transition and ensure medical education programs are attending to societal needs. OBME requires a developmental mindset and approach to assessment to be effective. However, this shift to developmental assessment, such as milestones and entrustable professional activities (EPAs), also requires changes in curriculum and the creation of assessment programs. We will explore these issues, early lessons learned from Milestones and EPA research, and the implications for undergraduate and graduate medical education moving forward.  Following this session, participants will be able to:  discuss the educational theories underlying outcomes and competency-based medical education; discuss the role and challenges of developmental assessment in graduate medical education; and explore the link between graduate medical education and healthcare outcomes.

The Future of Clinical Medicine and Implications for Medical Education

Presented by James O. Woolliscroft, MD, Lyle C. Roll Professor of Medicine, Professor of Learning Health Sciences, University of Michigan Medical School. 

Course description/learning objectives: What will the clinical practice of medicine be like in 2030? Given developing trends in clinical medicine, this talk will explore educational implications for current medical students and trainees. Following this presentation, participants will: appreciate the transformational potential of technology and new understandings of health and disease on the clinical practice of medicine and have a framework with which to begin to rethink the medical education curriculum and requisite learning experiences.

The things we know, the things we think we know but don’t, and the things we don’t know but should

Presented by Geoff Norman, PhD, Professor, McMaster University, Health Sciences.

Course description/learning objectives: It is now more or less accepted that all educational interventions are created approximately equal. Systematic reviews comparing problem-based learning with conventional instruction tend to show quite small effects. Systematic reviews show that various digital technologies (virtual patients, e-learning) have typical effect sizes of 1.0 when compared to no instruction but 0.0 when compared to any alternative. Such findings provide little basis for continuing to conduct research comparing curricula, yet we persist in advocating the virtues of one learning method over another. Such persistent beliefs in the face of negative evidence are pervasive in education. Conversely, contemporary educational psychology has identified a number of powerful educational interventions that can lead to large learning gains with minimal investment. Some examples are mixed practice, distributed practice, test-enhanced learning. Yet these strategies remain largely unknown to the medical education community. In this talk, the facilitator will systematically explore things we think work that don’t, and things that do work that we don’t know about. He will then advance some reasons why this may be the case, and some suggested strategies to avoid these problems in future. By the end of this workshop, attendees will be able to describe why comparison of “popular” educational interventions yields small effect sizes; discuss the evidence related to teaching/learning methods as it can be applied to medical education; and summarize the “powerful education interventions” as described in the educational psychology literature.

The Why, What, and How of Curricular Transformation at the University of Michigan Medical School

Presented by Rajesh S. Mangrulkar, MD, Marguerite S. Roll Professor of Medical Education, Associate Dean for Medical Student Education, Associate Professor of Internal Medicine, and Associate Professor of Learning Health Sciences

Course description/learning objectives: In this talk, Dr. Mangrulkar will provide an overview of the curricular transformation journey he is leading at the University of Michigan Medical School, one that is oriented towards graduating leaders and change agents in medicine to improve health, healthcare and healthcare science. This 8-year project began in January 2013, with the first graduates slated to emerge from the fully mature program in 2021. During his presentation, he will describe the key strategic pillars of the program, as well as the challenges of transformative change in a large, traditional, research-oriented university such as the University of Michigan. Learning Objectives: At the end of this session, participants will be able to map the new curricular architecture of the University of Michigan Medical School (UMMS) to the goals of the desired medical education program, drawn from the specifics of a multi-pronged needs assessment; describe the key strategic elements of the new curriculum at UMMS, including how these programs support the development of new capabilities in the graduate; and state how UMMS is deliberately addressing the challenges of organizational change management, as this curriculum is implemented in modules over eight years.

Using virtual humans to train nurses and surgical technicians to speak up about patient safety risks

Presented by Andrew Robb, Computer Science and Engineering PhD Candidate, University of Florida.

Course description/learning objectives: Virtual humans are currently being applied to many aspects of medical education. This talk focuses on two team training exercises that use virtual humans to teach nurses and surgical technicians how to speak up about patient safety risks in the operating room. We will discuss speaking up behavior, how virtual teammates are both similar and different from human teammates, and guidelines for how virtual humans can be used effectively. Following this presentation, participants will be able to list ways to speak up about errors in the operating room and describe the ways in which virtual humans can be used for team training.

Virtual Patients in Medical Education

Presented by Benjamin C. Lok, PhD, Associate Professor, Department of Computer and Information Science and Engineering, University of Florida.

Course description/learning objectives: Dr. Lok will discuss recent advances in virtual patient technology, computer-based simulations of patients used for medical skills education. The talk will discuss the current state of the field, upcoming advances, and will include an interactive demonstration (a virtual patient will be created). By the end of this session, participants will be able to describe where (in the program) and how (contexts and content) virtual patients can help learners achieve specific learning objectives; compare virtual patients with other approaches to achieving similar/identical objectives (e.g., communication skills/breaking bad news) and discuss advantages of virtual patients in these circumstances; and summarize how data gathered by virtual patients enhances assessment of learners’ knowledge and skills.

Working within Medical Education’s Hidden Curriculum

Presented by Frederic W. Hafferty, PhD, Professor of Medical Education, Associate Dean for Professionalism, College of Medicine, and Associate Director of the Program for Professionalism & Ethics at the Mayo Clinic. 

Course description/learning objectives: Not all of what is taught during medical training is captured in course catalogs, class syllabi, lecture, notes and handouts…. Indeed, a great deal of what is taught—and most of what is learned—in medical school takes place not within formal course offerings but within medicine’s ‘hidden curriculum.’ By this session’s conclusion, participants will be able to contrast the formal versus the other-than-formal aspects of medical student learning; associate key hidden curriculum concepts with faculty life; and relate issues of the hidden curriculum to issues of interprofessional education.