Medical Educator Minute – Educators as leaders

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Collaboration is at the heart of what we do at MedStar Health, especially within the GME community. All of our residents, fellows, and faculty bring diverse perspectives and experiences to the table, and creating an environment where everyone feels valued and heard is essential to our collective success.

The Josiah Macy Jr. Foundation defines the learning environment as “…the social interactions, organizational culture and structures, and physical and virtual spaces that surround and shape the learners’ experiences, perceptions and learning.” Many theories and frameworks have tried to encompass the complexity of the learning environment and emphasize challenges in workplace learning. Gruppen, et. al outlines a framework that focuses on the multidimensional aspects of our learning environment as follows1:

 

The authors conclude that the learning environment is comprised of not only complex social interactions but also involves the surrounding support and environment and encompasses not only learners but the patients, teachers, and leaders within an organization.

1.Gruppen, Larry D. PhD; Irby, David M. MDiv, PhD; Durning, Steven J. MD, PhD; Maggio, Lauren A. MS(LIS), PhD. Conceptualizing Learning Environments in the Health Professions. Academic Medicine 94(7):p 969-974, July 2019. | DOI: 10.1097/ACM.0000000000002702

To foster constructive and respectful conversations, begin by building trust.

Take the time to understand where your colleagues come from and what they aim to achieve. Actively listen – without planning your next response while they’re speaking and offer positive reinforcement that encourages additive dialogue. Simple tools like saying, “That’s a great point. Let’s discuss it further one-on-one,” or “What if we explored this idea together?” can enhance collaboration and show that every voice matters.

Motivating one another to teach and learn is also crucial.

By creating a safe space for exploration and experimentation, we can challenge assumptions, offer valuable insights, and uncover innovative solutions. Use open-ended questions to clarify ideas and delve deeper into issues: “Can you elaborate on that?” or “Help me understand your perspective.”

Inclusion is key.

By ensuring all voices are heard, we harness the power of diverse ideas and backgrounds. Encourage participation with phrases like, “What do others here think?” or “Thank you for sharing your perspective—it’s helpful to hear different views.”

Together, we are stronger. Let’s continue to learn from each other, embrace our collective strengths, and grow as a community dedicated to advancing healthcare excellence

To learn more, check out: journals.lww.com

Medical Educator Minute – Best practices for simulation in medical education

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Medical education has learned from other professions that have established uses of simulation in training, such as aviation and the military. With limitations on duty hours potentially restricting patient encounters, and a growing emphasis on patient safety, simulation increased steadily across healthcare education. Simulation is traditionally used for learning or practicing low-frequency, high-stakes patient encounters or for procedural skills. However, more recently, simulation is being used in health profession education to practice complex communication scenarios (e.g., delivering bad news) or situations that may be emotionally charged and require an environment of psychological safety to practice (e.g., responding to microaggressions). Beyond traditional simulation, new and innovative ways of using simulation are emerging in medical education, including rapid cycle deliberate practice, ‘just in time’ simulation, and group simulation (stay tuned for future MEMs to learn more about these!).

Features of high-fidelity simulation that lead to effective learning:

Curriculum Integration

The simulation experience must be planned, scheduled, implemented, and evaluated in the context of a broader medical curriculum.

Feedback

A critical component of learning, use the three Ps for simulation: Plan, Pre-brief/Prepare, and Provide feedback/debrief

Deliberate Practice

Involves repetitive performance of cognitive or psychomotor skills with specific and rigorous skills assessment; must have multiple SIM experiences that are not exactly the same

Mastery Learning

The goal of mastery learning is to ensure that all learners achieve the objective level of mastery performance, a higher level than competence alone – some learners may require more time/practice than others

Range of Difficulty

Learning is most effective when trainees begin at an appropriate level for them, demonstrate performance mastery at that level, then advance through increasing levels of difficulty

Capturing Clinical Variation

Simulations that encompass a variety of patient presentations are far more effective for learning than those having a single case, presentation, or scenario

Individualized Learning

It’s not only about learning at one’s own level, but also about the learner being an active participant, continuously shaping and adapting the learning experience to meet their specific needs

To learn more, check out AMEE Guide #82 – Best Practices for Simulation in Healthcare Education

Medical Educator Minute – “Coaching” in medical education

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What is “coaching” in medical education, and how is it different from traditional teaching and feedback?

Coaching helps learners recognize their growth potential and fosters responsibility in finding their own path to improvement. Unlike traditional teaching, which focuses on telling, coaching emphasizes asking, enabling learners to develop lifelong adaptive skills (Hammound et al., 2022). While formal coaching programs exist, “impromptu coaching” is gaining attention for its ability to support trainee growth through brief, focused interactions based on a specific area, skill, or patient encounter that has been directly observed by the coach.

Five factors for effective impromptu coaching:

  1. Identify coachable moments – this can be any observed moment of patient care
  2. Create a supportive setting – ensure appropriate time and space for conversation
  3. Use time wisely – focus on a specific skill or area
  4. Ask questions – the hallmark of coaching – to help the learner uncover their own mental processes, strengths, and gaps
  5. Build a trusting relationship – coaching is grounded in growth mindset, ensure the learner feels capable of improvement

So, what does this look like in practice?

You’ve just finished rounds with your learner. During the last patient encounter, the patient’s family member became upset when discussing the plan of care. The learner seemed uncomfortable and ended the encounter quickly, seemingly dismissing their concerns.

  1. “Before we move on for the day, do you have a minute? I’d like to debrief that last encounter.”
  2. “I felt it got a little tense at the end, what was your experience?”
  3. “What part made you uncomfortable?”
  4. “Why do you think the family member responded that way? How might you have approached the conversation differently?”
  5. “Conflict can be very uncomfortable. What do you think you can do to make the conversation more comfortable?”
  6. “How can I help you work on these skills?”

To learn more:

Medical Educator Minute – Setting the (feedback) stage

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Starting this week, we’re launching a new monthly feature in Academics This Week called “Medical Educator Minute”, which will feature quick tips for teaching, giving and receiving feedback, and improving the learning environment based on the literature and curated by Dr. Elizabeth Chawla and Dr. Sarah Thornton. Our first feature below focuses on the importance of ‘setting the stage’ for feedback.

Setting the (feedback) stage:

Feedback conversations can be challenging for both educators and learners: educators often don’t know what to say or where to start, may be concerned about how their feedback will be received, or feel their time with the learner was too limited to make a comprehensive assessment. Learners can be equally unsatisfied if they are not able to reflect on feedback given, find it unhelpful because feedback does not align with their learning goals, or fail to get any specific feedback. So how can we ensure any time with learners facilitates opportunities for feedback and professional development?

Any interaction with a learner, even if brief, can use the following framework:

  • Set Expectations – it’s important for both the educator and the learner to understand what is required for the interaction or rotation. At the beginning of a week on service, the beginning of a surgical case or procedure, the start of an ER shift, or the start of a clinic session, the educator should clearly state expectations for the learner.
  • Learner-Driven Goals – the learner should identify and communicate to the educator specific goals for the time they have with the educator, based on their personal professional growth, current level of performance or experience, and time available. e.g., “I really want to work on my procedural skills during this ER shift.” The educator may need to help ensure goals are feasible and practical to the clinical space and that the goals align with stated learner curriculum.
  • Set a Time for Feedback – setting the expectation for a time and space for feedback at the beginning will help both the learner and educator feel prepared for the conversation, ensure it happens in a timely manner, and at a time when the learner is open to receiving the feedback. e.g., “at the end of the case, at the end of the shift, at the end of the month.” Remind the learner that self-reflection of performance and goals will be part of the feedback discussion.

Feedback conversations can be framed by recalling previously stated expectations and learner-stated goals set at the beginning of the interaction. Self-reflection is a critical part of receiving feedback. e.g., “What went well? What would you like to work on for next time?” Setting the stage can be very useful for ensuring feedback conversations are focused, timely, and productive, even during busy clinical loads.

To learn more, check out this article by Burgess et al about feedback in the clinical learning environment.

 Elizabeth Chawla, MD, Sarah Thornton, MD