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

People Profile – Dr. Kathy Stolarz

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Kathy Stolarz, DO, FAAFP, (Family Medicine)

Kathy Stolarz, DO, FAAFP, (Family Medicine) dreams of a healthcare system where each and every patient has access to excellent care without regard to socioeconomic factors or type of health insurance.

“As the daughter of an immigrant and the granddaughter of Holocaust survivors, I am passionate about creating an inclusive healthcare system that addresses the needs of populations that experience adversity,” she explains.

This passion—and an interest in developing tangible skills to address healthcare disparities in her own backyard and across the globe—initially led Dr. Stolarz to become a Family Physician. Now, as the Associate Director of Global Health, MedStar Academic Affairs, she underscores how the recent pandemic made clear the importance of global health. “We cannot provide healthcare in a silo. The future of healthcare IS global health,” she says.

According to Dr. Stolarz, the opportunities at MedStar Health for global health engagement have allowed her to grow an international network of bidirectional partnerships, work with residents and faculty from all specialties across Medstar Health, and advocate to Senators and Congressmen on important healthcare issues.

And, through the MedStar-Georgetown Global Health Equity Track, Dr. Stolarz says MedStar Health is training the next generation of physicians to meet global health needs. She encourages interested MedStar Health GME learners to contact her and get involved. She also encourages GME learners to travel and experience another healthcare system outside of the United States, if possible, and explains, “Your eyes will be opened to the possibilities and opportunities that exist for change.”

In addition to her role in global health, Dr. Stolarz is also the Associate Program Director for the Department of Family Medicine at MedStar Franklin Square Medical Center and an Assistant Professor in the Department of Family Medicine at Georgetown University. Dr. Stolarz calls family medicine physicians the “Swiss Army Knives of healthcare” on account of their unique skillset and ability to care for patients of any age in a multitude of settings.

When she’s not caring for patients or training family medicine residents in the inpatient, outpatient, and labor and delivery settings, you can find Dr. Stolarz on hiking trails around Baltimore with her son, daughter, and husband or on the soccer field where she plays each week (and says she is actively recruiting other physicians to join her!).

People Profile – Dr. Jeffrey Breton

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Jeffrey Breton, MD, (PGY 4; Neurological Surgery)

Jeffrey Breton, MD, (PGY 4; Neurological Surgery) was recently elected as one of the newest members to MedStar Health’s Graduate Medical Education Committee (GMEC), the team of residents and administrators that oversees the system’s many residency and fellowship programs.

Dr. Breton hopes to use his GMEC role to help fellow residents maximize valuable education time while respecting their needs as humans and providing an equitable and fulfilling workplace.

“There are many competing pressures on residents to be productive clinically and academically, with the expectation of somehow simultaneously mastering a specialty, possibly securing a fellowship, and trying to live your life outside of the hospital,” Dr. Breton explains.

He says his co-residents—whom he describes as “a source of knowledge, support, occasional commiseration, and friendship”—have been an immense help in managing these pressures. He also credits the neurosurgery faculty with taking a keen interest in their learners’ education and well-being and helping them succeed.

To incoming residents, Dr. Breton suggests a practical solution for juggling competing priorities: “Organization is paramount. With inspiration from one of the senior residents, I developed a color-coded organizational system to make sure I knew which consults I needed to call, drains I needed to pull, orders I needed to place, and consults to see and staff.” With a system like this in place, he says he’s been able focus more of his energy on learning medicine and taking care of patients.

Outside of the hospital, Dr. Breton tries to set boundaries and make space for the activities he enjoys most, like reading; hiking; following his favorite baseball teams, the Boston Red Sox and San Francisco Giants; honing his musical talents on the guitar, piano, and ukulele; and spending time with his co-residents, friends, and fiancée.

A fellow at the Center for Medicare and Medicaid Innovation (CMMI), a part of the Centers for Medicare and Medicaid Services (CMS), Dr. Breton often thinks about how healthcare might change in the future. CMMI develops and implements models for new and innovative forms of healthcare delivery. “These alternative payment models revise the incentive structure with the goal of improving quality or decreasing cost while keeping an eye towards addressing health inequities,” he explains. “In the future, I expect that there will be a larger role for quality and outcome-based metrics for public and private payers than there is today.”

People Profile – Liza Shaban

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Liza Shaban, MD, (PGY 2; Internal Medicine)

Liza Shaban, MD, (PGY 2; Internal Medicine) is a dedicated physician who calls both Jordan and Washington, D.C. home. She draws inspiration from her upbringing, where she was encouraged to look for ways to make a difference in the world. This sense of service led her to a career in medicine, with a focus on internal medicine. Dr. Shaban is passionate about providing equitable healthcare and has developed a strong interest in working with diverse populations through her clinical training and research.

“My inspiration to pursue medicine came from a combination of personal experiences and a desire to serve others,” she says. “Growing up in an empowering home and school environment, I was encouraged to overcome societal limits and give back to my community. Volunteering ignited my passion for equitable healthcare. My clinical training and research further solidified my interest in internal medicine and affirmed my commitment to serving diverse populations.”

As one of the newest members of the System GMEC (Graduate Medical Education Committee), Dr. Shaban is committed to improving medical education and residency training. She advocates for resident well-being and inclusivity, aiming to shape policies that create a supportive learning environment. Her success at MedStar Health has been driven by the collaborative culture and leadership within the organization, along with her proactive approach to learning and skill development.

In her personal life, Dr. Shaban maintains a balance through activities like pickleball, cooking, and spending time with friends. She encourages her colleagues to prioritize their well-being and build strong support networks during the demanding training years. Looking ahead, Dr. Shaban envisions a future in U.S. medicine that prioritizes preventive care, improves care coordination, and addresses healthcare disparities to ensure equitable access for all.

People Profile – Dr. Katherine Lewis

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Katherine Lewis, DO, (PGY 2; Family Medicine)

Katherine Lewis, DO, (PGY 2; Family Medicine) is a dedicated Family Medicine physician at MedStar Franklin Square in Baltimore, MD. Originally from Columbia in Howard County, Maryland, Dr. Lewis is excited to be practicing medicine in her home state. Her passion for medicine began early on, driven by a desire to interact with people daily and serve her community.

“Medicine was the only career I ever considered because I had always wanted a job where I could interact with people daily and serve my community,” she says. “I love that everyone is their own puzzle with a thousand different solutions, and it’s our job to find the best solutions to the puzzle that fits the patient’s goals.”

Dr. Lewis was drawn to family medicine because of the continuity of care it offers and the opportunity to help patients navigate the complexities of the healthcare system. She values being a central point of support for her patients and providing holistic, patient-centered care.

At MedStar Health, Dr. Lewis credits her success to the support of her colleagues, including her fellow residents and attending physicians, who provide mentorship and encouragement. Outside of work, she prioritizes her well-being by staying active with the Canton Run Club, kayaking, and spending time with her family, friends, and pets, Riggins and Rory.

As a prospective member of the System GMEC (Graduate Medical Education Committee), Katherine strives to make a difference. She is an advocate for positive change that enhances the resident experience at MedStar. She is approachable, open to feedback, and committed to being a team player. Her focus includes improving resident safety, wellness, and creative supportive spaces, ensuring that residents can thrive both personally and professionally.

Dr. Lewis envisions a future healthcare system that is more accessible and supportive for all patients, without the barriers that currently limit access to necessary care and treatments. When she’s not focused on medicine, she enjoys exercising, cooking, and planning her upcoming wedding.

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:

People Profile – Dr. Clark Restrepo

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Clark Restrepo, MD, PGY 4; Interventional Radiology

As a medical student at Georgetown University, Clark Restrepo, MD, (PGY 4; Interventional Radiology) knew that MedStar Health’s residency program would offer him the wide breadth of clinical experience he was looking for. He also knew that, with the guidance and mentorship of the amazing faculty at MedStar Georgetown University Hospital and MedStar Washington Hospital Center, his training would help him become a skilled and compassionate physician.

Now in his fourth year of residency, Dr. Restrepo has come to realize just how much of his success has been driven by not only those mentors, but everyone he interacts with each day.

“I greatly appreciate the support of the technologists, nurses, and staff who help manage the care of so many patients in the radiology department on a daily basis,” he says. As a new class of interns, residents, and fellows joins MedStar Health GME, Dr. Restrepo recommends they take this to heart.

“Make an effort to get to know the people you are working with. At a minimum, take the time to introduce yourself to all members of your patients’ team—whether that’s the case manager on the floor or the front desk clerk in the clinic. Everyone plays an important role in the daily care of our patients and should be recognized and appreciated.”

On a personal note, Dr. Restrepo also recommends that all trainees—not just those in radiology—take time to examine their patients’ imaging. “It will help you become a more well-rounded physician and give you a better appreciation of your patients’ disease process,” he explains. Dr. Restrepo has seen this firsthand as physicians of all specialties look to interventional radiologists for guidance, often during the direst times in a patient’s clinical course.

Being able to participate in the multi-disciplinary care of every patient in the hospital—from the pediatric patient who has just had an organ transplant to the new mother in the immediate post-partum period—is his favorite part of interventional radiology.

Dr. Restrepo acknowledges, however, that this aspect of his specialty can be exhausting as you are pulled in multiple different directions. To keep his energy up, he makes sure to reflect on his daily experiences and remember the moments of appreciation from the patients, which he says give him the greatest job satisfaction and make him excited to return each morning.

To help others on his team who may be struggling, he looks for ways to maximize his involvement and tries to be available to help his colleagues in any way he can. “The goal is for everyone to finish their clinical responsibilities and be able to spend time with friends and family or enjoy personal hobbies,” he says.

Dr. Restrepo’s own hobbies include spending time outside, especially hiking the national parks near Washington, D.C., or golfing with friends and other residents. He likes trying new restaurants, even if it means driving 45 minutes outside the city for a more authentic experience. And, growing up in Chester Springs, Pennsylvania, outside of Philadelphia, Dr. Restrepo makes sure to keep up with his favorite teams, saying he cannot emphasize enough his passion for Philly sports: “GO BIRDS!”

People Profile – Dr. John Steinberg

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John Steinberg, DPM, FACFAS

John Steinberg, DPM, FACFAS, is the Co-Director of the Center for Wound Healing at MedStar Georgetown University Hospital and is the Director of the Podiatric Residency Training Program at MedStar Health. Dr. Steinberg also serves as a Professor in the Department of Plastic Surgery at Georgetown University School of Medicine.

Dr. Steinberg’s journey into the field of podiatry seems almost predestined, with a lineage of podiatrists preceding him. By seventh grade, he was already working in his father’s office, learning both the front and back-office operations. By the age of 13, he knew that he wanted to follow in the footsteps of his grandfather, father, and cousins.

John is now a podiatrist specializing in limb salvage surgery at MedStar Georgetown University Hospital. Since joining the MedStar team in 2004, John has contributed significantly to the field. In 2012, he stepped into the role of program director, further investing in a passion for teaching that he now considers his favorite part of the job.

John finds satisfaction in the clinical aspects of his work. He appreciates that patients can walk into the clinic and leave feeling better, often thanks to minor procedures that provide immediate relief. His dedication to preventing amputations and improving patients’ mobility has been a driving force in his career.

A key factor in John’s success at MedStar has been the team-oriented environment. Being part of the Department of Plastic Surgery and collaborating with advocates and like-minded colleagues has helped him advance both his practice and patient care. This team approach has been crucial in delivering comprehensive and effective treatments, and John recently published his first textbook on that very topic.

Outside of medicine, John emphasizes the importance of personal wellness. He incorporates tennis, rowing, and yoga into his routine, finding those both physically and mentally beneficial.  He “loves the simplistic approach of yoga. There are no weights needed – you can take care of your body with your own body.”

John values his family time, cherishing moments and family travel time with his two college-aged children who attend University of Virginia and James Madison University.

For incoming interns, residents, and fellows, John’s top advice is to trust the process. He acknowledges the initial confusion and stress of our interns but assures us that there is a method to the madness. He encourages active participation and patience, emphasizing the importance of the foundational first year, which includes more task-based work, before more hands-on surgical experience in the later years of training. His words of wisdom to first year residents are “Trust your leaders and be active!”

Looking ahead, John envisions a challenging yet promising future for medicine, particularly in podiatric surgery. He believes in the potential for hospital-based practice expansion and the importance of clinicians working as a team. “Technological advancements will help reduce administrative burdens, allowing physicians to spend more time with patients,” he says.

John is proud to be part of the MedStar Health team, valuing the culture of safety and support it promotes. He believes in the importance of truth and integrity, fostering an environment where patient safety and a collaborative, supportive culture is the highest priority.

People Profile – Dr. Brigitte Grewe

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Brigitte Grewe, DO, (PGY 3; Family Medicine)

Brigitte Grewe, DO, (PGY 3; Family Medicine) chose her specialty because she says it tapped into the three things she loves most about being a physician: working with kids, women’s health, and procedures. “I got a mix of all three by working in family medicine,” she explains.

As the MedStar Franklin Square Family Medicine Residency recruitment chief, Dr. Grewe aims to highlight these and other opportunities offered by family medicine in the hopes of attracting “the most accomplished and down-to-earth humans” to the program.

Dr. Grewe represents her residency program on social media (follow along at @medstarfranklinsquarefm on Instagram!) and at recruitment conferences. During the recruitment season, she also helps to organize pre-interview hangouts and resident interview schedules.

“The role of recruitment chief is not just about posting cute reels and stories on Instagram to attract an audience, but it’s to highlight and document how unique and skilled the people of our program are. It’s to show a culture of residency that is supportive of the resident and a place you can’t wait to join,” she says.

Having a good support system—especially a supportive husband, parents, and her MedStar Health residency “family”—has helped Dr. Grewe succeed at MedStar Health. Making sure to have your own support system in place is one piece of advice Dr. Grewe offers to this year’s incoming class of MedStar Health GME interns. She also says to prioritize balance, which she tries to do by hiking, cooking, traveling, and playing outside with her husband and dog whenever her residency schedule allows.

For Dr. Grewe, the great primary care doctors who cared for her and her loved ones while growing up in Hagerstown, Maryland, played a large part in inspiring her to pursue medicine herself. Dr. Grewe hopes that the future of medicine in the United States is one where more people of diverse backgrounds are inspired to pursue medicine.

“Time and again,” she says, “I’ve seen better patient satisfaction when they see someone who looks like them open the exam room door. I hope that is the future of health care.”

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