Looking back to the future: A message for a new generation of medical educators. Harden RM. Med Educ. 2011; 45:777-784.
Available online from the Baystate Health Sciences Library or from PubMed at your institution.
Ah, July... A new crop of students or residents for many of us educators and, even if your academic year is different, July is a fantastic time to make professional resolutions. You might remember I tried to encroach on your resolutions last year, and I enjoyed invading your personal goal-setting so much, that I decided to make it an annual event.
SO, that brings me to Ronald Harden. Harden brings us "back to the future" in this article by reflecting on his career in medical education in order to offer his list of Lessons Learned.
I know it's tempting, but try NOT to jump straight to the Lessons Learned. "But, Rebecca!" you'll say, "It's a list with short paragraphs and bolded headings!" I know, I know. But trust me when I pull out my inner qualitative researcher to tell you that "context matters." Read where he has been to recognize the value in his words.
And the value is great. Harden was an endocrinologist in Glasgow when he started as junior doctor. His passion for medical education grew and his perception of the influence of his colleagues, students, and his environment are palpable. His reflection is part medical education history, part UK medical education yearbook, and part graduation speech, balancing a determination to improve education with the good fortune to be in a position to do it.
But let's be honest. The Lessons Learned in this article are what you're going to read on the elevator.
And here's where your resolutions will evolve. Take heed that you, as a clinical educator, regardless of your profession, can be just a bit more awesome than you already are by reflecting on what Harden's lessons mean for you. Innovation. Nudges. Practicality. Collaborators. Funding. Publishing. Fun. These are not a menu of choices for educators: they are priorities for success. Make a resolution for each of these. For example.
Lesson 3: Nudges are important. What small, powerful innovation can you promote in your area?
Lesson 6: There is always something to learn outside of your practice. Too true. Go to a lecture or talk that is NOT given by your profession or your department. Crash someone else's grand rounds.
Lesson 10: Have fun! Well, I do not condone this one, BUT if you must enjoy what you do, take your work, not yourself, very seriously.
Ron Harden has a successful, international career based on advancing medical education. He's been senior editor of journals, keynote speaker at international conferences, and has held several leadership roles professionally. But Ron Harden started one July, many years ago, as a junior clinician. Like you.
So Happy New Year! Read this article and make some resolutions for your own career. Then write about your path, and I'll link to it. Promise.
Bottom Line:
It's the New Year for someone right now, which means resolutions are ripe for the making. Grab a glass of champagne, your educational enthusiasm, and this article by Ron Harden. Then set some resolutions to make yourself a better teacher, a better scholar, a better clinician. Your students and your patients will benefit.
The expert patient as teacher: an interprofessional Health Mentors programme. Towle A, Brown H, Hofley C, Kerton RP, Lyons H, Walsh C. Clin Teach. 2014; 11:301-306.
Available online from the Baystate Health Sciences Library or from PubMed at your institution.
Attending professional conferences is a great way to get inspired. Agendas are usually filled with a gluttonous amount of great ideas and innovations that I end up consuming ferociously for my practice.
Hm.
Disturbing visual image aside, conferences are equal parts overwhelming and rejuvenating, yet since we're months away from conference season, I thought this article - which reads like a conference-bound, broad-sweeping, well-rehearsed oral presentation of an innovation - might similarly inspire us in the "off season" (and from the comfort of our own living room couches).
The authors present an innovative program in which patients are mentors for a small, inter-professional group of students. Is it novel that patients teach students how to care for patients? Not necessarily.
But driving the innovation of this program are some considerations of program development that I have repurposed in the hopes that they inspire you.
1. Reflection. Whether you view it as the icing on the cake or the cake itself, reflection is a key part of learning. Journaling and debriefing encourage both students and mentors to pause and draw meaning from their experiences and discussions. Anyone who has ever journaled or read the journal entries of others can attest to the power of reflective practice on learning.
2. Demand creativity. Students in this program are asked to cap off two-semesters of conversations not with a test or an essay but with a "tweet" and a "creative, visual representation of their learning." Remember that pesky leveling of learning objectives? "Creative" exercises are up there with synthesizing new knowledge. Not a bad way to "test" the material...
3. Data, data, data. Note the ways that the program facilitators gather data and review it for program effectiveness. Facilitators here are keyed in to the qualities that make this program work and are diligently monitoring the program to see if it meets goals, using both quantitative and qualitative data. In fact, I would argue that they could probably stand to collect some more quantitative data on students' development of competencies. I said it. But (and here's the confusing part), see #4...
4. Think hard before overthinking it. In their reflections and advice to other programs, the authors write; "Minimal instructions: keep it simple, trust the process, and resist demands for more structure and instructions." Who doesn't love more structure? Their sentiment is helpful, though, that while you're collecting all of this great data, pause before you act too aggressively on it. (Just don't ask me how to do that.)
Bottom Line:
Let this article infuse you with the inspiration that normally only comes from the burnt coffee and beige hotel chairs at your professional conference. Their innovation is interesting, but the real reason to break out the highlighter is the advice around their program development; a true boost of professional development without that pesky name tag.
Impact of Formal Continuing Medical Education: Do Conferences, Workshops, Rounds, and Other Traditional Continuing Education Activities Change Physician Behavior or Health Care Outcomes? Davis D, O'Brien M, Freemantle N, Wolf F, Mazmanian P, Taylor-Vaisey A. JAMA. 1999; 282(9): 867-874.
Available online from the Baystate Health Sciences Library or from PubMed at your institution.
Many of you design or attend educational conferences and events, yes? And, you dutifully evaluate your educational conferences and events, yes? (What!? OK, just nod - but email me. We can talk later.) This article - resurrected from the late 90's - asks if stepping away from our practice to attend an educational event is, well, worth it.
Turns out, when Davis and colleagues asked if educational conferences changed physician behavior, they found that - SPOILER ALERT - that yeah, um,.. well, sure - you know, sometimes. Say it with me: "Well, I could have told you that."
Look, Davis and his colleagues ask a really important question, and they answer this question about the literature appropriately by searching the literature. But the meat of this article is not the study. In fact, I might argue that this is the second time this week I've seen a qualitative discussion answered with a quantitative solution.
I could go into a diatribe on the Limitations and Implications sections of this article (For example, I could ask "you did a meta-analysis on RCTs evaluating educational events? Were you TRYING not to find anything?" But I won't.)
Instead, I draw your attention to the Conclusions. They argue that formal CME interventions seeking to change provider behavior and patient outcomes must focus on "the complex intrapersonal, interpersonal, and professional educational variables that affect the [provider]-learner." In other words, your educational event is not occurring in a vacuum.
They go on to say, in a nice way, that didactics don't work.
And that's where I think they contradict themselves.
Sure, some speakers are just better than others. But to say they don't work? I've attended many grand rounds where the speaker has inspired me, or motivated me, or introduced me to new collaborators or new concepts or prompted intellectual conversation with my neighbor. Did my practice improve that day? Perhaps not.
But educational events don't occur in a vacuum, remember? And it is perhaps not the didactic itself - or the fact that it was a didactic - that generates the effect. Instead, it's the cumulative effect of these educational pauses - these times for collegial reflection and intellectual conversation across roles and professions - that improves practice.
In research speak, this means that the didactic is not the intervention that should be studied. Rather, it is the practice of coming together as a group of educators to talk about teaching as it affects all of us and our patients that is the true intervention to be studied. Educational research is funny like that - RCTs just aren't always the best design.
Bottom Line:
Educational events don't occur in a vacuum, and studying them is not as simple as picking from a menu of clinical research designs. Evaluate your educational event as an educational event, and study it using educational research tools; you'll have a better chance at finding the impact on provider and patient outcomes if you know what you're looking for.
