Conference Soapboxing...

Integrating quality improvement with Graduate Medical Education: Lessons Learned from the AIAMC National Initiatives. Blanchard RD, Pierce-Boggs K, Visintainer PF, Hinchey KT. Am J Med Quality. 2015; Jan:1-6. 

Available on request from the Baystate Health Sciences Library or from PubMed at your institution.

This week is the 2015 ACGME Annual Educational Conference in beautiful, sunny San Diego, CA. Well, I live in Massachusetts, so I'm not sure if San Diego is sunny and beautiful right now, but I'm pretty sure it's not -8 degrees FOR A HIGH, like it is here.

But I digress.

The ACGME Conference is about more than conference coffee and "armchair hypothesizing;" it's about reflecting on our role in graduate medical education - our one little corner of the room - and how we might commit to improvement. Isn't it?!

In that spirit, I present to you this shameless self-promotion post - a look at the brilliant work of Blanchard (and her brilliant colleagues) - who asked about the brilliant work of AIAMC National Initiative participants to create this article - a reflection on how we might best integrate quality improvement (QI) with graduate medical education (GME).

Here's why that's important [Grabs mic, Hops up on soapbox]:

Medical education is a unique opportunity to not only improve the patient care for tomorrow; what these AIAMC participants will tell you is that it's a pathway towards improving our patient care today. Can we ask every clinician at our institutions to improve the quality of their care? Sure. Can we hold them accountable? Yes,... they make big sticks...

But these AIAMC participants harnessed the power of GME to integrate QI into more than one project. They found way into changing organizational culture - and by doing so - supporting consistent attention to the most important fibers in the fabric of our patient care.

[Drops mic, Hops off soapbox]

Bottom Line: 

So, grab yourself that conference coffee, and that free hotel pen. Read this article, and use it as a guide to commit to one change - 1 change! - that will help you align GME with quality improvement at your institution. And let us know how it goes..

Breakfast of Champions: Patricia O'Sullivan, EdD.

This post is the first in a new feature for Feed the Educator, titled "Breakfast of Champions." This feature is packed with everything you need to start your week off right, with short reflections - including advice, tips, or quotes - from educational innovators and pioneers in clinical education. These posts were written for you; the motivated, super-talented, interesting, and awesomely capable clinical teacher. Dig in!

Patricia O'Sullivan, EdD, is a Professor in the Department of Medicine and Director of Research and Development in Medical Education at the University of California, San Francisco. Dr. O'Sullivan has over 30 years of experience in clinical education and - get this - she used to work at Baystate!  Dr. O'Sullivan has won awards for her contributions, and we are lucky that she offers the following to us in this month's BOC post.  

How do you see yourself as a medical educator?

I have worked in medical education for 35 years and recognize that we are fortunate to have so many clinicians who enjoy the role of teacher and being involved in the education of students, residents, fellows and peers. However, have you thought that this interest has the potential to change you? 

I have thought about how one’s clinician identity incorporates the identity of a medical educator. I ask, are they two completely separate identities? Is one more important than another? Do they work alongside each other? Are they really hand-in-glove? To make the transition to the latter, “merged identity,” that really does change you, I offer a series of tips:

• Have a consultant identity

• Recognize that we are collaborators

• Arm yourself with educational tools

• Take “their” perspective

• Go to “their” environment

• Build a network

• Clarify ideas

• Be cognitively flexible

• Find the money

• Be generous

Please read more about these in a commentary that I wrote: O'Sullivan, P. S. (2012). Reflections on the identitydevelopment of medical educators. Medical Science Educator, 22, 129-132. (Available on request through the BMC Health Sciences Library here) 

From the Field: Reconceptualizing the Feedback Dilemma in Clinical Education

This guest post comes to us from Jack R. Scott, EdD, MPH; Winthrop University Hospital – Stony Brook School of Medicine. Dr. Scott leads faculty development in teaching and educational research and scholarship, so you can rest assured that your next 2 minutes will be well spent in reading his thoughts. Now, put your feet up and dig in!

The "educational alliance" as a framework for reconceptualizing feedback in medical education. Telio S, Aijawi R, Regehr G. Acad Med. 2014.

Available online from the Baystate Health Sciences Library or from PubMed at your institution.

The Educational Alliance offers keen insights for our long-standing, historic assessment of students’ clinical performance, namely formative feedback. Most will agree that our assessment methods have been ineffective, infrequent and even haphazard when measuring observed clinical performance. While students often report that receiving feedback is among the most defining moments in their clinical rotations they are quick to recognize its inefficiencies that we seem to stubbornly ignore. Perhaps this is due to our own lack of standardized approaches, infrequent observation opportunities, subjectivity, fear of giving negative comments, complex procedural logbook ‘sign-offs’ or even intimidating learning environments. Yet much like in apprenticeships, we believe that our judgments and advice are important no matter how flawed.  Whatever the extant disconnect in authentic formative assessment, we need a method that approaches consistent reliability. The solution may be in an adaptation of the therapeutic alliance in psychotherapy, namely the ‘educational alliance’.

These authors purport an innovative process by a clinical-educator sufficiently trained in giving constructive feedback in appropriate clinical/surgical education settings. This educational alliance offers a mentoring role-model that is best applied at multiple assessment points. Incorporating technology may likewise add authentic assessment opportunities (there must be a feedback algorithm app for this).

We are all guilty of grade inflation when we eschew standardized rubric measures or behavioral anchors that award a grade for students that is not truly deserved.  Extrapolating our brief encounters into a grade is limiting. So that is why multi-source feedback is ever more in vogue. Clerkship Directors should assign an experienced faculty member who aspires to excellence in accurately assessing students’ clinical performance.  Such a consistent approach ensures that ‘we act according to what we believe’ (Latin: agree sequitar credere). Let’s recognize, optimize and reward exemplary learner-centered assessments that are coherent with the credible relationship-based therapeutic alliance model. 

Bottom Line:
Being a great teacher means giving great feedback (in all its forms) to students. They are inextricably linked. This article offers one way that an alliance can start the process. Carpe diem.