Love to teach and recognize that learning is what really matters!

 From the 3/5/2021 newsletter

Director’s Corner

 

 

Love to teach and recognize that learning is what really matters!

 

By Adina Kalet, MD MPH

 

 

In this issue of the Transformational Times, we celebrate the Kern Institute’s KINETIC 3 Faculty Development program. Dr. Kalet thinks about how engaging with a faculty development “Community of Practice” transformed her from just another good teacher into an educator ...

 

 

I have always loved to teach. Ask my little brother about the forced spelling lessons when he was a toddler. In high school and college, I taught dance to peers and little kids at a day camp. But it was not until I became a clinical teacher that I realized that it was not enough to just love to teach. If we want to educate masterful physicians, we needed to focus on learning.

  

One night as an Intern …

 It was the dead of winter. Mr. M was admitted to my care for hypothermia and impending delirium tremens, a life-threatening consequence of alcohol withdrawal.  Joe, “my” medical student, followed me to the ER. As expected, Mr. M smelled rank and was talking gibberish (confabulating), his eyes were bright yellow where the “whites” should have been (icterus). Vitamins had been given to stave off a full-blown encephalopathy, and the first of many milligrams of Librium were already flowing into his veins along with warmed fluids. Blood was drawn and sent to the lab. The ER nurse had donned protective gear ready, on my say so, to give Mr. M a warm water bath that would not only warm him up but also wash away the dirt caked most prominently on his feet and to treat the overwhelming case of pediculosis capitis (“head lice”). As I engaged with his incoherence and gently examined Mr. M, I sensed Joe drift as far away from the bedside as he could possibly get. I was miffed that he did not show greater interest.

 Later in the evening, after ensuring that the now fresh-smelling, no longer tremulous, Mr. M had a close-to-normal body temperature, Joe and I sat side-by-side in the Doctors Station. I wrote the admission note and orders, reviewed Mr. M’s extensive medical chart, and pondered the deranged blood chemistries, his chest X-ray and the ECG. Typically, medical students overflow with questions; Joe, oddly, showed little interest and sat quietly while I worked.

 Irritated with his passivity yet wanting to wake his curiosity to the wonders of medicine, I decided to do some “teaching.” I walked to the green board, took up the chalk, and began a wide-ranging lecture. I discussed alcohol as a direct and indirect toxin, with acute and chronic manifestations in every organ in the body. I “pimped” Joe on the physical exam findings and labs which he dutifully reported. I pressed him to discuss why Mr. M was irritable but still charming even while his words did not make much sense. I pushed on. Why does he have yellow skin, tremors, an enlarged heart, a huge belly, but skinny limbs? Why does he have few red blood cells in a wide range of sizes, altered liver function in that particular pattern, and the irregularly irregular cardiac arrythmia? And finally, Why does he have this the remarkable number of ER visits, abominable hygiene and nutrition, no home, no money, no family? 

 After reveling in a medical textbook’s worth of physiology, toxicology, neurology, psychology, pathology, and dermatology – all knowledge relevant to Mr. M’s care - I plopped down in the chair. Joe was clearly impressed. I was jazzed, astonishing even myself with how much I could recite with great enthusiasm and passion.

 It was a fun, self-satisfying performance but, I know now, that did not make it a great education.

 

Why not? First of all, I never stopped to assess what Joe already knew, what he felt, or what he made of the whole experience. I did not discern if he would walk away from my lecture being any more able to care for patients like Mr. M who disgusted or frightened him. Did he now understand how to approach difficult patients emotionally and intelligently? Would he deal with them employing care, competence, and compassion? I had no idea.

 In addition, I neither tried to understand why Joe was so passive about learning, nor did I have a clue how to help him become a more the engaged and motivated learner.

 The next day, it dawned on me that Joe likely had a powerful emotional reaction to Mr. M. Did he recognize a loved one or himself in the end stage alcoholism? I did not know. Did he question his ability help in the face of such suffering? I never asked. If true, then he could have left that evening emotionally overwhelmed, questioning his career choice. 

 As a result, it is possible that my “performance” lecture had the opposite of my intended effect; rather than filling him with knowledge, I might have left him intimidated and less confident. Although Joe might have given me a glowing evaluation based on the attention I gave him (not a bad thing), I realized that, in the long run, I might have failed him.

 

 The road to becoming an educator

 After that evening, I became much more interested in becoming a better educator. Being an educator would require me to both know a great deal, but also know how to share that knowledge effectively. Although I still cared about what I taught the students, I wanted to be able to ensure they would and could learn.

 It was then that one of my mentors sponsored me to attend a weeklong faculty development program for medical educators. We worked in small groups co-creating active learning tasks (e.g., role plays, bedside rounds, reflection writing, and dialogue) and engaging in facilitated “personal awareness” groups.  I shared the story of my experience with Joe, and we role played alternative versions of that “lecture.” This was a profound experience which prepared me to return to residency as a much more effective educator.

 Ultimately, I joined the Facilitators-in-Training (FIT) program of the Academy of Communication in Healthcare (ACH). A senior member of the ACH faculty served as my “Guide.”  In monthly meetings, she coached me to identify my own learning goals and strategies. Together, we facilitated small group learning at national faculty development courses where I honed my skills with her feedback. We worked together for almost seven years, at which point I went on to serve as a guide to others.

 For over thirty years, ACH had created a community of medical educators who share a passion for communication skills training in medical education. ACH members have created innovative curriculum at many institutions and healthcare systems, conducted key scholarship, published a newsletter, a journal, and textbooks, and continued to conduct faculty development.

  

The value of Communities of Practice (CoP) in medical education; Creating concentric circles

 Most faculty development activities in medical schools consist of lectures or one-off workshops. This strategy simply does not work. Instead, experts suggest that it is best to build a community of practice (CoP) situated in an authentic workplace (See “For Further Reading” at the end of this article or click on the article links: O’Sullivan and de Carvalho-Filho.) A CoP is a group of people who "share a concern or a passion for something they do and learn how to do it better as they interact regularly.”

 CoPs are based on learning theories first proposed by cognitive anthropologist Jean Lave and educational theorist Etienne Wenger who were studying what makes apprenticeships powerful learning experiences. At their best, apprenticeships are complex sets of social relationships in the context of a community which creates a living, dynamic curriculum. CoPs are organized in concentric circles with those most intensely involved and experts at its center. Novices initially participate in the periphery, sometimes simply “lurking,” while listening in without engaging. Facilitators actively communicate with and invite in those peripheral participants. Learning happens at all levels of the organization through structured coaching relationships among individuals. Learning is, however, most intense as individuals engage more and move toward the center of the CoP.  This is one of my favorite learning theories, because it provides evidence to guide the growth of our faculty development practice in the Kern Institute.

  

KINETIC3 and the road to developing MCW’s CoPs

The essays in this issue demonstrate the many ways in which the KINETIC 3 program has established and is enriching a Faculty Development CoP at MCW.  By attracting committed, passionate medical educators to engage together in shared learning and practice, we are building capacity to enhance the learning environment for all our students. We continue learning as we tie ourselves together in learning relationships around our shared work.

 While there are basic “teaching skills” components to the KINETIC3 offerings, the members of the Kern Faculty Pillar, under the Direction of Dr. Alexandra Harrington, are building the skills of faculty that improve teaching performance and develop impactful, life changing educators. KINETIC3 graduates are already sharing their skills with colleagues, creating eddies that will become the concentric circles of our own Communities of Practice.

At the Kern Institute, we hope every faculty member will consider applying for the KINETIC3 program during their career. As faculty, we all hope to be the best educators we can be as we share our knowledge and passions. Only then will we engage, prepare, and support every student, even the ones like Joe, who passes through our doors.

 

 

For Further Reading:

O'Sullivan, Patricia S. EdD; Irby, David M. PhD Reframing Research on Faculty Development, Academic Medicine: April 2011 - Volume 86 - Issue 4 - p 421-428 doi: 10.1097/ACM.0b013e31820dc058

de Carvalho-Filho, M. A., Tio, R. A., & Steinert, Y. (2020). Twelve tips for implementing a community of practice for faculty development. Medical Teacher, 42(2), 143-149.

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.