Showing posts with label Communities of Practice. Show all posts
Showing posts with label Communities of Practice. Show all posts

Friday, May 21, 2021

The Hogwarts Model: Putting it all Together in Learning Communities is Foundational to the New Medical School Curriculum

From the 5/21/2021 newsletter


Director’s Corner


The Hogwarts Model: Putting it all Together in Learning Communities is Foundational to the New Medical School Curriculum  


Adina Kalet, MD MPH


Dr. Kalet discusses how MCW’s Learning Community (LC) model has the potential to benefit students and faculty members, addressing our desire to build character and caring, while strengthening both academic and social opportunities for our learners …



Last spring, in anticipation of a rough, rapidly evolving, and socially isolating year, the MCW School of Medicine built a learning community (LC) structure for the entering M1 class to ensure social cohesion and engagement. We wanted students to weather the pandemic with regularly scheduled and academically meaningful structured connections with their peers and between students and faculty members. We accomplished this by weaving together the required REACH (Recognize, Empathize, Allow, Care, Hold Each Other Up) Curriculum and the voluntary 4C Academic Coaching Program. We wanted the students to experience a sense of continuity and have sufficient time to establish true collegiality and strong bonds through “cyberspace.” 

A targeted, sophisticated faculty development process was devised and implemented to train over seventy MCW faculty and staff and twenty-seven students to be leaders. Now, a year later, we are in the process of analyzing the data and can report that the experiment was a success. Preliminary student feedback is inspiring. Similar to experiences at other schools with LCs, the participants report that they gained a great deal. The LC has become a central component of the evolving proposal for the new MCW medical school curriculum. 

This issue of the Transformational Times describes the process and amplifies the voices of both students and faculty participants. I hope you will read the descriptions and enjoy the personal stories they share.   


"It matters not what someone in born, but what they grow to be." 

– Professor Albus Dumbledore

The most well-known learning community model is Hogwarts School of Witchcraft and Wizardry, that secondary boarding school administered by the British Ministry of Magic in an unlocatable spot in the Scottish Highlands.  Upon arrival at Hogwarts, new students are assigned by the sorting hat - based on a magical mash up of personality, character traits, and a bit of “destiny” – to one of the four houses, Ravenclaw, and Gryffindor, Hufflepuff, or Slytherin, named for their founders. Just in case you are one of the few people alive who doesn’t know what I am talking about, read the seven volume Harry Potter series by JK Rowling for more details (or watch the movies). You will learn that once assigned to a house, students are pretty much set for years of mostly healthy academic and athletic competition and a great deal of intrigue. At Hogwarts, as in many idealized academic settings, students develop lifelong bonds with housemates by studying, eating, living, and having innumerable terrifying adventures together. 

This identity setting framework is very important to individuals and to the whole Wizarding community. Increasingly, medical schools - as well as many other higher education environments – are embracing this rather “ancient” model to redress the persistent concerns about lack of academic continuity and  inconsistent mentoring, and to provide the healthy social connections that enhance lifelong resilience. 


What are Learning Communities? 

Learning communities are not “extracurricular,” but fully integrated foundational components of the curriculum. Each LC is a group of people who share common academic goals and attitudes and meet regularly to collaborate on learning activities. While it has all of the “student life” benefits in common with advisory colleges, “eating clubs,” dorms organized by affiliations, sororities, or fraternities, an LC goes well beyond simply providing a rich social structure. They are best thought of as an advanced pedagogical design. Medical schools around the world are adopting this model, the highest profile among the early adopters have been Harvard and Johns Hopkins

Rather than considering the individual learner as the only relevant unit of instruction and performance assessment, these “communities of practice” explicitly acknowledge that education is a shared cultural activity with a significant communal component. This sociocultural approach is not a new idea, but it remains a challenge to implement effectively. At its best, the LC model provides a means to structure medical education in truly relationship-centered - as opposed to course-centered – ways.   

In our proposed LC model, academic coaching is fundamental. This inextricably links the cognitive and non-cognitive components of learning on the road to becoming a physician, and put relationships among members of the community at the center of that learning and professional identity formation. 

As part of the Kern Institute’s Understanding Medical Identity and Character Formation Symposium (see my Director’s Corner on April 30, 2021), a group of national leaders discussed “The Nature of Learning Communities and the Goals of Medical Education.” David Hatem, MD (University of Massachusetts), William Agbor-Baiyee, PhD (Rosalind Franklin University), Maya G. Sardesai, MD MEd (University of Washington), and our own Kurt Pfeifer MD, explored how their LC structures explicitly address students’ acculturation to both medical school and the profession of medicine. They reported how a healthy learning environment counters the noxious impacts of the “hidden curriculum,” while supporting students on their professional journeys during medical school, aiming to ensure that students are ready for, and will thrive in, a lifetime of practice as a physician.  

The panelists also shared the collective experience of the  forty-seven medical school members of the Learning Communities Institute (LCI), reviewing the essential characteristics LCs must possess to foster character, caring, and the development of a mature and hardy professional identity. These include:

  • Committing dedicated medical school resources and time in curriculum 
  • Assigning buildings or spaces that allow students to gather to form relationships (Johns Hopkins constructed a building dedicated to their learning communities) 
  • Aligning espoused professional values with values that are practiced by promoting the skills of doctoring while intentionally countering the learning climate’s unsavory elements and its hidden curriculum  
  • Promoting longitudinal relationships between mentors and students from beginning to end of medical school, thus enabling mentors to simultaneously support learners while holding them to high professional and academic standards
  • Supporting character formation through peer mentoring programs and career decision making

With these guidelines to inspire us, and seeking the collaboration with and approval of the MCW’s Curriculum and Evaluation Committee and the Faculty Council, we intend to build LCs tailored to our institutional culture and strengths. For more, see the essay in this week’s newsletter entitled, “Learning Communities at MCW – A Vision for the Future.”  


The critical importance of continuity - Putting it all together

Throughout my career as a medical educator, I have been involved in efforts to structure close student-faculty engagement and mentoring through small group learning structures. This has included decades of teaching in small groups in an introduction to clinical medicine course for M1 and 2s and being an Internal Medicine “Firm Chief” responsible for successive cohorts of clinical clerks (M3s) while leading an Advisory College style program. These learning structures have often been profoundly satisfying for students, my colleagues, and for me as we provided meaningful educational experiences and mentoring. But none of these experiences provided students with truly longitudinal - admission to graduation - integrated coaching or mentoring. I always knew we could be doing better. I fully believe that the LC model promises a real opportunity for the continuity the current system lacks. 


There is benefit to the faculty, as well

There is no better way for faculty to develop wisdom as medical educators than by committing to a longitudinal process. I started my career focused on residency education and got to know wave after wave of trainees as individuals. These relationships showed me the common developmental trajectories and predictors of success or failure and, therefore, made me a more patient, accurate, and persistent coach. For example, I noticed that the first year residents who worked most slowly in clinic, staying later than peers to finish their patient care sessions, often grew into skillful and efficient clinicians, and were more likely to be eventually selected as chief residents. Knowing this made me more patient and kept me from “taking over” to get their patients “out the door.” I let the novices struggle a bit, confident that their patients were receiving better, more attentive care. It was personally rewarding to know that my patience helped to nurture some wonderful, future colleagues, but I only knew this because I had provided years of longitudinal mentorship. 



Medical school should be a guided experience toward a life in medicine. Learning communities offer a framework for “putting it all together,” providing solutions to many of our modern challenges in medical education while enabling the magical relationships with the student’s peers and faculty. Our goal is to create opportunities for discovery and growth because, as Professor McGonagall once noted, “We teachers are rather good at magic, you know.”



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.


Friday, March 5, 2021

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 Teacher42(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.