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.

Questions for Four of the 4C Students

From the 5/21/2021 newsletter

 Questions for Four of the 4C Students

Trevor de Sibour, rising M2; Radek Buss, rising M3; Julia Bosco, rising M2; and Ryan Power, rising M3

Medical students Trevor de Sibour, Radek Buss, Julia Bosco and Ryan Power discuss their experiences as students in the Coaching for Character, Caring and Competence (4C) Program …

In August 2019, the Kern Institute launched the Coaching for Character, Caring and Competence (4C) Program. This optional four-year longitudinal program pairs students with faculty coaches who will help to foster the student’s professional growth. The students and coaches have individual student-led meetings, as well as small group meetings to discuss topics such as character, professional identity formation and other topics that will help them through medical school and beyond. 

We wanted to hear from students about why they chose to participate in the 4C program and the impact that this program has had on them. 4 M1s, Trevor de Sibour, Radek Buss, Julia Bosco and Ryan Powers, submitted their responses to us on 4 questions about their experience with the 4C Coaching Program. 

What made you sign up for the 4C program? 

Trevor: I signed up for the 4C program because of the mentorship opportunities it provides. I had attended a large university for college where I struggled to find mentorship, particularly pertaining to character and professional development. Moreover, I was concerned about connecting with faculty and potentially peer mentors due to the ways in which COVID-19 has altered our everyday interactions. As such, when I learned of 4C, I immediately decided to apply. I felt it was well structured and an excellent way to quickly connect with a faculty member, peer mentor, and other students in a casual setting.

Radek: As an international, first-generation college graduate, I was faced with a lot of stressful unknowns when beginning medical school. Therefore, when given the opportunity to apply for the 4C program, I did not hesitate at all. I have always been very fond of the mentors I have had as a student, and I realize that I would not be where I am today without their guidance and support. The 4C program was the perfect opportunity to meet new mentors in medicine and form lasting professional relationships along the way. 

Julia: Following a year of medical school applications, April 30th finally arrived, and I began the matriculation process at MCW. Little did I know that the certifications, requirements, and deadlines would not stop coming once they started. As I navigated this process amidst the COVID pandemic, I felt overwhelmed and isolated. As deadlines grew closer and questions accumulated, these feelings of isolation persisted. As the pandemic dragged on, our matriculation process and education became increasingly virtual. First, our Second Look Day was canceled. Then, my CPR class was delayed, then canceled, then moved online. Coming from a small liberal arts college, I was intimidated by the prospect of what was looking like Zoom School of Medicine. With my higher education being entirely in-person (at my college class attendance was mandatory), I knew, in this virtual world, I needed mentorship ASAP, and on a whim and blindly seeking support, replied to Dr. Pfeifer’s call for participants in the 4C program. 

Ryan: At the beginning of medical school, there are suddenly a lot of questions and a lot of options you didn't have time to consider before. Throughout undergrad and the application process, your only real question is "Can I get in?" Then, suddenly, you start medical school and you have so many extra questions like what you'll do for research, how will you study, what information is truly important, how will you function in a healthcare team, what specialties should you pursue, and the list never ends. When I saw an opportunity for a coach and a mentor, I saw an opportunity to meet with someone who had those questions before, too. Not only that, I knew that anyone who signed up to be a mentor for the program obviously had an interest and a passion in helping me find those answers. 

What has been the most beneficial part of the program? 

Trevor: The most beneficial part of the program is the insight I have gained from each group member. I have an excellent coach whose perspective on medicine I find enlightening, a fantastic peer mentor whose medical school advice has been invaluable, and three incredible peers whose distinct viewpoints have helped shape my understanding of what it means to be a medical student. 

Radek: The 4C program has been source of a very different type of education, more closely resembling the one I was accustomed to as a student at a small liberal arts college. Whether one on one with my coach, or during our group meetings, the discussions are focused on topics such as well-being, emotional agility, or personal strengths. While those may not pertain to pathophysiology or pharmacology, they are undeniably an important aspect of medical education as a whole. We must be able to take care of ourselves in order to properly, and to the best of our ability, treat others. The 4C program has filled this gap in my medical education, for which I am grateful. 

Julia: Structured mentorship. As I discussed above, my entire education was in a small and exclusively in-person environment, which I found critical to finding mentorship. Looking back on my first year of medical school, if not for the 4C program, I would not have had the same opportunity to have such a positive mentorship experience early in my medical education. I have been able to connect with peers, mentors, and develop a feeling of belonging at MCW, despite this virtual age. From day one, I was accountable to other people, and they invested in my development. This structured mentorship has facilitated my growth as a student doctor and professional. I have the privilege of receiving one-on-one mentorship from Dr. Ankur Segon, our group coach, where we spend the entire hour developing strategies to overcome obstacles I am currently facing. Additionally, Miranda Brown, our group’s near-peer mentor, invests in my practical clinical skills. For example, last semester, she generously read and provided feedback on my clinical notes. Their input and feedback have been invaluable. I cannot imagine my first year of medical school without their mentorship and the support of my peers in my 4C group. 

Ryan: Medical school can be a bubble sometimes. You're focused on your next exam, or STEP, or rumors you hear from classmates or social media about what's important and what you need to do to be a good student. Having a mentor who has two feet firmly planted in the practicing world of medicine is a really great way to get the unequivocal truth. How are my grades actually viewed by residency directors? How can I grow in personal and professional ways, rather than just academically? There were plenty of things I never considered that were brought up by my mentor, and they've been invaluable both in class and in personal growth.

How has your coach impacted you? 

Trevor: I greatly appreciate the guidance my coach has provided me in regard to my professional development. During our most recent one-on-one meeting, I went in unsure and somewhat cynical of what I wanted the next steps of my professional development to be. Ultimately, we had a really productive and candid conversation that helped me create goals that I found to be meaningful and personally satisfying. Having a mentor who I can be honest with, without having to worry about any repercussions, is invaluable. 

Radek: My coach has significantly impacted my career as a medical student. From the first day of this program, she has been open to my questions, no matter how trivial, and supported/guided me through my first two years of medical school. The opportunity to meet with her regularly allows me to continually monitor my progress and compels me to stay on track in accomplishing my goals; it’s as though she is there to both support me, but also keep me accountable. 

Julia: Dr. Ankur Segon has been an excellent individual and group mentor. In the group setting, he is engaged, provides individual and generalized feedback, and always asks us directly if we are keeping our minds and bodies healthy. For me, this investment and concern keep me accountable to and help me prioritize my health, which is easy to abandon in the chaos of M1. In the individual setting, Dr. Segon has provided support, helped me navigate professional and personal decisions, and provided his insight on the matter. Additionally, he continually demonstrates what it means to be a good mentor, which is a skill I hope to cultivate in medical school. I look forward to my dedicated 4C meetings. Because of the supportive environment Dr. Segon fosters, I know I can bring any stress or concerns to these meetings, and when I need to, I know that my 4C coach, near peer mentor, and peers are willing to help or to help me get the help I need. 

Ryan: My coach has made MCW an incredibly positive place. I always have someone I can message or email with questions, and she is always willing to celebrate successes with the rest of the group and me. It's invaluable to have a trustworthy resource to dispel any confusion or doubts through such an arduous process.

Why would you recommend the program to incoming students? 

Trevor: There are multiple reasons I would recommend the program to incoming students. For students who find seeking out mentorship daunting, 4C is invaluable, as it pairs you with a faculty member who is clearly committed to providing quality guidance. Moreover, the topics discussed at group meetings are not found elsewhere in medical school curriculum, yet have the potential to make students well rounded future physicians. How much students will benefit from 4C is associated with how much they invest. So for those who are ready to invest in the program, I highly recommend it. And who knows? Perhaps along the way, they too will meet one of their best friends through the program. 

Radek: I would highly recommend the program to incoming students because it connects you with a coach whom you meet with regularly, and therefore are able to develop a professional relationship. As a coach who is often heavily involved in medical education, they provide support, share ideas, and guide you through your time at MCW. Medical school can be quite stressful and hectic, especially the beginning, and having a coach who helps you navigate your student life is priceless. 

Julia: I highly recommend the 4C program to incoming students. I have found this program to be genuine and critical in my growth as a professional. Although similar opportunities for growth and support exist in the M1 curriculum, I think that since this program is elective and outside medical education proper, participants want to invest in and learn from each other, and so, this does not feel like just another obligation taking time away from my studies. To incoming students, I would say: you get out of this program what you put into it. 4C could become like other programs if its participants do not commit, so invest in it. As someone who came to medical school looking for accountability and quality mentorship, I found what I was looking for in the 4C program. 

Ryan: The Big Sib program (which is also hugely helpful) is a really great start to get advice and direction on the academics and requirements of your coursework, but throughout your first two years at MCW you likely won't have regular contact with many mentors who are actively practicing and navigating medicine. This is a great way to get paired up with a faculty member who cares enough about helping and developing students that they've volunteered time out of their incredibly busy schedules to do just that.

Trevor de Sibour is a rising M2 from Grand Rapids, MI, and attended undergrad at University of Michigan. 

Radek Buss is a rising M3 from Prague, Czech Republic, and attended undergrad at St. Norbert College. 

Julia Bosco is a rising M2 from Green Bay, WI, and attended undergrad at Hillsdale College, in Hillsdale, MI. 

Ryan Power is a rising M3 from Racine, WI, and attended undergrad at UW-Whitewater.

Learning Communities at MCW - A Vision for the Future

 From the 5/21/2021 newsletter

Learning Communities at MCW - A Vision for the Future

Kurt Pfeifer, MD, Marty Muntz, MD, and Cassie Ferguson, MD

As the Kern Institute continues its work on implementation of well-being into the medical school curriculum and exploration of the use of learning communities (LCs) in medical education, members of the Kern Institute and key stakeholders have met to discuss the larger vision for what LCs might look like at MCW …

Within the next decade, we envision Learning Communities (LCs) being an integral part of the continuum of medical education, spanning from undergraduate (pre-medical) schooling through graduate medical education (residency & fellowship), and encompassing all healthcare professions (including, for example, nurses, physician assistants, nurse practitioners, pharmacists, physical therapists, and social workers). LCs will target multiple critical objectives, both social and academic, and will greatly improve students’ preparedness for their careers in medicine by providing accessible, essential, and longitudinal relationships in the form of mentorship, coaching, support, and advice with faculty, senior colleagues, and/or peers. Moreover, LCs will provide an essential forum for development of character and caring by serving as a “safer space” for individuals to come together and provide multiple different perspectives as each student forms their professional identity. 

In this essay, we outline what a comprehensive LC program could look like at MCW.

General Structure

Learning Communities would include students from each year of education to provide networks of peer support that span the breadth of the medical school experience (Figure 1). Previous experience from the REACH Curriculum indicates that groups of eight peers provide an optimal group dynamic. 

To enhance the network of support and learning, interprofessional education would be coordinated by having groups of learners from other professions work with medical students within their LCs. Broadening the inclusion further would also allow for resident physicians - perhaps even LC graduates if they stay at MCW for residency - to be part of an “extended family” that can participate sporadically in LC activities and serve as mentors. Lastly, students can participate in supporting the development of future medical students by engaging in mentorship activities with pre-medical/undergraduate students, especially underrepresented in medicine (URM) individuals. 

Each LC would have two faculty facilitators as well as two student facilitators. The faculty facilitators would share responsibilities for leading group activities and would divide the responsibilities for individual student coaching. At least one faculty facilitator would be a clinical faculty and, if both are clinical faculty, the LC would also include a foundational science faculty member or course coordinator to provide their valuable perspective. One M3 and one M4 from within the LC would be nominated to serve as student facilitators. They would join select small group meetings and serve as the student leaders of the LC.

The LC is the basic unit of the LCs program, but higher levels of structure facilitate other aspects of medical education. Given the number of MCW students, six LCs will be collected into a House. The House will provide a format for larger learning activities, including coordination of cohorts in the event of restricted in-person coursework and social events. 

The House structure also incorporates mechanisms for remediation and behavioral health support. We propose that a Continuous Professional Development course directors could be assigned to each house and serve as a resource to faculty and students in their LCs to develop and implement remediation plans and provide additional career planning advice. To encourage students’ willingness to discuss behavioral health and reach out for assistance, we propose having a behavioral health clinician assigned to each House. This individual could come to House and LC meetings and therefore encourage students to get behavioral health assistance by connecting with an individual in their personal network rather than an unknown clinician.

Key: Undergraduates [UG], Nursing [RN], Pharmacy [Pharm], Physician assistant [PA], Resident [Res], Other health professionals [Other], Faculty facilitators [Fac], Student facilitators [Stu],Continuous Professional Development director [CPD], Behavioral Health professional [Ψ], Learning Community directors [LCD]

Activities in LCs

LCs would not have their own curricula but would be a venue utilized to achieve the objectives of key curricular threads – foundational science, clinical science, and personal/professional development. By their nature, they would be most heavily used for achieving objectives of the latter, including well-being, professional identity development, and empathy/character enhancement. These could be achieved through different combinations of LC individuals (Figure 2). However, the LCs could pursue foundational and clinical science objectives by maintaining group continuity for activities such as team-based learning exercises, physical exam education, and medical ethics discussions.

Concluding thoughts

LCs have developed a prominent role in modern medical education for good reason. Groups of students and faculty maintain continuity over the span of education, developing longitudinal faculty and near-peer mentorships and a “safer space,” where a growth mindset can be fostered. Such groups are even more important at large medical schools like MCW. LCs will allow us to place the learner at the center of the educational process around which we weave the comprehensive threads of medical education (Figure 3). 

 Kurt Pfeifer, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is a member of the Student and Curriculum Pillars and a 4C Faculty coach for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Marty Muntz, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is Director of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics at MCW. She is the Director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Learning Communities at MCW - Building on the REACH Curriculum and the 4C Program

 From the 5/21/2021 newsletter

Learning Communities at MCW - Building on the REACH Curriculum and the 4C Program

Kurt Pfeifer, MD; Marty Muntz, MD; and Cassie Ferguson, MD

The team reviews MCW’s experiences with the REACH Curriculum and the 4C Program, each of which has elements of the proposed Learning Community model …

The challenges of training in medicine have never been greater. Medical students are expected to develop a larger fund of knowledge in hectic clinical environments burdened by great financial, social, and public health pressures. This creates can have numerous consequences, including burnout and increasing rates of psychiatric disease. To better support students and reduce these potential problems, many medical schools have implemented learning communities (LCs).

LCs are comprised of faculty members and students who regularly meet together for community-building, academic and personal support, professional development, and curricular activities. Since the early 2000s, many medical schools have implemented these types of programs, and according to the most recent survey of US medical school have LCs or are developing them . LCs have been shown to improve faculty engagement, student well-being, and professional development.

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In the last few years, MCW has embarked on its own exploration of LCs and has implemented programs which, although limited in scope, are based on the philosophy of LCs.

MCW’s REACH Well-Being Curriculum 

LCs can positively impact student well-being, which has become a major priority for US medical schools. In 2018, with the support of the MCW School of Medicine and the Kern Institute’s Student Pillar, Dr. Cassie Ferguson implemented a well-being curriculum aimed at teaching skills related to well-being and providing opportunities to talk with and learn from peers and faculty members. Utilizing longitudinal groups of faculty, staff, and students, the structure of the REACH (Recognize, Empathize, Allow, Care, Hold Each Other Up) Curriculum incorporates a LC model.

REACH consists of didactic sessions followed by facilitated small-group sessions which focus on the content and objectives covered in the didactic sessions. When first implemented, the program included three sessions in the spring semester of M1 year and three in the fall semester of M2 year. Each small group has eight medical students (ten in the first two years of the program) and two volunteer facilitators. One of the facilitators is a clinical faculty member and the other is a behavioral health clinician or a student support staff member. Using session guides with learning objectives and suggested discussion questions, facilitators conduct two-hour sessions with their students. The objectives of the REACH curriculum are to describe how the well-being is integral to becoming a caring and competent physician and practice skills that will help students thrive in medicine. 

Evaluation of the curriculum was accomplished through a seventeen-question survey made up of Likert scale and open-ended questions. Sixty-two students at MCW-Milwaukee (30%) completed the survey. 85% of respondents believed that what they were asked to learn in REACH was important and 70% would recommend that other medical schools adopt REACH. The REACH small group sessions played a significant role (>70%) in building relationships with peers and faculty. Students commented on the benefits of getting to know their peers, realizing they were “not alone” in how they felt, and feeling faculty were genuine and cared about them.

Following its successful first two years, the REACH program was expanded into the Fall M1 semester starting in August 2020. Now the program uses the same groups of students through the first three semesters of medical school, but in the first semester small groups, volunteer M2 students are utilized as facilitators. Evaluation is ongoing but early subjective feedback has been strongly positive.

MCW’s 4C Program 

The Coaching for Character, Caring, and Competence (4C) Program was launched in August 2019. 4C is structured around the core concept of LCs where groups of students and faculty cultivate professional growth within longitudinal relationships. Within this framework, multiple different components can be implemented to meet specific objectives (Figure). 

Roughly fifty students volunteered for the program during AY2019. Thirteen volunteer faculty were grouped with three to four students each, and these groups meet monthly covering character and professional development topics. In addition, faculty meet individually with each of their students every other month. The program is directed by Kurt Pfeifer, a faculty member in the Student and Curriculum Pillars of the Kern Institute. 

Initial data showed great support for the program as a whole. There was a strong impact on development of mentorship, support for students, and a sense of faculty engagement. Students in the program were less likely to have feelings of isolation and reported strengthening of several character traits, including perspective, self-regulation, perseverance, and social intelligence. 

For AY2020, a new group of volunteer students was sought and the response was overwhelming. Greater than 55% of the incoming class desired to enter the program. Based on available resources, the program was able to enlist fifty-six new students along with fourteen new faculty coaches. The program also added a program of near-peer coaching in AY2020 which paired volunteer M3 near-peer coaches with each group of M1s and M4 near-peer coachs with each group of M2s. Furthermore, MCW-Central Wisconsin and MCW-Green Bay incorporated adaptations of the 4C program for their campuses. 

Evaluation of the 4C program is also ongoing, but subjective feedback from students and coaches alike has been strongly positive. 

Next steps

REACH and 4C both continue to move forward with planning expanded activities and refined content with the coming academic year. These programs have been pivotal for informing MCW’s curricular re-design process, and the hope of their directors and coordinators is that they will form the basis for a comprehensive LCs program at MCW in the future.

For further reading:

Smith S. Acad Med. 2014 Jun;89(6):928-33. 

Eagleton S. Adv Physiol Educ. 2015;39(3):158-66. 

Smith SD et al. Acad Med. 2016;91(9):1263- 9. 

Rosenbaum ME et al. Acad Med. 2007;82(5):508-15. 

Wagner JM et al. Med Teach. 2015;37(5):476-81.

 

Kurt Pfeifer, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is a member of the Student and Curriculum Pillars and a 4C Faculty coach for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Marty Muntz, MD, is a Professor of Medicine (General Internal Medicine) at MCW. He is Director of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. 

Cassie Ferguson, MD, is an Associate Professor of Pediatrics at MCW. She is the Director of the Student Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Questions for Three of the 4C Coaches

From the 5/21/2021 newsletter

Questions for Three of the 4C Coaches

Edmund Duthie, MD; Amy Farkas, MD, MS; and David Marks, MD, MBA

Drs. Edmund Duthie, Amy Farkas, and David Marks, who serve as coaches in the 4C Program, discuss their experiences and encourage other faculty members to volunteer in the future …

In August 2019, the Kern Institute launched the Coaching for Character, Caring and Competence (4C) Program. This optional four-year longitudinal program pairs students with faculty coaches who will help to foster the student’s professional growth. The faculty who serve as coaches volunteer their time to the program. The students and coaches have individual student-led meetings, and small group meetings to discuss topics such as character, professional identity formation and other topics that will help them through medical school and beyond. To help prepare the coaches for these discussions, monthly faculty development sessions are hosted where a content expert on each topic gives an hour session. Group meeting facilitation guides are provided for the coaches, as well. 

We wanted to hear from the faculty about why they chose to participate in the 4C Program and the impact that this program has had on them. Three coaches, Drs. Edmund Duthie, Amy Farkas, and David Marks, submitted their responses to us on four questions about their experiences with the 4C Coaching Program.

What made you sign up for the 4C program?

Dr. Duthie: I signed up for 4C program to better connect with our students. A longitudinal approach was appealing. 

Dr. Farkas: Joining the 4C program as a faculty coach seemed like a great way to pay it forward. I was part of a similar program as a first-year medical student at the University of Pittsburgh and I still mentor with my assigned faculty mentor thirteen years later. To offer that to the next generation of students was important to me.

Dr. Marks: The Kern Institute’s recruitment for new 4C coaches occurred at an opportune time. As a physician administrator, I was heavily involved in COVID care as a leader in both the Incident and Recovery Command teams; I recognized the resumption of operations needed to include better care for our patients, caregivers, staff and learners as a whole. In my personal life, my daughter’s medical school graduation was canceled, and though she was hooded “online,” I recognized that this current medical school class would face unique challenges as a result of the pandemic’s impact on education and socialization. I felt called to offer my services as a 4C Coach to pass on my experience and resilience having served many years as a clinician, and as a leader in both medicine and healthcare administration.

What has been the best part of the program?

Dr. Duthie: Getting to know a small group of M1s better and connecting me with the students, their challenges, and the curriculum. 

Dr. Farkas: Getting to know the students and to watch the group dynamic. My students are great supports for each other, particularly in the time of COVID when so many normal social supports are removed. Knowing that they have connected outside of our 4C group is wonderful. 

Dr. Marks: Our 4C group is composed of unique, talented individuals who are progressing remarkably through the challenges of M1 (and M3). Their personal and professional growth is tremendous. Coming alongside them and encouraging/coaching has been terrifically refreshing for me and I look forward to their ongoing formation as good physicians.

How has being a coach impacted you?

Dr. Duthie: I have achieved my goal of connecting with students. Unexpected benefits: getting to work with the near-peer coach has been great. Further, the faculty development has helped me to grow as a thoughtful educator. 

Dr. Farkas: In the rest of my job, I am pretty removed from the first year of medical school. It’s nice to have a reminder of what that time is like, as it provides me insights into where my MS3 and MS4 students are coming from so that I can better support them. It’s also just a lot of fun. 

Dr. Marks: The coaches’ development sessions and curriculum turned my attention to the resources we have in the Kern Institute; exposure to these individuals and resources allowed me to seek new opportunities of study and growth for myself. I was particularly drawn to discussions of character which prompted thoughts on how clinical operations, artificial intelligence (AI), and patient care are at risk by new technology. Adoption of artificial intelligence can pose challenges for safe, compassionate, and ethical health care. I wanted to explore if appropriate implementation and use of these tools could be addressed with character education and wisdom. This path ultimately led me to apply to become a Kern Scholar and pursue additional training in character education. 

Why would you recommend other faculty join the program as a coach?

Dr. Duthie: Definitely would recommend. It is a commitment, but grounds us in why we are a medical school and why we became physicians. 

Dr. Farkas: Absolutely! Seeing the students’ excitement and watching them develop over the last year has been very fulfilling. I look forward to helping them on their journey over the next few years. 

Dr. Marks: I highly recommend the mentor position in the 4C program as a means to give back to learners and to stimulate one’s own understanding of the current challenges faced by our caregivers. The program has proved to be rewarding not only as I provide counsel and guidance, but also as I gain insight and wisdom from my colleagues. Additionally, the tools that the Kern Institute provide are important and relevant to our broader medical and administrative community.

Edmund Duthie, MD, is a geriatrician and Professor in the Department of Medicine at MCW. 

Amy Farkas, MD, MS, is a general internist and Assistant Professor in the Department of Medicine at MCW. 

David Marks, MD, MBA, is an interventional radiologist and Professor in the Department of Radiology at MCW. 

Learning Communities at the Medical College of Wisconsin: Past, Present & Future

From the 7/24/2020 newsletter

Learning Communities at the Medical College of Wisconsin: Past, Present & Future 

Cassie Ferguson, MD, Kurt Pfeifer, MD, Marty Muntz, MD, Cassidy Berns, Kaicey von Stockhausen, and Adina Kalet, MD, MPH 

This Kern Institute team describes their work on the rapid evolution of Learning Communities at MCW and the proposal for expanding the effort putting the learner at the center of education ...

The new academic year is upon us. New medical students arriving in Milwaukee will be find a campus than that looks very different from the one they saw on interview day. Orientation will be mostly virtual. Those unscripted moments and chance encounters that allow students to make connections with new people in the first few weeks of school will be few and far between. Everyone will be wearing masks and sitting at least 6 feet apart in classrooms. There won’t be the option to wander the hallways or find that perfect place to study. It all must be scheduled in advance.

These changes to medical education necessitated by COVID-19 pandemic are layered upon the preexisting challenges of rapidly expanding biomedical knowledge and increasing time and fiscally constrained clinical environment. These challenges may have compounding consequences, including burnout and increasing rates of depression, anxiety, and suicidality. To better support our students and to help promote a sense of connection and community amidst social isolation, the MCW School of Medicine (SOM) is implementing learning communities (LCs). 

LCs were first developed on undergraduate campuses to foster professional growth of students with similar academic interests. LCs partner faculty members with groups of students longitudinally to promote communitybuilding, academic and personal support, professional development, and curricular activities. LCs transform the medical school curriculum from coursestructured to learner-centered; putting the student- embedded in cohesive communities, at the center of the curriculum. 

Since the early 2000s, many medical schools have implemented LCs, and a 2012 survey showed that 52.4% had LCs and 48.3% of those without them indicated that they were considering creating them.1 Studies of LCs have demonstrated substantial improvements in faculty engagement, student wellbeing, and professional development.2 2018 surveys of MCW students and faculty conducted by the Kern Institute confirmed strong support for the implementation of LCs. 

With implementation of a pass/fail course grading system for the first two years at MCW, a strong system of mentorship for students is imperative not only to identify students who would benefit from additional support and intervention, but also to encourage students who are already successful to develop goals in the pursuit of excellence. LCs can promote inclusive behaviors and ensure effective transitions for all students. Finally, as the COVID crisis persists and social distancing limits interactions between students and faculty, LCs are an excellent means of assuring support for students and development of student faculty relationships. 

Current State of Learning Communities at MCW 

REACH Well-Being Curriculum 

As referenced above, LCs can positively impact student well-being. Growing evidence detailed in the National Academy of Medicine’s 2019 report on professional well-being indicates that learner burnout may negatively impact the quality and safety of patient care, the adequacy of the workforce, and the professionalism and personal health of learners. While system factors are the major contributors to burnout, attention to well-being in the learning environment may mitigate their effects. 

In Fall 2019 at the MCW SOM with much support from Academic Affairs and the Office of the Dean, the Kern Institute Student Pillar implemented a well-being curriculum aimed at teaching well-being skills and providing opportunities to talk with and learn from peers and faculty members. The REACH (Recognize, Empathize, Allow, Care, Hold each other up) curriculum, which is intentionally structured as longitudinal groups of faculty, staff, and students, uses an LC model. 

Designed and directed, by Dr. Cassie Ferguson, Director of the Kern Institute Student Pillar, The objectives of the REACH curriculum are to describe how the well-being of medical students, trainees, and physicians is integral to becoming caring and competent physicians; and, to identify characteristics and practice the skills that will help students thrive in medicine. The curriculum is designed around research-based best practices across several disciplines, including psychiatry, positive psychology, and mindfulness; pilot program data; and, interviews with students. The content emphasizes the importance of several fundamental concepts: storytelling, embracing vulnerability, nurturing selfcompassion, creating space and opportunity to examine one’s thinking patterns, developing emotional health, and fostering community. These concepts are woven into discussion of core topics including seeking behavioral health help, community building, creating boundaries, mindfulness, meditation, suicide prevention, imposter syndrome, productive generosity, beginner’s mind, digital minimalism, and looking for joy in the learning and practice of medicine. 

REACH consists of four didactic sessions and three facilitated small-group sessions in the first year, and three didactic sessions and three facilitated small-group sessions in the second year. Each small group comprises 10 medical students and two volunteer facilitators- a clinical faculty member and either a behavioral health expert (some of whom are also clinical faculty members) or a student support staff member. Facilitators receive detailed session guidelines with learning objectives, suggested discussion questions, activities, and links to related resources (e.g., didactic session videos, podcasts, articles, books). 

Evaluation of the curriculum was accomplished through a 17-question survey made up of Likert scale and open-ended questions completed by 62 students at MCW-Milwaukee (30%). 85% of respondents believed that what they were asked to learn in REACH was important; 70% would recommend that other medical schools adopt REACH. The REACH small group sessions played a significant role (>70%) in building relationships with peers and faculty. Students commented on the benefits of getting to know their peers, realizing they were “not alone” in how they felt, and feeling faculty were genuine and cared about them. 

4C Coaching Program 

The Kern Institute at MCW identified LCs as also having great potential for pursuing innovations supporting character and caring in medical education. After exploration of LC-related components and features with Kern National Network partners and MCW students and faculty, the Coaching for Character, Caring, and Competence (4C) program was launched in August 2019. 4C is structured around the core concept of LCs – groups of students and faculty in a longitudinal relationship to cultivate professional growth. Within this framework, multiple different components can be implemented to meet specific objectives (See diagram). Roughly 50 students volunteered for the program during AY2019. 13 volunteer faculty were grouped with 3-4 students each, and these groups meet monthly covering character and professional development topics. In addition, faculty meet individually with each of their students every other month. The program is directed by Kurt Pfeifer, a faculty member in the Student and Curriculum Pillars of the Kern Institute. 

With its initial launch, 4C centered on longitudinal coaching at the Milwaukee campus, but in AY2020, near-peer mentorship will also be piloted, and activities will be extended to the Central Wisconsin campus. 

Initial data show great support for the program as a whole and strong impact on development of mentorship and support for students and sense of faculty engagement. Students in the program were less likely to have feelings of isolation and reported strengthening of several character traits, including perspective, self-regulation, perseverance, and social intelligence. 

Incorporating Learning Communities into Curriculum for Fall 2021 

The Office of the Dean identified a pressing need to intentionally and thoughtfully expand on the existing LC structures at the MCW Milwaukee campus this fall. As detailed above, LCs can mitigate the potential consequences of social distancing rules by providing a “home” for every student and built-in opportunities for connection with peers, faculty, and support staff. 

Based on discussions between Academic Affairs, Kern Institute faculty, Dr. Lisa Cirillo, Jennifer Hinrichs, Mary Heim, and Dean Kerschner, a proposal was created for a longitudinal, tiered structure of LCs, where smaller groups of students roll up into larger groups of students allowing for intimate discussions without missing out on interacting with a variety of people. The objectives, activities, and facilitation of each group will be appropriate for their size and will enhance students’ experience and learning at MCW. 

Class of 2024 will be broken into 5 “On-Campus Learning Groups” each of which will be broken into three Orientation Groups of approximately 16 students each (again, depending on the size of the class). These groups will be established during the Orientation week. The Orientation Groups will be broken into two REACH Groups. The REACH curriculum is currently a mandatory part of the Clinical Apprenticeship course (conducted in the spring of M1 and fall of M2 years). Dr. Ferguson, Director of REACH, is engaging in discussions with Academic Affairs and Dr. Cirillo about incorporation of REACH into the Foundations of Clinical Medicine and Foundational Capstone courses as well. 

Students will additionally have the option to sign up for the 4C coaching program, which has groups of 4 students led by a volunteer faculty coach and a near-peer coach (M3 student). Current plans are for two 4C coaching groups to combine to form a REACH group, with the 4C faculty coaches also serving as those students’ REACH facilitators. Because the 4C Coaching Program is optional, not all students will receive this content. 

Vision for the Future of LCs at MCW 

We envision LCs evolving to provide a longitudinal structure that both supports and challenges each student as they achieve required competencies and develop and pursue individual goals at MCW. Students will be welcomed into an intentionally created group of peers, faculty and staff that will provide a sense of belonging from Day 1 at MCW – with LC faculty leading small group activities during Orientation and presenting the coats to their group at the White Coat Ceremony. With consistent expert faculty and staff guidance, LCs will provide meaningful opportunities for shared learning, peer teaching, and social connectedness through the challenges and joys of medical school that we are currently unable to guarantee given our large class size and reliance on a traditional curricular and advising model. LCs will also enable MCW to more fully transform to a competency-based education model of learning and assessment, as each student and their LC faculty share responsibility in ensuring that progress toward competence and excellence is consistently pursued. The bond among LC members will grow with time and shared experiences, culminating with the opportunity for LC facilitators to meaningfully participate in the Hooding Ceremony and Commencement. Both faculty and students desire and would greatly benefit from the realization of the community described in this vision statement. 

Cassie Ferguson, MD, Kurt Pfeifer, MD, Marty Muntz, MD, Cassidy Berns, Kaicey von Stockhausen, and Adina Kalet, MD, MPH are working on the rapid evolution of Learning Communities through their work at the Kern Institute, Medical College of Wisconsin.

1 Smith S. Acad Med. 2014 Jun;89(6):928-33. 

2 Eagleton S. Adv Physiol Educ. 2015;39(3):158-66. Smith SD et al. Acad Med. 2016;91(9):1263-9. Rosenbaum ME et al. Acad Med. 2007;82(5):508-15. Wagner JM et al. Med Teach. 2015;37(5):476-81. 

3 https://nam.edu/systems-approaches-to-improve-patient-care-by-supporting-clinician-well-being/ 

Mentoring Toward Purpose and Meaning: Helping our students retain their passion for medicine by asking Why?

From the 7/24/2020 newsletter

Mentoring Toward Purpose and Meaning: Helping our students retain their passion for medicine by asking Why?

Adina Kalet, MD, MPH

In this week’s Directors Corner, Dr. Kalet reminds us that focusing on well-being alone is not enough. Our students want and need mentoring on how to make a purposeful and meaningful life in medicine, especially in these tumultuous times …

“...Tell me, what is it you plan to do with your one wild and precious life?” 

From "The Summer Day" by Mary Oliver

Becoming a physician is challenging in all ways. And yet it is a choice. Even the most optimistic medical student will have moments of great distress and doubt, and they will - and should - seriously question their choice of life path from time to time. After all, while it is a privilege to join a profession which offers the possibility of a lifetime of meaningful work, it is not a career for everyone. There are many ways to make a satisfying life. Pursing the practice of medicine when it is not what you really want to do can be tragic for the practitioner, their family and their patients.

While we are sometimes faced with trainees and colleagues who need compassionate off-ramps from medical training or practice, the vast majority of our matriculating students can safely assume they will become practicing physicians. This is why regular opportunities for recommitment to, and for the reexamination of life goals, is as much a critical wellness practice as taking time to exercise, eating healthfully, practicing mindfulness and compassion, and laughing regularly. But, like other wellness practices, most of us need support and encouragement to do what is good for us.

Get to the Heart of the Matter by asking Why? Why? Why?

I first participated in an exercise call "The History of the Future" in 2010, as a participant in the Hedwig van Ameringen Executive Leadership in Academic Medicine® (ELAM®) program, and have since used it hundreds of times with students and colleagues since then. This is a simple practice to help a student or colleague plan well for their future. It goes as follows:

I hand them a piece of paper on which I have scribbled today’s date at the bottom and this same day five years from now on the top with six dates in between as follows:

My History of the Future

July 24, 2025: Celebrate what? With whom? 

July 24, 2024:

July 24, 2023:

July 24, 2022

July 24, 2021:

6 months from today: 

2 months from today: July 24, 2020 (today)

I hand them a pen and give the following instructions:

"Imagine it is exactly five years from today, you are celebrating a personal accomplishment. What are you celebrating? And who are you with? Write these things next to the date. Then work backwards in time, down the page. Make brief notes on what you will need to be doing on those dates in order to make sure you have something to celebrate in five years."

Then I stand up and prepare to leave the mentee alone with the task for at least ten minutes.

Invariably, before I can leave the room they ask, “Do you mean a personal or professional celebration?” I turn back and say, “Yes! Both! And by the way, don’t hold yourself back or feel intimidated, because this is pure fantasy, the future never happens as we plan, so don’t sweat it.”

Then I go get a cup of coffee. When I return, they are either writing furiously, or tapping their pen on the desk looking pissed. I sit across from them and ask, “So tell me, what are you celebrating and with whom?”

I have found that debriefing this exercise almost always helps mentees imagine and plan for a desirable, purposeful future. Even when - especially when - they have no idea what they want! It also always guides me away from the common mentor pitfalls of talking too much and providing well-intended but irrelevant advice. According to the leaders of the Center for Applied Research who taught me this approach, research suggests that people develop more vivid stories when asked to think about a situation in the past tense. Doing this helps individuals think more concretely and realistically about how to create the future they want, especially because it enables them to think about weaving together different strands of growth and development - like personal and professional goals - that need to occur to achieve that future. This method is similar to strategies used successfully with other mastery-oriented competitive athletes, gamers (like Chess Olympiads) and concert musicians.

There is a trick to getting to the heart of the matter in very brief conversations. When the mentee describes their “celebration” and describes who they are celebrating with, I listen carefully. Only then do I ask, as benignly as possible, “Why?”

There is often a long silence. Eventually the student gives an answer, “Because I am my parents’ only child,” or “Because I want a big family," or “Because I have worked for this my whole life," or “Because, I am an introvert and much prefer very small gatherings.” No matter what they offer, I nod, encouraging them to elaborate until I can reasonably again ask, “Why?” And so on, until we have done this at least five times (The 5 Whys). With each cycle the answers get deeper and more authentic. Almost always we end up discussing if and how they will be courageous enough to stay the course or choose a new path, perhaps the one “less traveled by” that will be worth their “one wild and precious life.”

Once we are sure we understand why the student wants to be celebrating what they are celebrating we drop down the page to the line that reads “two months from today,” and talk about possible next steps. At that point I might give some advice. I always recommend they keep the piece of paper. These are career conversations worth having from time to time.

Learning Environments that are Communities

It is our obligation as medical educators to graduate people ready and able to practice medicine in a rapidly changing environment. What does this mean? I believe that in addition to ensuring mastery over the knowledge and skills required - a tall order in and of itself - we must also attend to the character and spirit of the developing physician. This is because every one of us deserves a physician who is capable of both deep thinking, technical skill and feeling, an individual who has the capacity to care for us even if we do not share a culture, color or gender, through a wide range of personal health challenges, across a lifetime. We need physicians capable of empathy and with a strong sense of purpose and meaning in their work. This is not a guaranteed outcome of our medical education system, it takes a community of committed students, their families, educators, staff and patients willing to have those deeper, more difficult conversations. There will be a necessary dialectic between this idealistic vision and the practical realities - but we need both to ensure progress and accountability toward a better set of outcomes for the health of our communities.

In this issue of the Transformational Times, Cassie Ferguson, MD, Kurt Pfeifer, MD, Marty Muntz, MD, Cassidy Berns, and Kaicey von Stockhausen share the justification and basic plan for building a Learning Community structure for MCW. This is one doable way that we can keep trainees in touch with why they have chosen their path.

My 2010 "History of the Future" still hangs on the refrigerator door to remind me of the old saying “best laid plans of mice and men often go awry.” While the details were fantasy, I remain on the path to ensuring all of us have access to remarkable physicians.

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.

Never Waste a Crisis! Now is the Time to Build Learning Communities

 From the 7/17/2020 newsletter

 

Director’s Corner

 

 

Never Waste a Crisis! Now is the Time to Build Learning Communities

 

 

Adina Kalet, MD MPH

 

 

 “In this week’s Director’s Corner, Adina Kalet argues that we must embrace the moment by making educational technology work for us and ensuring that the learning communities we create put our students on the path to becoming masterful physicians…”

 

 

We face an existential crisis in education. Because of the pandemic and social distancing, educators need to focus on the essentials: life, health, and the creation of robust learning communities designed to enable our students, teachers and institutions to thrive during these tumultuous times. 

 

The strategies to accomplish this are well understood and readily available, but there are unknowns. The federal government is insisting that all K-12 schools must open this Fall. In fact, any rapid recovery of the economy, if possible, will depend on children returning to the classroom so that parents can return to work. However, completely reopening all schools may put children’s and adult’s lives at risk. 

 

As of last week, two-thirds of US colleges had decided to reopen their campuses for the Fall term. My daughter, niece, and nephews will be on-campus soon, anticipating and needing social connections with peers and teachers. Faculty and students thrive in active learning communities, but university faculty are concerned that reopening might lead to life-threatening consequences. 

 

Can colleges and universities create meaningful learning communities at a “distance”? Although some depend less on tuition dollars for short term survival than others, many schools are justifiably worried that education will suffer and that students will balk at paying full tuition for an “online only” education. Evidence demonstrates, though, that people value (and therefore will pay for) high-quality distance learning. Virtual education fails if it simply deliver lectures and other routine elements of existing curricula to laptop screens filled with squares of bored faces. High-quality distance learning maximizes learning by deploying carefully crafted instruction in a socially nurturing community even if the learners rarely, if ever, meet face-to-face. It focuses on both individual and collaborative peer learning and enables close, meaningful connections with teachers. 

 

 

Teaching virtually

 

I am experiencing high-quality cyberspace learning, right now. 

 

I co-direct the US site for a premier international Master’s in Health Professions Education (MHPE) program which has been predominately virtual for almost thirty years. It is organized into twelve units, two of which are designed to be synchronous in-person experiences, while the other ten units remain open until all assignments are submitted and the final grade awarded. While the program is designed as a two-year, thesis-required program, students have up to five years to complete the degree.  

 

At this moment, I am teaching in an intensive, full-time, three-week course in qualitative and quantitative research methods. Although my class was designed to be taught in a classroom, we are meeting entirely on Zoom. This has turned out to be as much fun as being in a room together. I have been delighted to see that the virtual platform leads to as much if not more learning when compared to my face-to-face experiences over the past five summers. 

 

Despite the fact that my students and I are rarely in the same place, I know them well. I was involved in recruiting them into the program and I taught them last year in the introductory medical education unit. I provide feedback in our ePortfolio. I have mentored a couple of them one-on-one, heard about their progress at weekly faculty meetings, and will follow each of their thesis projects from now until graduation. 

 

Although the students work in different institutions, health professions, clinical disciplines, and time zones, they also know each other well. They started this two-year program together as a cohort and continue to collaborate on assignments. They take advantage of Google Docs (free). They support each other, share questions, frustrations, and personal celebrations on What’s App (free), Facebook (free), and other social network platforms. In Zoom, they are respectful of each other, smile a lot, and share inside jokes. The student who is pregnant with twins gets advice, support, and empathy. 

 

Working virtually has not dampened collaboration. Each of the students works independently on their thesis project, but they share their work with the group at weekly seminars. They work in pairs and threes on reading and writing assignments. They meet one-on-one with mentors and thesis advisors. I lead the course and attend as many of the group sessions as possible to monitor each student’s growth and make connections across the course material. The six faculty – some compensated and some volunteer – teach as a team. We have our own relationships with the students and with each other. We are – the teachers, students and staff – a “learning community.” 

 

 

Harnessing and enhancing technology

 

Technology bridges continents. Many of the most agile US universities and medical schools have globally distributed campuses where students in New York City or Boston share classes and faculty members with students in Shanghai, Abu Dhabi, Paris, Prague, or Brooklyn. Our own MCW students in Central Wisconsin and Green Bay attend synchronous foundational medical sciences lectures with their peers in Milwaukee. The infrastructure and comfort with technology is available. 

 

The “new normal,” though, can lead to a sense of grief and loss and many, if not most, traditional educators believe being physically present with their students enhances their craft, effectiveness, and satisfaction. I agree! I love to dance across the stage and draw on the board while making eye contact and inviting individuals to engage in the material about which I am passionate. 

 

Putting face-masked professors behind Lucite-barriered podiums with students dotted at six-foot intervals is not the answer, but our current distance learning alternatives are not perfect, either. For example, when our regional campus students are linked into the lecture halls in Milwaukee, they sometimes report that camera angles make them feel as though they are “in the cheap seats,” and find that some lecturers forget that the off-site students are watching. We can find better ways.

 

Contrast this with how the BU Executive MBA brings teachers and students into close virtual contact at almost life-size, enabling teachers to physically move, write on the board and read non-verbal expressions. The Kern Institute is building a learning lab where ideas like these can be turned into working models and studied. Faculty can be nurtured to enhance their capacity to connect with students. With some investment, we can address the need for educational engagement without endangering lives or hog-tying professors. By working together intentionally, we will develop prototypes of relationally sophisticated and technologically-sufficient learning communities.  

 

 

Building learning communities

 

With careful attention to explicitly building learning communities that attend to the social and emotional needs of both learners and teachers, education can be a very exciting enterprise even when we can’t all be together in the same room for long periods of time. 

 

Learning communities are not a new idea in medical education. Since being first introduced at the University of Iowa Carver College of Medicine in the early 1990s, over forty US medical schools have embraced this approach to create effective, supportive learning environments which structure longitudinal personal relationships between learners and teachers for the purpose of integrating knowledge and clinical skills. The community nurtures the growth and development of a healthy professional identity essential to becoming a masterful physician. 

 

In the Kern Institute, we have begun building the elements of this “learning community” approach through our REACH curriculum under the leadership of Catherine Fergusson, MD and the 4 C Coaching program led by Kurt Pfeifer, MD. Collaborating with Lisa Cirilo, PhD, the MCW Assistant Dean for Basic Science Curriculum, and the Office of Academic Affairs, we are working to rapidly integrate with existing programs so that students who come to campus (literally or virtually) over the next weeks will be welcomed into communities that provide a sense of belonging, caring and collaboration. 

 

 

The broader challenge

 

The past few months have proven that we do have the technology and educational science to enable smooth transitions to highly blended, largely virtual instructional environment. If we attend to making certain our students can afford and have access to the technology in safe settings and must come together only when “hands on” experiences are critical – such as in human anatomy labs and clinical skills instruction – we can learn from this moment and keep our learners and teachers safe. 

 

The day will come when we are all back in the classroom together. In the meantime, we must use this opportunity to harness technology, innovate educational approaches, build character, strengthen our learning communities, and transform medical education.  

 

 

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.