MCW's Seventh MedMoth Storytelling Evening

  

MCW's Seventh MedMoth Storytelling Evening

MCW MedMoth, a student-initiated and student-led storytelling event, was held on November 30, 2023. Over 100 appreciateive listeners came to support the ten storytellers as they shared tales on everything from the lifelong scars left after shoplifting to lessons learned from running a food pantry program to a death in the ICU. 

Some of the stories will soon be featured on the Medical Education Matters podcast. 

Thanks to the Kern Institute, the Kern Family Foundation, and the Charles E. Kubly Foundation for support of MCW MedMoth over the past four years. These events reflect human centered design principles and character. MedMoth supports students, staff, faculty, and health care professionals in human flourishing and resilience.

Big props to the MedMoth team: MCW students Meg Summerside, Linda Nwumeh, Amber Bo, Meghan Schilthuis, Corey Briska, and Maya Martin, and to Kern faculty/staff Shannon Majewski, Devarati Syam, Adina Kalet, Bruce Campbell, and Cassie Ferguson. 

Look for the next MCW MedMoth evening in Spring 2024!

Design Thinking in Action: Medical Students Weigh-In on the Mobile Health Clinic

From the December 23, 2022 issue of the Transformational Times

Perspective/Opinion 

Design Thinking in Action: Medical Students Weigh-In on the Mobile Health Clinic 

 

By Emmy Lambert, BS – Medical Student 

Patient-centered care calls for patient-centered spaces. Medical students were given the opportunity to dust off their creative brains and ponder the details, big and small, of an exciting new mobile clinic…  

Human-Centered Design. It’s all around us. Or at least, it should be… 

Simply put, human-centered design is a method of empathy-based problem-solving. Through a three-phase design process of inspiration, ideation, and implementation, human-centered design tailors products towards those involved in their use – so-called “stakeholders.” These stakeholders are consulted and considered in every step of the design process to ensure the output will meet their needs. Truly an ingenious approach, if you ask me.   

They’re building a WHAT? A mobile clinic! 

In an effort to address preventative health screening disparities in certain zip codes in Milwaukee, there is a joint venture between the Population Health Department and OB/GYN Clinic at Froedtert Hospital, the Kern Institute’s Human-Centered Design (HCD) Lab, and the UW-Milwaukee Lubar Entrepreneurship Center to design and implement a Women’s* Mobile Health Clinic. The working timeline aims to complete research by the end of the 2022 calendar year, build the clinic in late spring of 2023, and begin providing care next fall.   

As part of the ongoing research process, the HCD lab hosted a design workshop for second-year medical students in the Health Systems Management & Policy Pathway. As a student member of the HCD lab for nearly a year, I had the privilege of facilitating this session with Dr. Ilya Avdeev and Dr. Lana Minshew. As a team, we guided students through a series of activities to stimulate creativity and prime their listening skills before conducting design research for the clinic.   

We asked the HSMP students to brainstorm the needs of a women’s mobile health clinic, identify stakeholders, and generate solutions to a few stakeholder concerns. Students collaborated in teams, writing furiously on sticky notes, whiteboards, and scrap paper. The room was abuzz with solution-oriented energy. Their knowledge of health systems and roles as medical students added a unique perspective to the ongoing project. Some of Dr. Avdeev’s graduate-level engineering students attended the session as well, lending a different angle of design understanding to the process.    

The students said they loved it! 

The session was well received by the students. Clayton Vesperman, M2, commented, “I thought that the Mobile Clinic Design session was one of the most unique and engaging sessions I have had as part of the Health Systems Management and Policy pathway. The opportunity to collaborate with Engineering students who had a background that was outside of the medical field was a great opportunity to learn how other fields approach problems as well as the types of issues they prioritize. As medical students, we have abundant opportunities to learn from other health professions, but learning to work alongside entirely different fields can be very beneficial as they can play a large impact in the patient experience even without directly influencing the patients’ healthcare.”  

Victoria Le, an M2 also in the HSMP Pathway, commented, “I thought it was interesting to see the process of working through nitty-gritty details of making an idea come to life. I liked how thorough it was, including the way we tried to anticipate different issues that would be roadblocks to the mobile clinic. I also thought it was a good way to balance the creative process with a more rigorous evaluation of ideas.”  

My takeaway? 

I was so impressed with the creativity and collaboration demonstrated by my peers! Their willingness to engage across disciplines, work together to problem solve, and experience medicine from the patient perspective is promising for the future of medicine. A few of the ideas presented at this workshop have been considered for the ultimate implementation of the mobile health clinic, which is set to hit the streets in the fall of 2023.   

Design with us! 

The Human-Centered Design lab is currently collaborating with the Lubar Entrepreneurship Center at the University of Wisconsin – Milwaukee and Froedtert hospital on a community-centered design project focused on designing two mobile health clinics to serve the greater Milwaukee area. To create the most effective community-centered design as possible, we invite community members to join the design team by sharing your experience with mobile healthcare or offering your ideas using a full-scale clinic design model. The model is in the first-floor cafeteria lobby of the MCW – Medical Education Building and will be open to everyone through January 31, 2023.   

Note: 

*The term “women” encompasses those who identify as female, possess female reproductive anatomy, or face female-related health issues. 

Emmy Lambert is currently an M2 at MCW Milwaukee. She is a student member of the Human-Centered Design Lab pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. She passionately co-runs the MCW Chapter of Medical Students for Choice, manages operations of MCW DOSE, and teaches Hatha and yin yoga classes at Collective Flow MKE.  

Implementation Science and Medical Education Transformation

 From the 4/23/2021 newsletter

Perspective/Opinion

 

 

Implementation Science and Medical Education Transformation

 

 

Jeffrey Amundson, PhD, Michael Braun, PhD, and M. Chris Decker, MD

 

 

Drs. Amundson, Braun, and Decker provide an overview of the basic stages of Implementation Sciences, acknowledging that the process must attend to the people and culture where it occurs …

 

Implementation science - a thoughtful, structured rollout of a new initiative - can help make new programs more successful. In the April 2, 2021 issue of the Transformational Times, Drs. Amundson, Webb, Prunuske, and Kalet discussed the use of implementation science methods in the curriculum transformation process. As we move forward with this change, and with the broader transformation of medical education driven by the Kern Institute, let’s take some time to reflect on implementation science: why it’s important, and what it tells us about how and why to start off right.

 

Why are we talking about Implementation Science?

Successful implementation and maintenance of evidence-based practices for organizational changes or programs are a necessary precondition at Kern for providing successful programs, driving innovation at MCW and elsewhere, and generating scholarship. But there’s no guarantee that merely using an evidence-based practice (EBP) will lead to its adoption. For example, here is a story from Bauer and Kirchner’s (2020) article in Psychiatry Research:

“It was, by all estimations, a successful research effort. We had mounted a randomized, controlled clinical trial across eleven sites in the US Department of Veterans Affairs (USVA), testing an organization of care called the Collaborative Chronic Care Model (CCM) for bipolar disorder versus treatment as usual. Over three years of follow-up, the CCM showed significant positive impact on weeks in mood episode, mental health quality of life, social role function, and satisfaction with care - all at no increased cost to the healthcare system. In parallel, a two-year, four-site randomized controlled clinical trial of the bipolar CCM in the Group Health Cooperative of Puget Sound (now Kaiser Permanente), showed very similar outcomes at minimal cost, compared to treatment as usual. Both studies were published in the same year in mainstream psychiatric journals that are read and respected by mental health researchers, clinicians, and administrators. The CCM for bipolar disorders began to be endorsed by national clinical practice guidelines in the USVA and in Canada, and the bipolar CCM was listed on the US Substance Abuse and Mental Health Services Administration's prestigious National Registry of Evidence-Based Programs and Practices.

And yet, within a year of the end of the studies, none of the 15 sites had incorporated the CCM into their usual workflow. The clinicians who had participated in the CCM went back to their usual duties, and the individuals with bipolar disorder went back to receiving their usual form of care.” (Emphasis added)

Something more than sound evidence is needed for a program to be successful, and implementation science is an approach designed to address the how and the why of getting started right, once the “what” has been defined.

 

What is Implementation Science?

Implementation science is the systematic study and practice of program implementation to increase chances of acceptance, adoption, fidelity, and success. For a new initiative, this means the program is supported and practiced by a broad range of practitioners and stakeholders. It also means the practice of the program adheres to the program’s tenets and dictates. And it means that the program achieves desired outcomes predicted by theory and evidence. Notably, this process involves many similar components of continuous quality improvement (CQI). CQI also involves the continual review of an ongoing program’s implementation, fidelity, and outcomes to adjust the program while it remains in operation.

 

Basic Stages of Implementation Science

There are numerous specific models of implementation, and all identify similar stages of the process. Here are five basic steps to the process of implementation as guided by implementation science.

 

Exploration – Needs, Options, and Partners

The implementation team is responsible for getting the stakeholders and learning environments ready. They explore and research different EBPs to share. This might involve reaching out to other organizations who have implemented similar practices, literature reviews, and mock learning environment experiences to familiarize stakeholders with what evidence-based approach looks and feels like. The implementation team develops needs-assessments to ready stakeholders for the next stage of Installation.

 

Installation - Who, What, When, and How

During this phase, the implementation team identifies human and operational resources that become part of an implementation plan. This plan lays out who will be using the new program, where it will be used, who will be asked to do their work differently. It anticipates necessary training to prepare others for changes and details how the new program will be evaluated.

 

Initial Implementation - Measurement, Meetings, Learning Environment, Support, and Observation

When practitioners use the innovation for the first time, implementation teams help develop competencies required by the EBP, help administrators adjust organization roles and functions, and help leaders fully support the process. During this process, the team is rolling out the implementation plan, sharing EBPs chosen to implement, and displaying and modeling the use of resources.  The team is using valid tools to measure effective EBPs, look-fors (things that represent expected strategies and outcomes), peer support opportunities, plans for observation, and plans for touch-base/how are things going meetings.

 

Full Implementation - How Many People? Fidelity, Good Outcomes, New Standard of Work

During this stage, stakeholders involved are using an effective intervention with fidelity and good outcomes. Notably, expected outcomes should be realistic and aligned with theoretical predictions. The new ways are now the standard ways of work and Implementation Teams ensure that the gains in the use of effective practices are maintained and improved over time and through transitions of leaders and staff. This can involve follow-up meetings with staff, review progress monitoring with educators and administrators to ensure fidelity.

 

Sustainability - Financial and Programmatic

Sustainability planning and activities need to be an active component of every stage. These activities can involve ensuring that the funding streams are established, adequate, and sustainable (financial sustainability, e.g., funding for educators, staff, and administrative time) and ensuring that the implementation infrastructure is established, reliable, effective, and sustainable (programmatic sustainability, e.g., vertical articulation with new stakeholders to identify what worked for which stakeholders).

 

Attending to People and Culture

Another critical dimension for successful implementation in every stage is the people and cultural changes required. Though we may discuss implementation science as a prescriptive way to implement a new program, we would be remiss if we ignored the fact that any change within an organization requires extraordinary commitment and sacrifice from the individuals who are asked to carry out the change and live with the consequences (both good and bad) from the change. These changes will impact personal mattering, professional identity, feelings of purpose, and other emotional elements and must be treated by all with humility, empathy, and compassion. And as organizations learn within the implementation, rate of implementation, which can add to the impact of change, is an important consideration. We look forward to exploring these elements of implementation science in a future article.

 

 

In sum, Implementation Science can help effectively identify and validate a need, strategically plan for change through implementation plans, and provide structure for data collection and reporting on the impact of the change. Engaging employees at all levels (e.g., faculty, staff, learners, etc.) early in the implementation process is key to aligning an EBP with the values and culture of the organization. In future issues of the Transformational Times, we look forward to writing about additional important elements of successful implementation and also about the transformational journey of the MCW curriculum reimagining. Stay tuned!

 

 

Jeffrey Amundson, PhD is a postdoctoral fellow in the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

 

Michael Braun, PhD is a program manager with Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

 

M. Chris Decker, MD is Chief Transformation Officer and a Professor of Emergency Medicine at MCW. He is a member of the Human-Centered Design Lab, and has leadership roles in the Design Sprint Program and the Transformational Ideas Initiative (TI2) seed grant program for the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

 

 

Practical Wisdom in Medical Education: A Student Perspective

 From the 4/23/2021 newsletter

Perspective/Opinion

 

Practical Wisdom in Medical Education: A Student Perspective

 

Clara Bosco – MCW-Milwaukee Class of 2022

 

Ms. Bosco explains how reframing the role of the medical student from “observer” to “an apprentice acquiring practical wisdom” can shift the relationships between faculty and learners in a meaningful, growth-centered way …

 

In the case of the virtues…we acquire them as a result of prior activities; and this is like the case of the arts, for that which we are to perform by art after learning, we first learn by performing, e.g., we become builders by building and lyre-players by playing the lyre. Similarly, we become just by doing what is just, temperate by doing what is temperate, and brave by doing brave deeds. (Aristotle, Nicomachean Ethics, 1103a 31-1103b 25).

 

 

 “You really should be coming into every room,” scolded my attending. Ugh, day one on internal medicine service and I’m already in trouble. “...all I mean is that there are important, sometimes difficult, conversations you should witness, even if they’re not technically your patient,” she concluded. I didn’t realize the importance of this aspect of clinical training until experiencing a later conversation, my very first family meeting at the VA.

This Monday morning meeting included our primary team, palliative care, social work, and the wife and daughters of our patient. The meeting was intended to convince the family of the gravity of the patient’s condition, a medical reality they had been resistant to thus far. The palliative care physician, due to her expertise in goals of care conversations, led the call with such decorum and grace. I was struck by her collected interaction with the distraught family, who parroted cosigned phrases like, “but he’s not like everyone else,” and “he’s a fighter” in response to the news that their loved one had only around six months to live. To these retorts, the palliative care physician recited a phrase I will never forget: “We have patients who surprise us on both ends of the spectrum, some living shorter or a lot longer.” Oddly enough, this admittance of uncertainty consoled the family, who now felt comfortable with our team’s recommendation for hospice care. The family agreed, the call ended, and arrangements were made; the patient was discharged on Wednesday and died on Sunday morning.

In light of the above anecdote, what is the significance of bearing witness as an apprentice? As a medical student, oftentimes, it entails feelings of floundering, imposing, and space-wasting, as we unreflectively trail in and out of patient rooms on the heels of actually useful attendings and residents. But, for Aristotle, apprenticeship is a cardinal experience since it is the vehicle to become practically wise in a field like medicine where “practical wisdom” is defined as “the art of deliberating well, to make the appropriate choice and to establish the right means through a specific action in order to achieve a particular moral end.” It is through witness of expert physicians interacting with patients that we, as trainees, can move beyond our pre-clinical, theoretical understanding of the human body to a patient-centric, bio-pyscho-socially driven medical practice.

To further elucidate the role of practical wisdom in clinical medicine, consider how an oncologist might deliberate whether to pursue chemotherapy vs. surgery to treat a patient’s cancer. Theoretical wisdom, i.e., knowledge of cellular mechanisms, surgical technique, etc., is certainly necessary to best treat a disease. However, theoretical considerations alone may not be sufficient to best treat a particular patient’s illness. For example, does the patient have certain comorbidities that exclude them from surgery? Do they have health insurance? Do they have reliable means of transport for serial chemotherapy sessions? Are they able to take off work for surgery and do they have some to care for them? These considerations illuminate the numerous extra-scientific dimensions that must be weighed, via practical wisdom, to achieve the best treatment plan for a particular patient.

From an educational standpoint, integrating foundational concepts like practical wisdom into medical school could prove to be useful for both trainers, and, especially, trainees. For educators, practical wisdom could provide the foundation for effective role-modeling and mentorship. For students, introducing practical wisdom early and often in medical school could provide a much-needed conceptual framework for students to better understand their role as an apprentice. The long hours at the hospital, the feelings of “shadowing,” and uselessness to the team are stressful realities of medical students that certainly contribute to burnout. However, if these challenging experiences were reframed as formative to developing one’s own practical wisdom surrounding clinical reasoning and patient care, a new sense of purpose and ownership of the apprentice role may be encouraged among medical students.

 

 

Clara Bosco is a third-year medical student at MCW-Milwaukee. She is interested in the philosophy of medicine, bioethics, and artificial intelligence and works with Fabrice Jotterand, Ph.D. Director of the Philosophies of Medical Education Transformation Laboratory (P-METaL) in the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Building a New Curriculum for MCW

From the 4/2/2021 newsletter

Director’s Corner

Building a New Curriculum for MCW

Adina Kalet, MD MPH

Dr. Kalet focuses on how we must change our educational strategies to achieve the most important work we have as educators: To prepare medical students to become caring, character-driven physicians that can manage a rapidly expanding knowledge base in rapidly evolving health care systems …

As you will read in this week’s Transformational Times, MCW Academic Affairs has been engaged in a process of reimagining the medical school curriculum. 

This has been an almost two year-long, deliberative, and creative process. As part of the comprehensive Liaison Committee of Medical Education (LCME) self-study we do every eight years for reaccreditation, MCW launched small group curriculum conversations. Robust discussions in key stakeholder working groups were bracketed by two full-day retreats. We defined key curricular principles and outlined a new three-phase structure and its predominant instructional designs (case-based sessions, spiral weeks, etc.).  This is important work and no small task. 

I have also been told that MCW has had both successful and unsuccessful experiences with curriculum reform in the past. We are not alone in this, Yet, I have participated in a number curriculum renewal cycles in medical schools around the world. I can attest that our approach has been well managed. The process and outcomes have been inspiring and the team has embraced a road-tested model for organizational and curriculum change to guide their work. The principles and concepts are evidence-based and well understood. There is a nice balance between ancient wisdom (e.g., “learning from patients”) and newer ideas (e.g., Programmatic Assessment of Master Adaptive Learners). 

It seems as though everyone is reforming their curricula (again)

The LCME began accrediting US medical schools in 1942. Since then, most US medical schools have engaged in significant changes in their curriculum about every ten or so years. Lately, the frequency of major curricular updates has been accelerating toward   but has not yet arrived at   a robust continuous quality improvement process. 

In 2018, only 15% of US medical schools were either not planning or had recently implemented a major curriculum change. 35% were in the planning phase and 31% in the implementation phase of a major curriculum reform. The majority of the schools engaged in curriculum change were deliberately moving away from the early 20th century Flexnerian “2 + 2 model,” with two years of predominately pre-clerkship basic sciences followed by two years of immersive clinical experiences. On the whole, they were moving toward more integrated models where students spend less time in classrooms and more time learning the foundational sciences while mastering the cognitive aspects of clinical work. 

Curricula were forced to change as hospital practices changed

This is not a revolution, but more of an evolution. Change, however, has been slow in coming. Why is this? Plenty of schools have attempted the switch. There is ample evidence that students learn best in well-integrated curricula with early and rich exposure to the real-world applications (e.g. written cases, simulated cases, early actual patient experiences). Students demonstrate knowledge and skills when held to very high standards and cultivate their developing medical identities while supporting their well-being as future physicians. 

Change is hard because, traditionally, medical educators have been “curriculum agnostic.” When I was a resident, Saul J. Farber was both our the chair of the department of medicine and dean of the medical school. He was an absolute legendary bedside teacher who was fond of saying that the formal curriculum was irrelevant. He believed that the most important thing we could do as a medical school was choose the right “kids” and then engage them (he said, “throw them”) into caring for patients in our large inner city, safety net hospital. 

For his time, Dean Farber was not wrong, but he wasn’t right, either. In his era   what we often referred to tongue-in-cheek as, “the days of the giants” (he was chairman of medicine for thirty-two years, after all!)   people were hospitalized for weeks at a time while they underwent diagnosis and treatment.

This pace was slow enough that students and teachers could spend a great deal of time together with patients, eliciting their histories and conducting detailed physical exams and bedside maneuvers. The students in that generation before mine witnessed the “natural course” of disease processes, and were able to then spent hours in the hospital library, the laboratories, and reading rooms, reviewing radiological images and having midnight meals where cases were discussed in detail. Using a slow, deliberate, iterative process, their role models showed the students how to integrate all the material and choose courses of action. 

This held true for surgical specialties, as well. Patients who were to undergo an operation were routinely admitted to the hospital the afternoon prior to their procedure. This allowed enough time for them to undergo work-ups by the junior medical student, the senior medical student, the intern, and the surgical resident ahead of time. Postoperative patients stayed in the hospital for weeks prior to the development of rehabilitation centers and long-term care facilities. 

In that earlier era, many teaching hospital physicians also conducted basic science research. It was common (even into my era) that students would walk to the clinician-scientist’s lab to discuss the relevant physiology, microbiology or biochemistry and receive a quick “chalk talk” about the scientific principles underlying their patients’ condition and treatment. 

By the time I was a resident in the early 1980s, the pace of hospital work had revved up, and patients were either very acutely ill or hospitalized very briefly. Most diagnoses and therapeutics moved outside of the inpatient setting and, therefore, outside the view of most medical students. Science was conducted at a distance from the clinical environments. Fewer and fewer scientists were clinicians and fewer clinicians did science. To ensure adequate preparation for practice, medical schools were forced (they were reluctant at first) to create ambulatory care experiences for students and residents. This was only one of many major shifts in medical school curricula. 

Some new and some old elements will create a relevant curriculum for the new healthcare environment

Hospitals now run 24/7/365 and stress the constant downward pressure on “length of stay.” While hospitals are exciting, most medicine is practiced in clinics and community settings. New sciences have become critical to being a physician.  We are constantly struggling to keep our educational structure, content, process and outcomes relevant.  

At the same time, medical school curriculum requirements have become more and more structured and complex. Dean Farber would be aghast. Where are those “midnight meals”? Where is the time to learn through discussing cases and sitting with patients and families? It all seems hopelessly romantic and out of touch with modern reality. But I think we do better by holding firm to core principles and innovating. 

So, what are the non-negotiables elements as we move forward? 

We can protect the “baby” (integrative learning processes essential to becoming a physician) as we consider “spilling out the bathwater” (experiences that don’t lead to deep learning). 

First, we have to build curricula around the knowledge that a physician’s most profound and long-lasting learning occurs while thinking about and interacting with patients. Second, we must recognize and support great teachers who care about learning, are knowledgeable, remain optimistic, and know how to motivate. Third, we must set and hold everyone to measurable high standards. 

This is where Dean Farber got it right. Take excellent, motivated students and mix them up with great teachers with a range of content expertise and provide them with endless “clinical material” against which to demonstrate their growing mastery. Voila! Medical education alchemy. 

Engaging and caring for our stakeholders

Based on educational research and our desire to create new, vibrant approaches, we believe that a strong medical school curriculum will enable groups of students and faculty to learn by puzzling together through a wide range of cases. That is our goal. 

As we create the new educational environment, the students who are still in the current curriculum will need to be cared for and educated. They will be invited to engage in the planning for, and piloting of, new curricular and assessment elements. If we do this right, our students will be the main beneficiaries, yet some will likely feel and express discontent. 

Faculty will need to take new roles, learn new skills and feel like novices again. We will need to work closely with small groups of students across many content domains outside of our own content expertise. We will have more interaction and, therefore, more collaboration between scientists and clinicians. Those of us who are excellent lecturers will lecture on topics best communicated that way. The rest of us will learn new ways. This will be difficult for some. 

The bumps in the road will be smoothed out by working together

Like all medical schools, MCW is a complex organization with many missions and complex governance. We will need both design and change strategies as we anticipate and prepare for predictable challenges both within and without.

A strong leadership team and communication plans are emerging.  Creating and implementing a cutting edge, locally relevant curriculum will take significant effort, cooperation, forbearance, respectful debate, a wide range of expertise, and extraordinary program management skills. While I hope we will be doing a lot of celebrating, I also know this will we stressful. 

The Kern Institute will be there to support faculty development, administrative savvy, and complex and integrated assessment. In a few years, we will have the infrastructure in place to continually improve the curriculum so that future changes will be incremental rather than revolutionary. 

I believe we are long overdue for an upgrade and that the time is now. Even Dean Farber would likely see the wisdom in that.

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.

Shared Change is a Rigorous Process

From the 4/2/2021 newsletter

Perspective/Opinion

Shared Change is a Rigorous Process

Jeffrey Amundson, PhD, Travis Webb, MD, MHPE, Amy J. Prunuske, PhD, and Adina Kalet, MD, MPH

The team describes the development of the curriculum transformation working groups, reports on their recent activities, and looks forward to the Human-Centered Design approach that will clarify and accelerate the curriculum redesign …

 

Change is hard.  However, when change is a shared experience, many of the stakeholder concerns and expectations can be attenuated by communicating and demonstrating conscientious and prudent planning.  The process of curriculum change is a large-scale change that requires thoughtful organization of various stakeholders into manageable and effective teams.  

MCW is currently transforming our traditional 2 + 2 curriculum into one that integrates foundational science with clinical knowledge and skills through case-based, inquiry focused, individualized learning with an emphasis on inclusion and wellness.  To achieve this transformation, various change management strategies have been used including Kotter’s 8 Step process of change and components of Implementation Science to create a rigorous process of communication and structuring with stakeholders. 

Envisioning and building the team 

A common starting point in most models of change management is to communicate a vision of the most important reasons for change. In Kotter’s 8 Step process and similar models (e.g., ADKAR), shared vision is the foundational concept for change. 

This first step at MCW began when all course directors, chairs, education deans from all campuses, Curriculum and Evaluation Committee (CEC) members, selected education staff, and student representatives from all campuses were invited to a Curriculum Exploration retreat held on October 2, 2019.  This involved approximately 100 stakeholders who began an iterative process that developed principles to provide a foundation for medical school curriculum redesign at MCW.

The next step was to create a team of representative stakeholders responsible for coordinating and guiding teams through effective communication and activities. The Curriculum Exploration Steering Committee became this coalition, and included basic science and clinical chairs, course directors, administrative leaders, and Curriculum and Evaluation Committee (CEC) representatives. These same individuals were dispersed throughout the subcommittees to promote contiguity for effective communication and activities. Please see the steering committee and subcommittee rosters at the end of this article. 

Exploring the five principles

After ratifying the new curriculum principles, the steering committee charged subcommittees of key stakeholders to consider how to implement these principles into a comprehensive curriculum considering the complexity of the three-campus institution. Subcommittee members were recruited via email, InfoScope postings, and verbal communication. The kick-off meetings of the “Principle Groups” occurred September 9th and 10th, 2020.

A Principle Group subcommittee took charge of each of the following: 

• Principle 1: Integration of foundational and clinical science learning throughout all years of curriculum.
• Principle 2: A systematic approach and focus on assessment that drives learning and assures that students achieve desired competencies.
• Principle 3: Individualized approaches to learning that are ultimately tailored to student interest and career goals.
• Principle 4: A student-centered, inclusive culture with a focus on wellness.
• Principle 5: An evidence-based instructional approach that is inquiry driven and utilizes active learning.

The subcommittees provided monthly progress reports starting in September 2020 which culminated in final reports on January 1, 2021 (a link to the five principle group reports is available here from an MCW computer or through InfoScope). Additionally, as Lindsey Bowman, Senior Administrative Assistant for Curriculum noted, the guiding coalition efforts were a standing CEC agenda item during the 2020-2021 academic year. These updates provided opportunities for discussion at seven curriculum meetings over the 2020-21 academic year. The coalition communicated monthly with the CEC, its M1-2 subcommittee, its M3-4 subcommittee, and the executive committee. In addition, there were also quarterly meetings with the Directors of Medical Student Education, the M1-2 Course Directors and Coordinators, the Advanced Clinical Experience Committee, and the Clerkship Directors.  It is important to emphasize most of this rigorous process was undertaken while adapting to the impact of the pandemic.  

These individuals have done an outstanding job through the first steps and generated numerous short-term wins (another common component of “models of change”), including formulating a set of design principles from the final Principle Group reports (i.e., Core Content, Instructional Approaches, Assessment, and Faculty and Student Support).  These principles served as the next piece of the process to create a larger team of volunteers.  Additionally, as in many models of change, the next steps will include establishing reasonable targets and, in MCW’s case, using competencies, learning objectives, and suitable governance frameworks to reduce barriers for stakeholders to work across silos.  

The next steps

The next stakeholder teams will clarify medical school learning objectives around: 

• Patient Care and the Health Care System
• Knowledge for Practice
• Communication 
• Personal and Professional Identity 

In models of change, this represents the transition from preparation to initiation of change.  

Importantly, these proposed changes rely heavily on stakeholder input so stakeholders can learn from mistakes and adjust the process as it moves from planning to implementation (as well as adjusting during implementation).  

MCW, with help from the Kern Institute’s Human Centered Design Lab, will capitalize on this input in the next steps.  Human-Centered Design is a team-based approach to problem-solving that uses empathy to develop a deep understanding of any problem.  This allows the problem to be clearly articulated, paving the way for the brainstorming of solutions, followed by prototyping the solution that is most impactful.  This will lead to a process of continuous and intentional short-cycle iterative improvement to the solutions design. 

Much work is yet to be done, and we hope that all faculty, staff, residents, fellows, and students will engage in this exciting process to achieve sustained acceleration (a very important component of change). Given the efforts put forth so far and with a continued rigorous process, the shared experience of change can achieve a fruitful transformation.

Jeffrey Amundson, PhD is a Postdoctoral Fellow in the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education. Travis Webb, MD, MHPE is a Professor in the Department of Surgery and Associate Dean for Curriculum at MCW. Amy J. Prunuske, PhD is an Associate Professor at MCW-Central Wisconsin. 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.

COMMITTEE AND SUBCOMMITTEE ROSTERS

Curriculum Exploration Steering Committee:  

Amy Prunuske, Travis Webb, José Franco, John Hayes, Alexandra Harrington, Malika Siker, Jonathan Marchant, Bill Hueston, Matthew Hunsaker, Lisa Dodson, Adina Kalet, Jon Lehrmann, Marty Muntz, Melinda Dwinell

Subcommittee Members (Faculty and Staff):

Jennifer Hinrichs, Joe Budovec, Marty Muntz, Mindy Dwinell, Jonathan Marchant, Craig Hanke  Sandra Pfister, Lisa Cirillo, Joe Brand, Hershel Raff, Steve Hargarten, Bipin Thapa, Beth Krippendorf, Marika Wroszek, Teresa Patitucci, Allen Last, Craig Young, Jeff Fritz, Maria Hintzke, Megan Waelti, Terra Pearson, Kathlyn Fletcher, Karen Marcdante, Brian Lewis, Lisa Dodson, John Meurer, Monica Shukla, Kerry J. Grosse, Catherine Thuruthumaly, Ankur Segon, Alan Bloom, Ellen Schuman, Karin Swartz, Carley Sauter, Leslie Ruffalo, Robert Treat, Erin Green, Mary Ann Gilligan, Tavinder Ark, José Franco, John Hayes, Paul Knudson, Elizabeth Hopp, Bill Hueston, Jules Blank, Roy Long, David Brousseau, Pat Foy, Kathleen Beckmann, Brian Law, Jordan Cannon, Johnny Neist, Dan Stein, Jon Lehrman, Malika Siker, Cassie Ferguson, Himanshu Agrawal, Theresa Maatman, Kurt Pfeifer, Kristina Kaljo, Linda Meurer, Anita Bublik-Anderson, Becky Bernstein, Jean Mallett, Adrienne German, Nicholas Yunez, Travis Webb, Ali Harrington, Ashley Cunningham, Amy Prunuske, Patrick McCarthy, Adina Kalet, Ellen Sayed, Ashley Zeidler, Art Derse, Jacob Prunuske, Erica Chou, Megan Schultz, Jay Patel, Joe Barbieri, Curt Sigmund, Matt Hodges

Subcommittee Members (Students):

Kelli Cole, Mario Castellanos, Marko Ivancich, Chase LaRue, Taylor Brockman, Haley Pysick, Gopika SenthilKumar, Alec McCann, Colton Brown, Emily Nordin, Jess Sachs, Connor McCarthy; Syndey Newt, Emily Schaefer, Phil Hartfield