From the 3/5/2021 newsletter
Director’s
Corner
Love
to teach and recognize that learning is what really matters!
By
Adina Kalet, MD MPH
In
this issue of the Transformational Times, we celebrate the Kern Institute’s
KINETIC 3 Faculty Development program. Dr. Kalet thinks about how engaging with
a faculty development “Community of Practice” transformed her from just another
good teacher into an educator ...
I have always loved to teach. Ask my little brother about the forced
spelling lessons when he was a toddler. In high school and college, I taught
dance to peers and little kids at a day camp. But it was not until I became a
clinical teacher that I realized that it was not enough to just love to teach.
If we want to educate masterful physicians, we needed to focus on learning.
One night as an Intern …
It was the dead of winter. Mr. M was admitted to my care for hypothermia
and impending delirium tremens, a life-threatening consequence of alcohol
withdrawal. Joe, “my” medical student, followed
me to the ER. As expected, Mr. M smelled rank and was talking gibberish
(confabulating), his eyes were bright yellow where the “whites” should have
been (icterus). Vitamins had been given to stave off a full-blown
encephalopathy, and the first of many milligrams of Librium were already
flowing into his veins along with warmed fluids. Blood was drawn and sent to
the lab. The ER nurse had donned protective gear ready, on my say so, to give Mr.
M a warm water bath that would not only warm him up but also wash away the dirt
caked most prominently on his feet and to treat the overwhelming case of
pediculosis capitis (“head lice”). As I engaged with his incoherence and gently examined Mr. M, I
sensed Joe drift as far away from the bedside as he could possibly get. I was
miffed that he did not show greater interest.
Later in the evening, after ensuring that the now fresh-smelling,
no longer tremulous, Mr. M had a close-to-normal body temperature, Joe and I sat
side-by-side in the Doctors Station. I wrote the admission note and orders,
reviewed Mr. M’s extensive medical chart, and pondered the deranged blood
chemistries, his chest X-ray and the ECG. Typically, medical students overflow
with questions; Joe, oddly, showed little interest and sat quietly while I
worked.
Irritated with his passivity yet wanting to wake his curiosity to
the wonders of medicine, I decided to do some “teaching.” I walked to the green
board, took up the chalk, and began a wide-ranging lecture. I discussed alcohol
as a direct and indirect toxin, with acute and chronic manifestations in every
organ in the body. I “pimped” Joe on the physical exam findings and labs which
he dutifully reported. I pressed him to discuss why Mr. M was irritable but still
charming even while his words did not make much sense. I pushed on. Why does
he have yellow skin, tremors, an enlarged heart, a huge belly, but skinny
limbs? Why does he have few red blood cells in a wide range of sizes, altered
liver function in that particular pattern, and the irregularly irregular
cardiac arrythmia? And finally, Why does he have this the remarkable
number of ER visits, abominable hygiene and nutrition, no home, no money, no
family?
After reveling in a medical textbook’s worth of physiology,
toxicology, neurology, psychology, pathology, and dermatology – all knowledge relevant
to Mr. M’s care - I plopped down in the chair. Joe was clearly impressed. I was
jazzed, astonishing even myself with how much I could recite with great
enthusiasm and passion.
It was a fun, self-satisfying performance but, I know now, that
did not make it a great education.
Why not? First of all, I never stopped to assess what Joe already
knew, what he felt, or what he made of the whole experience. I did not discern if
he would walk away from my lecture being any more able to care for patients
like Mr. M who disgusted or frightened him. Did he now understand how to approach
difficult patients emotionally and intelligently? Would he deal with them
employing care, competence, and compassion? I had no idea.
In addition, I neither tried to understand why Joe was so passive
about learning, nor did I have a clue how to help him become a more the engaged
and motivated learner.
The next day, it dawned on me that Joe likely had a powerful
emotional reaction to Mr. M. Did he recognize a loved one or himself in the end
stage alcoholism? I did not know. Did he question his ability help in
the face of such suffering? I never asked. If true, then he could have left
that evening emotionally overwhelmed, questioning his career choice.
As a result, it is possible that my “performance” lecture had the opposite
of my intended effect; rather than filling him with knowledge, I might have
left him intimidated and less confident. Although Joe might have given me a
glowing evaluation based on the attention I gave him (not a bad thing), I
realized that, in the long run, I might have failed him.
The road to becoming an educator
After that evening, I became much more interested in becoming a
better educator. Being an educator would require me to both know a great deal,
but also know how to share that knowledge effectively. Although I still cared about
what I taught the students, I wanted to be able to ensure they would and
could learn.
It was then that one of my mentors sponsored me to attend a weeklong
faculty development program for medical educators. We worked in small groups
co-creating active learning tasks (e.g., role plays, bedside rounds, reflection
writing, and dialogue) and engaging in facilitated “personal awareness” groups.
I shared the story of my experience with
Joe, and we role played alternative versions of that “lecture.” This was a
profound experience which prepared me to return to residency as a much more
effective educator.
Ultimately, I joined the Facilitators-in-Training (FIT) program of
the Academy of Communication in Healthcare (ACH). A senior
member of the ACH faculty served as my “Guide.” In monthly meetings, she coached me to identify
my own learning goals and strategies. Together, we facilitated small group
learning at national faculty development courses where I honed my skills with
her feedback. We worked together for almost seven years, at which point I went
on to serve as a guide to others.
For over thirty years, ACH had created a community of medical
educators who share a passion for communication skills training in medical education.
ACH members have created innovative curriculum at many institutions and
healthcare systems, conducted key scholarship, published a newsletter, a journal,
and textbooks, and continued to conduct faculty development.
The value of Communities of Practice (CoP) in medical education;
Creating concentric circles
Most faculty development activities in medical schools consist of lectures
or one-off workshops. This strategy simply does not work. Instead, experts
suggest that it is best to build a community of practice (CoP) situated in
an authentic workplace (See “For Further Reading” at the end of this article or
click on the article links: O’Sullivan and de Carvalho-Filho.) A CoP
is a group of people who "share a concern or a passion for something they
do and learn how to do it better as they interact regularly.”
CoPs are based on learning theories first proposed by cognitive
anthropologist Jean Lave and educational theorist Etienne Wenger who were
studying what makes apprenticeships powerful learning experiences. At their
best, apprenticeships are complex sets of social relationships in the context
of a community which creates a living, dynamic curriculum. CoPs are organized
in concentric circles with those most intensely involved and experts at its
center. Novices initially participate in the periphery, sometimes simply
“lurking,” while listening in without engaging. Facilitators actively
communicate with and invite in those peripheral participants. Learning happens
at all levels of the organization through structured coaching relationships
among individuals. Learning is, however, most intense as individuals engage
more and move toward the center of the CoP.
This is one of my favorite learning theories, because it provides
evidence to guide the growth of our faculty development practice in the Kern
Institute.
KINETIC3 and the road to developing MCW’s CoPs
The essays in this issue demonstrate the many ways in which the KINETIC
3 program has established and is enriching a Faculty Development CoP at MCW. By attracting committed, passionate medical educators
to engage together in shared learning and practice, we are building capacity to
enhance the learning environment for all our students. We continue learning as
we tie ourselves together in learning relationships around our shared work.
While there are basic “teaching skills” components to the KINETIC3
offerings, the members of the Kern Faculty Pillar, under the Direction of Dr. Alexandra
Harrington, are building the skills of faculty that improve teaching
performance and develop impactful, life changing educators. KINETIC3 graduates
are already sharing their skills with colleagues, creating eddies that will
become the concentric circles of our own Communities of Practice.
At the Kern Institute, we hope every faculty member will consider
applying for the KINETIC3 program during their career. As faculty, we all hope to
be the best educators we can be as we share our knowledge and passions. Only
then will we engage, prepare, and support every student, even the ones like
Joe, who passes through our doors.
For
Further Reading:
O'Sullivan,
Patricia S. EdD; Irby, David M. PhD Reframing Research on Faculty Development, Academic
Medicine: April 2011 - Volume 86 - Issue 4 - p 421-428 doi: 10.1097/ACM.0b013e31820dc058
de Carvalho-Filho, M.
A., Tio, R. A., & Steinert, Y. (2020). Twelve tips for implementing a
community of practice for faculty development. Medical Teacher, 42(2), 143-149.
Adina
Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute
for the Transformation of Medical Education and holder of the Stephen and
Shelagh Roell Endowed Chair at the Medical College of Wisconsin.
