Medical Education Transitions

I have been noticeably absent from the online space over the past few months.  However, I think I have a valid reason for this.  I am excited to announce a major professional transition.  I have been given an incredible opportunity, and am excited to begin a new chapter in my career.

Beginning January 4, 2016, I will begin as the Education Editor for the NEJM Group within the Massachusetts Medical Society, which oversees the New England Journal of Medicine and other educational offerings such as Knowledge+.  This position will allow me to learn from and work with an amazing group of folks in medical publishing, and provide exposure to new opportunities for learning in healthcare.  I will work with the adaptive personalized learning product, Knowledge+, and will learn from the other journal deputy editors associated with the Review Articles within the Journal.  NEJM Group already is well established with the Journal itself, Journal Watch, Knowledge+, CareerCenter, and a new product launched in December 2015 called NEJM Catalyst that focuses on healthcare delivery.  Clinically, I will care for patients and continue to teach residents through the Med-Peds Residency at Brigham & Women’s/Children’s Hospital of Boston affiliated with Harvard Medical School, after getting settled.

This means leaving my academic home, the Indiana University School of Medicine, to begin this full-time position with NEJM Group.  I have learned so much from the incredible people there; I will miss my mentors, colleagues and friends who have taught me so much.  I will miss the CME team, who has helped me better understand how physicians and other health care providers learn.  Of course, the residency program with which I have been associated since 2002, and prior to that as a resident trainee, will always be a part of what I do.  As much as I will miss it, I leave knowing that the program is in good hands and thriving, with amazing residents and faculty!

I am excited to begin this new journey; the folks at NEJM Group have been so welcoming to me.  I will pick up my Twitter and blogging presence, and look forward to sharing my experiences with my medical education friends, colleagues, learners and mentors!

MedX | Ed Reflections

I am a medical educator and have been privileged to teach at the Indiana University School of Medicine as a faculty member for over 14 years.  I have had the opportunity to train many residents and students over the years, with the addition of focusing on faculty as well through overseeing the CME unit in recent years.  This is a privilege not taken lightly.  I feel strongly about trying to further my own professional development with respect to being the best teacher and physician I can be.  One such way to do this is to attend conferences relevant to one’s specialty.  I have attended many of these over the years, allowing me access to resources for networking and meeting other people who have similar interests.

Given my interest in emerging technology to improve patient care and education, I submitted an abstract to the MedX | Ed conference this year, and was pleased to have been accepted for an oral presentation related to lifelong learning and emerging technology.  I have watched the MedX conference via the live stream over the past few years, but attending in person—WOW!  What an inspirational two days!

There were so many different things to learn, and this short blog doesn’t truly do it justice; nevertheless, I will give just a few highlights that stick out for me.  Some were about newer technologies, such as what Dr. Neil Mehta presented on how to integrate technology with information management.  Some were about interprofessional education, which makes me excited when I see that the CME/CPD community has been really emphasizing the importance of this over the past several years.  Some were about connection and human touch (I expected to enjoy Dr. Abraham Verghese’s talk, but was inspired beyond my wildest dreams) to show empathy with patients.  Some were medical students themselves creating startup companies to improve medical education (Picmonic and Osmosis).  Some were about shifting the paradigm and creating curricula on updating topics related to medicine on Wikipedia.  Some were about storytelling (both from learners themselves and from patients; INCREDIBLY powerful), which I emphasize but am convinced I must emphasize even more [and for the record, YES, CME/CPD conferences SHOULD be providing MORE patient panels to hear more about the patient perspective].

This is truly a one-of-a-kind conference!  I thought I tweeted a lot during meetings (see my recent reflections on Tweeting the Meeting here and here, but wasn’t even close to some of the influencers in complete “status tweeticus”.  I thought I blogged quickly, but others created wonderful blog posts within hours and even live.

It was also great to meet many of these folks in real life (although I admit I could have been better).  In addition, through the power of social media related to this conference, I was contacted (while in the airport heading to the conference) for my opinion on a story about skills that physicians of the future need to have, which was published on day 2 of the meeting.  

A hearty “Thank You” to Larry Chu and the entire MedX | Ed team for putting on what I think is the most innovative conference I have ever had the privilege of attending.  To solve some of the current problems in healthcare, we need more than just doctors, and this conference delivered on describing some real solutions!  I hope to attend again in the future, and look forward to seeing and meeting new folks in future years.

P.S. Yes, my own presentation did include descriptions of emerging technology, storytelling, and how innovative methods of education can influence the learning process and potentially patient care!

Physician Leadership and Lifelong Learning

I haven’t been posting much recently, with valid reasons.  I began a Business of Medicine MBA Program at the Kelley School of Business, and have homework, readings, and assignments that have immersed me in new subjects.  I absolutely love being a student again!  The lifelong learning which I enjoy writing about is alive and well, and I feel invigorated with the opportunity to learn new subject areas with other like-minded physician students who are in this with me.  The class demographics are quite diverse and reflect different specialties and reasons for choosing to enroll in an MBA program designed for physicians.

In one course, Healthcare Revenue and Delivery, we discuss issues relevant to healthcare today.  We had the opportunity to delve into the implementation of learning healthcare systems, and also physician leadership and engagement.  Some key takeaways are critical and reflect some of the educational curricula that are being updated both at the medical school level and also at the residency level.  These takeaways are challenges faced by physician leaders of the future, but should be tackled if we are going to actively address healthcare in the current environment.

First, team approaches to solving problems usually are better than just one independent voice making decisions in a unilateral manner.  We absolutely see this in the training environment, where some trainees function at a very high level when working with others health care providers, and some need more guidance with respect to understanding team dynamics.

Second, asking questions is probably just as important as (and maybe more important than) having the answers.  This gets at not necessarily being the “captain of the ship”, but rather a facilitator of others.  Much learning goes on when leaders listen and ask questions!

Third, leaders need to leverage external innovation (partnering with others who have expertise different from one’s own) as a valuable asset to move an organization forward.  We all can’t be experts in everything!

Fourth, it is important to make the mission and vision of an organization real.  Sometimes this means saying “no” to something that is in direct conflict with one’s values.  Constant reminders of the mission are always helpful when making key decisions.

There were many other points made, but these resonated with me as important aspects to take away during our first few days.  I anticipate more posts as a result of these vibrant, healthy discussions about healthcare, including not only where it is but where it is going!  

#ITeachMedicine

I have mentioned for several years now how social media has been able to impact how I teach, and how others learn in medicine.  It has been an incredible journey to see, as I have met many folks virtually whom I would otherwise never meet.

It is also amazing how quickly information can be spread via social media.  Sometimes, this can be bad, but other times, it can be very good.  A great example of advocacy within medicine began earlier this month, with a tweet from a surgeon-in-training, Dr. Heather Logghe (@LoggheMD).  A blog which began this campaign describes early successes.  This campaign continues to grow, and has amassed an incredible number of tweets and impressions.  It is so refreshing to see stereotypes broken down, and to see the human side behind these incredible physicians.  I've never met Heather, but as a residency program director, I am impressed!

I got to thinking: the #meded hashtag (for medical education) has really taken off over the past few years due to my colleague, Dr. Ryan Madanick from the University of North Carolina, and includes a weekly tweetchat and many other tweets at any time.  #meded has even been described in the peer-reviewed literature (here and here).  How about highlighting some of the amazing medical educators out there who enjoy teaching medicine (at any level)?

So here goes: #ITeachMedicine is starting today with this blog.  Please distribute to all of those dedicated teachers who make medicine and the teaching of and within it a wonderful profession! I am a #meded ‘er, and #ITeachMedicine !!

Etiquette for Live Tweeting at Conferences

Recently, I published a paper on the topic of “Tweeting the Meeting”, along with Dr. Janine Zee-Cheng.  In that paper, we briefly discussed the topic of etiquette with respect to tweeting during conferences.  I came across this piece from a few days ago in Nature about conference tweeting.  The blog piece describes two options for the “default” at meetings.  Should the default be that tweeting is allowed (unless the speaker explicitly asks attendees not to) or that tweeting is NOT allowed (unless the speaker gives explicit permission to do so)?  I am not sure of the right answer for this, but given how common this has become, I believe that conference organizers should actively discuss this option when planning meetings, and make the default answer explicit as possible.

A problem might ensue when the default is that it is allowed, but individual speakers who know very little about Twitter are upset when they find their content disseminated via this social network.  It begs the question that guidelines or policies really should be created and disseminated to potential presenters at the time that those presenters submit their abstracts.

I wonder how many scientific associations have formal policies about this topic, and if they do, how is that policy disseminated prior to meetings?  Maybe this is an area ripe for more research, and one that should be discussed among those who plan scientific conferences.

Learning Theory and Social Media

I read this really interesting piece on learning theory for medical educators interested in the use of social media.  The authors hint that it is really important for educators to consider an understanding of learning theory when integrating social media into the learning process.  I agree wholeheartedly for many reasons.  

First, after having given a recent grand rounds (to two separate audiences) on the topic of learning theory in medical education and how technology can help, I feel that it is very important to reflect on these theories for a better understanding of why learners use (or don't use) social media and other emerging technology.  Communities of practice (CoPs) are a great way to bring groups of people together around a common theme, and virtual/electronic CoPs are catching on in medicine and medical education.

Second, it is important, as the authors mention, to consider connectivism and constructivism as key theories behind why some learn with social media (and may prefer to learn via such tools).  Using constructivism, learners should be reflective, and the teacher needs to adopt a facilitative approach (instead of being an "expert").

For the educators out there who are integrating social media into your learning methods, which theory or theories reflect why you use social media or how your learners use social media?

CME, Industry and Outcomes

Recent medical literature describes the challenges of demonstrating the impact of CME on physician learning (with a focus on the lack of impact), and the need to reform the current system.  Writers suggest that it really is not having the impact that it should, given the financial resources provided.  Others have questioned how it is funded, suggesting that it may be biased given the resources provided by industry, and that it should be changed. 

While I admit my own bias as an Associate Dean for CME for a major medical school, I feel that it is important to study the peer-reviewed literature to best understand this important topic.

First, is the industry influence really that significant?  A piece by Cervero discusses this, and found limited evidence of the impact of industry influence on CME.  In the recent ACCME 2014 report (Table 8), only 11% of accredited CME received commercial support from industry.  My interpretation of this is that the commercial support is certainly not an overwhelming part of CME programs (our own institutional data would definitely mirror this finding).

Second, what is the real impact of CME?  The same above author recently published a piece in JCEHP (full disclosure: I am the social media editor for this journal, but was not involved in any way in the creation, revision, or decision to publish this manuscript) that concluded that CME can indeed impact patient outcomes and physician behavior (the former more than the latter).

Third, improvements in how CME is disseminated should occur.  Within this realm, patients should be included, and interprofessional learning should occur in team environments; this is highlighted by the new President and CEO of the ACCME, Dr. Graham McMahon, in a Viewpoint piece in JAMA that came out online earlier this week.

So where should we go from here?  I think there are several things we can consider.  Most importantly, physicians and other healthcare providers should continue to learn in order to provide optimal care of their patients in a changing environment; CME is one way to aid this learning.  Those in the field have been thinking about how to restructure it for many years and have made major strides in focusing on quality improvement.  Second, we should also consider learning healthcare systems as a way to promote learning for those who provide care for patients.  Lastly, we should be diligent about using technology to make our learning more effective.  Examples include online journal clubs and virtual communities of practice.  Given the complexities that abound in medicine in the current environment, anything that can make the process of learning how to "keep up" and best care for our patients easier should be welcomed.