Education in the Clinical Years: Challenges and Opportunities

Uh Welcome to our webinar today on education and the Clinical Years, challenges and opportunities. I'm really excited uh for this event and to have this conversation with such a wonderful panel.

So I'm joined today um uh by three panelists. Uh I'll let each person introduce themselves and we're going to go in alphabetical order.

So, first name and last name, we're very cooperative in this alphabet alphabetization today. So we'll start with Doctor Cooley.

Hi everyone. My name is Andy Cooley and I am a cardiothoracic surgeon down in East Texas.

Um I did my training throughout the Midwest down in and then down in Dallas and was in practice for about nine years. Um when we opened a new medical school here in Tyler Texas.

So it's the latest ut uh medical school. We just welcomed their first class.

Um I have gotten bitten by the education bug, so I've actually transitioned out of clinical practice uh to being part of the leadership of the school and I'm the director of all the clinical clerkship.

So basically year three and four are completely under my purview. It's, it's extra six months in our curriculum.

We have phases a little different. But um all in all, I'm really excited about how we are using osmosis to address some of our challenges.

Um And I've been working with osmosis just over a year, getting close to a year and a half on the uh the clinical line and I oversee all of the surgical um product terrific.

Thank you, um Eric Grant. Next, please.

Sure. Thank you, Catherine Eric Grant.

I'm a pa by training. Um I trained at Wake Forest in North Carolina and was there for 16 years on the faculty at the School of Medicine there.

And then in 2020 when things were nice and calm, I decided to come to Richmond to start APA program because I've always wanted to build one from scratch the way I felt like it should be done.

And so I've been very happy to do that here, integrating a lot of adult learning techniques, osmosis and other self directed learning uh approaches which seem to be what our learners need now.

Um especially post panic as we get through that. Uh My clinical training mostly is in infectious diseases and physical medicine and rehab though I'm not currently practicing the administrative tasks.

Have me uh pretty busy at the moment. So, thank you.

I'm happy to be here and participate. Wonderful.

And Jay. Hi.

Uh Yeah, thank you. Uh Super excited to be a part of this panel.

I'm Jay. I'm currently a med student at Mayo clinic on the Arizona campus.

And I'm actually currently taking a gap here between my 3rd and 4th year to pursue a master's in medical education. Um Hence my love for this subject and my presence here.

Um and before entering medical school, I actually taught at a medical university abroad as a Fulbright scholar. And I think that's where my, my passion for medical education started.

And so I'm hoping with kind of all of these things to call me in one big uh you know, future in Med Ed. However, that may um come about, but super exci excited to chat with everyone about um you know, the clinical experience and as a learner, what it's been like and someone who wants to educate what that also looks like.

Fantastic and Chantelle since you're on screen, do you wanna do a quick intro? Yeah, definitely.

Um My name is Chantel. Um I'm the beauty marketing manager at osmosis just helping out today with the event.

Um Yeah, thank you everyone for being here hailing from Tulsa, Oklahoma. Fantastic.

I realize I really failed to introduce myself. So I'll remedy that before I ask the first question.

Uh So Catherine Johnson, uh director of educational strategy and academic engagement uh at Severe Global Medical Education Division, which includes osmosis as well as our other portfolio products.

So, clinical key student complete anatomy, uh clinical key and clinical cases. So we're super excited.

I love med ed too. So I'm really thrilled for uh this conversation.

So let's uh dive right in. I'd like to start by talking about the transition from classroom to clinic and the continued emphasis on really early clinical learning experiences, particularly in med schools.

What is the most significant challenge you've encountered in clinical education? And how have you addressed or mitigated those in your studies uh in your and in your program?

So uh j I'll let you answer that as a student, but I wanna start with uh um uh Doctor Cooley, I think with this one. Yeah.

So I think um there's a few things that are a challenge, especially with how compared to when I went to school, it was very clear cut.

You know, here's your two years of foundational science, here's your clerkships. And so there was some crossover but really not how intentional it is.

Now. Um our clerkship and or sorry, our, our foundational curriculum is actually very clinical and we've been trying to pull everything in and then on the flip side, we're building our, our clerkship.

So we're pulling foundational science into those encounters as well. So it's not just like a one way integration and then we kind of forget the, the foundational sciences later.

Um We're big believers that all that foundational science is really gonna help teach how to think, especially as knowledge just boons not to get on a tangent cause I will love it.

I'm a, I'm a big excited fan of A I, but I think we have to use it right? And being able to understand science of, to identify when it's wrong is going to be a huge part of learning in the future.

Um And that all really comes from that foundation. So getting that clinical um in early is something we're seeing in that foundational science, but the students aren't quite, you know, it's a lot to try to put foundational and clinical together right in the beginning.

So I'm excited about the newer line that it does have that framework for them that they can understand um how to get that into the earlier years.

And then when you transition over the intention is to again have that framework for either a symptom workup for that clinical reasoning or a disease.

So they can have the basic building block scope to their level. So when we were building it, we had that in mind have slowly of scoping it appropriately.

And I think that has probably been our biggest challenge of finding that sweet spot before we, you know, got in, input it out into the world.

Um because it was clinical, we all know you can go down a rabbit hole and keep going with detail and well, this may come up on this circumstance, they need to know that they need to know that.

So really starting with where it should be as then new clerkship level. Um so they learn the rules and then they can learn the exceptions to the rules in that conversation with their clinical faculty.

Um So really, this is a tool to give them that scaffolding. But then they can go on and have really good engaged discussions with their team as they're on their clerkship, seeing those things to learn the nuance and learn, it applies here, but not here because, but they have that foundation that they can work with and to have those discussions.

So long answer, I'm longwinded. You guys will catch that.

Um But really, I think the biggest challenge is that appropriate scope for their level and we work really hard to try to address that.

Eric, you mentioned how excited you were to build a program from the ground up that taught things the way you thought they should be taught.

So I'm really keen to hear your thoughts on this. Sure.

Um I would repeat a lot of the things Doctor Cooley said about scaffolding and the importance of scoping. Um The medical earners trust us to curate things appropriately in the beginning because you can't see the forest for the trees and everything's as important as whatever comes out of the instructor's mouth.

And so it's hard to know at first. So we built in a lot of problem based learning and small group learning early in our curriculum which are intentionally designed with social determinants of health as along with basic science and clinical science.

All wrapped together. So as the students start to tackle these things, it's quite overwhelming at first, which is where the curated resources come in to say, why don't you watch this video?

Why don't you read this article? Let's do a simulation about this to let you transfer those skills from knowledge as you're talking about in some of your questions today to practical application.

And so I think the rep the repetition of that process is the most important thing because it takes for all medical trainees, you know, this months and months to years to really change the way you think and approach things.

And so that proper foundation with the proper structure that's already been referenced is the way to, to start I think. And so that's what we've done in our curriculum.

Wonderful Jay, I'm really curious uh for your experience as a consumer of uh the curriculum and also as a, as a teacher as you mentioned uh outside of the US.

Yeah, I think again to reiterate what's been said, the biggest maybe um issue uh for me as a learner and maybe classmates is that gap.

Um and going from the preclinical, the clinical and viewing them kind of as two distinct phases and not having a little bit of like a blur in between that time frame.

And one of the examples II think of is um you know, going from doing preclinical foundational science and then going to problem based cases and we start getting presented, for example, with values of, of labs and things like that and, and we go from 0 to 100.

And I felt like there was never, you know, in my curriculum, let's say an example, you know, this is what this lab represents.

Let's like, define it, let's first define what these mean, what they correlate to in real practice and you know, what does a high value and a low value mean?

And then let's go to the problems where you can actually see the lab values in the case. Um So that's 11 example.

But if I were to say the, the quote unquote problem as a whole is definitely, I feel like we, we don't build the appropriate scaffolds.

Um We, we make huge jumps. Um And I'm not sure if it's like you say, for the learner, we don't know yet what we're supposed to exactly know.

But then maybe for the, the educator, we look at a bigger picture and, and can't realize that the learner doesn't know a basic thing.

And so we make these jumps. Um So how do we, I guess the question that I put out there is how do we reduce those jumps?

How do we communicate better? Um So we're not missing the basics from the forest, I guess.

Yeah, excellent. And do you have your hands up?

And this is almost a really beautiful segue to question too, but I'm gonna like, do you wanna, do you wanna go to? I don't know what question too is, but do you wanna go to that?

I don't know, competency. And he said, but if we're competency and preparedness, but let's, I'm gonna go jump right in.

Ok. So I was, I was gonna say, kind of along with that, you know, this curriculum, it, the school may skip this chunk and that scaffolding.

And what does this mean? I think um I think that's one thing that again is a challenge, especially when you're looking at an a national system, right?

Of, of what we end up with you even, I'm in involved in GME as well and you don't really know what you're gonna get until they get there.

Right? II it's, we're not all on the same page basically.

So I think one thing that was very appealing um with osmosis of why I wanted to even get involved in the first place. And then things that again, we very intentionally designed is that the videos are chunked in the small bits so they can fit in one when you're on the fly as a student.

Like I have 10 minutes, let me watch this on the way to go, you know, see this patient, but it's also chunked from an an educator standpoint where you can fit it into different styles of curriculum, but then having it linked to the foundational science videos.

So, so, um you know, we've noticed that there's, there's some apprehension of new faculty of, of people that aren't as used to being clinically or educationally involved.

They're great physicians but they haven't, you know, pulled up the Krebs cycle in a few decades. Um, you know, it'll be linked right there that they can use that as well to feel more prepared for teaching.

Um, and then all of the, the content is linked to the national curricula for each clerkship. So it's not that here, it's really heavy on cardiac um which I'd be all for, I'm totally biased but heavy on cardiac, but we're missing, you know, sarcomas.

So it, it really goes along to make sure it's something that every school should be able to have all of these bits together um and fill those gaps for the schools as well because we can't deliver all the content, but we can provide, like you were saying, curated resources to help out with that.

So, Eric, do you wanna add anything? As you're nodding?

Yeah, I'm just, I'm, I'm a classroom nodder. So you've got students in your classrooms who just kind of nod all the time.

I tend to do that, but I did have something to add, which is um something Jay was sort of hitting on, which is we call the zone of proximal development in educational theory, right?

Like what is the leap from what the person currently knows to what they can know and comprehend? And if you have faculty or curricular designers who don't really understand how those mechanics work.

It's a bit a bit like shooting from the hip in terms of where you're comfortable. Like, Doctor Cooley was saying, like, I like cardio.

So I'm gonna talk a lot about this and overwhelm the learner versus under standing exactly where they've been and then hit that zone of lily pads if you will, they need to hop along to get across the pond without getting soaked.

Um And so that's, that's something that some of the products under Elvir do pretty well actually. And thoughtful faculty designing curriculum can integrate those uh as one classroom nodder to another.

I feel you. Um But despite saying I was gonna go to competency, I think we're beginning to get to an adjacent area around active self directed learning.

So I wanna just pivot there for a moment. Um uh I'm really curious about the role of um uh our own uh our own selves in that learning, right?

And how that might look different in the clinical years than, than during the classroom years. And I'm thinking Jay about your question around, how do I know what to know um any tips you can share for learners, whether they be students or uh clinicians or residents for continuous learning in these uh in these patient cares settings.

And especially during these transition times, I'll start with you, Eric. Hm.

Let's see. So I think where I would start is what I was thinking is metacognition.

Um That's one of my favorite words to drop on medical learners, which is what we can offer as clinicians with experience and educators with experience is letting the students know how we're thinking about things.

So literally breaking down your thought process as we do in our rationales and our clinical explanations and our worksheets and saying this is how I would think about this with you.

And this is not foolproof, not bulletproof, but this, these are my biases and these are the things that I tend to see and then the things I fear, which you may also fear.

Um And so pulling that wrote knowledge blocks forward into the clinical phase and then pushing them around on the table with someone with experience so that you can begin to see the nuance.

Um I think is a, a key thing to really embrace in the clinical years today. Do you wanna go next?

Yeah, of course, this is uh something I was actually recently talking about in, in uh a class of mine as part of my masters about, you know, self directed learning strategies.

And I said, well, wouldn't it be great if, you know, when we started medical school, we had a, a, you know, a mini course or a crash workshop on, you know, what does the evidence show?

What does the research show is the best way to study and learn? And so on and so forth.

And someone pointed out to me, well, isn't that something that we should even be learning in high school and undergrad? And I was like, you're right.

It's not a medical school problem. It's, uh, it's like, I just holistically, I feel like the science of learning or these strategies are reserved for, um, you know, maybe people in psychology or neuroscience or neuro biology because it's in their domain.

But, uh you know, I thought I had is what if we, we had many workshops or many sessions on um showing people the evidence of, you know, this is what spaced repetition data shows or this is what, you know, if you do X amount of practice questions, then your score exponentially grows like this.

Um And I think that's maybe one way we get people to realize that methods that we thought worked before, like highlighting or rewriting textbook notes or reading text doesn't necessarily work.

But um II guess that's the best thing I would say is I would have loved for when I started medical school for someone to sit me down even for half a day and be like, you know, here's these strategies, you know, go out and try them.

Um instead of kind of trying to learn all of the fire hose knowledge and at the same time trying to figure out how the heck do I study the, the knowledge at the same time.

Um So if I could say that pointer II, if you're at an institution is try to integrate many ways of teaching students learning strategies and, and the evidence behind those strategies, I love evidence based education.

I do. All right, Eric.

Yeah, see your hands up briefly. Just, just to re encourage what Jay just said, that's so helpful to pull the curtain back as soon as you can and show those mechanics of the science of learning to the learners and explain learning outcomes, explain instructional objectives, explain what goals are and the science of learning like spaced repetition.

Um in terms of interleaving and different skills which can build the framework you need to do medicine learning, which is just different.

So I agree with that wholeheartedly. Uh Yeah.

So Andy just dropped to make it stick is a great book uh that talks about this. If you've not read that is, it is a uh it is a fun book.

Uh And a quick plug for those of you who may have osmosis subscriptions. There is a collection of videos within osmosis on the science of learning.

Um And at quite a few conferences just being on the heels of of the, the double AMC conference where it wasn't so much a topic.

But in conferences past around many programs really do have these learning how to learn courses built into the orientations.

Uh At the same time, I wholeheartedly as the mother of a teenager uh setting off to college fully endorse um evidence based educational and study strategies which is not underlying and highlighting in 17 different colors.

So, um yes. Right.

I do wanna now pivot to where I thought we were going to be, which is around competency. Right.

There's a lot of talk about competency based medical education. It's been happening uh for years, but I think the voices are growing louder.

How is your program assessing the competency and preparedness of students during rotations? And uh if feedback is involved in that or I imagine it is, how are you delivering feedback to students?

And uh Jay when we get to you, what is your experience of this with respect to assessments and feedback? So, um I have a little bit of a different, this is kind of my, my area where I get really, really geeked out.

So we're developing kind of a different way to do things down here. Um As a new school, we have a benefit of being able to really look at what everyone else has done and what they wanna do and you know, worth thinking are going with programmatic assessment and, and how to give, you know, so much formative feedback to really um to really induce change and that self directed learning, lifelong learning, um building that motivation and that curiosity in people is really the goal right of, of self directed learning.

So it continues through a lifetime. Um So how do we do that?

And how do we use assessment as a tool instead of just a benchmark? Um So we're looking heavily into that.

There should be a lot more to come, but we're, we're building up a different model. Um Can I talk about cats here, Catherine?

Is that ok? No, ok.

I won't go, I won't go too crazy cause I could talk like for hours about it. But so we're building a model called the clinical assessment team, which are the CS and basically doing more of um taking from the social science world where they have something called observational coding.

So we're going to embed the cats in our units to be able to have really detailed um assess assessments of workplace based assessments of our noncognitive skills, gathering feedback from our faculty on clinical reasoning on, on professionalism.

But, but defining it down to very, very granular detail. Um That's why we need an extra team to do it because no one has time for that, right?

So, um and with that, we're taking all of this feedback in a formative manner and then using it for coaching. So instead of we have a very narrow area of our shelf exam, an S and a professionalism score, that's our summative pass fail.

We have some extra things like a group or a uh AQ I project for honors, you know, that type of thing, but mostly everything is formative.

The clerkship directors actually function as master adaptive learning coaches and they get this feedback back and then they meet once a month to, to develop that master adaptive learner, that mindset of lifelong learning, whether it's through their noncognitive skills of communication and professionalism, or if it's clinical reasoning or if it's I needed time or not, it's better, you know, those type of things really to hit all of those competencies by using that very data oriented feedback.

But with the goal that it's formative, so we really wanna build them um that informed self assessment because there's so much out there showing positions to, I mean, everybody, we're terrible at assessing ourselves, you know, we think, oh yeah, I'm above average.

Well, not everyone can be above average cause it is just average. So um so this really kind of gives that that outside very standardized to minimize bias perspective.

So they can start getting an accurate view of that needs assessment um through the master adaptive learner model. So that's another plug.

I think it is all severe this time. So um the master Adaptive learner book actually has some pretty good sections on coaching and, and how to build out those models.

So it's really good. I love it.

So always on my desk. This book uh which is a plug for the American Medical Association who uh is the uh the maker of this while we publish it.

Uh oh and, and one thing to add, I think it's key with assessment but also with the, with the product in general is to really not ignore the fact of assessment burden and the teaching burden on time because right now clinicians have so much pressure to do production, understaffed.

I mean, name it across the board. Like really system issues with that having as much as people might love to teach, they don't always have the time to do it or do it the way they want to.

So coming up with systems coming up, that's one of one of the big reasons we're, we're using osmosis as a part of our curriculum.

Um And so the clinical faculty, when we get them, it's not to have them sit there and take two hours writing a powerpoint to deliver a lecture that, you know, we know that's not the best way to deliver anyway content.

So it's so when we have our clinical faculty time and attention, it is to really get that clinical reasoning, that expertise out of it rather than hashing over, you know, the history of, of cardiac surgery or something like that.

So, Eric, that's such good information. I might add that there's a important building point to think about.

And you've been through this doctor K for building this out is like, how do we link what we've already done to where we're going in the clinical phase.

And so schools of thought um in the pa a world were a 24 month curriculum, the average pa program is 27 months. So mostly we're talking about two years of time is to link the first year and the second year and think of them as one curriculum, not two different curricula.

And that usually makes a good sense. Some things are just so different in the clinical phase.

You can't shove it into the first year for us and you just put it out there. Billing and coding is a good example.

It's kind of hard to talk about that until you've seen a little bit of it ahead of time. But you can get the concepts, but then it's important for your teams to map it out.

So uh what is your end goal for the competency? How good and how autonomous should they be at the end of these educational opportunities and then set the benchmarks for time.

So at the end of the first term, they should be novice and aware that this exists. And by the third term, they should be able to hold a needle driver appropriately and maybe not put too many holes in something not supposed to put too many holes in.

And then at the end of their surgical rotation, they should be able to tie these four different knots and this subcuticular thing and do all that.

And so that's the mapping part, which takes a lot of time, but it's really important to get the experts in the room and then map out what do you expect by the end and what are the competency benchmarks?

Not just start finish Jay? I'm really curious to, um, to hear your thinking about this.

Yeah. Um, well, first of all, I love hearing kind of these innovative ideas in the curriculum space that's happening down there in Texas, maybe I should consider relocating.

Um, but, uh, you know, II have a little bit of a, a story. Uh I think a few months ago, I was talking to a classmate and we were talking about, you know, our, our clinical rotations are graded pass, high pass or honors.

And she said to me, oh, well, I honored this rotation. I don't remember which one it was.

And I said, OK, that's fantastic. And I could sense that she was super proud and I asked, do you feel like your skill set improved from the beginning to the end of that rotation?

And she thought for a moment and she said no. And, and that was it for me.

It's like I've, I've felt frustrations at times where the, the greater what we consider as the competency doesn't necessarily match what we feel like we've learned or, or what we feel that we're capable to do.

And so I personally, as a learner have felt some dissonance in um you know, well, yeah, I passed or I honored but I still feel like I can't read an EKG or I still feel like I can't do XYZ.

And so um you know, for me, it's that question of how do we align those things where um yes, we do have specific criteria to grade people.

And at the end of the day, that assessment correlates to maybe how they're gonna match into residency. But like we said, when they show up, you know, we have all these people showing up in GME coming from very different um base levels.

Um And so that's been uh a learner perspective of frustration where I feel like the grade doesn't align at all with what I wish to learn with what I wish my competency is actually at.

Um And yeah, I'll leave it at that. Yeah, I think to jump off of that, II think that's a, a huge and common issue within, within medical education and the clinical side cause we oftentimes are, are assigning grades based on proxies for those skills, right?

So there's great evidence out there that we're usually not in the room watching. You do the full H and P like that's the, you go in there and see how you do when you come back and tell me.

So half the time we're, we're grading you on your presentation skills on your note skills, but not really on how you were with that patient and what you can do with that, you know.

So I think that um I think you hit it right on the head of one of the big challenges right now. Of of kind of learning as faculty to see what we actually are assessing.

So are we actually assessing how good you're you are at reading that EKG or did we assess that you were good at giving me a presentation about a chest pain patient?

And the EKG was swept in there. So we just kinda say, yeah, you're good, you know, so or you worked really hard on this rotation, you did a great job.

So you get honors, whereas your skill level may not have changed at all or may stay at this, you know, superficial know a lot of things about a lot of things but not that depth that we're gonna need to know for clinical practice.

So I think the more conversations as a field we have about this will be really helpful to start saying like, oh wait, we didn't actually assess how good you are doing that.

We assessed how good you were about talking about it. So I think some of those the frameworks, you know, Miller's pyramid, the online framework, those type of things as we, we dive in are a little bit more helpful to use those things instead of just, you know, use them for conversation, but actually learn how to implement them um in a, in a real way, like a concrete way as it at least to start a conversation about it more.

I wrote myself a note about the culture of learning. There's been a lot of conversations I've been um privileged to be a part of around this assessment, right?

How we receive us, how we receive things, as you said, Andy, how, how we um become lifelong learners, right? A master adaptive learners um and sort of the safety of that feedback, right?

I I'm interested in uh um seeing from your program at Tyler, right? The positive impact, but I'm not told be the positive impact of pass, fail, uh pass, fail clerkships and creating safety and saying, I think I did really well, but I'm really not comfortable yet doing this other thing.

Um So really excited uh to see to see how that uh that shakes out and what that means for transition J into residencies, right?

And about coming with really great handoffs. Uh But that's probably a conversation for another day.

Um Do you have before we move to the next question? And I'm relieved that we still have some time ahead of us.

Um uh Eric any additional thoughts about this that you, that you'd like to add from the the perspective of a pa a program director.

And hm only a cultural view from what you were just saying about starting this early with students in the preclinical phase.

Get them used to self assessing and use the same language that's accessible to that level of learner that you might ask them to do later as well where it's not too overly educated or heavy, but it's got approachable language and ask them to do it and then give feedback to their peers and then get feedback from their peers and sort of build this culture of, I need feedback.

I'm gonna do a lot of imperfect stuff and A I need to be approachable so that if someone needs to tell me something, I'm open to that.

And then b if I see something, I need to give feedback, I'm not learning it. As I hit the clinical phase, I've already got skills and I know how to do feedback and I know how to invite feedback.

And I'm pretty good at that so that culture needs to start early and, and to add on the, the exact opposite side of that is faculty development um for schools in the clinical again, we, we're all trained and usually some harsh conditions.

Um your cardiac surgery was pretty brutal as far as far as culture goes. So that, you know, it's the traditional is a very fixed mindset.

So if you admit, you don't know something, you know, that is weakness and that is your terrible, you know, that's, that's the old thinking and we all know that's not great for learning.

It's not great for the profession, it's not great for wellbeing. So these are the things, the culture now is shifting, but there's still a lot of people out there practicing that that aren't going to these webinars and aren't, you know, going through kind of this more progressive mindset.

So really as the leaders in the education space in your institution, taking the time to explain, it's not just a, it's not just a generation thing where these, you know, these gen Zs can't handle it cause that's how a lot of times it's perceived.

It's like, no, this is what a growth mindset can lead to. This is how we know neuroscience and learning science, it actually improves outcomes.

It makes that critical thinking better. It's gonna make them better.

It's not just, you know, the new fangled way to do things. So, um I think that faculty development is, is a such an important piece.

So we don't agree wholeheartedly of getting things ready and going on the student side from day one, that this is the culture, we're, we're breeding but make it.

So when they hit phase two, it's not just or sorry, we call it phase one, phase two, clerkships that it's not this all of a sudden, they are just getting slammed with even asking a question, you know, those type of things.

Um overall, we have to look at that whole system which is, is tough. Yes, thank you.

Um Yeah, part of that I think is also the professional identity formation, right? In that we, that we collectively have to model um model these behaviors.

And it, it is a challenge. It's a challenge I think for, for all of us.

Um So let's talk about some, some fun things, those feel a little daunting, right? Um Could each of you share an example of innovative teaching methods or technologies that have proven effective in enhancing your clinical education experience uh for students and or for faculty, whoever wants to start can jump right in.

So I have one that was I've used, you know, where our students are still up and coming. So what I use with the general surgery residents, um you know, as I mentioned before, I'm pretty passionate about keeping that foundational science through our clinical decisions.

Um So finding a way to um to make sure you're integrating that in their clinical decision. So II came up with for uh like I was in the Harvard Macy uh program.

And so my project was to build uh something called the adapt framework um to, to develop uh adaptive expertise. Um So basically, anytime you identify a clinical question, um you stop and so it stop and adapt.

So you stop and say, oh here's a question and a is associate some foundational science with it. I mean, it could be OK.

I have this going on with a valve. Let's talk about gradients.

That's what I'm associating. Uh two is uh the D is to describe, so describe that foundational concept.

We're gonna go high to low in any gradient, high pressure, low pressure and there's probably some point of resistance somewhere.

So what's that physiologic equation and describe that A is how the second A is how it applies to the clinical question. OK.

If we have this gradient, there's a high pressure going to a low pressure, there's a high resistance in a stenotic valve.

Then that changes the gradient this way that changes the pressure in the chamber, blah, blah, blah go on. Uh P is then predict.

So if we start changing those physiologic variables in the scientific concept, how it, how let's predict what would happen clinically with that patient.

So if uh resistance was worse, so the radius gets smaller, higher resistance, what would happen to that patient? Well, there'd be higher pressure in the ventricle.

It go back in the atrium um and go back in the lungs and then we'd have some pulmonary edema. And then finally, the last is tea is uh transfer.

So transfer this physiologic concept to another body part or another system. So you start making those links of when you know.

Ok, well, this is, you know, it's still the same physiology of if it's like an or a restrictive lung disease or a restrictive heart disease, it's still all about gradients and resistance.

Um So that was a way to, to start having student or start having the residents. Um you know, you can stop and ask those questions, but actually to start teaching it.

So when they're reading through something, I had a resident who was an, an intern and she was really struggling um just being overwhelmed and not being able to put the pieces together.

Everything she read was like a new topic, you know. So it's just like, oh my God, there's just so much.

But when you start looking at it this way, it's like, no, all these things follow this rule and so she could start putting that together when she was reading something, she'd just write a little adapt for it to start seeing in that encapsulation of how things fit together.

So I love that. Thanks for sharing.

That's cool. I can do two things really quick.

Um One agree with Doctor Cooley about structured approaches that teach the dynamic integrations of things. We know that we link things together, like the dual coding things that they do with videos and osmosis, which is so cool, it helps you learn and retain that stuff.

So yes, integrate that. And then we try to do that in our problem based learning groups where we use a fixed hypothesis generation approach to make sure the students are thinking about how to generate hypotheses across multiple organ systems all the way from the beginning.

So even if you can't think of anything hematologic, you're challenged to do so every single time so that you start to build that framework of, I'm not going to let my biases inform too heavily what I'm learning.

And then the second piece is engaging students on medical education topic techniques where I was before at Wake Forest, we built a certificate program that pa students MD students, C RNA students and pharmacy students could enter for free.

And it was based on some of the work um at Johns Hopkins and their med ed uh master's program they have up there cause a few of our faculty had done that program.

And so we built the certificate program that allowed students to explore a cold cycle Miller's pyramid. How does learning work?

All that good stuff? And they in their clinical years kept talking to us about how powerful that was.

They were saying things about now that I understand predictive value now that I understand bias now that I understand these things I get why clinicians were saying this is how we do it.

But there wasn't always that connect in the clinical training space, but it started to connect once they learned the foundational pieces.

That's neat. Thank you for sharing uh sharing that.

Um Jay, any, anything in particular for you. Um Either innovative things that, that you've used as a, as a learner or a pure teacher um or ones that you've experienced as part of your program.

Um Yeah, I mean, I love all of the, I guess third party resources and platforms out there. You know, for example, sketchy is really great for microbiology and pharmacology and just uh osmosis, of course, um something that I uh haven't experienced personally but have heard about and which was integrated in my curriculum is Escape games or Escape room games.

Uh, I think I first was exposed to that at a, a med conference. Um, and, uh, they do, they set up Escape Room games for their clinical foundations where they'll have, you know, every, at the end of every block like Renal, they'll, um, kind of have their students run through the med school and try to solve clues and puzzles and games that are, that are focused on those particular concepts and topics.

And um I just think that um students would love that and it probably does take a lot of work and effort to create it. Um But it's a way to really get curiosity and engagement flowing.

Um And another thing I broach is, um and that might come up a little bit later in the conversation is obviously a A I and, and Chat GPT.

Um You know, it has been a boom in the recent half year or so, maybe in that students are becoming more aware of it, but it's been fantastic to explain concepts or clarify confusion um or, you know, something that you might just purely not understand, you don't know the small differentiator between the answer B and C.

Um And even just something that I've been doing is running through with it to, to simulate a patient. I'll just ask it to be a patient uh like present with a random illness and allow me to talk to you to figure it out.

And um that's helped me a lot um in that whole, you know, how do we build differential diagnoses, especially if you weren't taughtt a specific framework.

How am I supposed to get my mind to like, think about this broad differential? Um So I would, I would recommend that um because it just generates so many new patient scenarios for you that you can just practice with at any point in time.

Um I get really excited talking about A I. So again, I will try to hold myself back for, for learning tools, not just, you know, productivity.

A lot of people think of it, you know, like as a surgeon uh like how do I make this email not sound mean like it'll rewrite it for me, which is very nice, but um and fully recommend 10 out of 10.

Um but for, for learning uh in the clinical space, it actually that keeping in mind you have to check it cause it will lie, right?

Cause it, it was trained originally off of Reddit. So you don't wanna be a Reddit level doctor like you wanna, you know, get stuff, but it is great for generating the where I need to go.

Great for saying here's my learning objectives, write me five N BM E style questions for each lo to get an idea of the type of questions that would be asked.

Um It may not have the right answers but then that's also you thinking of, did I get the right answer? Is that right?

It, it's, it'll stick better when you're like, no, here's why that's wrong. Like you, you have to know it even better to understand when A I is wrong.

So that's the thing there clinical setting though. It is really good about mapping out templates for you.

So if you are going, you're on neuro rotation and you're like, oh my God, I really wanna shine. I wanna make sure I don't miss any single part of a comprehensive neuro exam.

You can say hie pt write me a consult template for a patient presenting with a stroke while I'm in on a neurology rotation and it will give you all the headers.

You need to make sure you're hitting same thing with an operative note. If you're told, hey, you need to dictate this or you're going in on this surgery tomorrow on your surgery rotation.

Hey, give me a dictation of, of coronary artery bypass graft times four and it will give you all of the steps of that surgery, right?

Cause it's, it's uh the template for it. So you're obviously not, you know, performing every step.

You're not putting that by God. Don't put it in the record, but it's giving you this is every step you're gonna need to think of and you're gonna be seeing in that surgery.

So when you can cognitively kind of read that, then add hands, add the whole, you know, um immersive setting, that stuff's gonna stick way better.

So that's something that, that A I is great for and ready now for. So there's uh also this week, like two days ago, they just had some big announcements that now you can actually put, if you have a PDF, you can put that in the prompt um for GPT four.

And then basically you can ask it questions. So you can put, if you had a whole textbook, PDF, put it in there, then you can ask it the questions and it will only draw from the textbook instead of drawing from Reddit or wherever else it was trained on, you can make sure it's only drawing off of your data and that's of the last, as of the last couple of days.

This is just coming out. So I know I'll stop.

That's cool. I did not know that.

So, thank you for sharing. Um Are you uh one of our questions is uh from the, the audience from uh uh Khaled Qi is, do you think students uh in school are more tech savvy and more adaptive to new self learning platforms than the senior faculty who often try to keep new self directed resources at bay?

Um Erica, let's start with you and I'm curious, I'll, I'll maybe start with what my former um uh dean said at the medical school when we integrated IC as the um medical record system there.

She said, um and this is her not me. She said everybody over 40 hates it.

Everybody under 40 is fine with it like they, they have no issue. Now, that was her statement.

But I think the point is echoed in the question, which is we tend to use what we're comfortable with and we tend to resist change most of the time.

So if you have uh age irrespective, um if you have someone who is an early adopter, um who is into new technology and into those spaces, you kind of hope your educators are uh to some degree, then you can see a lot of that happening in the educational drip down into the curriculum.

But oftentimes we've been in medical schools, there's uh I'm gonna pick on Doctor Cooly, there's a cardiothoracic surgery lecturer who's been doing it for 25 years.

Um And nobody's gonna change that. Uh And that's gonna be how that goes.

And so I think it's case by case, but on the whole, our younger folks are certainly more tech savvy. It just doesn't mean they know what to do with it in the learning space.

I think that's the big question. Yeah, I think there, there is a generational difference.

Um And it not just opinion wise, I think that's pretty well documented what expertise used to be and what it is now. So it used to be the holder of the information you studied you knew it, it's in your brain.

Whereas now information is everywhere. Right?

So it's, it's not special to have the information. It's special to exactly what you said, know what to do with it, to curate it appropriately, to be able to manipulate that information into something, to choose the right decisions and things like that.

So the definition of what an educator expertise has, has changed and that's, that's hard to really, um, to really define for, for some people on the older space.

I think the thing that I that's helped me get the most traction with that idea of people like, OK, I'm getting it now. Um especially, you know, and even in, I'm like mid as, as sad as I am, I'm not the young generation anymore.

I'm like the the mid career. But um of how fast information doubles in the medical space.

So basically the amount of medical knowledge the world has doubles every 72 months. So compared to when I was in medical school, they, there was only 1/16 amount of what is known now and there's no way I could keep up with that or teach it right?

Because it's just exploding the thing that's really crazy. And this was pulled out before TT GPT and A I just got released on the world last year.

Um They were estimating in a few more years when A I came, it came early, but when it came, it, that information would double every 18 months.

So basically, we, there's no way we can keep up with all the medical knowledge to be able to teach it. By the time you're getting ready to teach it, it probably has changed already at this point.

So having the third party resources to help supplement that and take that burden off. So you can stay on the very top of, of where you are instead of kind of rehashing the historical stuff.

And this is the you, I mean, all, all the stuff that goes in every powerpoint and you know, all of that instead of spending your time there, spend your time here on this part and, and even with those changes that I wanna make sure we know too on, on the stuff we're building on osmosis, that's why we don't put things like here's the guidelines, here's the current guidelines and that's why it is in this um you know, in this script, in this um decision making tree because we know they're gonna change, it would be an outdated video in a year.

So we actually have a link out all the time of saying here's the most updated guidelines over here on the side to make sure that it's going to the most updated version for those decisions.

Um But I think that's, it's just such a different step generationally but understanding how expertise has changed and how the world has changed and this is to keep up with it is pretty important.

Thank you. All right, we have 10 minutes left just for a, a time.

Jack here. Uh I would love to hear.

I don't wanna answer for you. Uh doctor that you think it's a I, but what's the most exciting thing on the horizon for you as you think about educating the clinicians of the future?

Um And I'd love to hear from all of you. So let's do Andy J then Eric.

Yeah. So II think A I is but because it's a tool to do the things we need to do, I think it's a tool to bring humanity back into medicine instead of drive it out of medicine.

Um I think it's a tool that we can improve access to health care. That's all quality health care instead of just like you're gonna get what you get cause there's no one else to give it to, you know what I mean?

So I think A I as a tool is exciting but I think where we're going um As far as the, the idea that we're building physicians that have a mind of making sure we have care that is personable, that we care about professionalism and communication and how we treat our teams and to make sure there's access to care and D EI and all of those things.

I think that is the most exciting and that's what got me out of the clinical space is to help build that um compared to what it has been seeing what it could be, I think A I is the tool, one of the tools.

But I think the fact that this is a new kind of generation of where we're going with, with health care and treating people like human beings, I think is great.

Absolutely agree. J yeah, I think I would have to say A I as well.

Um And just, I guess two points is um one i in speaking with faculty and whether it's, oh my gosh, there's these third party platforms and resources or there's this A I thing.

Now, um there's a lot of fear I feel like in faculty, like this will take over my job. If I don't lecture, then what am I supposed to do?

And I've tried to kind of communicate well, isn't it more fun if you get to engage? You know, like, what if we talk through a case together?

What if we like do this higher level application and teaching together and you let the other, you know, things that have already been invented, take care of the things so you don't have to rehash.

So II feel like we need to take the fear out of being replaced with excitement for what is to come. Um And then the second fear with A II would say is uh you know, um talking about assessing whether the information is accurate or people just copying and pasting or plagiarizing and so forth.

And I go back to our traditional methods when we were taught in high school how to write a paper. Uh, you know, we were taught how to critically appraise resource versus, and find proper evidence.

And I think that's just what we need to teach people as well as how to now critically appraise the output that's coming from the A I, it's not any different than how we appraise articles that we read or textbooks or whatever it may be.

So, um focusing on the critical skills that um the critical thinking skills and the appraisal skills and the evaluation of what we should and shouldn't use is an even higher level skill than, than just um you know, uh copying and pasting from A I.

And people need to realize that that's what we need to hone on and not just altogether saying this is illegal or we're just copying.

Um So, Eric, what about you? I can't improve on that.

I have the same notes here and I think taking the fear out using it. Um thoughtfully, I have a colleague who's at the LMU, who is using A I and instructed it to play the role of 1/4 year medical student in an interprofessional conversation about rural health access.

And um it was really neat to see the output of that in terms of the bot actually only responding when it was supposed to um playing a certain role to allow I pe to happen when maybe it would not otherwise be available.

So, really interesting to think about how you can teach it to do more than just produce things for you. That's super cool.

That is really cool. All right.

We, no one said the word joy, I don't think. Um or maybe you did um Jay, but I think the power of sparking joy in educators, right.

There's wellness matters, wellness matters for all of us and um where we can have deeper human connections. And I think that's really critical to all of us being well and the wellness and health of our planet and patient outcomes and all of those things that um that we care about.

So if there are tools that can help get us there, I think uh we, we should embrace them. Um All right.

Last question with our last four minutes. What advice can you offer to educators and institutions looking to foster innovation and overcome challenges in clinical education and start with you, Eric?

Mm OK. So I'll be really brief advice is find the champion uh in your program who's comfortable with technology and who just needs a push or needs a catalyst or needs a little bit of advice and help getting moving.

It's kind of like finding the right person for your policy and procedure committee because you don't just wanna put anybody on your policy and procedure committees.

You want the right people on those committees. So like this, if you're looking to foster and it's not, you, you're a little fearful or you're not sure your bandwidth doesn't allow, don't give up on it.

Find the person in your group who can be the driver and then give them the platform and the resources if you can to let them innovate, take a chance, throw in something, new, design, something and see where that goes.

Jay, how about you? For me, it would be to find ways to integrate um learning theory, adult learning theory for both your learners, uh your, your uh undergraduate medical learners, graduate medical learners and your faculty.

Um If we can do that in little bits here and there, I think that would make huge strides in, in our professional lives, but also our personal lives.

Thank you. So I think in general, I found clinically um Q I uh even educationally a lot of times it's not a lack of ideas and a lack of solutions, it's a lack of being able to implement them.

So I think that's, you know, really frustrating. I think that's where burnout a lot of times comes from is like we can change this, we can make it better and then it just hit a wall over and over.

So I think that something that's really given me um more success in that, in that area, whether it's clinical administrations, whether it's school administration, combination of all the above um is to try to bundle solutions together.

So if you can figure out what the pain points are for the people who would tell you no, and somehow make your renovation also fix one of their problems.

Uh It works a lot better. So um uh I'm trying to think of an example.

So for Q I, right, II wanna improve the the quality from a community level hospital up to a university level with our new school, right?

Q I is a huge topic. So what we're weaving it into the systems based practice in our curriculum, our honors, you do AQ I project but still problems.

What happens? We have all these Q I projects that still have to go through the whole clinical process, right?

So I'm like, OK, what can be a value add for this clinical administration to wanna do all this stuff for our students? Well, you know, university, we can pull supply statisticians, we can supply these different things.

So it turns into kind of a bigger project but you're, you're doing things that are taking care of their problems. So they see the value besides like, oh it's another, you know, academic thing and that's the the academic snobby people want this if you're solving their practical problems as kind of the tool to make your goal happen.

I've had a I mean, there's some crazy projects going on down here like that cats program to say, guess what we're gonna pay for these people so that it takes off that assessment burden for the faculty.

So they don't get emails all the time to finish their bubble sheet. You know, they get to sign off on the narrative right there in the moment.

Yeah, I said that sign done and they get back to work, they see their patients. I mean, they're like, yes, let's do that.

We have more people signing up because they don't have to get emailed to death. Um So finding those pain points, I think is my very long winded answer and incorporate those into your as part of your solution for your innovation.

I love that. Um And I just wanna acknowledge there is a question from Shika Hill around a is there a virtual or formal education for clinical faculty to explain basic teaching concepts?

Uh both basic and advanced concepts. Uh We answered that in the chat a little bit adjacent.

See adjacently, thanks to Chantelle. There is a link to a free course called uh Fundamentals of Teaching and Learning in health Professions.

Jay, this gets a little to yours around. What is the science of learning and how can we do that?

So I invite you to check out that, that link there. Um And the code F TL Fundamentals of teaching and learning F TL free uh will make it no cost for you uh and your faculty.

So thank you all for joining. I wish we could talk for another hour.

This has been really um really thought provoking and really fun. So, thank you all for your time.

Thanks to those of us uh who are joining. Yes.

Uh Co Harvard Macy has an amazing course. It sounds like Eric that your program has some really uh really amazing certificate uh course as well.

So check out those resources and we will hope to see you next time. Thanks everyone.

Thank you.