The Power of Active Learning and Engaged Learners - Dr. Amin Azzam, Faculty Engagement Coordinator at Osmosis

Hillary Acer: Hi, I'm Hilary Acer. Have you ever wondered how medical, nursing, and other health professional students acquire, retain, and apply the huge amount of information they need to learn, especially at a time when it's estimated that medical knowledge is doubling every seventy-three days? Well, we're going to explore that question today with an expert in learning science and medical education who just happens to be a longtime Osmosis team member, Dr. Amin Azzam. 

His official title is Faculty Engagement Coordinator, but that doesn't begin to capture his broad impact on the success of Osmosis or his constant efforts to support fellow team members, faculty, and learners and how he serves as a role model for our core values. In all of this, he brings his expertise gained through earning a medical degree and two master's degrees, being a practicing psychiatrist, and serving as a professor at three Bay Area universities where he pursues and teaches innovations in learning science...and one of those universities just happens to be my alma mater, UC Berkeley. 

So, thanks so much for joining us today, Amin. Glad to have you here.

Dr. Amin Azzam: It's a real privilege and a pleasure. Go Bears. And thanks, Hillary, for having me on the podcast.

Hillary: Great to have you, Amin. So, of course, I know a lot about you, but for our listeners, what would you like to add to that very brief description and what got you interested in

medicine and psychiatry in the first place? 

Dr. Azzam: Yeah, let's start with sort of the origin story there of my exploration in health care. So, when I was in college, I did some summer research lab stuff with a lab that was doing work with monkeys and they had touch-sensitive computer screens. We were looking for medications that could improve their memories in service of eventual patients with Alzheimer's or other memory-robbing conditions and that's what really turned me on into the possibility of going to medical school. I applied to and didn't get into MD-PhD programs, but got into med school only. I became interested in psychiatry during med school. 

As many of the listeners will know, med school in the US is four years long. The first two years

are predominantly in the classroom setting. The last two years are predominantly in clinics and hospital settings. So, during my psychiatry rotation, I was on the psych consult liaison service. That's the part of psychiatry that is consulting on other patients in a hospital. Let's say somebody has a heart attack and they look depressed. The internists would say, “Hey, Psychiatry, come see this patient of ours and tell us if you recommend starting an antidepressant. I was really fascinated by the mind-body connection and how our physical health was affected by our emotional health or mental health, and that's what really turned me on to psychiatry. 

Then after that, I came to the San Francisco Bay Area for my residency, fell in love with the Bay Area and my wife, and I've happily been here for a couple of decades now. 

Hillary: Wow. What a story. I know you and your wife are actually about to celebrate your 100-year, I don't know if we call it an anniversary, but... 

Dr. Azzam: Birthday.

Hillary: Birthday. There we go. So, the combined birthday celebration. Congrats to you both. 

Dr. Azzam: Thank you. Yeah, we're excited about it. 

Hillary: Awesome. Amin, part of your role today is educating students and also educating faculty on how best to teach and engage your students in virtual settings and in the classroom setting. I'd love to dig in a little bit since many of our listeners are teachers or instructors or faculty. What are some of the key concepts and methods in learning science that you rely on in your own teaching? 

Dr. Azzam: I'll start actually with a couple of short phrases that we use at Samuel Merritt University, where I'm a simulation educator. In the simulation-based education space, we believe that learning is active, that learning can be fun, and in order for that to be true, it has to be a safe space for learning. There's some evidence-based recommendations from the simulation community around how you create those safe spaces for learning. I think those first two things are really important, though. Learning is active and learning is fun. So we want to create spaces where our learners are actively engaged rather than passively recipients from knowledge on high, right? 

So old models: lectures are such an ineffective mode of learning because you're just sort of pouring knowledge into an empty vessel and theoretically filling it up like a pitcher of water, and that really has long since been shown to be one of the least effective strategies for ensuring learning. It's really teacher-centric. So, anything that you can do to make learning active is going to be extremely valuable. Then, learner-centric strategies for educational models where the learners are driving their own learning can really maximize the value of the time spent synchronously. 

So, I think I'll just start with that and see where you want to go from there.

Hillary: Yeah, maybe from there we dive in a little bit more to your students that you teach. I'm curious, what changes or what impact have you seen in using these more active and engaging teaching models with your students? 

Dr. Azzam: So, another story. When I was in residency and developing my interest in education, I met a colleague who was one of the curriculum developers at the Berkeley Joint Medical Program. The UC Berkeley-UCSF Joint Medical Program is like a regional campus

of UCSF. The students are on the Berkeley campus for the pre-clerkship years, but they're all simultaneously doing master's degrees in health and medical sciences as well. That curriculum is entirely problem-based learning. PBL is an active, student-centric form of collaborative learning. 

I think that watching those students be enthusiastic for learning medicine was eye

opening for me. At first, when I heard about this Berkeley wacko model with half a medical school where the students drive their own learning, I was totally skeptical. But the scholar and researcher in me said, let me gather data before I pass judgment. There was a one-way mirror observation space and that mentor of mine, Kevin Mack, said to come watch. So, I sat behind the one-way and watched these students leading their own classroom, small-group learning and  it was just palpably infectious how excited they were to learn medicine. And I was like, wow, this is really powerful. 

So, I think that is an example where learning from students about what works for them can be a very powerful teaching tool for teaching the teachers how to be more effective teachers. 

Hillary: That's really interesting and a great segue because part of your work at Osmosis is helping other faculty get creative around their ways of teaching and obviously rely on some of the evidence-based models that have already been tested. So, can you tell us a little bit about your work on faculty engagement with Osmosis and some of the things that you've engaged in with our teams? 

Dr. Azzam: Yeah, as you heard, I developed my interest in medical education, and now more broadly health professions education, quite early in my career. I had a chance to go back and do a master's in education, which again, sort of helped prepare me to do the work of faculty development. As I've advanced in my career and I’m further along now, my mentorship can be around junior colleagues who are engaged in health professions education careers or in which that's a portion of their professional identities. It's been really fun to sort of expand that -- not just in faculty development at my three health science universities that I work at -- but also now with the larger Osmosis community.

So, earlier on, I would work with some early adopting schools that were exploring using Osmosis or sort of partnering with us with our resources and say, “Well, now how and where are we going to embed these resources?” Be that the videos, be that the question bank or the study tool. Formally talking with faculty around curriculum development got them thinking not just creatively, but innovatively in ways that they could see using these tools and resources. It's one thing to just buy it and say it's a resource, use it on your own students, and it's entirely another thing if you think about embedding it in the class. 

Here’s a concrete example: if you love the videos as a faculty member, you might think, “I'll just let the students watch them.” But a more appropriate strategy might be -- or a more effective engaging strategy might be -- to collectively watch the video in the lecture hall and pause it at any time you want and narrate sort of your own perspective building on top of the video. Or you can say, “If anybody has any questions at this moment, I'm here to answer them.”

So, now you've got students that are watching the video synchronously while being in the classroom with the faculty member to sort of deepen, broaden and extend the learning. That would be an example of some faculty development work where I'm brainstorming with faculty about your local context. How are you going to use these resources that you've invested in? We want to maximize the utility and the value of them...and other things like that.

Hillary: That's great, Amin. I think that work has helped engage more students, probably hundreds if not thousands of students around the globe. I'd like to take a little bit of a turn into something that you've also disrupted in the Wikipedia space. One of the ways you first connected with Osmosis was through your 2013 New York Times article about the importance of using Wikipedia as a learning resource. Tell us a little bit about how you've engaged your students on Wikipedia and changed the conversation around using that resource. Maybe you can describe a little bit about what that involved and what you met along that journey. 

Dr. Azzam: I'm so glad you asked. This is a really a passion project of mine. The story behind that New York Times article is I had a med student of mine who was doing a master's in Public Health at Berkeley. He paused during his med school years to do the MPH. We were hanging out on campus having a coffee date, and he said to me, “Amin, why are you fighting us as faculty in Wikipedia? We all go to it first because it's written in a way we can understand and it's available everywhere. Why don't you help us make it better?” I always like to acknowledge Dr. Mike Turken because it was his brilliant idea - I  just happened to be far enough along in my career to both listen to my students' wisdom and operationalize his idea.

So, when I learned about all the back infrastructure that exists within Wikipedia -- the WikiProject Medicine community, who are all dedicated volunteers interested in improving the quality of health information on Wikipedia -- I realized that my unique opportunity was as a faculty member to create a formal course of some kind or an assignment of some kind at UCSF. 

At first, I wanted to embed it into the Doctoring 101 course Intro to Patient Care. It was too wacko crazy an idea at the time to get my co-directors on board. So, the only way I could embed it in the school curriculum was to create a fourth-year elective as a month-long immersion rotation. In hindsight, that turned out to be wonderful because the students who were really interested in helping improve Wikipedia and give back to Wikipedia were the ones that signed up for the elective. As fourth-years, they also had a lot of knowledge but hadn't forgotten how to speak English because they're not so far along that they've forgotten that the quality of communication is really important. The words you choose really matter. 

So, we were the first med school in the United States, if not the world, to create an elective, credit-bearing course dedicated entirely to improving the quality of health information on Wikipedia - and that proved a sexy topic. The New York Times called and interviewed me and Osmosis co-founder Shiv Gaglani read that article. Shiv cold-called me, he reached out to me about it because Shiv and his co-founder Ryan Haynes were crowdsourcing their classmates for

content creation -- formative question banks for their classmates initially in anatomy and then other subject areas -- and I was crowdsourcing med students as content creators on Wikipedia. So, it was a lovely intro to Shiv and learning about what he and Ryan were trying to do and it made sense to just collaborate and to explore crowdsourcing as a teaching and learning strategy, both within Osmosis and within Wikipedia. That work has grown and grown and grown through the decade I've now been at it. A number of other medical schools through the Osmosis network initially have created Wikipedia editing assignments or courses or electives and we've seen it expand to other health professions as well. 

The movement, as I like to call it, has really grown and grown. The Wiki Education Foundation, a nonprofit that is dedicated to the marriage between Wikipedia and academia, provides all sorts of resources for faculty interested in creating Wiki editing assignments and they aggregate the schools that do these courses into what they call campaigns. So, we have a campaign of students in the health professions that contribute to Wikipedia in their formal classroom settings and I'm just pulling it up right now and I can tell you that today, Wednesday, June 28, there have been 157 courses and 2,400 health professional students worldwide have added 2.42 million words, 29,100 references, and 245 images to articles that have been viewed 88.2 million times since those students contributed to the articles. 

It's just really powerful just to see an entire movement seeded and to appreciate that health professional students want to do good in the world. This is a way where they can maximize their capacity of doing good in the world and also prevent the spread of misinformation. So, it's a real passion of mine and I'm thrilled that I continue to have the opportunity to do this work with the Osmosis community as well. 

Hillary: Wow, Amin, congratulations on the impact. I had no idea the numbers were that huge. 88.2 million views. That's incredible. As a non-health professional, I know that whenever I feel sick or something, I'm going to Google or to a search engine to look up my own symptoms and to try to get more information and often one of the first resources is Wikipedia. So, we know patients are going there. We know medical students or health professional students are probably going there as well and to give them an opportunity to both learn about the conditions they're editing as well as help to teach others and educate others -- we haven't even touched on the accessibility of that content -- but that's a huge impact. So, thank you for that. Thank you for making that content more reliable and accurate and for disrupting the education space a bit. 

Dr. Azzam: Yeah. And thank you to the Osmosis community too, for also helping maximize the capacity to spread the word. Sometimes, like intermittently, I'll give webinars to convince people to do this work and the faculty that will join, they'll be like, “Whoa, I had no idea this was going on. What a novel idea.” And I'm like, “It ain't novel. I've been doing it for ten years. You just haven't been paying attention to innovations.” I have to do that in, of course, a less pointed way. I have to invite the team to join this movement. It really is exciting to work with faculty to see their “ah-ha” moments and to help them appreciate that when you do things like this, strategies like this, it's a triple win. It's great for the students because they learn something deeply; it's great for you as a faculty member because your students are engaged in enjoying the work and you have fun teaching again; and of course, it's great for the readers of Wikipedia, who choose to get health information there. So it's like, why is it not everywhere yet? It just makes sense to me that we need to evangelize some more.

Hillary: Well, on that note, Amin, if somebody is interested in getting involved, how do they get involved if they want to start a Wikipedia editing course or if students want to get credit

for this? 

Dr. Azzam: So, the first resource is the Wiki Education Foundation (wikiedu.org) the nonprofit spinoff from Wikipedia that does this work and they're going to have all sorts of resources online from online training modules that students and faculty can engage in, to a whole learning management system to embed the course or the assignment in, and then, of course, faculty like me who are happy to do individual consultations to brainstorm strategies to embed it. Do you want it to be with early learners? Do you want it to be with later learners? Do you want it to be across professions? Do you want the students to create new content or to edit existing content? There's just so many resources there. 

One more plug about my favorite tool. With the Wikiedu dashboard, they had to create their own learning management system because all of the existing ones don't play nicely with Wikipedia yet. But what their tool allows you to do is, as a faculty member, you can see every edit each student makes. It back highlights the words written by your students. So, it makes it much more similar to a class assignment rather than the wild west of Wikipedia where you don't know who's editing and who's doing what. You really can track everything your students are doing. You can track their adherence with any sort of Wikiedu produced modules that you want to ask your students to do. It's just really powerful.

Hillary: Let's hope we see a few more institutions and faculty and students engaging in that work. We have been excited to have you engage our student communities actually in this work. I think we've had a few dozen students go through that course with you who are part of the Osmosis Medical Education Fellowship program, which you've been a part of for a long time...a long-time mentor and advisor to our students. 

Today we have about 150 medical and nursing students around the globe doing various activities on their college campuses, hosting events on everything from wellness, and hopefully soon emotional resilience type events, to volunteer events, blood drives, and study sessions. They're doing a lot of great work. I'd love to get your take on the Osmosis Medical Education Fellowship (OMEF) and some of the work that you've done there, including the volunteer activities like Tarjimly that you've gotten our students involved in. Maybe you can speak a little bit about that. 

Dr. Azzam: You bet, sure. The OMEF-ONSA (Osmosis Nursing Student Ambassador) program now, as it is currently named, was a wonderful brainchild early on in Osmosis...the realization that this is a global network of health professional students and it would be useful to have it to build community across schools. The program initially was only medical students and now medical and nursing and soon to

be broader health professions will be included as well. 

The idea is it's a subset of students that are really committed and dedicated to a lot of the Osmosis values and to doing good locally can learn from each other and build community around best practice, tips and advice around not only maximizing the education of your classmates but also growing as a community of student leaders as well. 

For me, it's a chance to sort of -- I'm going to say this a bit tongue-in-cheek -- three universities is just not enough for me. I need more universities to mentor students at, right? So, the three that I teach at here, but also now a global network of amazing young professionals in development. It's been very, very fulfilling to do that work. A plug to any other faculty who are listening: if you're interested in getting involved with mentorship of students across the globe, the OMEF-ONSA program is always looking for additional mentors to help develop these young professionals. So, a plug for that. 

The work that I've been doing with students beyond their local context -- the Tarjimly project you mentioned, for example -- is an opportunity to partner with other nonprofit health-related individuals or organizations to continue to maximize doing good. Tarjimly is an app for real-time interpretation or translations for individuals who are refugees, asylum seekers, or others in need...immigrants who don't speak the language in the country that they're currently engaging in.

The kind of help that Tarjimly can provide includes legal, but also health-related stuff. For example, you may be an asylum seeker in another country and you don't speak the language of the healthcare provider. What we need in those situations is real-time interpreters who are what I call trilingual: they speak English; they speak another language -- or worldwide, it can be any two languages, any two language pairs -- and then the third language is the language of healthcare. You've got to be able to understand the term myocardial infarction and translate into another language so that the individual who's seeking healthcare understands the words the health provider is saying. 

The Tarjimly project is one in which we've been working with OMEFs and ONSAs to develop an in-app assessment tool to assure that volunteer interpreters are truly trilingual. We've created common scenarios that an individual who's an asylum seeker or a refugee might be experiencing and the OMEF-ONSAs recorded the audio question stem. So if you will, they're playing the patient who's saying, ‘I've fallen and I have this headache’ and then the applicant candidate has to listen to that audio file in another language, interpret it into English and record the answer for the test. Then we have a cutoff score to ensure they are deemed to be sufficiently health knowledgeable to do no harm. Then, we can have this global network of volunteers for Tarjimly and, again, do large social good in real time. 

Hillary: Such an important initiative. For all the medical or nursing students who are interested in getting involved in projects like that, or in working with amazing faculty like Dr. Azzam, you can certainly apply. If you just go to the osmosis.org careers page, you can check out all the student opportunities that we are hoping to have you join. 

We weren't going to talk about this initially, but it happened a few years back and I want to make sure we cover it based on the Tarjimly conversation and helping those around the world in need. You were instrumental in the translation project with our Syrian students. Can you talk a little bit about that project and what it led to? 

Dr. Azzam: Sure. So, Osmosis videos were all originally in English. I know we're doing some language expansions today, but in the earlier years a lot of health professional students would turn to the videos, especially in war-torn areas where there was a sudden loss of additional resources. When Syria experienced civil war, a lot of the medical students there were struggling to continue their studies. There was a community of students across three medical schools in Syria that agreed to translate the videos or at least subtitle them, if you will, into Arabic. 

I think full credit goes to Shiv, again...other leaders in Osmosis heard about this and were like, “Well, we need to give away the product to the students because it's such a valued resource and they're doing this volunteer service of transcribing the narrated videos.” So, in exchange for the subset of students who are volunteering to do those interpretations, Osmosis gave away the whole product to all the medical students in Syria across all the medical schools. It's a really, really powerful example where it's about, again, doing good in education beyond quote-unquote merely making money. 

I was involved with the effort to tell the world about that by writing a scholarly manuscript and so the two co-student leaders and I drafted something that was eventually accepted to The Lancet, which is a top tier journal, demonstrating the proof of concept of this idea. I hope that we can do similar work in other languages where we can work with other student volunteers who are trilingual in healthcare, English, and a third language where we can continue to invite them -- since they loved the video so much -- invite them to also sort of spread the word to other students who might benefit from the subtitles in another language. 

Hillary: Definitely. And we're seeing some technologies help with this as well, but it certainly does not always capture the healthcare language, as you mentioned, so there's still a need for that human oversight today. I really appreciate the work that you've done on that front. 

Dr. Azzam: I'll just say your point is really well taken. We're in this explosion of generative AI right now. You may have heard of this term of “hallucinations” where generative AI will make up things that don't really exist. They'll even make up references that don't even exist. So, I think in healthcare we want to lean into the tools, as well as make sure there's some sort of content expertise to vet what generative AI is doing. But that's another example where I think we want to innovate by using the tool rather than being afraid. 

It's exactly the same thing as what happened with Wikipedia. Instead of sort of shunning it and saying, no, I'm going to say, let's think about how we can use generative AI -- both within Osmosis and Elsevier, but also within individual medical schools and health professional schools -- to maximize learning, right? So, instead of saying, ‘you can't’ to students, we're going to say ‘you can’ and let's talk about what you noticed that did and didn't work.

Hillary: Definitely. I think several of us at Osmosis are excited about the future of generative AI in augmenting learning. Certainly not replacing any of the tools or any of the important faculty or the human care side of things either, but finding ways to, you know, make inefficient things more efficient or make it better in some way.

So, Amin, we've talked a lot about your work in disrupting education and teaching and learning, as well as volunteer work around the world. What we haven't touched on too much yet is your background in psychiatry and all of the work that you do around emotional resilience and helping to train people and educate people around how to be healthy and really take care of their well-being in a world that is quite stressful and constantly changing. I'd love to know a little bit about the work that you're doing in that space. 

Dr. Azzam: Yeah, sure. So, I am a psychiatrist, as you said, and my clinical work is psychotherapy groups for patients living with chronic medical conditions. I define that as anybody with active symptoms and no cure. I really love that work. The groups are incredibly powerful because people learn from, about, and with each other and I create a psychological safe space for that to occur. 

When the throes of the pandemic were really at its worst, there was a lot of emotional distress, as we all know. Our department decided we needed to support the frontline health care workers by offering some emotional wellness and support services to prevent fatigue and burnout and exhaustion. Psychologists and psychiatrists in our department were offering those services on Zoom free of charge to the UCSF employees, and I came to realize that that didn't need to be restricted to UCSF. 

I was a member of the Osmosis community, and Osmosis employees were also struggling emotionally in their own contexts. So, I was thrilled to export the four-week cognitive behavioral therapy groups that I had offered for UCSF employees to Osmosis employees. I'd never done anything like that before because it was sort of more within an employer setting rather than a healthcare environment and I know that you, Hillary, were very involved with helping me decide in partnership that, “We're not offering employee mental health services, here. Amin’s not a shrink. Well, Amin is a shrink, but he's using his shrink knowledge to sort of do emotional wellness work with employees. 

So, we've done several rounds of that. It's been very fulfilling. I just finished another round earlier today, before this interview, with eight more teammates and it's really fulfilling work because people realize they're not alone at work. They realize that we're all humans at work and that it's okay to be human and by supporting one another by being human, actually it makes the workplace a healthier environment. So, yay for emotional wellness. 

Hillary: We are so lucky to have you leading those groups, and I've personally benefited from them. So, thank you for offering your time and expertise and just warmth and good human nature to help us get through what has been a very tumultuous few years. 

As we wrap up, I think what we'd like to cover is advice that you have for folks in the healthcare world, whether those are students or maybe folks that are just getting started in their practice. Any advice you'd like to offer our audience before we close up? 

Dr. Azzam: There's a phrase that I haven't quite perfected in my own utterances that I've more recently been reminding my students. At the end of any small group instruction -- it's harder to do in large groups -- but at the end of any kind of educational experience I've had, I like to invite people to do one of the following three things: one, identify one thing they learned today, or in the session; two, identify one thing they remain curious about; and three, identify one thing they're going to carry forward into their practice. I used to just limit it to one thing they learned, but then my med students get nervous, and then they try to one-up each other, or they're worried that it wasn't big enough. So, by broadening to the three categories, I create space for us to go wherever is cognitively most salient at the moment. 

The phrase that I haven't mastered yet in my own utterances is about the curiosity one. What I'm trying to figure out how to say is that curiosity is this environmentally-sustainable, never-ending fuel for learning and if we remember to lean into our curiosity, we grow and we learn. And it's just wonderful, really. So, I remind any learner listening and any faculty member listening and any staff member listening...let's remember to remain curious as that environmentally-sustainable fuel for human growth. 

Hillary: Well, the energy that you bring to your teaching and to your psychiatry work, Amin, is contagious, and you can definitely feel how curious you've been and needed to be as things have changed over the years. I think that's great advice to our audience. 

Thank you so much for your time, Amin, and thanks for being with us today. I think we'll go ahead and wrap up with that question, unless there's anything else you'd like to cover. 

Dr. Azzam: I'll wrap up with what I started with. It's both a pleasure and a privilege to be on the podcast with you. Thank you so much. 

Hillary: We appreciate you, Amin. Thanks again for being with us today. I'm Hillary Acer. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.