Reported by G. Robert D’Antuono, MHA
I had the good fortune to hear a presentation by Graham McMahon, MD, MMSC, President and CEO of the Accreditation Council for Continuing Medical Education (ACCME), on the emerging challenges in medical education during the virtual AHME Spring Institute last May, 2021. Nearly everyone in medical education today is challenged to master new, more effective ways to train medical students and residents and to provide continuing professional development to teaching faculty. Dr. McMahon, a skilled thought leader and clinician educator, has impressed us with his traditional and novel concepts and methods to teaching and learning. An endocrinologist by training, he is a passionate educator with experience at every level across the continuum.
The COVID pandemic has created opportunities and challenges in medical education: virtual learning has now become the standard method for learning and engagement. We are now better situated to enable blended pre- and post-learning activities, and faculty can be more flexible in curriculum development and planning. Dr. McMahon presented five concepts deemed to be innovative and effective educational practices:
- Fundamentals of learning. If you think about what distinguishes our learners, medical professionals are experienced learners, competent leaners, they can retain information well, and they are curious for more information. They are motivated to achieve mastery yet challenged by a busy, stressful environment that may mitigate learning. More importantly they suffer from a lack of feedback which leads learners to believe that they may be more competent than they actually are. As a result, there is a tendency for learners to become complacent and have difficulty achieving mastery. Mastery of learning can be achieved via carefully designed and managed curricula, as well as adopting assessments with actionable feedback and steps toward improvement. Dr. McMahon stressed that clinicians are in fact motivated to achieve mastery and are especially responsive to comparative and constructive feedback. Fatigue, cynicism, and burnout interfere with learning and must be mitigated.
- Case-based learning. Social learning can be used to explore cases. It is a cognitive process that takes place in a social context. It can occur purely through observation or direct instruction and in the absence of motto reproduction or direct reinforcement (Bandura). Barriers to learner engagement can be significant. For example, environmental distractions (noise, pagers, crowds), fatigue, low attention span of the learner, overconfidence, ambivalence or lack of motivation, and an overall group mentality regarding the case experience. To mitigate these barriers, case selection is important. It should be interesting, meaningful with an achievable goal. Perhaps the case can be formatted to offer an individualized offering and build on prior learning. Offer hypotheticals. Making the case collaborative and a rewarding, positive and fun experience also help enhance learner engagement.
In summary, the keys to case-based learning are: to clearly articulate the intent of the case; topic must be relevant to the learner; be of appropriate complexity; be discussed in a safe manner (e.g. “Which tests would you order?” rather than “What’s the correct test?”); and conclude with feedback and resolution from the faculty expert.
- Team-based learning. A social construct for learning is important as we are in a different world with so many clinicians and staff involved in the care of one patient. The care of patients is increasingly interdependent upon a different range of professionals. Each member of the team will remember different things about the patient. Team-based learning is less efficient, however, the broader input from the team typically results in a better outcome due to the unique insights of each team member. Teams also reinforce and leverage human needs and when they are constructed to work well. Such as our need for belonging, esteem, and safety. We must move to an environment that is improvement focused rather than efficiency focused and is psychologically safe for team members to express themselves and accept feedback. Teams fail due to inadequate communication, lack of team infrastructure, authoritarianism, hierarchies among the professions on the team, inadequate attention to people and their needs. All these serve to create a negative learning environment for a team. Ensuring team diversity is essential as well to gain different perspectives from different backgrounds.
- Adaptive learning. Adaptive learning leverages both sophisticated and simple education technology tools. Educational technology means that you can be more efficient via individualized and adaptive learning plans. You can connect and compare learner groups. There is now evidence that online learning is more efficient. Gains in knowledge, skills, and attitudes occur faster than through traditional instructor-led methods. Online learning is more flexible and can accommodate diverse learning styles. The best of all, online learners have demonstrated increased retention rates, better utilization of content and better achievement of knowledge, skills and attitudes as previously mentioned.
- Faculty strategies. Faculty must push learners into a new learning zone which assures psychological safety and accountability. They must feel responsible for creating a learning environment that is positive. Faculty must have administrative skills, leadership skills and know how to understand how a learning environment promotes learning and well-being. The competency skills of learner feedback, scholarship, professionalism, assessment, program evaluation, remediation, clinical teaching and the science of learning are essential for all teaching faculty.
In summary, Dr. McMahon emphasized that powerful learning experiences can be engineered using available technology. Knowing your learner; building trust; incorporating assessment, feedback, active learning and using a team as a learning unit, are key to the medical education process.
Resource: For a copy of Dr. McMahon’s slides, click here.
G. Robert D’Antuono, MHA is emeritus Assistant Dean for CME, formerly the Winthrop University Hospital Campus for SUNY Stonybrook SOM, now NYU Long Island Medical School, Mineola, NY and Co-Editor-in-Chief, SACME CE News.