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IAMSE Spring 2020 WAS Session 4 Highlights

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[The following notes were generated by Rebecca Rowe, PhD.]

IAMSE Webinar Series, Spring 2020

Speakers: Luan Lawson, MD, MAEd, Brody School of Medicine at East Carolina University and Kelly Caverzagie, MD, University of Nebraska College of Medicine
Title: “Preparing Faculty to Teach Health System Science (HSS) in the Clinical Learning Environment”
Series: Evolution and Revolution in Medical Education: Health Systems Sciences

Objectives

  • Highlight opportunities for and challenges to faculty developing the skills necessary to teach HSS.
  • Identify the importance of aligning HSS curricula and learning experiences with health systems priorities and initiatives to promote successful HSS curricular outcomes.

What have you learned thus far from the previous Webinars in this series on HSS?

  • New professionalism of systems citizens
  • Value-added roles for medical students
  • Students as change agents

The idea of HSS is not exactly new. It is a study of how health care is delivered, how health care professionals work together to deliver that care and how the health systems can improve patient care and health care delivery. HSS is really innovative and is a comprehensive and holistic framework.

Remember from the HSS framework wheel of patient, family and community, that all of the domains noted are domains that have existed previously within our faculties and health care systems, there are folks that are experts in one of these individual components of the HSS framework. However, having these siloed in the various individual places does not help us with the comprehensive framework for how physicians need to be able to navigate the changing landscape of healthcare and an era in which the only thing that is certain and constant is the change we are undergoing.

What we have noted from the previous Webinars is there is a need for educational change.

  • Deficiencies in UME and GME teaching
    • Systems-based practice
    • Cost and value
    • Evidence-based care
    • Interprofessional teams
    • Safety and improvement science
    • Response to errors
  • Limiting Factor for Change
    • Lack of a critical mass of clinically-based faculty members who are ready to teach and model HSS.

Clinical teachers face complex challenges by teaching while simultaneously learning about redesigning clinical delivery systems while simultaneously delivering care and working more closely in interprofessional teams and healthcare delivery systems. Refer to Clay, MA, et.al. Acad Med, 2013.

Principles for Faculty development

  • Employ effective change management strategies
  • Employ sound educational practice
  • Accountable practice.

Let’s start with Accountable practices and then come back to the first two bullets.

Accountable practices:

  • We need to figure out how to align our educational roles, our institution’s needs, as well as, the excellence that we expect from our faculty participating in these types of programs.
  • Funding is an important component.
  • Must be adaptable

Employ effective change management strategies: (Reference: McLean, Cilliers, Van Wyck. Faculty development: Yesterday, Today and Tomorrow. Medical Teacher, 2008)

There are some things that we need to be thoughtful of and require significant planning.

  • Institutional culture and content
  • Overcome barriers
  • Market to promote buy-in
  • Involve experts in the design
  • Multidisciplinary faculty
  • Risk-taking role models.

Employ sound educational practice:
HSS provides us with amble opportunities to employ sound educational practices. HSS is not something that is stagnant, as it requires an interplay of multiple domains and multiple healthcare providers.

  • Needs assessment
  • Goals and priorities
  • Accommodate diversity
  • Use different formats for activities
  • Employs principles of adult learning
  • Create durable materials
  • Extend over time

What challenges lie ahead in the developing faculty?

  • Faculty (lack of) expertise
  • Logistics of teaching HSS
  • Evolving Health systems
  • Providing meaning to faculty

Challenge 1: Is a Perceived Faculty Lack of Expertise

  • Experiential knowledge is great
  • Functional knowledge is limited
  • Application varies by HSS domain
  • Expertise relegated to the few (e.g., Chief Quality Officer)

How can we overcome the faculty lack of experience? What opportunities do we have? Leverage Faculty Experience.

  • Embrace faculty (unique) expertise
  • Utilize lived experiences
  • Co-learning with the students
  • Expand the concept of educators, where the educator does not necessarily have to be the expert.

Challenge 2: Logistics and Realities of Teaching HSS

  • Limited space and opportunity in an already packed curriculum
  • Lack of faculty role modeling in HSS
  • Inconsistent expectations across UME-GME-CME
  • Assessment is hard

What are the opportunities teaching HSS?

  • Frame expectations for faculty
    • Understand the ‘lens’ through which the student enters the system
    • Develop the interprofessional teams
    • Focus on “Mindset, skillset, toolset” of students
    • Professional identify formation
  • Align curricular structures and assessments
    • Ensure that HSS is “valued” in summative assessments
    • Signpost HSS curricular activities
    • Role model HSS in authentic clinical settings

Challenge 3: Faculty Buy-In is Lacking

  • Topics are unfamiliar
  • HSS is not routinely rewarded in academia
  • Limited time to teach and role model due to competing demands
  • Realities of compensation

What are opportunities of this challenge: Need to provide meaning!

  • Formal incentives
    • Promotion and tenure
    • Support scholarly activities
    • Formal recognition (Can be as simple as a thank you for the Dean to a formal award such as “Teacher of the Year”
    • Diverse teaching opportunities
    • Creation of new professional roles such as small group facilitators, program leadership
  • Leverage faculty professional identity
    • Faculty learning communities and interprofessional collaboration
    • New mentoring relationships
    • Personal growth and professional satisfaction
    • Transferrable and broadly applicable skills

Challenge 4: The Health System

  • Health systems are not always viewed by faculty as a “partner”
  • Students rotate in multiple health systems
  • Health system priorities frequently change
  • Faculty priorities may not align with health system priorities
  • Uncertain future of healthcare

Opportunities here with regards to the Health System Challenge

  • Introduce reality
    • Providers and systems are incentivized to partner to improve patient care
    • GME focus on sponsoring institutions
    • Prepare students to practice medicine for next 40-50 years
  • What do we have in common?
    • Clinical and non-clinical priorities
    • Don’t “solve their (the clinical site) problem”  Facilitate their “solving of the problem”
    • Goal: Student development of background knowledge and skills
  • Engaging the health system
    • Formalize partnership between medical school and health system to enhance clinical care AND education.
    • Leverage the clinical learning environment to focus on all health professions students, residents, and fellows
    • Students are future leaders for health systems and practices
    • Increased cross-campus collaborations and IPE

What are the opportunities for your institutions?

What are we doing at ECU?
Developed the Brody Teachers of Quality Academy
Evolving and improving:

  • Educators to design curriculum
  • Frontline educators to teach curriculum
  • Clinical mentors and role models to change culture
  • Expanded leadership and team concept

    Desired program components

  • Interprofessional faculty
  • Strong sponsorship
  • Protected time
  • Problem-centered
  • Immediately applicable
  • Tangible products as outcomes
  • Faculty contributions to curricular design

    Lessons learned

  • Faculty and learners can learn together
  • Expand the definition of faculty
  • Support interprofessional and intraprofessional development
  • Teaching while practicing while learning is hard!
  • Mentoring is critical
  • Manage change and uncertainty
  • Align institutional needs and faculty interest
  • Money  protected time

What we are doing at UNMC

  • Will start with a story.
  • Start with the University (UNMC) and the Nebraska Medical Center that has always had a relationship. The relationship existed between educational units and clinical delivery systems.
  • Health System Leader: “Isn’t that (education) what the University does?”
  • Academic Leader: “What do they (hospital) care about education?”
  • Realized needed to think about this differently and over the course of several years, many transformations took place where instead of just having a working relationship, we worked to develop a partnership.

Why is the alignment needed?

  • Training competent providers require that they train in competent systems. Asch, et.al. JAMA, 2009
  • Competent systems cannot exist without competent providers.
  • Therefore, a partnership is a “win-win” relationship

Building Leader Role (Reference: Myers, et.al JGME, 2017)

  • Institutional role with focused responsibility in alignment
    • Quality and patient safety role in GME
  • Shared priorities between education and clinical enterprise
  • Need to speak with each other’s language
  • Chief “Dot-Connector”

Final thoughts

  • Different approaches and roles to achieve common outcomes
  • Different strategies for different situations
  • Embrace and manage change (process  change)

Contact information:
Luan Lawson: lawsonjohnsonl@ecu.edu
Kelly Caverzagie: kelly.caverzagie@unmc.edu