IAMSE Spring 2018 WAS Session 1 Highlights

In case you missed the March 8th Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

The Importance of Nutrition in Physician Performance and Well-Being
Presenters: Angela M. Cheung and Maryam S. Hamidi
March 8, 12 PM ET

The Importance of Nutrition in Physician Performance and Well-Being

  • Improving physician dietary habits and hydration is a novel approach to supporting wellness and preventing burnout.
  • According to a 2017 AMA survey, the burnout rate for physicians had increased to 51%, up from 40% in 2013. Conservative estimates show that physician suicide rates in the US are between 300 and 400 per year.
  • Physician burnout negatively affects patient care.
  • Emergent studies demonstrate a link between nutrition and physician performance.
  • Physicians report that inadequate nutrition and hydration impact their work performance.
  • Diet is important in brain health.
  • High cognitive demands require proper nutrition for optimal performance.
  • Physicians identify the following barriers to healthy eating: lack of nutrition breaks, limited healthy food options in the workplace, limited food storage and eating areas in the workplace, prioritization of clinical work over self-care.
  • Nutritional strategies for improving short-term cognitive performance include: hydration, meal timing, meal composition, meal size and strategic use of caffeine.
  • Hydration enhances the nervous system. Dehydration can impair cognitive function and mood modulation.
  • Coordinating meal times with one’s own circadian rhythms optimizes nutritional effectiveness.
  • Thoughtfully balanced meal composition and portion control can enhance cognitive and functional performance.
  • Nutritional strategies for increased alertness include: eat larger meals before 10 pm, eat light snacks after lunch that contain protein and carbs, hydrate often, drink coffee or tea (caffeine increases core body temperature), chew gum (improves blood flow to the brain).
  • Sustainable individual and institutional interventions are needed to support and improve physicians’ nutrition.
  • These nutritional strategies can be applied across all health professions.
  • Taking care of oneself leads to better patient care.

For more information on the next session or to register, please click here.

#IAMSE18 – Plenary Speaker Highlight: Christina Puchalski

The 22nd Annual IAMSE Meeting is just around the corner, and we would like you to get to know some of our keynote speakers! We have five plenary speakers this year, and we hope you enjoy their presentations.

Christina Puchalski: Connecting to Our Call: A Profession of Service and Love [George Washington Institute for Spirituality and Health]

In this talk I will cover what gives meaning to us as MDs— being in relationship with our patients, accompanying them in the midst of their suffering, and then our reflection rounds program which help med students reconnect with their call to serve by reflecting on their patients.

For more information on Dr. Puchalski, please click here.

Be sure to register for the 2018 IAMSE Meeting! The Meeting will be held at the Green Valley Ranch and Resort, just outside of Las Vegas, Nevada on June 9-12, 2018. Registration may be found online here.

We look forward to seeing you there!

IAMSE – ScholarRx Student Grant Information

The International Association of Medical Science Educators (IAMSE) is pleased to announce the “ScholarRx-IAMSE Student Educational Research Grants” Program, developed in partnership with ScholarRx to promote student participation in medical education research. Up to two (2) student grants will be awarded for up to $2500.

Applicants will need to have a faculty mentor sign off on the proposal confirming that all policies will be met. Proposals must be accompanied by a letter from an appropriate institutional official confirming that the institution will pay to send the student to the IAMSE meeting the year following project completion to present the results of the proposed work; timing of the presentation is flexible as to be appropriate for the completion of the project.

We encourage faculty members to forward this message to their students. Applications are to be submitted on the submission page found here by 11:59 PM Eastern Time on March 31, 2018.

Students who are enrolled in a degree/certificate program (such as BS, MS, PharmD, PhD, MD, DO) at a school or institution are eligible for this grant program. Persons with advanced/terminal degrees (such as postdocs, PhD, MD, MBA) who are employed in their field, or who have faculty appointments, are not considered to be students. The recipient needs to be an IAMSE student member in good standing. However, ScholarRx will generously provide a one year IAMSE membership to non-member student grant applicants at no cost.

All information regarding the ScholarRx-IAMSE Student Educational Research Grant Program, including the application process, eligibility, proposal format, and evaluation criteria, can be found on the IAMSE website here.

#IAMSE18 – ESME Program with Ron Harden and Adi Haramati

IAMSE is once again pleased to offer the very successful, AMEE-sponsored course: Essential Skills in Medical Education (ESME), led by two distinguished educators: Prof. Ronald Harden, University of Dundee and Prof. Aviad Haramati, Georgetown University. The ESME course requires a separate registration and is held on a full day prior to the IAMSE conference, continues with special discussion sessions during the conference, and concludes with a full afternoon on the final conference day.

This course explores numerous themes including: learning outcomes and curricular planning, teaching and learning methods, assessment strategies, educational scholarship and the teacher as a leader. The course is ideal for faculty educators who are eager to learn about the principles of health professions education or for seasoned individuals interested in exploring new ideas and trends. Upon completion of the ESME course (with certificate), participants are eligible to enroll in the IAMSE Fellowship program.

Have you registered for the 2018 IAMSE Meeting? Don’t forget that the Early Bird Deadline is April 1st! Be sure to register before then to receive the reduced rate. Register online today at

We look forward to seeing you there!

#IAMSE18 – Plenary Speaker Highlight: Stuart Slavin

The 22nd Annual IAMSE Meeting is just around the corner, and we would like you to get to know some of our keynote speakers! We have five plenary speakers this year, and we hope you enjoy their presentations.

Stuart Slavin: Medical Student Mental Health: Challenges and Opportunities [Saint Louis University School of Medicine]

Educators have increasingly recognized the problem of poor mental health of medical students. High rates of depression, anxiety, burnout, and suicidal ideation appear to be endemic and begin in the pre-clinical years. New programs are being implemented to address this but to date have largely focused on individuals and their capacity to manage stress with approaches such as mindfulness and resilience training. While these interventions are appropriate and much needed, they may be insufficient. The situation needs to be viewed as an environmental health problem and efforts should be made to try to reduce the toxicity of the learning environment itself. This presentation will describe the approach and outcomes of a multi-faceted, integrated program implemented at Saint Louis University School of Medicine focused primarily on the pre-clinical years designed to improve student well-being that could serve as a model for change in other medical schools.

For more information on Dr. Slavin, please click here.

Be sure to register for the 2018 IAMSE Meeting! The Meeting will be held at the Green Valley Ranch and Resort, just outside of Las Vegas, Nevada on June 9-12, 2018. Registration may be found online here.

We look forward to seeing you there!

IAMSE – Publications Committee MSE Article Review

The Publications Committee provides another review of an article in Medical Science Educator (MSE).  This month’s publication by Roman, B., Hayden, C. & Parmelee, D. (Wright State University Boonshoft School of Medicine), entitled “The Effectiveness of Engaged Learning: 8 Years of TBL in Internal Medicine and Psychiatry Clerkships”, used the paired t-test to compare two TBL clerkships and three teacher-centered clerkships on the basis of NBME test performance. The original research article is cited in Medical Science Educator, September 2017, Volume 27, Issue 3, pp 475-479 and can be located online at Team-based learning (TBL) was devised by Dr. Larry Michaelsen et al. at the University of Oklahoma in the early 1970s for courses in business school to allow class time for students to master problems in small groups and eliminate lectures. In each TBL session there is an advanced preparation assignment (individual pre-work), both independent and group readiness assurance tests consisting of 5-20 multiple choice questions, termed IRAT and GRAT respectively, and “team-based” clarification and application exercises that relate one or more problems with specific choices.  Although TBL has been demonstrated to improve academic scores in pre-clinical medical school courses, including anatomy, molecular and cell biology, etc., there are few studies on the use of TBL in the clinical curriculum. In the above cited Roman et al. manuscript TBL was incorporated into both the internal medicine and psychiatry clinical clerkships during the third year of medical school.  Whether the TBL system caused an improvement in final NBME subject exam scores for each clerkship, when compared to “teacher-centered clerkships”, was investigated over a period of 8 years. The results provide evidence that students enrolled in the two TBL clerkships produced higher scores than the traditional teacher-centered modalities, when compared to the norm of national scores on the respective NBME standardized exam over a period of 8 years. The authors conclude that a TBL curriculum at their institution provided a sustained improvement over teacher-centered clerkships.

IAMSE Winter 2018 WAS Session 5 Highlights

In case you missed yesterday’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Competency Based Education Across the UME-GME Continuum: the EPAC Program
Presenter: Deborah E. Powell, MD
February 8, 12 PM ET

Education in Pediatrics Across the Continuum (EPAC): a pilot program that seeks to establish a model for competence based-medical education (CBME) through variable-time, meaningfully assessed demonstration of competence across the continuum of undergraduate and graduate medical education using pediatrics as a test specialty.

EPAC was never intended to be a model or all medical education, but rather a model to prove the feasibility of CBME.

Why Pediatrics?

  • American Board of Pediatrics was involved innovation initiatives and was interested in considering time variable advancement.
  • Pediatrics and surgery had been identified in previous studies as two specialty areas where a relatively high percentage of students could remain committed to the specialty throughout medical school.

EPAC in a Nutshell

  • 4 cohorts of medical students (up to 4 per cohort) at 4 participating medical schools would be selected before their first clinical year and offered a pediatrics residency position at the institution at that time.
  • EPAC curriculum designed by a school team which included pediatrics clerkship director, pediatrics residency program director and EPAC faculty director
  • Data collected on cohort students and non-cohort peers interested in pediatrics
  • Longitudinal outpatient pediatrics clinic with designated preceptors begun in Year 2 or 3 and continued into GME
  • In addition to required school specific assessments, a common assessment system will be used for all EPAC students (core EPAs, specific pediatrics EPAs and milestones as well as common standardized tests) with specific uniform thresholds for advancement to GME
  • 8 of 12 students in cohort 1 met the threshold for advancement to GME during the first semester of their fourth year in medical school in a time variable progression
  • 3 students in cohort 1 left EPAC during or after their first clinical year using the pre- designed opt-out path
  • Students are being followed in GME in comparison with their non-EPAC peers

Curriculum is different at each of the 4 schools participating in EPAC (University of California, San Francisco, University of Colorado, University of Minnesota, University of Utah)

Consistent for all four Schools

  1. Longitudinal continuity pediatric clinic, beginning in Year 2 or 3, extending through all residency
  2. Residency slots guaranteed at each school when a student is selected for an EPAC cohort
  3. Emphasis on pediatrics throughout curriculum (early pediatric clinic experiences, service learning projects, summer “internships” after Year one) starting in year 1
  4. Each school agreed to take 4 annual cohorts of students with up to 4 students per cohort. First group of students entered medical school in 2013


  1. Third year LIC in Minnesota and San Francisco (MN LIC is pediatric centric)
  2. Selection of final cohort at end of Year 1 in Colorado, mid-Year 2 in Utah and Minnesota, end of Year 2 in San Francisco
  3. Special pediatrics clerkship and other pediatric focused clerkship experiences in Utah

Year 1 – EPAC Explore

  • Students are introduced to pediatrics and to the EPAC program in a variety of ways in the different schools, including pediatric interest groups, targeted sessions with pediatric faculty, school service learning projects, etc.
  • MN offers a summer 2-week internship in pediatrics with a general pediatrician

Year 2 EPAC Focus and EPAC Match

  • In EPAC Focus students are offered different activities in each school which immerse them more in pediatrics as a specialty – these may include focused pediatric physical exams, evening sessions with pediatric faculty, etc.
  • EPAC Match is the selection of the final cohort. All schools have an application process that includes interviews.
  • One school (CO) selects candidates at the end of year 1 so phases are accelerated

Since all of the clinical years at the four schools are different, the 3rd and 4th years are from the University of MN model.

“Year 3” and beyond University of Minnesota

  • Longitudinal Integrated Clerkship (LIC)
    • Meets the requirements of all the standard core clerkships with exception of the sub-internship
  • Up to 12-month prototype but time-variable depending on student achievement
  • Transition Phase Curriculum:
    • “Preparation for residency” experiences focusing on inpatient medicine
    • Includes required sub-internship (NICU) and pediatric hospitalist “sub-internship”
    • USMLE Step 2 CK and Step 2 CS
    • Enrichment:
      • Time-variable experiences tailored to address specific competency areas requiring further development
  • Pediatric Residency at the University of Minnesota (GME)

Guiding Principles about Assessment

AAMC Core EPAs and EPAs for a general pediatrician are the framework for the program – we focus on 5 of the Core EPAs in particular which are mapped to the corresponding pediatric EPAs

EPAC students will meet all of the school and LCME graduation requirements


Common learner assessments for all EPAC sites will be performed Advancement according to demonstrated ability that results in entrustment will be the primary criterion. Learner progress in the program must be based on performance against specific outcomes (the competencies as demonstrated through certifiable or Entrustable activities), not only on time. Have agreed on specific

EPA milestone level (3a) for progression to residency across the 4 schools

Specific outcomes Individualized progress

In addition, in order to assure the entrustment needed for advancement to GME, the EPAC group decided to evaluate the core EPAs in a variety of clinical settings

Well care
Simple acute illness
Chronic care, single disease
Chronic care, complex
Urgent, emergent or escalating care

There are 17 Core EPAs for General Pediatrics. Five for the Core EPAs for entering Residency were matched with the corresponding Core EPAs for General Pediatrics.

Core EPA #1 matched with Core EPA for Pediatrics #1
Core EPA #7 matched with Core EPA for Pediatrics #2
Core EPA #9 matched with Core EPA for Pediatrics #4
Core EPA #10 matched with Core EPA for Pediatrics #5
Core EPA #13 matched with Core EPA for Pediatrics #7

Assessment: Summative

  • Each continuity preceptor also completes quarterly summative assessment of student on the 13 core EPAS
  • Can display each preceptor’s data, average and self-assessment over time for any given student

Assessment Clinical Competency Committee (CCC)

  • Quarterly: September, December, March and May
  • Modeled after residency CCCs
  • Committee composition (at MN): EPAC leadership team and continuity preceptors
  • Reviews all assessment data for each student
  • Reports de-identified ratings for each student to APPD LEARN database to allow tracking of student progress over time from all schools

CCC provides:

  • Longitudinal, developmental, individualized assessment
  • Feedback given to student in individual meeting with EPAC course director
  • Shared with preceptors

Program Evaluation

In addition to individual student assessment, we are working on evaluating the EPAC program across the 4 schools.

Goals are to address the following issues with a variety of methods including surveys, site visits and focus groups and for a varied group of stakeholders (including faculty, trainees, regulatory bodies and funders):

  • Feasibility – can we do it
  • Fidelity – can we do it equally well at all sites
  • Safety – will we do no harm
  • Significance – professional identity, burn-out, etc. using standardized survey instruments and controls

To date seven students have left the EPAC program

Why is EPAC Working?

  1. Dedication of the medical educators involved with the project
  2. Willingness of students to trust and experiment with something new
  3. Support of regulatory groups – in particular:
    American Board of Pediatrics (ABP)

Continuing Work

  • We are continuing to follow our EPAC students in GME and compare them to their non-EPAC GME peers (Stemmler grant)
  • We need to show that our EPAC students are at least comparable to their non- EPAC peers in their progress through GME and into fellowship or practice

What Can We Learn from EPAC (and projects like EPAC)

  • Regulations can be flexible for pilot projects
  • When (how early) can students make lasting decisions about career choice? How are those decisions made?
  • Better definition of readiness for residency
  • Can we assess “competency (clinical competency)” accurately
  • Can we move trainees into and through residency “early”? Is four years of medical school necessary?
  • Can we redefine the “generalist” education of medical school?
  • What do we really need out of our UME tracks?
  • Can we develop more pathways/choices for our students?
  • What are the long-term effects of these efforts. Better? Worse?

We hope you’ll join us for the Spring WAS series, which begins on March 8! For more information or to register for the Spring WAS, please click here.

#IAMSE18 – Featured Member: Amina Sadik – Site Host

The 22nd Annual IAMSE Meeting is just around the corner, and we would like to introduce one of the 2018 Site Hosts, Dr. Amina Sadik of Touro University Nevada:

I first joined IAMSE during the 2007 Conference in Cleveland. Hence, I have been able to take what I have learned by attending yearly to mentor other faculty at Touro University Nevada, both physicians and non-physicians alike. I took the “Essential Skills for Medical Education” course during my second IAMSE conference at the University of Utah in Salt Lake City and completed the portfolio project the subsequent year and received my certificate of completion in Leiden University Medical Center in the Netherlands. My mentor for the project, Dr. Haramati, selected my portfolio to be used as an exemplar for years thereafter. In addition to tools acquired through the MMEL program, ESME’s course and project completion allowed me to develop a new curriculum for medical biochemistry that has since allowed our students’ board scores to be above the national average.

I contribute my students’ success to the use of clinical cases, which illustrated the usefulness of medical biochemistry in the practice of medicine. Should a medical educator be dedicated to student successful learning, the completion of the “ESME” course is the first step toward that goal. One of my fellow faculty members, who took the course as part of the IAMSE pre-conference activities, said “ it was one of the best courses I have ever taken.” I concur! The second step toward concretizing one’s goals in medical education and research is the completion of the fellowship offered by IAMSE. IAMSE’s Fellowship program opens up research opportunities that do not require huge amounts of funding to accomplish and fulfill the publication requirements for promotion. At least two of the scholarly articles in my promotion portfolio to full professor were published in the IAMSE educator journal, Medical Science Educator. Qualitative research is very useful for educators who are busy and might not have the funding and/or the time and guidance to conduct their own research in the area of curriculum development, course creation, assessment, and program evaluation.

As a resident of the host city and faculty member of the co-sponsor medical school for this year’s IAMSE conference, I could not be more excited. This year focuses on “prevention” and “wellness,” two timely and important topics of discussion. As an osteopathic medical school, Touro University Nevada knows that prevention is key. As I anxiously await this year’s conference, I am looking forward to meeting the new fellows and members of IAMSE, celebrating the 10th anniversary of the Fellowship program to which alumni fellows and interested IAMSE members are invited.

Be sure to register for the 2018 IAMSE Meeting! The Meeting will be held at the Green Valley Ranch and Resort, just outside of Las Vegas, Nevada on June 9-12, 2018. Registration may be found online here.

IAMSE Winter 2018 WAS Session 4 Highlights

In case you missed yesterday’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Continuity, LICs and Competency-based Education
Presenter: Molly Cooke, MD, MACP
February 1, 12 PM ET

Today’s Goals

  • What actually happens in a Longitudinal Integrated Clerkships (LICs)
  • Outcomes of Longitudinal Integrated Clerkships (LICs)
  • How Longitudinal Integrated Clerkships (LICs) support competency-based medical education

What actually happens in a LICs?

LICs move away from the Block Clerkships.

  • For example: one week in a LIC at UCSF may have the students spend ½ day in each of family medicine, internal medicine, surgery clinic, pediatrics, neurology and surgery OR.
  • The week also includes “white space” which allows the student to study on their own, follow up with a patient or to prepare for case presentations, etc.

LIC can be somewhat overwhelming for the student. Over time during the year, their preceptor burden decreases as their confidence increases.

Learning Map for the student with the same patient over the course of the year. Over the year the student gains a great understanding of who this patient truly is. Starts to see the person with a diagnosis and not in an isolated way!

First few encounters

  • Gathering and documenting clinical information

Early focus

  • Increasing emphasis on diagnostic skills

Mid-year focus

  • Increasing emphasis on management skills

End of the year

  • Highlight system of case and quality issues

Keep feature of LICs is Continuity.

Five steps:

  1. With curriculum (which is the patient)
  2. With peers
  3. With site and staff
  4. With preceptor
  5. With patients

Overview of the Outcomes of LICs

  • Improve learning outcomes and psychological outcomes of the students
    • More mentoring
    • Better learning atmosphere
    • Better quality of feedback
    • Better quality of clerkship overall
    • Don’t show the “binge and purge” format normally seen in the Block Format
    • Show better retention of specialty knowledge over the course of the year.
    • Tend to “de-silo” specialty knowledge
  • Improve the patient’s experience
    • The patient feels better quality of care
    • The patient feels comfortable with the medical student and is a liaison between the patient and the doctor.
    • The patient feels the student is learning and growing with them.
  • Improve the preceptor’s experience
    • Get to know their students better
    • Know the student well enough to tailor their teaching and provide more individualize mentoring.

How Longitudinal Integrated Clerkships (LICs) support competency-based medical education

  • LICs support competency-based education

Van Melle’s Core Components of Competency-Based Medical Education

  1. Competencies required for practice are clearly articulated.
  2. Competencies are arranged progressively.
  3. Learning experiences facilitate the progressive development of competencies.
  4. Teaching practices promote the progressive development of competencies.
  5. Assessment practices support and document the progressive development of competencies.

Curiosity-drive learning

  1. Clinical medicine, including the presentation, differential diagnosis and management of the conditions seen in practice.
  2. The basic science foundations of clinical findings, disease pathogenesis, evidence-based medicine and treatments.
  3. Emotional and psychosocial issues (ours and the patients’).
  4. The clinical microsystem, community resources and barriers and the larger US health system.

For more information on the next session or to register, please click here.

IAMSE – Spring 2018 WAS Registration Now Open!

Registration is now open for IAMSE Webinar Series Spring 2018! Sessions begin on Thursday, March 8, 2018.

Integrating Nutrition and Wellness Instruction: Practical Applications for Health Science Educators

As a follow-up to our successful series on faculty and student wellness and resiliency and as a prelude to our annual meeting integrating nutrition and wellness education in teaching the health sciences, the 2018 Spring IAMSE Web Seminar Series focuses on specific examples of how schools have implemented programs to address these issues. The first session will feature presentations by Angela Cheung from the University of Toronto and Maryam Hamidi from Stanford who will describe the current status of physician nutrition, barriers to healthy eating by physician training and practice, and suggestions for awareness recognition of the importance of proper nutrition in the wellness of physicians.  The second session will be presented by Nicholas Pennings from Campbell University who will highlight, from a practical standpoint, how a new osteopathic medical school implemented a longitudinal nutrition theme focused on obesity. The next session will be presented by Sian Cotton who will provide a detailed description of a highly successful center for the promotion of integrative health and wellness at the University of Cincinnati. The fourth session will be another paired presentation by John Yoon from the University of Chicago and Tania Jenkins from Temple who will highlight research focused on the moral and spiritual development of students over-time, conducted as part of the of the “Good Physician Project”. The series concludes with a presentation by Jo Shapiro from Beth Israel on promotion of student wellness using peer-support groups. This series will set the stage for our upcoming meeting and provide insight into implementation of these important curricular initiatives.

March 8 – The Importance of Nutrition and Physicians’ Wellbeing – Presented by Angela Cheung and Maryam Hamidi

March 15 – Fat Chance for Nutrition and Obesity Education in Medical Schools – Presented by Nicholas Pennings

March 22 – Integrating Wellness & Nutrition: Lessons from University of Cincinnati – Presented by Sian Cotton

March 29 – Project on the Good Physician: Using Life Stories to Study Medical Student Wellness – Presented by John Yoon and Tania Jenkins

April 5 – Mitigating the Emotional Toll of Medical Errors – Presented by Jo Shapiro

For more information or to register, please click here.

#IAMSE18 – Plenary Speaker Highlight: Robert Kushner

The 22nd Annual IAMSE Meeting is just around the corner, and we would like you to get to know some of our keynote speakers! We have five plenary speakers this year, and we hope you enjoy their presentations.

Robert Kushner: Teaching Nutrition in the Context of Lifestyle Medicine [Northwestern University Feinberg School of Medicine]

Students of the twenty-first century must acquire a competence in lifestyle medicine, a new discipline that has recently emerged as a systematized approach for the management of chronic disease. The individual components and skillsets that define lifestyle medicine primarily address the behaviors that contribute to noncommunicable diseases, including diet, physical activity, sleep, stress, substance use and behavior change. This presentation will review a novel approach of how the science and application of nutrition can be incorporated into the broader context of healthy living for undergraduate education.

For more information on Dr. Kushner, please click here.

Be sure to register for the 2018 IAMSE Meeting! The Meeting will be held at the Green Valley Ranch and Resort, just outside of Las Vegas, Nevada on June 9-12, 2018. Registration may be found online here.

We hope to see you there!

IAMSE Winter 2018 WAS Session 3 Highlights

In case you missed yesterday’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Integration, Competence and Expertise: Preparing Learners for the Future
Presenter: Nicole N. Woods PhD
January 25, 12 PM ET

Discuss the current and future state of Competency Based Medical Education (CBME).

The Expert: The planned model of CBME and most educational programs is that at some point the individuals that enter and complete our programs will in fact end up as experts.

Medical education can be seen as the pathway that allows our learners to become experts.

What are a few of the assumptions we make as educators along this pathway prior to CBME?

Required Skill: assume students will have a set of required skills at the end of the journey or pathway.

Time: assume a certain amount of time that this journey to expertise is to take.

Single summit: everyone reaches the same place and there is only one-way to get there.

Inevitable: expertise is an inevitable outcome of the journey.

Some of these assumptions can be problematic. CBME has been proposed at many schools as an opportunity to address these assumptions/challenges head on.

1.Competencies are clearly articulated

2.Competencies are arranged progressively

3.Learning experiences facilitate the progressive development of competencies

4.Teaching practices promote the progressive development of competencies

5.Assessment practices support and document the progressive development of competencies

Core components of CBME are underlined above.

Keep in mind that CBME, like any approach to education will succeed or fail based on how it is implemented.

If we have not put into place the learning experiences, the teaching practices and the assessment practices to support the skills that our students need, all of this work will be for not.

Expertise Development: What does it mean to be an expert in a given field and what is the pathway to get there?

Most of the models agree that at the very least an expert must be able to efficiently and effectively perform all of the general, everyday tasks that make up their daily work.

Routine Work—Something you’ve seen before or know how to deal with.

According to Dreyfus and Dreyfus “when things are proceeding normally experts do what normally works”.

Here’s the challenge.  Medical practice is not just about routine work.

Non-Routine Work – Something you’ve never seen before or don’t know how to deal with.

Useful models of expertise development tells us the expert must be prepared to deal with:

Complexity: problem that looks similar to other problems but now has an added level of complexity.

Ambiguity: problems and solutions are not always obvious.

Novelty: encounter something that they have never seen before. Expert is not able to just walk away.

Adaptive experts use existing knowledge to solve routine problems and are able to create new solutions to non-routine problems. Can deal with both routine and non-routine problems.

Adaptive expertise is not the sole trajectory of education.

We have a Goal.

We want to use CBME to create educational experiences that prepares students to become competent.

Competence is the ability to handle routine and non-routine aspects of clinical work.

Therefore, teaching strategies, learning experiences and assessment practices must prepare learner to handle routine and non-routine clinical problems in the future.

Adaptive experts use existing knowledge to problem solve.

Knowledge is memory and memory is knowledge.

Information enters the brain and is processed and is stored in short-term memory. With rehearsal or practice that information would eventually move out of short-term memory in to long-term memory where it can be retrieved when needed. If there is no practice or rehearsal, the information is forgotten.

In order to keep this information in long-term memory, it seems that repetition becomes really important.

Here’s the problem. Repetition encourages shallow processing. Basically repetition is not as useful as we think in transferring information from short-term to move to long-term storage.

Repetition does not necessarily enhance memory and can actually harm later performance.

Learning experiences that emphasize repetition are insufficient for the development of knowledge.

Therefore in the implementation of CBME we need to be mindful that we don’t inadvertently emphasize repetition of performance as demonstration of competence.

There are different types of knowledge and CBME has to be constructed to support the development of all of them.

Procedural knowledge: knowing what to do.

Conceptual knowledge: knowing WHY you’re doing it.

All knowledge is contained what is known as a semantic network, which is a set of abstract concepts and specific experiences.

Basis of semantic network is Connections are based on meaning and based on why.

Semantic networks are comprised of boxes and lines. The boxes are the nodes and the lines are the connections between the nodes.

Nodes are clinical concepts and connections are basic science concepts.

Any educational models need to emphasize integration of procedural and conceptual knowledge.

Need to teach and assess in an integrated fashion.

The depth of the memory trace depends on the meaning you extract from the stimulus not the number of times it is encountered.

Why does any of this matter?

Need to adapt/create solutions to address new problems.

New solutions to new problems require deep conceptual knowledge

CME teaching and assessment must be carefully constructed to foster the development of conceptual knowledge through instruction and assessment that capitalizes on Variation.

Variation allows learners to purposely learn through problem solving.

Assessment is a good way to do this.

Static assessment is to teach and then test. Does not provide crucial information about learning processes deficient cognitive functions.

Better way to assess is through dynamic assessment. Assesses the level of internalization and transfer value to other problems of increased level of complexity, novelty and abstraction.

CBME can support training for routine and non-routine problems.

Adaptive experts use existing knowledge to solve routine problems where conceptual knowledge is needed to adapt new solutions for non-routine problems.

Can support development of conceptual knowledge through integration, contextual variation and dynamic assessment.

For more information on the next session or to register, please click here.