News

IAMSE Spring 2019 Webinar Series: “Moving USMLE Step 1 After Core Clerkships: Rationale, Challenges

The 2019 IAMSE Spring Webcast Audio Seminar Series begins soon! This season will focus on the role of basic science in current medical education. How can basic science instruction continue to fulfill its mission of providing a scientific approach to the practice of medicine? The IAMSE spring series is addressing this question by presenting several new approaches to improve foundational science instruction beyond integration with the clinical sciences. This March, we’ve lined up eight speakers to shine a light on the topic across multiple landscapes in medical education. Our fifth and final session’s speaker is Dr. Michelle Daniel.

Stepping Beyond the “Moving USMLE Step 1 After Core Clerkships: Rationale, Challenges and Early Outcomes”
Presenters: Michelle Daniel, MD, MHPE, FACEP – University of Michigan Medical School
Session: April 4, 2019 at 12pm Eastern Time

Schools undergoing curricular reform are re-evaluating the optimal timing of Step 1. Historically, students have completed the exam immediately following the basic science curriculum. A small but growing number of schools have moved Step 1 after the core clinical clerkships, citing a number of reasons for the change, including promoting long-term retention and understanding of basic science concepts. As schools undergo curricular transformation, educators are looking to peer institutions to share their experience and lessons learned. They are also seeking data to guide decisions. In this webinar, Dr. Daniel will review the reasons to consider a change, the potential hurdles one might encounter, and the findings of recent studies. This will serve as a springboard for dialogue surrounding the optimal timing of Step 1.

IAMSE Excellence in Teaching Award Nominations Deadline Extended

Nominations for the 2019 Excellence in Teaching awards has been extended! The new deadline for receipt of the completed nomination packets will be March 18, 2019.

Since 2007, IAMSE has honored member medical educators with two prestigious awards to recognize and promote teaching excellence and educational scholarship in the medical sciences. Qualified candidates may self-nominate, or be nominated by an IAMSE colleague.

Details regarding each award, required application materials, and deadlines are found in the document linked here. All nomination/application packets must be received by Danielle Inscoe (Danielle@iamse.org) no later than March 18, 2019.

Invitation to Submit Manuscripts on Team-Based Learning

In the last quarter of 2019, Medical Science Educator, the journal of the International Association of Medical Science Educators (IAMSE), will be publishing a special journal section dedicated to the topic of “Team-Based Learning.” In this section, the journal would like to explore best practices from institutions around the world where TBL is implemented in the health sciences curriculum.


Team-Based Learning™ (TBL) as an active learning strategy was developed in the 1970s and is organized as modules, each typically consisting of 3 steps: preparation, testing and application. The method is evidence-based and a substantial body of research on TBL has already been published. TBL originally took off in the USA, but nowadays the method is being used in more and more schools around the globe, including medical schools and other health care related curricula. 
 
The Editorial Board of Medical Science Educator is currently soliciting article submissions on this topic and welcomes contributions in the selected formats of Innovation, Short Communication, or Monograph. Please see our websitewww.medicalscienceeducator.org for a more detailed description of these article types and for the Instructions for Authors. All submissions will be peer-reviewed according to our regular review process. Accepted manuscripts will be collected in a special section in issue 29(4) or will be published in one of the regular issues thereafter.
 
Manuscripts to be considered for this special section must be submitted by May 1st, 2019 through our online submission system that can be found by visiting:www.medicalscienceeducator.org. In your cover letter, please refer to the topic “TBL Special Section” to indicate that you would like to be included in the special section.


I look forward to receiving your submissions.


Thank you, Peter G.M. de Jong, PhD
Editor-in-Chief, Medical Science Educator

IAMSE Spring 2019 Webinar Series: “Stepping Beyond the ‘Step 1 Climate'”

The 2019 IAMSE Spring Webcast Audio Seminar Series is quickly approaching. This season will focus on the role of basic science in current medical education. How can basic science instruction continue to fulfill its mission of providing a scientific approach to the practice of medicine? The IAMSE spring series is addressing this question by presenting several new approaches to improve foundational science instruction beyond integration with the clinical sciences. This March, we’ve lined up eight speakers to shine a light on the topic across multiple landscapes in medical education. Our fourth session’s speakers are Dr. Kathy Andolsek and David Chen, MSIII.


Kathy Andolsek MD, MPH

Stepping Beyond the “Step 1 Climate”
Presenters: Kathy Andolsek – Duke University and David Chen – University of Washington
Session: March 28, 2019 at 12pm Eastern Time Join a conversation about how our medical education community could collaboratively address the “Step 1 climate” that is described by medical students in a recent Academic Medicine article. The lead author will explore how Step 1 has inadvertently but incontrovertibly adversely altered the preclinical learning environment, specifically with regard to the quality of education, diversity, and student well-being. The author of an accompanying commentary will provide historical context as to the purpose for which this test was designed and the unintended consequences as it has been used for other purposes, such as residency selection. Bring creativity, imagination, and a willingness to seek consensus options that address all stakeholder group needs. 



To follow Dr. Andolsek on Twitter follow @GME_MD and to follow David Chen on Twitter follow @davidroychen.

A Review from Medical Science Educator from Dr. Dani McBeth

As many of you are aware, Publications Committee members agree to provide a monthly review of an article in Medical Science Educator (MSE). We hope to alert you to something you may have missed, or just spur you to revisit an issue you may have already looked at. We want IAMSE members to get the most of their association journal and to consider publishing their own educational research in MSE when the time comes. Remember access to the journal is a benefit of membership and you can do so by logging in at IAMSE.org and then clicking the IAMSE Publications tab.

In the latest issue, December 2018, I was very interested to read the article “Graphic Stories as Cultivators of Empathy in Medical Clerkship Education.” As one of the newer medical schools, even though my school as a BS/MD Program has existed for 40+ years, we Have now added the last 2 years of medical school education and currently have our first class of 3rd year medical students in clerkship.

There is a substantial literature documenting the erosion of empathy in many medical students, particularly during the first clerkship year. Substantial contributions to this work have been made by Bruce Newton, well known IAMSE member, and his colleagues publishing articles in Academic Medicine and our own Medical Science Educator. As an aside, Bruce was awarded the IAMSE Master Teacher Award in 2016.

In the study reviewed here, small numbers of medical students were recruited from two Canadian medical schools to take part in a qualitative research study aimed at examining empathy in medical students during the clerkship years. Participants completed an online survey that included written responses to open-ended questions regarding a case vignette and then one-on-one in-depth interviews regarding their perceptions of empathy change during clerkship years and the effects of the intervention studied here on maintaining empathy. The results suggest a dynamic interplay between personal factors, the specific clerkship environment and support systems in determining the effects of clerkship years on the empathy expressed by individual students. The specific intervention studied here was the use of graphic short stories, also known as comic books as a potential tool to examine the physician and patient role and to stimulate discussion of empathy role modeled in the comic books. The graphic stories depicted a patient living with Type-2 diabetes and were previously developed for use in an earlier study of pre-clerkship students and their approach to patient interactions. In the study here, the richness of the approach was particularly illuminated in the reporting of themes that emerged from the analysis and specific quotes from the written responses and one-on-one interviews. For me, this is so often the case when reading a qualitative research study. Results described barriers and facilitators of empathy during training including medical education and training, the clinical environment and personal approaches. Not surprising, participants described an inverse relationship between burnout and empathy; as feelings of burnout increase, the capacity for empathy declines. Participants described strategies for preventing burnout and enhancing empathy that fell into several categories:

  • Medical education including frequent reminders of the need for empathy, communication workshops, reflective assignments and frequent feedback following clinical encounters. 
  • Administrative efforts including wellness programs and easily accessible and confidential counseling support.

Finally, the potential role of the comic books was investigated, and participants found them to be an effective medium to remind students of the importance of empathy in their clinical encounters. The extensive discussion in the paper provides further context and characterization of ways to think about maintenance of empathy during the clerkship years. Future directions for this research include investigation of methods for integrating the use of graphic stories into medical curricula and to further evaluate their impact as well as expanding the studies to include larger numbers of students and additional sites. 

This paper has stimulated my thought processes about better supporting our clerkship students. In the first two years of medical school when students are together as a cohort, there are numerous communication skills workshops, reflective assignments, narrative medicine sessions and specific discussions of empathy. As students move into clerkship, this cohort effect is lost and although some of the methods used in the pre-clerkship years continue, such as reflective assignments, much is lost. This at the same time that students are dealing with the stressors of clerkship education, the need to prepare for Step 2 exams and to prepare for residency application. This paper has given me much food for thought about how to improve our support of clerkship students to prevent burnout and preserve empathy.

Respectfully submitted,
Dani L. McBeth, PhD
Chair, IAMSE Publications Committee
Associate Dean for Student Affairs
CUNY School of Medicine / Sophie Davis Biomedical Education Program 

IAMSE Excellence in Teaching Award Nominations Closing February 28

Nominations for the 2019 Excellence in Teaching awards will be closing February 28, 2019. Both awards will be presented at the annual meeting in Roanoke, Virginia in June.

Since 2007, IAMSE has honored member medical educators with two prestigious awards to recognize and promote teaching excellence and educational scholarship in the medical sciences. Qualified candidates may self-nominate, or be nominated by an IAMSE colleague.

Details regarding each award, required application materials, and deadlines are found in the document linked here. All nomination/application packets must be received by Danielle Inscoe (Danielle@iamse.orgno later than February 28, 2019.

IAMSE Spring 2019 Webinar Series: “Role of Foundational Sciences in Clinical Years”

The 2019 IAMSE Spring Webcast Audio Seminar Series is right around the corner! This season will focus on the role of basic science in current medical education. How can basic science instruction continue to fulfill its mission of providing a scientific approach to the practice of medicine? The IAMSE spring series is addressing this question by presenting several new approaches to improve foundational science instruction beyond integration with the clinical sciences. This March, we’ve lined up eight speakers to shine a light on the topic across multiple landscapes in medical education. Our third session’s speaker is Dr. Kim Dahlman.

Role of Foundational Sciences in Clinical Years
Presenter: Kim Dahlman – Vanderbilt University Medical Center
Session: March 21, 2019 at 12pm Eastern Time

Traditional medical curricula generally place the majority of foundational science learning into the pre-clerkship years. Yet, it has been recognized that foundational science education should occur across the medical curriculum to promote excellence in clinical performance. This session will provide participants with an innovative approach to integrating foundational sciences and meaningful clinical experiences in the post-clerkship curriculum. Participants will learn about several educational strategies and the resources necessary to achieve successful integration of foundational sciences and patient care. Furthermore, participants will recognize the challenges and learn practical solutions of this approach in order to implement post-clerkship foundational science integration at their own institutions.

IAMSE to visit #TBLC19 in Tampa, Florida, USA

The 18th Annual Team-Based Learning Collaborative (TBLC) Meeting will be taking place in Tampa, FL from March 14th-16th, 2019. The IAMSE booth will be present at the conference to exhibit, so if you plan on attending this meeting, do not forget to swing by and say hello! 

Registration for the Essential Skills in Medical Education (ESME) Program is Now Available!

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.

Additional ESME details and registration information can be found athttp://www.iamseconference.org. Don’t forget to register before the Early Bird deadline onFriday, March 15!

#IAMSE19 – Plenary Speaker Highlight: Claudia Krebs

The 2019 IAMSE meeting offers many opportunities for faculty development and networking, and brings medical sciences and medical education across the continuum together. This year’s main topic is Adapting to the Changing Times in Health Sciences Education. One of our four confirmed keynote speakers is Claudia Krebs from the University of British Columbia in Vancouver, BC, Canada. Dr. Krebs will be speaking on using disruptive technology to enhance medical education.

How to Use Disruptive Technology to Make Education Better – Not Just Different
Presenter: Claudia Krebs – University of British Columbia
Plenary Address: Sunday, June 9, 2019, 12:45 PM – 1:45 PM

The digital world has become a natural extension of our analog world, every aspect of our lives has been touched by the power of the digital revolution and medical education is no exception to this. As educators we have been called to change our approach to learning so that our students will become competent and flexible partners in a rapidly evolving health care system. Transformative education requires both our intellect and our creativity so that we can leverage the potential of pedagogy and technology for the best impact in our classrooms. Not every aspect of learning requires a complex solution, it is imperative that we learn about the tools we have at our fingertips. We need to learn how to create with these emerging, disruptive tools, how to explore the possibilities that are only now opening up to us. Emerging technologies such as VR and AR have the potential to disrupt our approaches to learning, to engage students, to provide learning experiences that touch our learners in a very profound way.

We are just at the cusp of these developments and it is imperative that we become co-developers with our students so that we can create media with authenticity. Development with emerging and new technologies requires a multidisciplinary team with medical experts, engineers, artists, students, faculty, and staff. As the boundaries between the digital and the analog are blurring, how can we ensure that we anchor our students in the here and now? Can we use technology to help students develop empathy and connection with those who are in their care? We will explore the transformative power of technology when used effectively towards a pedagogical goal. This talk will discuss best practices for design- from simple to complex, from chalk talks to virtual reality – and how to integrate these materials into evolving curricula

IAMSE Spring 2019 Webinar Series: “Going Lecture Free for Gen Z”

The 2019 IAMSE Spring Webcast Audio Seminar Series is right around the corner! This season will focus on the role of basic science in current medical education. How can basic science instruction continue to fulfill its mission of providing a scientific approach to the practice of medicine? The IAMSE spring series is addressing this question by presenting several new approaches to improve foundational science instruction beyond integration with the clinical sciences. This March, we’ve lined up eight speakers to shine a light on the topic across multiple landscapes in medical education. Our second session’s speakers are Drs. Brenda Roman, Mary Jo Trout and Irina Overman.

Brenda Roman, MD

Going Lecture Free for Gen Z
Presenters: Brenda Roman, Mary Jo Trout 
and Irina Overman
Session: March 14, 2019 at 12pm Eastern Time

The WrightCurriculum, a lecture free curriculum, began in 2017 at Wright State University Boonshoft School of Medicine, with the goal of having students become self-directed learners using evidence-based teaching and learning activities. We have several aims with this curriculum. First, help students develop skills in critical thinking. Second, help students learn how to discover the best evidence to make decisions. Third, give students the skills to keep learning throughout a life of service in the practice of medicine.

Mary Jo Trout, Pharm D, BCPS, BCGP

We are aware that the majority of medical schools still have lectures as a significant part of their instructional hours, and believe if USMLE scores for a medical school are fine, “why take a risk in changing the curriculum?”  Faculty may fear that active learning diminishes their teaching role. However, using teaching and learning strategies that are based on the science of learning, especially retrieval-based practice, actually requires faculty to do a great deal more than “cover the content”. Faculty are charged with designing questions and classroom activities that get students to use the course content to answer questions and solve authentic problems. Authentic “teaching moments” for faculty occur frequently in active learning sessions as faculty probe student thinking and connect knowledge to its application. The emphasis is shifted to creating “spaces for productive discomfort” in pushing students to learn in order to “make it stick.

Irina Overman, MD

We utilize active learning strategies of team-based learning, peer instruction, case-based learning, and problem-based learning, in which students are only in the classroom about 3 hours/day during the Foundations Phase, allowing ample time for self-study and advanced preparation. Since Peer Instruction is being utilized in over 60% of our curricular time, we will spend more time discussing Peer Instruction, from the faculty perspective in developing session material and how to effectively facilitate sessions, and from the student perspective in how learning gains are made in the sessions.

At the end of the session, participants will be able to: 

  • Explain the evidence and rationale for using active learning strategies throughout medical school, and how active learning strategies contribute to student attendance and team-work.
  • Formulate effective approaches to implementing a lecture-free curriculum that is grounded in science, specifically using the teaching modality of Peer Instruction (PI).
  • Introduce best-practice strategies, tips, and lessons learned from going lecture-free.”

IAMSE Winter 2019 WAS Session 5 Highlights

[The following notes were generated by Mark Slivkoff, PhD]

IAMSE Webinar Series, Winter 2019

Speaker: Daniel P. Harrington, M.D.
Interim Dean
Virginia Tech Carilion School of Medicine
Title: The Learning Environment System and Case Studies
Series:
The Learning Environment in Health Sciences Education

Dr. Harrington initially presented the viewers with a list of objectives:

  • Development of Learning Environment in a new medical school
  • Review LCME Element 3.5
  • Review the development of the Learning Environment program at VTCSOM
  • Describe the Learning Environment Advocacy Committee
  • Review the examples of concerns registered with the committee
  • Describe the periodic review of the LE in the VTCSOM and affiliates
  • Review the clerkship year LE

Some Background: The Virginia Tech Carilion School of Medicine

  • VTCSOM was founded in 2008 as a public-private partnership between Virginia Tech and Carilion Clinic
  • VTCSOM is the smallest medical school in the country with 42 student/class and 168 total students
  • Innovative curriculum with 4 domains – Basic Science, Clinical Science, Research and Interprofessionalism integrated across the 4 years
  • The curriculum in the first two years is centered on Problem Based Learning
  • As of July 1, 2018 VTCSOM became the 9th college of Virginia Tech
  • VTCSOM receives over 4,000 application for 42 positions
  • The Multiple Mini Interview is used to rank 300+ interviewees for 42 positions
  • Of the 5 graduating classes, all students have USMLE Step 1 and 2 scores above the national mean
  • Students comment that the intimacy of the small classes, rigorous research requirement, and close relationship to Carilion Clinic are elements that make the school successful
  • All 5 graduating classes have 100% MATCH

LCME Element 3.5 Review: The Learning Environment/Professionalism

“A medical school ensures that the learning environment of its medical education program is conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, faculty, and staff at all locations and is one in which all individuals are treated with respect. The medical school and its clinical affiliates share the responsibility for periodic evaluation of the learning environment in order to identify positive and negative influences on the maintenance of professional standards, develop and conduct appropriate strategies to enhance positive and mitigate negative influences, and identify and promptly correct violations of professional standards.”

Development of a Learning Environment Program

  • VTCSOM did not have a formal learning environment program prior to 2014
  • The LCME accreditation visit in 2013 cited the school because only a small number of student concerns (unprofessional/mistreatment issues) had been documented prior to the LCME visit and that there was no formal program in place to address student complaints and to promote a healthy LE
  • In order to correct the citation VTCSOM developed a program to address the learning environment in all aspects
  • The core of the program is the Learning Environment Advocacy Committee (LEAC)
    • Multidisciplinary membership: 7 students (peer elected), 3 residents, 5 faculty (appointed by the dean), a nurse representative, a staff representative, a Carilion HR representative, and dean advisors
    • The committee meets monthly
    • Concerns may be received from students, residents, faculty, deans, staff; but most are from students
    • Concerns may be anonymous and are generally logged on the end of block or clinical rotation student evaluations in the One45 system or on an anonymous website called BEACON
    • Concerns can also be brought directly to members of the committee, clerkship director, residency director, dean or faculty member

Summary of the LEAC Committee Work, 2013-2019

NUMBER OF CONCERNS THE LEAC ADDRESSED PER YEAR

2013-2014

19 (4 mistreatment / belittlement; 15 unprofessional behavior)

2014-2015

28 (6 mistreatment / belittlement; 22 unprofessional behavior)

2015-2016

14 (3 mistreatment / belittlement; 11 unprofessional behavior)

2016-2017

16 (0 mistreatment / belittlement; 16 unprofessional behavior)

2017-2018

34 (1 mistreatment / belittlement; 33 unprofessional behavior)

2018-2019 YEAR TO DATE

14 (2 mistreatment / belittlement; 12 unprofessional behavior)

Summary of Concerns Reported to LEAC in AY 2017-2018

  • During Academic year 2017-2018, the thirty-four (34) total concerns reported involved twenty-six (26) different individuals.
  • Twenty-one (21) of the twenty-six (26) total individuals were faculty members representing appointments in six different departments.
  • Of the twenty-one (21) different faculty members, there were six (6) individuals for whom multiple concerns were reported.
  • All concerns were of “unprofessional behavior” and no concerns were of “mistreatment”
  • Three (3) of the twenty-six (26) individuals were residents
  • For all three (3) of the individuals, concerns were made about “unprofessional behavior”
  • Two (2) of the twenty-six individuals were students
  • One (1) student concern was made if “unprofessional behavior” and the other one (1) was made of “mistreatment”

Learning Environment Summary

  • An additional component to the LE program that was developed as a result of the LCME citation, was a periodic survey of the learning environment of all constituents
  • Three surveys (2014, 2015, 2017) have been conducted and are planned every other year (the next one is in March 2019)
  • The LE survey is sent to all students, all residents, all faculty, all staff, and the selected group of nurse representatives
  • The survey results are reviewed by the dean, dean’s group, chairs, staff
  • The survey results are presented to each class
  • A summary of the survey results are sent to all faculty, residents, and selected nurses
  • An action plan is developed to address areas of concern
  • Overall, the VTCSOM learning environment was perceived quite favorably in 2017.
  • All stakeholder groups perceived a very high degree of sensitivity to culture, diversity, and inclusion on average – to an even greater extent than in prior years.
  • On average, all four student groups (M1-M4) rated their maintenance of a healthy work/life balance lower than other items. Moreover, three groups of students (M1, M2, and M3) rated their work/life balance lower than M1, M2, and M3 students in 2015.
  • Most stakeholder groups rated items regarding teamwork and peer support higher than in previous years, although these items were not the highest rated items on average.
  • Almost all stakeholders were knowledgeable about VTCSOM policies and procedures related to the learning environment.

Other Elements of the Learning Environment Program

  • Each incoming class has an orientation about professionalism and mistreatment
  • The incoming class learns about the importance of the learning environment and the LEAC committee, appropriate policies, and ways to report concerns
  • An annual review of the LEAC is presented to each class(LCME requirement, membership, and how to report concerns)
  • The third year class orientation to clerkship includes a two hour workshop presenting actual cases. Following each case a facilitator discusses the students’ emotional responses to the case and options on how to address the issue
  • The LCME Independent student survey and the annual GQ survey results report that students know the policy on unprofessionalism and mistreatment and how to report concerns

VTCSOM 2018 GC – Learning Environment Results

Awareness of Mistreatment Procedures

Year

VTC

National

2014

88.2%

78.6%

2015

87.9%

80.8%

2016

97.2%

82.3%

2017

94.4%

86.1%

2018

92.1%

88.1%

Awareness of Mistreatment Policies

Year

VTC

National

2014

94.1%

93.3%

2015

100%

94.5%

2016

100%

95.7%

2017

100%

97%

2018

100%

97.5%

Details of The Year 3 Clerkship Learning Environment Work Shop Training

  • The M3 Clerkship LE Work Shop occurs in the 2nd or 3rd week of the first clerkship in July each year
  • Students are divided into four group of 10 or 11 students each group with a facilitator
  • 10 cases are presented with discussion by the students
  • Discussion includes the severity of each learning environment issue and ways to address or report each concern
  • Discussion as to the severity of the concern is often lively while discussion on how to address is fairly uniform
  • Most student do not feel comfortable addressing the issues directly but want to come to a dean or present the issue anonymously
  • Two examples of cases were described

Dr. Harrington concluded with:

Lessons Learned since the Learning Environment Program was established

  • That unprofessional behavior and mistreatment occurs at all levels of the medical school education process
  • Perpetrators exist at all levels from students, residents, staff, attendings, and nurses
  • Despite processes that are in place to anonymously report, the GQ shows that students still fear retribution
  • Due to the power differential, the expectation that students can address these issues directly remains unlikely
  • The educational process to promote the LE is difficult at many levels including the clinical areas
  • Anonymous reporting makes correcting the issues with the right person very difficult
  • There is a need to educate students on what are appropriate reportable issues
  • We fail to adequately prepare a student for residency where these issues continue but are more enculturated and thus more difficult to eradicate
  • Concerns are often reported as unprofessional behavior or mistreatment and in the opinion of the committee are not valid