May 2022 Faculty Development Tip

MITE Monthly Tip
May 2022
Maria Egger, PA-C

Cultivating a Learning Organization

Timely and pertinent continuing education is essential for keeping a health organization
motivated, nimble and innovative. Learning at the organizational level is required to meet the
challenges of working in a complex, changing, oftentimes unpredictable system tackling highstakes
problems. Organizational learning may occur at the level of team, office, department, or
division and is defined as a complex process where individuals collectively examine group
experiences, create, receive and pass on knowledge, enabling organizations to adapt to a
changing work environment. Provision of a clear mission, incentives, and continuing education
and training opportunities serve only a portion of the elements needed for learning to happen
this way. A solid learning organization requires an underlying foundation of specific building
blocks to enable skillful development, acquisition and transmission of knowledge leading to
adaptability.

Key points:

• A supportive learning environment, concrete learning processes and practices,
and reinforcing leadership behavior are the foundation of an effective learning
organization.
• These elements operate synergistically to promote organizational learning but
can be examined and developed separately.
• Useful survey tools have been developed to examine and rate learning at the
organizational level.

The 3 building blocks of an effective learning organization:

A supportive learning environment requires four distinct features. The first is psychological
safety. Organization members must feel free to voice their thoughts and opinions, admit
mistakes and ask questions without fear of repercussion. The second feature is appreciation of
differences. Considering opposing viewpoints can spur on new ideas and innovation. Third is
openness to these new ideas to come up with new approaches to problem solving. Lastly, time
must be allowed for reflection. It is not enough to put in the hours required and check off tasks.
Organization members must be allowed time out to look back on group processes to determine
if stated goals have been met and what could be done better next time.

A concrete learning process and practice allows an organization to develop, collect and share
knowledge between and among groups systematically and efficiently. Experimentation must be
encouraged, new approaches and outcomes must be tracked, rigorous examination and
interpretation of new problems must be ongoing, education for new and veteran employees
must be provided. Finally, sharing of information must be delivered in a systematic way, in all
directions, quickly to those who need-to-know. A robust learning process and practice requires
the underpinnings of a supportive learning environment.

Finally, leadership that reinforces learning by actively and respectfully listening to members
thoughts and opinions, encouraging new ideas and experimentation, placing importance on
efficient and transparent knowledge sharing, and allowing time for reflective analysis to support
a climate where learning will flourish.
Singer et al., (2012)


Assessing your learning organization
These 3 building blocks interact and work together to promote organizational learning, but each
block and its comprising elements can be examined separately so that organizations may assess
the strengths and weaknesses of their learning environment. The Learning Organization Survey
(LOS) developed in 2008 by Garvin, Edmondson and Gino is a 55-item online diagnostic survey
that measures how well your organizational unit functions as a learning organization. Individuals
or groups (who average their scores) may compare scores to benchmark data from baseline
organizations. Derived from the LOS is the LOS-27 developed in 2012 by Singer, Moore, Meterko
and Williams. Designed for use in the healthcare setting, this survey distills the LOS into a 27-
item survey with wording relevant to healthcare organization members. Interestingly, studies
using these tools have revealed marked variance among teams within a single organization and
even in a single department.

As educators we know the significant amount of time spent in quality improvement, curriculum
development and rollout for our teams and departments. Periodic assessment of our
organization learning environment would aid in ensuring our efforts are effective and
sustainable, team members remain energized and adaptable, and we continue to deliver up-todate
and safe patient care.

References:

Garvin, D., Edmondson, A. C., & Gino, F. (2008). Is yours a learning organization? Harvard Business

Review, 86(3), 109-116.
Singer, S.J., Moore, S. C., Meterko, M., & Williams, S. (2012). Development of a short-form
learning organization survey: The LOS-27. Medical Care Research and Review, 69(4), 432-459.
To see LOS-27 in action:
Edmondson, A. C., Higgins, M., Singer, S. & Weiner, J. (2016). Understanding psychological safety
in health care and education organizations: a comparative perspective. Research in Human
Development, 13, 65-83.

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April 2022 Faculty Development Tip

What are the best approaches for Professional Development for Healthcare workers?

Nora Fagan, RN, MSN, BScN, CMSRN

Introduction

Professional development for those working in healthcare is of utmost importance in order to ensure all interdisciplinary teams up to date on the most current evidence based practice. Within the rapid paced environment of healthcare today it can be a great challenge to foster professional development among staff due to the ever growing demands on healthcare workers.  It ends up feeling like one more demand on top of an already very heavy load.  What are the most effective ways to approach professional development with healthcare works so that it doesn’t feel like as heavy of a lift?  Professional development presented and encouraged the right way motivates staff to improve their current practices and in turn improves patient outcomes.  Working within a culture that promotes professional intrigue can also have a positive impact on retention rates and work satisfaction. Staff report feeling less workplace anxiety when they have a greater confidence in the work they do each day.

What fosters Professional Development?

According to Mlambo, Silen & McGrath (2021) who did a metasynthesis on nursing perspectives on professional development the following are the most important themes.  These overlapped greatly with a similar study that focused on providers.

  • Organizational Culture
  • Supportive Environment from Leadership
  • Attitudes and Motivation
  • Perception of Barriers
  • Perceived Impact on Practice as a core values

What hinders Professional Development?

According to Hanlon, Prihodova, Russell, et al (2021) the following barriers hinder professional development among providers.  These overlap significantly with the previous study that focused on nurses.

  • Staff Burnout
  • Culture of Anti –Intellectualism
  • Lack of Leadership Support
  • Lack of Time
  • Lack of Incentives
  • Lack of Recognition

What are the best ways to fill the gap?

Professional development for healthcare workers needs to be made a priority within organizations.  Leadership support and recognition that fosters a culture of learning is essential in order to increase engagement in lifelong learning.  Encouraging staff by openly discussing the perceived impact of professional development within their work environment needs to be a modeled behavior.  Staff of all levels of experience need to be held to the same professional development standards.  There is a great focus on professional development of those who are new to the profession. Maintaining professional development throughout ones career across all interdisciplinary groups should be highlighted as well as celebrated within organizations.  Targeting what hinders the ability to engage should include allowing for dedicated time that is protected. Recognition, incentives and support to seek out opportunities for professional development could greatly improve the workplace culture as well as heighten the awareness of this core value for any work environment.

References

Hanlon, H. R., Prihodova, L., Russell, T., Donegan, D., O’Shaughnessy, A., & Hoey, H. (2021). Doctors’ engagement with a formal system of continuing professional development in Ireland: a qualitative study in perceived benefits, barriers and potential improvements. BMJ open11(11), e049204. https://doi.org/10.1136/bmjopen-2021-049204

Mlambo, M., Silén, C., & McGrath, C. (2021). Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. BMC nursing, 20(1), 62. https://doi.org/10.1186/s12912-021-00579-2

 

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February 2022 Faculty Development Tip

Differences among Millennials vs Generation Z and the Effects This Plays on Medical Education

Abtin Farahmand, MD

Introduction:

Medical education continues to transform itself based on the generation of learners being educated. As an example with Millennials, medical schools and educators have reduced the number of large didactic sessions and have incorporated more technological educational platforms for these learners. From a medical school and in larger context health care perspective, Generation Z (also known as “iGen”) is now becoming the predominant demographic matriculating. From a medical education perspective, it has been demonstrated the importance of curtailing how education is taught based on the unique features of each generation.

Key Points:

  • Mental health is more prevalent than previous generations
  • Volunteering has diminished compared to previous generations
  • A higher need for mentorship and guidance rather than independent learning is seen among Generation Z

Whether this can be surmised from our society as a whole, there has been an increase in focus of mental health among medical students. This was prompted by reports demonstrating that nearly half of medical students suffered from burn out. Furthermore, studies have demonstrated nearly 12% of students faced suicidal ideation and over 80% demonstrate signs of psychological stressors in general. Medical schools have responded by having an increased emphasis and funding toward services such as counseling as well as adjusting educational experiences and grading rubrics to lower mental health disturbances. Unfortunately, Generation Z is faced with an even higher prevalence of mental health that is also getting worse in time. Reports demonstrate that between 2005-2017, there was nearly a 50% increase in suicidal ideations; this is as a reminder pre-COVID, which already has led to increase in burnout and stress among health care employees. It is important that our medical education for this generation emphasizes mental health safety and ways to mitigate mental health not only for the students’ sake, but also for their future patients as it has been demonstrated psychological distress leads to diminished abilities for individuals to empathize and be altruistic.

 

Volunteering is on the decline among Generation Z. Though nearly 75% of all medical schools have student-run clinics and volunteering is considered integral in the application process for medical school, less than a third of Generation Z students are likely to perform volunteer work once admitted to college. A recent survey demonstrated as few as 12% of first year college students participated in volunteer activities. Interestingly, there is a unique difference among this generation in how they tend to volunteer when they decide to do so. Generation Z is more likely to utilize entrepreneurial and technological skills to address a problem rather than direct “hands on work” if you will. This does lead to opportunities in medical schools to foster this generation’s unique focus on technology and entrepreneurship.

 

Generation Z tends to also have a more unique stance, when it comes to more sensitive or disturbing educational topics such as rape, abortion, addiction, abuse and assault. These are key subjects in medical education with the hopes that with education in these materials will allow physicians to be more empathetic and communicate more effectively when such topics arise with patients. Already in the undergraduate level, students within Generation Z have demanded for trigger or content warnings be issued prior to discussing such material and for there to be safe spaces for them to go to feel safe after such discussions. Interestingly, in 2018, fewer than 11% of students were aware of what a trigger warning is, and less than a third support their use in medical education. However, as generation Z becomes more immersed in medical education, likely there may have to be considerations of adjustments towards this sentiment.

 

Lastly, in terms of physical spaces for learning, Generation Z has been described as having nearly opposite sentiments compared to Millennials. Though Millennials, similar to previous generations, preferred large, open unstructured environments which allowed for communal work, Generation Z tends to prefer quiet spaces where task-specific activities are readily apparent. They also have a much higher preference towards mentorship as an expectation as a way of learning rather than learning materials independently.

 

As seen, each generation poses a new set of challenges for educators and educational systems to best optimize the learning experience. Generation Z is the newest generation entering the medical system and it is important from a healthcare perspective we adjust our learning for this new generation. A higher emphasis on mentorship, mental health, potential trigger warnings for disturbing materials, and a further emphasis on technological educational activities are some ways to cater towards this newer generation.

Reference:

Plochocki, Jeffrey. Several Ways Generation Z May Shape the Medical School Landscape. Journal of Medical Education and Curricular Development. Volume6:1-4. October 2019.

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December 2021 Faculty Development Tip

How to teach Operational Excellence Techniques during clinical precepting

Elizabeth Eisenhardt, MD, FACP

Operational Excellence and Quality Improvement principles can provide ripe educational opportunities beyond the standard format of lectures or book reading. Quality Improvement/Operational Excellence principles can be taught “in the moment”, “at the bedside” or “just in time” during clinical precepting sessions. In the following article, I will give you some examples of how to achieve this.

To begin, let’s review the definitions of Quality, Improvement, and Operational Excellence. Quality can be defined as “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge AND the degree health services meet the expectations of healthcare users (the marketplace).” In the words of the famous scholar Juran, he describes quality as the following:

  • Attaining professionally agreed standards of care.
  • Something that is good, serves the purpose,
    and is worth the money that is paid for it
  • Reducing the variation around the target.

Improvement can be defined as “A change for the better (Kaizen), and not simply a change, but one which is supported by data, not a judgement call. “  Quality Improvement work tends to be proactive, continuous process improvement work to shift a culture or to exceed expectations.

Operational Excellence can be described as a philosophy that embraces problem-solving and leadership as the key to continuous improvement with the change ideas coming from the “real place of work” or Gemba.

One of the founding principles of Operational Excellence is the 8 types of waste as pictured in the waste wheel pictured below:

If you keep a copy of this wheel close by while precepting, it can be useful to pull it out and ask a learner to identify a type of waste they observed during a certain patient interaction. Perhaps the learner is running late, because the patient had excess WAITING time to be roomed, or to check-in, or to enter the building after being asked screening questions.  Perhaps they observed TRANSPORTATION waste if a certain medication or vaccine is kept only on one floor and the staff had to retrieve it. There are numerous examples of waste that can be observed and discussed.

Another quick way to keep Operational Excellence alive in the moment of clinical precepting is to ask a learner to come up with a KPI ( Key Performance Indicator) that could be applied to their patient to achieve a missing quality metric. For example, if they are telling you how their diabetic patient is missing their A1C (measurement of their blood sugar), you can pause and ask the learner, “Can you think of a KPI that might help you capture more A1C ‘s on your patients?”  The answer may be something along the lines of “100% of diabetic patients will schedule a one month follow-up at time of check-out” or “100% of diabetic patients seen in the office due for A1C will have this test ordered at time of visit.” KPIs can be applied to nearly any quality metric to help improve results. KPIs are then posted to the clinical sites’ KPI board and seen during Operational Excellence Gemba board walks.

Helping learners to develop their Quality Improvement skills can have multiple benefits for them including increased engagement, increased understanding of the “bigger picture” and increased appreciation for inter-professional teamwork. I hope you will try out some of the techniques above!

References:

Website for the Institute for Healthcare Improvement: Improving Health and Health Care Worldwide | IHI – Institute for Healthcare Improvement

MMC Canvas: Quality Improvement Science Guide: Quality Improvement Science Guide (instructure.com)

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November 2021 Faculty Development Tip

Malia E Haddock, APRN-PMHNP

Integrating the Language of Harm Reduction in Clinical Teaching and Care

When reflecting on your clinical and teaching practices as they relate to patients with substance use disorder, it is important to consider the following:

  • The extent to which drug use and people who use drugs are subject to stigma and judgement
  • The extent to which stigmatization impacts how health care providers and trainees talk about and communicate with patients who use drugs
  • The extent to which stigma, judgment and internalized shame produce reluctance among patients who use drugs to communicate openly and honestly with their health care team

If contemplating this feels like uncharted or uncomfortable territory, Harm Reduction provides a framework and language to help bridge gaps between providers/trainees and patients who use drugs.

What is Harm Reduction?

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs” (Harm Reduction Coalition [HRC], 2021).

Click on below to watch a short video:

National Harm Reduction Coalition – Harm Reduction Truth

The Harm Reduction Coalition, a leader in Harm Reduction education and advocacy, offers specific guidance on how patients who use drugs can approach their health care providers. As providers and trainees, becoming familiar and comfortable with this kind of approach will support therapeutic encounters with individuals who have histories of negative experiences with the health care system. The HRC training guide includes the following topics, described more fully in attached brochure (HRC, 2021):

  • Talking about drug use is personal
  • Reasons why it may be hard to talk about drug use (and why some people decide not to)
  • Some reasons why it is good to talk about your drug use
  • When talking about your drug use, it’s OK to build trust first
  • If the doctor is focusing too much on your drug use
  • Examples of things you can say to the doctor when you don’t want to talk about drug use

Facilitate Honest and Compassionate Communication through Harm Reduction

  • Harm Reduction provides a framework for providers and trainees to meet patients where they’re at
  • Harm Reduction removes judgement and stigmatization from the narrative
  • Harm Reduction reduces the power differential between those providing and seeking care

Harm Reduction Strategies – Theory into Practice

References:

Harm Reduction Coalition. (2021). Principles of harm reduction. https://harmreduction.org/about-us/principles-of-harm-reduction/

Harm Reduction Coalition. (2021). Quality health care is your right. https://harmreduction.org/wp-content/uploads/2020/08/Resource-SaferDrugUse-QualityHealthcareIsYourRight.pdf

Further reading:

HRC Training Guide

https://harmreduction.org/wp-content/uploads/2020/08/Resource-SaferDrugUse-QualityHealthcareIsYourRight.pdf

Addiction Technology Transfer Center Network, Language Matters Guide

https://attcnetwork.org/sites/default/files/5-Language_Matters_9-18-17.pdf

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July Faculty Development Tip

MITE Monthly Tip

The Objective Structured Teaching Exercise (OSTE): Tips for Faculty Development

Corinn Martineau, PharmD, BCACP, CDOE

It is clear that faculty development is important to enhance clinical teaching skills, however there are few objective measures of the impact of faculty development on these skills. An Objective Structured Teaching Exercise (OSTE) is both a training modality and an assessment method for the teaching skills of faculty members, preceptors, and residents. Similar to the idea of the well-known OSCE (Objective Structured Clinical Examination), the OSTE offers opportunities to engage in and practice targeted teaching skills with a standardized student (1).

Take a moment to think, “When was the last time I was observed teaching a student or resident in my clinical setting?” Clinical educators are rarely observed teaching in their clinical environment and rarely receive feedback from peers with only minimal feedback from learners. Quality of clinical teaching is generally measured by written evaluations from learners, however these generally tend to comment on a teacher’s communication skills or interest in teaching and not concrete skills.

The OSTE’s simulated teaching scenario and utilization of the standardized learner provides the opportunity for the faculty member or preceptor to develop and practice key teaching skills while being assessed objectively with immediate feedback provided to the teacher. Some of the key benefits of this modality are the ability to adjust scenarios to provide a range of difficulties (support both your junior faculty and senior faculty), provide control over the variable clinical setting, and the chance to practice teaching skills and receive immediate feedback in a safe environment (2). Furthermore, the OSTE may offer interprofessional faculty training opportunities to engage faculty members that are involved in teaching a variety of professional learners, for example, a Clinical Pharmacist Faculty member developing skills in teaching a standardized Family Medicine Resident.

Boillat and colleagues provide wonderful insight and important tips on how to use the OSTE as a faculty and preceptor development tool. Summarized below are key tips and themes gathered from their work (2):

Clarify the Goal

  • What specific teaching skill are you looking to develop or enhance?
  • Is the teacher a seasoned faculty member or a first-year resident completing a Residents as Teachers curriculum?
  • A needs assessment may be helpful prior to this step to clarify the goal prior to the creation of the scenario.
    • If the OSTE is something to be incorporated into a faculty development curriculum, a needs assessment might help identify trends multiple faculty members hope to improve upon.

Determine Context and Target Audience

  • Will the OSTE be one component of a larger faculty development curriculum?
  • Will your target audience be junior preceptors or experienced faculty?
    • This will help to guide the level of difficulty of your scenarios.
  • Consider space restrictions and/or availability of standardized learners.

Identify the Teaching Skill to be Addressed

  • Teaching skills to be addressed should be observable behaviors that can be measured.
  • Will the scenario be focused on the ability to teach a specific procedure or focused on a specific competency such as communication?
  • The sky is the limit here! Refer to the article for many helpful examples.

Prepare the Scenario

  • Consider focusing on a scenario that is based upon real life situations.
    • Perhaps the OSTE illustrates a specific teaching challenge discovered during your needs assessment.
  • Scripts should be detailed leaving minimal room for improvisation
  • Make sure the scenario is relevant to all preceptors or faculty participating.
    • Consider altering scenarios for teachers from different disciplines

Develop the Assessment Tool

  • Assessment is key and may be formative or summative.
  • Consider an objective assessment tool that outlines the observable behaviors of the teaching skill
  • Assessment may include self-assessment, assessment by standardized student(s), and assessment by peer-teachers.

In summary, the OSTE is a unique teacher and faculty development modality that consists of a standardized teaching encounter with a standardized learner and an iterative process of feedback and practice for the teacher. OSTEs are a strong faculty development tool as they offer genuine scenarios, objective, real-time assessment, and direct feedback from peers and learners. Furthermore, OSTEs can offer opportunity for targeted faculty development based upon a needs assessment with opportunity for repeated practice.

References:

  1. Sturpe DA, Schaivone KA. A primer for objective structured teaching exercises. Am J Pharm Educ. 2014;78(5):104.
  2. Boillat M, Bethune C, Ohle E, Razack S, Steinert Y. Twelve tips for using the objective structured teaching exercise for faculty development. Med Teach. 2012;34(4):269-273.
  3. Trowbridge RL, Snydman LK, Skolfield J, Hafler J, Bing-You RG. A systematic review of the use and effectiveness of the objective structured teaching encounter. Med Teach. 2011;33(11):893-903.

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June Faculty Development Tip

Pronoun Visibility in Health Professions Education

Brandy Brown, LCSW

Program Manager, The Gender Clinic

The Barbara Bush Children’s Hospital

 

Learning Objectives:

  1. Understand the value of creating inclusive norms, by sharing pronouns, in medical education settings.
  2. Identify ways to professionally share pronouns in a medical education setting.

Sharing pronouns in a professional context has become the norm in major academic settings.  This is not surprising; many initiatives to improve education and healthcare come from students.  At Maine Medical Center, we have received feedback from students coming from many institutions, inquiring why our healthcare system and educational programs have not taken steps to normalize sharing pronouns.

In 2018, an MMC workgroup, collaborating with The Gender Clinic, began to look at small ways to effect change and improve support for the LGBTQ+ community in Maine.  Within a year, after consulting with providers and staff throughout the system, community members, patients, and other institutions, a recommendation was made to ask and encourage leaders to share pronoun education with their teams.  Several departments and groups began to champion this education and share it widely as a way to shift their culture.

Why is it important to include your pronouns- in your email signature line, badge, zoom, or introductions?

When we normalize sharing our pronouns, we reduce bias and assumptions among colleagues and clients. We eliminate guessing gender identity from social cues, a process that is particularly harmful to transgender community members. Instead of relying on transgender and gender-nonconforming people to inform and educate others, we can cultivate an environment of learning, respect, and inclusivity.

In 2015, Harvard University students began offering pronoun selections during student registration.  The Kennedy School of Government elevated those recommendations in the classroom, distributing stickers with pronouns on them. Gender Pronouns Can Be Tricky on Campus. Harvard is Making Them Stick.

Theodore Svoronos, 33, a lecturer in public policy, said the stickers took some of the stress out of teaching.

“I see those stickers as a gift,” he said. “It reduces the friction and the cognitive load for us to identify people the way they want to be identified.”

To understand the impact of normalizing pronouns in medical education, read about the experience of a medical student who recently published a personal narrative, Pronouns and Advocacy in Medicine, in the AMA Journal of Ethics, describing the experience of a nonbinary person sharing their experience as a medical student at BUSM and the impact that normalizing pronouns had on their medical education.   Consider also the recently shared experience of a recent Tufts graduate, planning to apply to medical school this year, Embracing Medicine- and One’s True Self.

In recent years, pronoun visibility and sharing has become more common in healthcare settings, as well as education.

“Adding pronouns to our email signatures is another step along the pathway to creating a more equitable, inclusive and accessible work environment and supports our commitment to a more safe and accepting society and healthcare system for all people.” Fenway Health, VP of Communications

“By committing to using the correct pronouns, we are creating a space of respect and inclusion for all our patients, our staff and students.” Mayo Clinic, Vice Chair of Administration

How do I edit my email signature?

Open your Outlook and select ‘New Email’ as though you are composing a new message. Select ‘Signature’ (next to attach item). Under the dropdown choices you can update an existing signature or create a new one.

What should I write in my email signature?

Consider what your pronouns are and add them following your name. At MyPronouns.org, they suggest the following format:

Jamaal Johnson Pronouns: he/him

OR

Jamaal Johnson (pronoun: he)

There is no single best way to share pronouns. You might use “she/her/hers” or “she/her” or just “she,” which generally refers to a larger set of pronouns.

You may also want to add a link to a website, with your pronouns like this: “My Pronouns: they/them ~ See www.mypronouns.org to learn more,” if you would like to include a resource that explains why you are making your pronouns visible.

How can I include my pronouns on ZOOM?

Adding your pronouns to your name on ZOOM is another great way to increase pronoun visibility in the workplace.

If you have downloaded the ZOOM app to your computer, login as usual and select the profile icon in the top right corner and then select ‘Settings.’ Select the Profile tab and click ‘Edit my profile.’ This will launch a window in your browser where you can follow the steps listed below.

(If you do not have the ZOOM app, go to ZOOM.us on your browser and login.)

  • In the ‘Profile’ section, click ‘Edit’ far to the right of your name
  • Select ‘Display Name’

References

  1. Gender Pronouns Can Be Tricky on Campus. Harvard Is Making Them Stick. – The New York Times (nytimes.com)
  2. Pronouns and Advocacy in Medicine | Journal of Ethics | American Medical Association (ama-assn.org)
  3. Embracing Medicine—and One’s True Self | Tufts University School of Medicine
  4. Fenway Offers Employees Pronouns In Email Signatures | Fenway Health: Health Care Is A Right, Not A Privilege.
  5. Mayo Clinic employees may now wear buttons displaying their preferred pronouns | Disrn

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May Faculty Development Tip-Finding Joy in Work After Hitting a Wall

Finding joy in work after hitting a wall

Elizabeth Eisenhardt, MD

Healthcare providers have been experiencing an emotional and exhausting process as they work to navigate the Covid-19 pandemic. The challenges and hardships from this pandemic stretched most humans to the end of their coping capabilities. Many health care workers felt stress and felt challenging emotional responses to the pandemic on both a personal and professional level, and yet were required and needed to be high functioning at work and at home. Interestingly, while we have a possible end to the pandemic in sight and some hope as we race to vaccinate all Mainers, many people are feeling worse than they did the same time last year at the height of the pandemic and its subsequent lockdown. Personally I find myself on the verge of tears more frequently when my patients ask me how I am doing now versus a year ago. Why don’t I feel better now during this time of renewed action against the pandemic? Psychologist Lisa Damour explored this phenomenon recently in her podcast entitled “My kids and I have hit a wall. How do we keep going? 3/25/21. In it she talks about how it is difficult for people to maintain hope even while the pandemic situation is more hopeful because we still don’t know what to expect and what the future will hold.

If we are having trouble finding hope, we need to re-discover and celebrate the joy we have in our work to combat our burnout.
The IHI ( Institute for Healthcare Improvement) feels strongly that finding joy in our work helps to prevent burnout. They published a paper on restoring joy to the workplace after asking colleagues over and over “what matters to you?” This single question enabled them to understand the barriers to finding joy in work and to develop a framework to overcome them.

In this paper, they outline four steps that leaders can take to increase joy in the workplace. The steps are as follows:
1.) Ask staff, “what matters to you?” They describe how having these important discussions help to engage staff and to identify risk of burnout.
2.) Identify unique impediments. What are the day to day pebbles that are causing annoyance verses the larger boulders that exist on an organizational level?
3.) Commit to a systems approach . What can be a small systems change that has large staff benefit?
4.) Use improvement science. Study and discuss any changes made with staff.

Wellness discussions should also center around academics and teaching burnout. It has been shown that low job satisfaction was associated with nonstatistically significant trends toward fewer peer-reviewed first-author publications, lower teaching skills confidence, and lack of institutional grand rounds presentation. Burnout was associated with a nonstatistically significant trend toward lack of institutional grand rounds presentation. Institutions may discover via these wellness discussions that their academic providers need to have better protected academic time as too often clinical demands creep in at the expense of teaching or research.

In my leadership role, I have held many what matters to you conversations. While sometimes challenging ,they have never failed to bring forth a clearer understanding of what staff need to find more joy in their work, and assist me in understanding my staff’s needs. These conversations are important to have with students and learners as well.

During one of these recent discussions, it was clear that staff were craving a safe space to express their emotional and experiences on a given week with their colleagues. In response to this need, our office created a weekly wellness huddle. We wanted to highlight its importance, thus we incorporated it into our Operational Excellence program and made it one of our Key Performance Indicators. Using this improvement tool we made it a priority to hold a weekly huddle around staff wellness. We documented staff responses to the huddle, and their direct quotes around the experience. It has developed into a bonding time with our staff, and many have commented that it has been helpful. In this strange time of seeing new hope regarding the pandemic, but not feeling it on an individual level, we are refreshed each week with our huddle and have formed tighter team work and increased empathy because of it.

I strongly encourage using the “What matters to you?” conversation and holding these conversations frequently to engage staff and faculty to develop improvement ideas which are then studied using improvement science.

Resources:

Glasheen, J. J., Misky, G. J., Reid, M. B., Harrison, R. A., Sharpe, B., & Auerbach, A. (2011). Career satisfaction and burnout in academic hospital medicine. Archives of internal medicine, 171(8), 782-790.

Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at ihi.org)

Shanafelt, T. D., West, C. P., Sloan, J. A., Novotny, P. J., Poland, G. A., Menaker, R., … & Dyrbye, L. N. (2009). Career fit and burnout among academic faculty. Archives of Internal Medicine, 169(10), 990-995.

 

 

April Faculty Development Tip: The Education of Psychiatry – Caring for Patients Experiencing Homelessness

The Education of Psychiatry – Caring for Patients Experiencing Homelessness

Malia E. Haddock, MS, PMHNP-BC

Although trainees incidentally care for patients experiencing homelessness throughout residency and beyond, intentional didactic and clinical experiences with homelessness create unique opportunities to increase interest, confidence and ability among resident psychiatrists in the care of underserved patients.

It is well known that individuals with unstable housing have disproportionally high rates of severe psychiatric and substance use disorders compared to their housed counterparts. Indeed, untreated psychiatric and substance use disorders are cited as primary causes of homelessness, and once homeless, psychiatrically-symptomatic individuals face additional barriers to accessing psychiatric care. Common obstacles include lack of affordable or reliable transportation, variable access to telephone/internet, and systems barriers such as scheduled appointments and attendance policies. However, intangible barriers such as provider discomfort with homelessness may further distance patients from psychiatric care.

HPATHI

The Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI) is a validated 19-item instrument designed to “assess medical students’ and physicians’ attitudes towards homeless persons and to measure their level of interest and confidence in their ability to deliver health-care services to the homeless population” (Buck et al., 2005).  The impetus for this inventory traces back to a 1985 publication on access to care among individuals with unstable housing. The report’s author, Elvy, writes, “The disinclination of the homeless to seek care may be due in part to the ways in which many health-care workers respond to them. A less investigated but possibly equally important circumstance is the attitudes that health-care professionals have toward the homeless” (as cited in Buck et al., 2005, p. 2). More contemporaneous academic discussions also play a role in HPATHI’s inception, particularly those involving the role of humanism and Social Determinants of Health curricula in undergraduate and graduate medical education (Buck et al., 2005).

Opportunities for Psychiatry

In “A Survey of American Psychiatric Residency Programs Concerning Education in Homelessness” McQuistion et al. found that while 60% of programs offered optional clinical and/or didactic experiences, only 11% of programs reported mandatory rotations in the care of patients experiencing homelessness. Lack of widespread mandatory programming was attributed to several factors, most notably lack of attending psychiatrists with expertise in caring for patients experiencing homelessness; lack of funding and/or logistical support to create programming; and perceived lack of homelessness in suburban and rural areas (2004).

Given the prevalence of severe psychiatric illness and substance use disorder among individuals experiencing homelessness, psychiatry trainees have much to gain from intentional exposure and training in this area. Over time, measurable improvements in interest, confidence and ability among learners may result in more accessible and culturally attuned care for this population.

 

Why HPATHI in Medical Education?

  • Acknowledges the impact of provider attitudes and behaviors on engagement with underserved patients
  • Raises awareness among educators and learners of the unique needs of patients with unstable housing
  • Establishes baseline data on attitudes, interest, confidence and ability in caring for patients experiencing homelessness
  • Uncovers experience and knowledge gaps that can be specifically addressed through curriculum development
  • Over time may lead to structural changes in both educational practice and care delivery to meet the needs of learners and underserved patients

References

Buck, D.S., Monteiro, F., Kneuper, S. et al. Design and validation of the Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI). BMC Med Educ 5, 2 (2005). https://doi.org/10.1186/1472-6920-5-2

McQuistion HL, Ranz JM, Gillig PM. A survey of American psychiatric residency programs concerning education in homelessness. Acad Psychiatry. 2004 Summer;28(2):116-21. doi: 10.1176/appi.ap.28.2.116. PMID: 15298863.

March Faculty Development Tip-The Prebrief: More than just an Orientation

February Monthly Faculty Development Tip

Shelly Chipman, RN

The Prebrief: More than just an Orientation

Our passion and responsibility as educators is to facilitate the acquisition of knowledge and/or skills upon our students. Traditionally, this has been a rather passive process, where faculty provide information and learners absorb by listening or watching; transference of knowledge is teacher focused.  Newer modalities of teaching, such as team based learning, case based and experiential learning provide a more active learning environment, thus moving accountability of learning to the student/learner (Cheng, 2016).  Simulation is one such experiential educational activity, which allows learners to participate in a reproduction of a realistic clinical experience. A reflective discussion about that experience called the debrief follows and is facilitated by the instructor, and is a critical component of active learning. It provides an opportunity for deeper learning and translation of technical, cognitive and behavioral skills to clinical practice (Arefeh, 2010).

While the debrief is well recognized as an essential component of simulation education, the less well known “prebrief” is also important to learning, and sets the stage for the simulated experience and debrief. Several components of the prebrief are necessary in order to optimize learning and learner engagement:

Psychological Safety: This provides the foundation for the deep reflection needed for learning and translation of that learning to clinical practice. Psychological safety is established in the prebrief so learners feel comfortable discussing potential errors, gaps in knowledge or even successes that were revealed during the simulation scenario.

Review Expectations: Providing a clear description of what the learners can expect and what is expected of them is critical to a successful session.

Explain format-rational-agenda: This description of expectations should include an outline of agenda, explanation of any ground rules and clarification of any questions or preconceived notions that the learners may have.  Transparency, clarity of objectives and rationale for training (formative vs summative) prior to the scenario is key to optimal learner participation.

Basic Assumption: Part of establishing psychological safety is setting the basic assumption of healthcare simulation, an underlying belief that learners are intelligent, well trained and want to improve (Rudolph, 2006).  By setting this tone and assumption, mistakes during simulation are viewed as puzzles to be solved, rather than mistakes or faults in skill. Although this is not explicitly stated in the prebrief, it is recognized by faculty behaviors throughout the simulation session.

Review confidentiality: This includes the concept of “what happens in simulation, stays in simulation”, addressing any observers and their purpose for observing and keeping the scenarios confidential, avoiding “scenario leak” to other leaners.

Introduce Environment: This includes the space, manikin, the equipment or any other unique aspects. Introduction to the environment is critically important to provide “buy in” and prevent learners from “blaming” the lack of fidelity as an issue that may have affected their performance (Rudolph, 2014).

Encourage embracing the uncomfortable: Evidence supports the concept that some level of stress and emotion helps enhance memory (Clapper, 2014). Simulation provides an opportunity for the learners to reach that sweet spot of learning, where they are uncomfortable enough to learn, but not so uncomfortable that they cannot perform.

Fictional contract: This is where learners are asked to suspend disbelief and faculty acknowledge that it is not a perfect replica of the clinical environment must be addressed in order to make the experience more valuable.

As simulation educators, it is vitally important to provide a prebrief that sets the stage for a successful debrief and experiential learning session. By practicing each of these important components and providing a prebrief in every simulation education session, educators can provide an environment that is engaging and enhances learning. These components can be utilized in many learner-focused educational activities to promote engagement.

 

Psychological safety

Review expectations

Explain format-rational-agenda

Basic assumption

Review confidentiality

Introduce Environment

Encourage embracing the uncomfortable

Fiction contract

 

Further Reading: (attached)

Rudolph, J, Raemer D, Simon, R. Establishing a Safe Container for Learning in Simulation: The Role of the Presimulation Briefing. Simulation in Healthcare. 2014 December 9(6): 339-349.

 

References:

Arafeh,J, Hansen, S, Nichols, A. Debriefing in Simulated-Based Learning, Facilitating a Reflective Discussion. Journal of Perinatal Nursing. 2010 24(4): 302-309.

Clapper, T. C. Beyond Knowles: What those conducting simulation need to know about

adult learning theory. Clinical Simulation in Nursing. 2010 January  VOL(6), e7-e14. doi:10.1016/j.ecns.2009.07.003

 

Cheng, A. Morse, K., Rudolph, J., Abeer, A. Runnacles, J, Eppich,W. Learner-Centered Debriefing for Health Care Simulation Education: Lessons for Faculty Development.  Simulation in Healthcare. 2016 February 11(1):32-40.

Eppich, W, Cheng, A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and Rationale for a Blended Approach to Health Care Simulation Debriefing. Simulation in Healthcare.  2015 April 10(2): 106-115.

Rudolph, J, Simon, R, Dufresne, R, Raemer, D. There’s no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simulation in Healthcare. 2006 1(1):49-55.