May 2023 Faculty Development Tip

MITE Monthly Tip
May 2023
Nora Fagan MSN, BScN, RN, CMSRN

Interdisciplinary Team Communication

The inpatient hospital environment is fast paced and at times chaotic.  Multiple interdisciplinary teams are constantly attempting to collaborate to provide high quality care that leads to positive patient outcomes. The lack of cohorting of patients by provider is a challenge.  Rounding schedules can be challenging for effective and accurate information that can be shared with the entire team. Ineffective communication among healthcare workers has been shown to be a major contributor to medical errors (Holodinksky, Hebert, Zygun et al, 2015).  Utilizing a schedule for interprofessional rounding within the inpatient environment could be an option to make this process more cohesive (Witz, Lucchese, Valenzano, et al, 2022).  Healthcare educators and leaders of all disciplines need to put a greater focus on how the interprofessional team works together sharing information on patient progress.  The following are key recommendations for implementation from a leadership perspective.

  • Establishing a private space for rounds
  • Foster accountability with participants
  • Awareness of staff comfort levels with public speaking or group dynamics
  • Utilizing the opportunity to coach and provide validation to participants

Creating a plan that participants can become familiar with that provides direction to the key points of reportable information for care planning can help teach effective communication. A healthcare environment that values collaboration and shared decision making will help to improve patient outcomes as well as lessen turnover rates staff (Witz, Lucchese, Valenzano, et al, 2022). The increasingly challenging patient flow crisis that healthcare organizations are facing could be significantly improved if there was a more standardized method for patient rounding that included all members of the healthcare team. Strengthening the engagement of the interdisciplinary team with patient rounding could additionally have a positive impact on quality improvement and other organizational change (Rangachari, Rissing & Rethemeyer, 2013).

References

  1. Holodinsky, J. K., Hebert, M. A., Zygun, D. A., Rigal, R., Berthelot, S., Cook, D. J., & Stelfox, H. T. (2015). A Survey of Rounding Practices in Canadian Adult Intensive Care Units. PloS one, 10(12), e0145408. https://doi.org/10.1371/journal.pone.0145408
  2. Rangachari, P., Rissing, P., & Rethemeyer K. (2013). Awareness of evidence-based practices alone does not transplate to implementation: insights from implantation research. Quality Management in Health Care, 22 (2), 117-125. http://doi.org10.1016/j.jmir.2022.06.006
  3. Witz, I., Lucchese, S., Valenzano, T., Penney, T., Lodge, R., Topolovec-Vranic, J & Bellicoso, D. (2022). Perceptions on implementation of a new standardized reporting tool to support structured morning rounds: Recommendations for interprofessional teams and healthcare leaders. Journal of Medical Imaging and Radiation Sciences, 53(4), S85-S92. https://doi.org/10.1016/j.jmir.2022.06.006.

April 2023 Faculty Development Tip

MITE Monthly Tip
April 2023
Amy Moore, MLIS

Enhancing Curricula with Information Literacy Frameworks

Information literacy is defined as, “the set of integrated abilities encompassing the reflective discovery of information, the understanding of how information is produced and valued, and the use of information in creating new knowledge and participating ethically in communities of learning.”1

Introduction

These days, information consumption and scholarly publishing are both fast-paced and show no signs of slowing. Educators are called upon to guide learners in the process of information creation, locating best evidence and knowledge dissemination in all fields but what guidance and supports exists? The Framework for Information Literacy for Higher Education was created by the Association of College and Research Libraries (ACRL) Task Force to provide a resource to enhance and support curricula while engaging learners. As described by the ACRL:

“The Framework opens the way for librarians, faculty, and other institutional partners to redesign instruction sessions, assignments, courses, and even curricula; to connect information literacy with student success initiatives; to collaborate on pedagogical research and involve students themselves in that research; and to create wider conversations about student learning, the scholarship of teaching and learning, and the assessment of learning on local campuses and beyond.”1

At the core of the Framework are six “frames” that guide learners and educators to a deeper understanding of information literacy through relevant examples. Each frame is accompanied by knowledge practices and dispositions to identify the learner’s comprehension of information literate abilities. The six frames include:

  • Authority Is Constructed and Contextual
  • Information Creation as a Process
  • Information Has Value
  • Research as Inquiry
  • Scholarship as Conversation
  • Searching as Strategic Exploration

Supporting Curricula with the Frames

Educational milestones in the health disciplines are directly aligned with the Framework for Information Literacy for Higher Education’s frames. In the article, Identifying Information Literacy Skills and Behaviors in the Curricular Competencies of Health Professions, the authors correlated information literacy skills with several health science program proficiencies.2  For instance, evaluating evidence is a foundational competency across many specialties. In graduate medical education, the demonstration of “locating and applying the best available evidence, integrated with patient preference, to the care of complex patients” marks a competency in evidence-based and informed practice.3 In the same vein, information literacy’s Authority Is Constructed and Contextual frame calls on the learner to evaluate evidence and “ask relevant questions about origins, context, and suitability for the current information need.”4 Similarly in nursing, requirements to “use information and communication technology to gather data, create information, and generate knowledge” are a foundation of education.5 Supporting this same idea, the Scholarship as Conversation frame encourages learners developing this ability to engage in the scholarly conversation and to attribute any previous relevant work.4

Key Takeaways

Be on the lookout for opportunities to use the Framework in your teaching to support your learners on their path to information literacy fluency. Use the knowledge practices and dispositions to evaluate your student’s level of understanding or engage them in discussion. Frames can also be used for instruction or assignments. Most importantly, the frames can offer an opportunity for collaboration. Reach out to MaineHealth’s Library and Knowledge Services for supporting in using the Framework for Information Literacy for Higher Education to enhance curricula.

References

  1. Association of College and Research Libraries. Framework for Information Literacy for Higher Education. Accessed November, 2022. https://www.ala.org/acrl/standards/ilframework#introduction
  2. Waltz MJ, Moberly HK, Carrigan EE. Identifying information literacy skills and behaviors in the curricular competencies of health professions. J Med Libr Assoc. Jul 1 2020;108(3):463-479. doi:10.5195/jmla.2020.833
  3. Accreditation Council for Graduate Medical Education (ACGME). Emergency Medicine Milestones. 2021. Accessed November 2022. https://prep.acgme.org/globalassets/pdfs/milestones/emergencymedicinemilestones.pdf
  4. American Library Association. Framework for Information Literacy for Higher Education. Accessed November, 2022. http://www.ala.org/acrl/standards/ilframework
  5. American Association of Colleges of Nursing. The essentials: core competencies for professional nursing education. 2021. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf

Further Reading

Framework for Information Literacy for Higher Education

 

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March 2023 Faculty Development Tip

MITE Monthly Tip
March 2023
Abtin K. Farahmand, MD

Maximizing the Academic Conference Experience: Tips for Your Career Toolkit

It is hard for many who attend large academic conferences on how to maximize one’s time. Often there are several lectures, and events occurring at once and participants may feel overwhelmed by how to best utilize their time. Some strategies including in this brief podcast below include the following:

    • Pre-conference preparation is key. Most conferences list their agenda well in advance and offer online platforms where you can create a unique agenda based on topics that interest you most. Make sure if you are presenting you know those times well in advance so it doesn’t conflict with other networking, lectures, and other agenda items you may be interested in.
    • Active engagement when you are attending lectures. Try to create breaks in your schedule to decrease academic overload.
    • Re-review. Try to take notes you can review once you are done with the conference so you can further retain what you learned.

The resource for an in-depth listen easy for one’s car ride:
Listen on Apple Podcasts: https://podcasts.apple.com/us/podcast/maximizing-the-academic-conference-experience-tips/id1525596962?i=1000565689953

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December 2022 Faculty Development Tip

December 2022 Faculty Development Tip
December 2022
Maria Egger, PA-C

Fostering Team Problem Solving and Learning as an Antidote to Burnout

Several weeks ago, I was listening to members of our healthcare team trying to determine the cause of a deficiency in routine patient care.  A patient has been found lying on a clean bedpad on top of soiled sheets.  The patient’s caregiver had admitted that she was unable to transfer the patient herself and did not want to leave the patient on soiled bedclothes; working solo she was able to clean the patient and get her onto a dry pad until she could get help with moving the patient out of bed.  This care team member commented that in a previous healthcare setting all routine patient care was performed in teams of two people and wondered if that system should be started in this facility to work more efficiently and provide optimal patient care.  The team leader agreed that this may be a better system, but no movement was made to develop ways to try out the idea.

Key points

  • Short-term, first-order problem solving is not enough to support healthcare team well-being and contributes to burnout.
  • Strategic, second-order problem solving can provide long-term sustainable solutions to systemic problems
  • Second-order problem solving involves participation and learning from the entire team, both leaders and members.

This situation just described illustrates two forms of problem solving.  The team member making up for the lack of assistance to safely transfer the patient demonstrated first-order problem solving.  First-order problem solving occurs when team members compensate for lack of resources or supplies with short-term fixes.  The problem at hand was solved, at least temporarily, but no systemic action was taken to prevent this problem from recurring.  While there may have been some short-term caregiver satisfaction in devising this workaround, repeating problems requiring subpar solutions will lead to mounting frustration, resentment, and burnout.(Tucker & Edmondson, 2003)

The team member suggesting a broader change to teamwork and workflow exhibited second-order problem solving.  This type of problem solving includes communicating to team leaders the problem and suggesting ideas about possible cause and solutions.  Effective second-order problem solving leads to team member inclusiveness, learning, increased job satisfaction and in the healthcare setting better overall patient care. For second-order problem solving to be successful team members must feel psychologically safe and empowered to admit mistakes and suggest solutions.  Team leaders must be approachable and visible to team members and actively encourage members to think about and voice possible solutions to problems.  All disciplines must be willing to “reach across the aisle” and be willing to modify practices or workflow to achieve the desired result.  Leaders must be willing to put in the time to organize and facilitate suggested solutions, involve the team in learning from trial and error, evaluate results and revise solutions.  (Tucker & Edmondson, 2003)

Even prior to the COVID pandemic burnout among healthcare team members was a serious problem.  Statistics published in 2015 cited rates as high as 37% of nurses and 60% of physicians contemplating leaving their profession Poorly designed systems and staffing shortages create a vicious cycle of increasing demands on time and resources contributing to caregiver fatigue in the healthcare workplace (Perlo & Feeley, 2018). Empowering the entire interdisciplinary healthcare team, both leaders and members, to be resourceful and innovative, to arrive at self-directed long-term solutions to systemic problems can preserve a sense of well-being, forward thinking and confidence in delivering optimal patient care.

Perlo, J., & Feeley, D. (2018). Why focusing on professional burnout is not enough. Journal of Healthcare Management, 63(2), 85–89. https://doi.org/10.1097/JHM-D-18-00003

Tucker, A. L., & Edmondson, A. C. (2003). California Management Review Why Hospitals Don’t Learn from Failures: Organizational and Psychological Dynamics that Inhibit System Change.

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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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