August Faculty Development: Teaching communication skills for difficult conversations

Teaching communication skills for difficult conversations-Annabelle Rae C. Norwood, MD MMP Geriatrics

As professionals working in the medical field, we are often tasked with difficult conversations of delivering bad news, disclosing medical error, or initiating advance care planning and end-of-life discussions with patients and their families. More often than not, skills needed to effectively communicate with patients about these difficult topics are not developed fully during medical training.  As such, the Accreditation Council for Graduate Medical Education now requires competency in communication skills for residents and fellows.1 There are different methods available in order to hone these skills.

Tip 1: Use of case-based learning, didactics and video clips

Perhaps not as effective as other methods discussed in this article, these can be easily incorporated into routine department conferences. These can also be useful when you have a large audience. These methods can serve as a foundation for the other methods discussed below. Concepts such as the Ask-Tell-Ask model,2 the SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, and Summary) mnemonic, a tool to present distressing information in an organized fashion,3 and the NURSE (Name the emotion, Understand the emotion, show Respect, Support and Explore) acronym, which is a method on how to respond to patient’s emotions with empathy4 can be discussed in these settings. Video clips can also be helpful in illustrating on how to set the stage for a family meeting, or what not to do when disclosing bad news.

Tip 2: Use of role-playing or sociodrama

These can portray social situations than merely describe them as in case-based discussions.  These can be a tool for learners to develop empathic understanding of a person’s point of view.5 Group size is a practical consideration. A small group of 4-8 learners, with a single role-play with a faculty facilitator can be successful as most or all of the learners can take an active role at some point. In a larger group, learners can pair up in a dyad or triad and practice simultaneously.6

Tip 3: Simulation-based learning and the use of standardized patients

These methods can ensure a consistent teaching approach and allow immediate feedback to the learner from the standardized patient and observing faculty. However, these methods may also entail a lot time for development of patient scenarios, and resources to train standardized patients. The Hannaford Center for Safety, Innovation & Simulation at the Brighton Campus is an excellent resource for this.7

Tip 4: Go to specialized workshops and training programs

The Oncotalk, a communication skills program developed for medical oncology fellows8 has been replicated and applied to other specialties giving rise to other iterations such as the Geritalk,9 NephroTalk,10 and CardioTalk11 to name a few. These are all mainly targeted towards fellows, but medical students, residents, attendings, advance practice professionals and nurses have also ben audiences in these workshops. These half- to multi-day retreats can be highly effective in developing communication skills as these studies have demonstrated. However, these can also be time-consuming and difficult to integrate into clinical training.

Tip 5: Give communication skills training in the “real world”

Clinical rotations are an underutilized venue for directly observed practice and feedback.12,13  Learners can be first an active observer during clinical encounters or family meetings. Later, the learner can play a more active minor role, such as giving an update about the clinical course using clear and concise terms, while a more senior person leads discussion about treatment options or goals of care discussions. In time, learners may also lead the entire discussion as well, with the faculty providing some support. Debriefing is an important component during these teaching sessions and should be done with the learner as soon as possible after the encounter. Specific feedback focusing on communication skills, not style, is key for the learner to reinforce good communication skills, and identify those that can be improved upon.13

Tip 6: Allot time for communication skills training

Whether it is allocating an hour a month during your weekly formal didactic sessions in your department, or having your learners attend a communication skills workshop, it is important in making sure that your trainees gain the skills they need to be “out in the real world”. Time may also need to be allotted for faculty development in this area.

  1. Accreditation Council for Graduate Medical Education [Internet]. [cited 2018 Jul 15];Available from: http://www.acgme.org/
  2. Back AL, Arnold RM TJ. Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope. New York, NY: Cambridge University Press; 2009.
  3. Baile WF. SPIKES–A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist 2000;5(4):302–11.
  4. Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. Approaching Difficult Communication Tasks in Oncology. CA Cancer J Clin 2005;55(3):164–77.
  5. Baile WF, Walters R. Applying sociodramatic methods in teaching transition to palliative care. J Pain Symptom Manage 2013;45(3):606–19.
  6. Jackson VA, Back AL. Teaching Communication Skills Using Role-Play: An Experience-Based Guide for Educators. J Palliat Med 2011;14(6):775–80.
  7. Hannaford Center for Safety, Innovation & Simulation [Internet]. [cited 2018 Jul 15];Available from: https://mainehealth.org/maine-medical-center/education-research/students-residents-fellows/hannaford-center-safety-innovation-simulation
  8. Back AL, Arnold RM, Tulsky JA, Baile WF, Fryer-Edwards KA. Teaching communication skills to medical oncology fellows. J. Clin. Oncol. 2003;21(12):2433–6.
  9. Kelley AS, Back AL, Arnold RM, et al. Geritalk: Communication skills training for geriatric and palliative medicine fellows. J Am Geriatr Soc 2012;60(2):332–7.
  10. Schell JO, Green JA, Tulsky JA, Arnold RM. Communication skills training for dialysis decision-making and end-of-life care in nephrology. Clin J Am Soc Nephrol 2013;8(4):675–80.
  11. Berlacher K, Arnold RM, Reitschuler-Cross E, Teuteberg J, Teuteberg W. The Impact of Communication Skills Training on Cardiology Fellows’ and Attending Physicians’ Perceived Comfort with Difficult Conversations. J Palliat Med 2017;20(7):767–9.
  12. Janicik R, Kalet AL, Schwartz MD, Zabar S, Lipkin M. Using Bedside Rounds to Teach Communication Skills in the Internal Medicine Clerkship. Med Educ Online 2007;12(1):4458.
  13. Hinkle LJ, Fettig LP, Carlos WG, Bosslet G. Twelve tips for just in time teaching of communication skills for difficult conversations in the clinical setting. Med Teach 2017;39(9):920–5.

July Faculty Development: How to Excel as a Mentor, According to Mentees

How to Excel as a Mentor, According to Mentees

Kaylee Underkofler, MD/MPH Candidate, Maine Track ‘18

What does it take to become a great mentor? While many have pondered this immense question, Lee et al. and Cho et al. sought an answer from perhaps the most important judge of mentors: mentees.1,2 Their goal was to identify the characteristics and practices of exceptional mentors in the eyes of students. The five tips listed below are a unified summary of their results. It is proposed that these ideas could be used to self-assess mentoring abilities, to build faculty development programs, or to guide students and young faculty in the search for a mentor.2 While all the nuances that go into becoming a truly great mentor could not be captured here, this list does include what is most commonly cited as being appreciated by mentees and serves as a place to start for those looking to improve their mentoring abilities.

 

  1. Exude enthusiasm. The list of personal characteristics that exceptional mentors possess is long and at times varied, but enthusiasm is a constant presence on that list. When enthusiasm for an idea or project is exhibited, it is infectious, spreading to excite passionate students capable of great things.
  2. Provide tailored career guidance. Outstanding mentors undoubtedly influence the careers of their mentees. They do this not by taking a one-size-fits-all approach, but by getting to know their mentees as whole individuals with unique personal goals. As a team, the mentor and mentee create a tailored plan that is distinct from the plan the mentor helps build for another mentee.
  3. Dedicate time, over a long period of time. Mentees emphasize the importance of both frequency of meetings and mentor availability, describing open-door policies and routinely making time for students as hallmarks of terrific mentorship. Furthermore, the longevity of the relationship is valued highly. Mentor-mentee relationships that extend beyond the duration of a project or time at an institution seem to inspire the most appreciation and admiration.
  4. Encourage work-life balance. Those who excel at mentorship are open to discussions about personal life, exploring topics such as family and hobbies. Not only do they discuss life outside of work, they encourage pursuing it. Mentors who organize outings and spend time with their students in a social setting are also viewed favorably by mentees.
  5. Serve as a role model for mentorship. In both articles cited, surveyed mentees describe a desire to utilize the practices of their mentors as they move in their careers from students to teachers. Similarly, those who have been nominated for awards in mentorship give credit to those who had previously served as mentors to them. It seems that great mentors beget great mentors.

 

Here are a few links if you’re interested in learning more about mentorship (and being an active mentee!):

  1. http://www.sciencemag.org/careers/2010/10/top-10-tips-mentors
  2. http://www.sciencemag.org/careers/2009/08/top-10-tips-maximize-your-mentoring
  3. https://facultydevelopment.cornell.edu/faculty-resources/mentoring/

 

References:

 

  1. Lee A, Dennis C, Campbell P. Nature’s guide for mentors. Nature 2007 Jun;447(14):791-797.
  2. Cho CS, Ramanan RA, Feldman MD. Defining the ideal qualities of mentorship: a qualitative analysis of the characteristics of outstanding mentors. Am. J. Med. 2011 May;124(5):453-458.

June Faculty Development: Teaching Digital/E-Professionalism-Reflections for deepening understanding of professional identity on social media

Teaching Digital/E-Professionalism:  Reflections for deepening understanding of professional identity on social media

Nicholas Knowland, TUSM-Maine Track Program, M18

Ensuring the public trust in the medical profession is the reason for promoting professionalism as a key component of medical education. Therefore medical curricula place significant emphasis on the development of professional behaviors.

Digital professionalism, or e-professionalism, describes the increasing interaction of medical professionalism with the greater public through social media outlets. The terms are new but the reality that online images or postings can reflect on students or practitioners has been present for some time and is usually associated with negative connotations.  This has resulted in what some authors have described as a ‘hidden curriculum of digital unprofessionalism’ in which digital unprofessionalism is punished but rarely overtly taught. Despite the consequences that digital unprofessionalism lead to for a clinical student or clinician, the academic literature is increasingly focusing on the positive opportunities associated with professional physician social media use, such as using social media to actively share quality information.

 

TIP 1:  Consider the Social Media  in Medicine Hierarchy of Needs

There is no clear consensus yet as to what should be taught to instill digital professionalism.  Overt curricula for teaching digital professionalism have recently been developed and are described in one of the references at the bottom of this paper but there is no clear consensus yet as to what digital professionalism really requires.  One useful paradigm is the “Social Media in Medicine Hierarchy of Needs”  to which there are three levels: Security, Reflection and then Discovery.

Discovery: Is the highest level of the pyramid, reached when the lower levels are met. Discovery focuses on how to use social media to benefit patient health, to mentor, and to innovate.

Reflection:  This middle level is where practitioners reflect on their personal online identity and how they want to use social media to interact with colleagues, patients and students.

Security:  This is the bottom level of the pyramid, patients and personal career must be protected from social media consequences or else reflective activities or efforts at discovery will surely be damaging to either the practitioner or their patients.  At a baseline patient privacy must be protected at all times.

In summary, the pyramid is built on:  security for the patients and yourself, reflection on how you want to engage, and discovery of new and evolving opportunities through social media that may prove beneficial to patients or your own career.

Specific questions addressing different aspects of the pyramid include:

Security: Do you know the AMA policy on professional social media use? Your employers?

Reflection:  What do you hope to learn or share?

Reflection:  What are your individual principles?(For example, safeguarding patient privacy is required,  but will you post about patient related experiences in a respectful tone that safeguards anonymity or simply choose not to post about work experiences altogether?)

Reflection:  What will be your personal policy for social media interaction with trainees?  None? Only past trainees? Only for those you are not personally going to evaluate?

Discovery:  How could you use social media to improve healthcare or to disseminate your expertise?

TIP 2:  Google yourself once in a while and see what pops up

Ensure that your professional digital persona is one you want your patients and colleagues seeing

TIP 3:  Reflective questions to propose to your learners

The ubiquity of social media, the lack of consensus exactly defining digital professionalism, the prominence of information sharing among the younger generation and the constant dynamism of social media platforms have made digital professional education difficult to provide.  Nevertheless, some experts at George Washington University Medical School have recently published some questions, used within their own curriculum, that provide good starting points for discussion:

What social media sites do you use most?  What purposes do you visit social media sites for (personal, professional, or both)?

Who are you representing online? Yourself? Your university/employer? Your profession?

How do you define e-professionalism online?

How has your social media identity changed since you entered medical school?

Are there expressions that may seem humorous in person but could appear unprofessional on social media?

If you were to draft a “social media guideline” for the incoming class what would it look like?

 

TIP 4:  Have examples of positive social media use ready

It is often the case that negative social media experiences or consequences come up in these discussions.  It is important to develop an understanding of these negative consequences to inform the notion of ‘Security’ in the social media hierarchy.

However, there are countless examples of positive social media use. Look at your colleagues’ behaviors or at trainees in other programs and bring those examples with you.  Such positive examples help you and your learners ‘Reflect’ on what positive digital professionalism looks like and how it can benefit the greater public and your own practice.

From there, it is a simple step to start looking towards Discovery.

1: Chretien KC, Kind T. Climbing social media in medicine’s hierarchy of needs.

Acad Med. 2014 Oct;89(10):1318-20. doi: 10.1097/ACM.0000000000000430. PubMed

PMID: 25076202.

2: Gomes AW, Butera G, Chretien KC, Kind T. The Development and Impact of aSocial Media and Professionalism Course for Medical Students. Teach Learn Med.2017 Jul-Sep;29(3):296-303. doi: 10.1080/10401334.2016.1275971. Epub 2017 Mar 8. PubMed PMID: 28272900.

3: Kind T, Patel PD, Lie D, Chretien KC. Twelve tips for using social media as a medical educator. Med Teach. 2014 Apr;36(4):284-90. doi:10.3109/0142159X.2013.852167. Epub 2013 Nov 21. PubMed PMID: 24261897. 4: Ellaway RH, Coral J, Topps D, Topps M. Exploring digital professionalism. Med Teach. 2015;37(9):844-9. doi: 10.3109/0142159X.2015.1044956. Epub 2015 Jun 1.PubMed PMID: 26030375.

 

 

May Faculty Development: The Art of Retention

The Art of Retention

Karyn King TUSM-MMC, M18

It’s midnight the night before a final exam and you’re sitting in front of a pile of notes that you half-heartedly studied while watching the entire series of Friends (again) during the past four weeks of your histology course. Driven by caffeine and an ingrained fear of failure, you realize it’s time to cram every fact you can into your brain before your 8:00 am exam tomorrow morning. Flash forward to one week later when your test scores come out. You nervously open the grading portal, an 87! You think to yourself, “not bad, what was that exam on again?!”

Does this scenario sound at all familiar?

As medical knowledge expands, those in the medical field are tasked with working towards mastery of a vastly large amount of information. Unfortunately, with the nature of multiple choice tests and standardized board examinations, several mistakes can be made while attempting to “master” this content. Below are some tips to not only help with examination performance, but also with long-term retention and subsequent incorporation of learned content into clinical activities.

Tip 1: We all forget things…and that’s ok

  • In 1880, Ebbinghaus set out to determine the relationship between learning and forgetting. Using a single-subject experimental design (i.e. using himself as the subject) he created a “forgetting curve” based on his retention of nonsense syllables over time. There have been several other attempts to classify the relationship between learning and forgetting which have produced similar, yet slightly variable forgetting curves. However, in 2015, the Ebbinghaus curve was successfully replicated by Murre and Dros, providing increased support for the validity of Ebbinghaus’ original curve created in the 1880s.1,5
  • The basic idea of the forgetting curve, whether you use Ebbinghaus’ original curve or not, has been used as a reference for tools aimed at better structuring study habits to combat forgetting learned material. While at its core, the concept of the forgetting curve is not all that surprising, the fact that we do forget content throughout the learning process is a key component of learning and cannot be overlooked.

Tip 2: Practice spaced learning instead of massed learning or “cramming”:

  • Remember the scenario we discussed earlier – the stress inducing all nighter? Well, to be fair, cramming isn’t all If you find yourself ill-prepared for an examination with very little time to dedicate to studying, cramming will certainly be of benefit to your short-term retention of the material and likely your immediate performance on the examination. The downside comes from the fact that cramming gives you minimal long-term retention of material. This is why cramming isn’t the ideal study method if you’re hoping to be able to apply the course content to future experiences, especially clinical care. This is where spaced learning comes in!
  • It has been shown in many studies that spaced learning (i.e. steady review of material over a period of time) with frequent repetitions of the material is much more beneficial for long-term retention.2,4 The most effective way to manage your spaced learning schedule is often with software (e.g. Anki) that has specific algorithms in place to help you determine appropriate spacing intervals for studying based on your specific study patterns and ability to retain information.3 However, if you are committed and your content is easily broken up into discrete chunks, you can in a sense create your own algorithm by breaking your content down into material that you study daily, every other day, weekly, immediately before the exam, etc.3
  • When considering how to apply spaced learning to clinical practice, it is important that we take the knowledge that we have acquired or the new skill we have learned and consciously and deliberately practice it in our day to day clinical work. Practice doesn’t always make perfect, but effortful and deliberate practice certainly makes you a better clinician. Spaced reminders of content as seen in the graph below will help to alter the projection of the forgetting curve and allow you to retain information longer.1, 3

 

References:

  1. Akresh-Gonzales, Josette. “Spaced Repetition: The Most Effective Way to Learn. NEJM Knowledge+.” NEJM Knowledge+, NEJM Group, 31 Jan. 2018, knowledgeplus.nejm.org/blog/spaced-repetition-the-most-effective-way-to-learn/.
  2. Ausubel, David P., and Mohamed Youssef. “The Effect of Spaced Repetition on Meaningful Retention.” The Journal of General Psychology, vol. 73, no. 1, 1965, pp. 147–150., doi:10.1080/00221309.1965.9711263.
  3. Gkiokas, Dimitris. “Spaced Repetition: Learn Once, Remember Forever.” The Metalearners, 15 Feb. 2018, www.themetalearners.com/spaced-repetition-learn-once-remember-forever/.
  4. Karpicke, Jeffrey D., and Althea Bauernschmidt. “Spaced Retrieval: Absolute Spacing Enhances Learning Regardless of Relative Spacing.” Journal of Experimental Psychology: Learning, Memory, and Cognition, vol. 37, no. 5, 2011, pp. 1250–1257., doi:10.1037/a0023436.
  5. Murre, Jaap M. J., and Joeri Dros. “Replication and Analysis of Ebbinghaus Forgetting Curve.” Plos One, vol. 10, no. 7, 6 July 2015, doi:10.1371/journal.pone.0120644.

April Faculty Development: Developing an Implicit Bias Curriculum: Six point Framework

Developing an Implicit Bias Curriculum: Six point Framework

John Gilboy, MS4 Tufts Maine Track.

Implicit bias has been shown to impact clinical decision-making and patient outcomes.1 In addition to clinical outcomes, bias among health care professionals has been linked to the gender gap within health care leadership and specialties. 2 While exploring health care disparities has been a focus in all levels of medical education, few educational interventions have adequately addressed recognition bias. Below is a six-point framework described by Sukhera et al to implement an implicit-bias-informed educational curriculum for health care provider.

Six Point Framework3

  • Creating a safe and nonthreatening learning context

Addressing bias in an educational setting is both risky and challenging for learners and educators. Often instructors and learners can be reluctant to recognize and disclose biases. However, by emphasizing and reinforcing that bias is pervasive in society and that only through explicit recognition is removal possible, learners will be more willing to reflect on personal practices and potential biases. When designing interventions, optimize learner and instructor characteristics to encourage safe and constructive discussion. Instructors should be approachable, nonthreatening, knowledgeable, and supportive of a safe nonjudgmental learning environment.

  • Increasing knowledge about the science of implicit bias

 

When addressing implicit bias recognition, include descriptions of the psychological and neurobiological components of bias and the cognitive science at the root of implicit biases. Discussing the scientific foundation of implicit bias will contextualize the pervasiveness of bias among both caregivers and patients. It also allows for discussion of the different types of biases.

 

  • Emphasizing how implicit bias influences behavior and patient outcomes

 

Emphasizing how implicit bias impacts clinical decisions and patient care is integral to this framework because it enables the instructor to align the educational intervention with health dipartites. It also facilitates discussion on the visible and invisible sociocultural forces that affect our interactions with colleagues, patient, and healthcare outcomes. When discussing with clinical learners, instructors are encouraged to compare bias to heuristic principles in clinical decision making to further highlight the effect on patient care.

 

  • Increasing self-awareness of existing bias

Implicit association test (IAT) is a computer based exercise that aims to assess a person’s automatic associations between words and pictures. Through utilization implicit association tests, instructors hope to spark discussion and self-inventory among learners. Additional techniques to increase awareness of biases work by enhancing reflective capability. Such techniques include an identity exercises in which a learner discusses the dominant and non-dominant cultures to which they belong.

  • Improve conscious efforts to overcome bias

Once identified, instructors show learners how to apply conscious effort in order to negate implicit bias in their decision-making and behaviors. Strategies discussed with learners include metacognitive strategies, which incorporate self-regulation, self-monitoring, and mindfulness training. Learners should be encouraged to set goals and longitudinal checkpoints over time to facilitate self-monitoring and reflection.

  • Enhance awareness of how implicit bias influences others

In conjunction with encouraging self-reflection, instructors illustrate the role that implicit bias plays in communication, rapport building, and empathy. Research has demonstrated that awareness of cognitive and affective components of empathy protects against the implicit bias formation and negative care effects. While social-contact-based interventions may be powerful, they can be difficult to manage in a group setting, particularly in groups with hierarchical power dynamics, and require an experienced instructor.

Figure 1 . Framework to integrate implicit bias recognition and management into health professions curricula, as proposed by the authors. The framework includes six key features: creating a safe and nonthreatening learning context, increasing knowledge about the science of implicit bias, emphasizing how implicit bias influences behaviors and patient outcomes, increasing self-awareness of existing implicit biases, improving conscious efforts to overcome implicit bias, and enhancing awareness of how implicit bias influences others. Under each key feature are a few examples of elements or strategies that should be incorporated into each category; for example, another strategy for increasing self-awareness of existing implicit biases is the use of facilitated discussions on how bias impacts care. Abbreviation: IAT indicates implicit association test.3

For more detailed explanation of framework: Framework article

To take implicit association test: https://implicit.harvard.edu/implicit/takeatest.html

Sources.

1) Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28:1504–1510.

2) Girod S, Fassiotto M, Grewal D, et al. Reducing Implicit Gender Leadership Bias in Academic Medicine With an Educational Intervention. Academic medicine: journal of the Association of American Medical Colleges. 2016;91(8):1143–1150

3) Sukhera, Javeed, and Chris Watling. “A Framework for Integrating Implicit Bias Recognition Into Health Professions Education.” Academic Medicine, vol. 93, no. 1, 2018, pp. 35–40., doi:10.1097/acm.0000000000001819.

March Faculty Development: How To Teach Quiet Learners

How To Teach Quiet Learners

 Journal Club Entry by Anne Sprogell, TUSM-Maine Track Program, M18

In order to understand how to teach a quiet learner, it is first important to understand a quiet learner. Shy, quiet, or introverted learners are generally characterized by increased reflective thinking and reduced sociability. Their strengths can include the ability to focus, pay attention to details, take thorough notes, and listen to patients and team members. However, these students can struggle with certain aspects of medical school including group discussions with a larger number of students, forming relationships quickly with colleagues in the ever-changing teams of residents and attendings on inpatient services, and in rounds when ideas need to be offered quickly and assertively. Despite these challenges, there might be a few tips that teachers can use to allow their quiet students to shine.

 

  1. Wait 5-10 seconds after asking a question for the quiet student to try to answer. Sometimes quiet students need a little more time to choose their words before they speak.
  2. If an extraverted student is dominating a small group with an introverted student, consider working with the extraverted to student to allow more time and space for the introverted student to contribute.
  3. If one student is dominating the conversation, redirect questions from that student to the quieter members of the team.
  4. Set expectations for the student’s participation and warn them the next time they will be asked to participate.
  5. If environment allows for it, offer space and time for students to practice presentations.
  6. If educational setting permits, allow introverted students time and space to recharge after socially demanding situations.
  7. Consider talking through cases one-on-one with an introverted student if they seem to be struggling in front of the entire team.
  8. If the learning environment allows for it, divide into smaller groups for discussion and use strategies like “think-pair-share.”
  9. Consider written assignments when appropriate. Quiet students might find it easier to express their thinking in a written format.
  10. Understand that quiet students may need to speak from notes, but will use them less as they become more comfortable.

References

  1. Davidson, B, et al. “Introversion and Medical Student Education: Challenges for Both Students and Educators.” Teaching and Learning in Medicine., U.S. National Library of Medicine, 13 Jan. 2015, ncbi.nlm.nih.gov/pubmed/25584478.
  2. Muller, Jessica, and David M. Irby. “Practical Teaching How to Lead Effective Group Discussions.” The Clinical Teacher, Blackwell Science Ltd, 16 May 2005, onlinelibrary.wiley.com/doi/10.1111/j.1743-498X.2005.00057.x/abstract.

February Faculty Development: How to Get the Most Out of a Survey

How to Get the Most Out of a Survey
By: Kimberly Dao, Maine Track, M’18
‘‘Let’s just do a quick survey.’’
— Someone in everyone’s program

Surveys are an easily accessible and commonly used tool in many disciplines. However, the
quality of responses and response rate can vary dramatically. Below are some basic tips to
maximize your survey.

Tip 1 : Picking the Right Survey Tool – There are countless survey tools available online. When
selecting the application, recognize the services offered, pricing, and complexity of each tool.
Qualtrics, SurveyMonkey, and Google Forms are among the most popular tools with specific
advantages to each.
a. Qualtrics: Recommended for large (>10,000 participants) sophisticated surveys that
require special types of input, allows survey takers to save their work and return later, or
if survey questions need to be integrated with other data sets. This product must be
purchased, but many institutions have this tool available for employees.
b. SurveyMonkey: Recommended for most simple research projects. Service is free with
the option for purchase of advanced services.
c. Google Forms: Recommended for simple research projects. Although it does not include
any tools to automate data analysis, you can track and monitor responses.
See below for sites that review/compare survey tools.

Tip 2 : Other Things to Consider – Do you need/require HIPAA compliance? Does your survey
support accessibility (like screen readers, text-to-speech tools, or screen magnifiers)? Does
your survey support mobile devices?
Tip 3 : Survey Design – “The Five Tenets of Survey Design” recommends avoiding: agreement
response items, multi-barreled items, unlabeled response options, unevenly spaced response
options, and non-substantive response options formatted together with substantive response
items. 1 For further explanation and examples, please see the attached table.
Tip 4 : Incentives – Studies have shown that surveys providing incentives have significantly
improved response rates. 4 The mean response rates for surveys providing incentives was
above 70%.
Tip 5 : Time Commitment – Be upfront with how long the survey will take. This enables
participants to plan appropriately.
Sites that review/compare survey tools:
a. TopTenReviews – http://survey-software-review.toptenreviews.com/(link is external)
b. Relevant Insights – http://www.relevantinsights.com/free-online-survey-tools(link is
external)
c. SocialBrite –
http://www.socialbrite.org/2010/09/16/5-top-online-survey-tools-for-nonprofits/(link is
external)

References:
1. Artino, A. R., Phillips, A. W., Utrankar, A., Ta, A. Q., & Durning, S. J. (2017). “The
Questions Shape the Answers”. Academic Medicine, 1.
doi:10.1097/acm.0000000000002002
2. Church AH. Estimating the effect of incentives on mail survey response rates: A
meta-analysis. Public Opin Q. 1993; 57: 62-79
3. Phillips, A. W., Friedman, B. T., Utrankar, A., Ta, A. Q., Reddy, S. T., & Durning, S. J.
(2017). Surveys of Health Professions Trainees. Academic Medicine, 92(2), 222-228.
doi:10.1097/acm.0000000000001334
4. Retrieved January 26, 2018, from
https://education.temple.edu/help/survey-tools-dissertations-and-research

January Faculty Development: Power Posing to Increase Presentation Quality

Power Posing to Increase Presentation Quality     

Andy Biedlingmaier, Tufts M18 Student on Medical Education Elective

Humans and nonhuman primates use open and expansive postures to convey power.  However, new research shows that these “high-power poses” not only communicate power, they also create it.  Therefore, high-power posing can be used to boost presenter confidence, and consequently improve audience evaluation, during high-stakes presentations.

Tip #1:  Spend at least 2 minutes in a high-power pose prior to a high-stakes evaluation or presentation.

Cuddy, Wilmuth, and Carney (2012) performed an experiment in which 61 Columbia University students were randomly assigned to hold either a high-power (expansive, open) pose or a low-power (contractive, closed) pose prior to performing a mock job interview.  Poses were held initially for 2 minutes, and then for an additional 5 minutes immediately before the interview.  Students assigned to the high-power poses reported feeling significantly more powerful after the interview, and scored significantly higher in terms of overall performance and hireability.  This response is believed to result from hormonal changes, as shown by Carney, Cuddy, and Yap (2010).  In their study, participants randomly assigned to high-power poses for two minutes showed a significant increase in testosterone and decrease in cortisol as compared to the low-power posers.  In fact, the low-power posers showed decreased testosterone and increased cortisol after posing for two minutes.  Additionally, high-power posers rated themselves as feeling more powerful on average, and were more comfortable with risk-taking.

Tip #2:  Use a high-power pose to re-gain control of an audience.

 Hale, Freed, and Ricotta, et al. (2017) suggest that the work by Cuddy and others as described above can be applied strategically to re-assert control over a room, or in handling a “difficult” audience member.  They recommend standing up straight with hands on hips as a method of self-assurance and to signal one’s authority to the crowd as needed.  However, one downfall to this method is that it might not be appropriate when addressing more “senior” audience members.

Overall, the work by Cuddy and others suggests a new understanding of body language.  Our posture can stimulate hormonal pathways that mediate our sense of power.  Harnessing this power through selective use of expansive “high-power” poses can improve performance during high-stakes presentations and may have applications in asserting control over an audience as necessary.

For more information on this topic, please see Amy Cuddy’s Ted Talk  

Sources:

Carney, DR, Cudy, AJC, and Yap, AJ.  2010.  Power posing:  brief nonverbal displays affect neuroendocrine levels and risk tolerance.  Pscychol Sci.  21(10):1363-1368.

Cuddy, AJC, Wilmuth, CA, and Carney, DR.  2012.  The benefit of power posing before a high-stakes social evaluation.  Harvard Business School Working Paper, No. 13-027.

Hale, AJ, Freed, J, Ricotta, D, et al.  2017.  Twelve tips for effective body language for medical educators. Med Teach.  39(9):914-919.

December Faculty Development: How do you learn best? Effective Teaching and Learning Style Preference

How do you learn best? Effective Teaching and Learning Style Preference

By: Sarah Couser, Maine Track MS4

Do you prefer to have a map or written directions when you travel somewhere new? When you pick up a

new book, do you buy a hard copy or the audiobook? As a student, did you write notes meticulously or

prefer to have a more hands-on learning experience?

As described by Neil Fleming, there are four different modes of communicating information. Visual

learners, are those that learn best when using graphs, flowcharts, or maps. Aural learners are those that

prefer to learn by listening or discussing. Read/Write learners prefer learning by reading or writing new

material. Kinesthetic learners are those that prefer multi-sensory experiences, including touch, smell, and

taste.

In 2006, Lugan and Dicarlo asked first year medical students to participate in a survey to discover their

learning style preferences. Of the 166 participants, ~5% preferred auditory information, ~5% preferred

visual information, ~8% preferred information in the form of printed words, and 18% preferred

kinesthetic learning, or learning from touch, smell, hearing, taste, and sight. The remaining 64% of

students preferred to learn with multiple modes of information. The study concluded that by knowing

students’ learning style preferences, teachers could help to provide individualized learning experiences for

their learners.

Although many of us are familiar with how we personally learn best, we often forget that others may have

different learning styles than our own. Just as you may doze off looking at diagrams or tables, others may

begin daydreaming if they are not provided with a visual during a lecture. Below, I’ve included some

helpful tips for teaching students with varying learning style preferences. Whether we are teaching in a

classroom or on clinical rounds, it is important to incorporate multiple modes of information. This will

improve our teaching, and ultimately, our students’ learning.

Visual:

• Utilize a powerpoint or videos to display important information

• Show pictures to learners or ask a patient to participate (impetigo or finger clubbing)

• Use a white board to draw diagrams, tables, or flowcharts

Aural:

• Verbally discuss important points with a group of learners

• Ask patients to participate in learning by sharing their own experiences

• Implement teach-back to provide learners additional opportunities to speak and listen

Read/Write:

• Offer lists or handouts for reading material

• Encourage learners to take notes

• Prompt learners to read outside of the hospital (UpToDate, research papers, etc.)

Kinesthetic:

• Provide learners with real-life examples or relevant cases

• Use metaphors that learners are familiar with to facilitate learning

• Ask patients to participate in teaching with physical exam findings (ascites or crackles)

Don’t know your learning style — whether you’re a Visual, Aural, Read/Write, or Kinesthetic learner?

Take the quiz here:

References:

Lujan HL, and DiCarlo SE. “First-Year Medical Students Prefer

 

November Faculty Development: Exercises in Virtue

Exercises in Virtue by Michael Stanley, MS4

Please open the PDF and see text icon in upper left hand corner for the lecture. For access to the original Power point document please email Medical Education at mededuc@mmc.org