In this section:

Medical Education in the Information Age

Stanford CME Reimagines the Future of Work with its Online Conference

Medical Education in the Information Age: Engaging learners and creating change across the continuum.
Reported by G. Robert D’Antuono, MHA

I had the good fortune to hear a presentation by Graham McMahon, MD, MMSC, President and CEO of the Accreditation Council for Continuing Medical Education (ACCME), on the emerging challenges in medical education during the virtual AHME Spring Institute last May, 2021.  Nearly everyone in medical education today is challenged to master new, more effective ways to train medical students and residents and to provide continuing professional development to teaching faculty.  Dr. McMahon, a skilled thought leader and clinician educator, has impressed us with his traditional and novel concepts and methods to teaching and learning.  An endocrinologist by training, he is a passionate educator with experience at every level across the continuum. 

The COVID pandemic has created opportunities and challenges in medical education: virtual learning has now become the standard method for learning and engagement.  We are now better situated to enable blended pre- and post-learning activities, and faculty can be more flexible in curriculum development and planning.  Dr. McMahon presented five concepts deemed to be innovative and effective educational practices: 

• Fundamentals of learning.  If you think about what distinguishes our learners, medical professionals are experienced learners, competent leaners, they can retain information well, and they are curious for more information.  They are motivated to achieve mastery yet challenged by a busy, stressful environment that may mitigate learning.  More importantly they suffer from a lack of feedback which leads learners to believe that they may be more competent than they actually are.  As a result, there is a tendency for learners to become complacent and have difficulty achieving mastery.  Mastery of learning can be achieved via carefully designed and managed curricula, as well as adopting assessments with actionable feedback and steps toward improvement.  Dr. McMahon stressed that clinicians are in fact motivated to achieve mastery and are especially responsive to comparative and constructive feedback.  Fatigue, cynicism, and burnout interfere with learning and must be mitigated. 
• Case-based learning.  Social learning can be used to explore cases.  It is a cognitive process that takes place in a social context.  It can occur purely through observation or direct instruction and in the absence of motto reproduction or direct reinforcement (Bandura).  Barriers to learner engagement can be significant.  For example, environmental distractions (noise, pagers, crowds), fatigue, low attention span of the learner, overconfidence, ambivalence or lack of motivation, and an overall group mentality regarding the case experience.  To mitigate these barriers, case selection is important.  It should be interesting, meaningful with an achievable goal.  Perhaps the case can be formatted to offer an individualized offering and build on prior learning. Offer hypotheticals. Making the case collaborative and a rewarding, positive and fun experience also help enhance learner engagement. 

In summary, the keys to case-based learning are: to clearly articulate the intent of the case; topic must be relevant to the learner; be of appropriate complexity; be discussed in a safe manner (e.g. “Which tests would you order?” rather than “What’s the correct test?”); and conclude with feedback and resolution from the faculty expert.

• Team-based learning.  A social construct for learning is important as we are in a different world with so many clinicians and staff involved in the care of one patient.  The care of patients is increasingly interdependent upon a different range of professionals. Each member of the team will remember different things about the patient.  Team-based learning is less efficient, however, the broader input from the team typically results in a better outcome due to the unique insights of each team member. Teams also reinforce and leverage human needs and when they are constructed to work well.  Such as our need for belonging, esteem, and safety.  We must move to an environment that is improvement focused rather than efficiency focused and is psychologically safe for team members to express themselves and accept feedback.  Teams fail due to inadequate communication, lack of team infrastructure, authoritarianism, hierarchies among the professions on the team, inadequate attention to people and their needs.  All these serve to create a negative learning environment for a team.  Ensuring team diversity is essential as well to gain different perspectives from different backgrounds. 
• Adaptive learning.  Adaptive learning leverages both sophisticated and simple education technology tools.  Educational technology means that you can be more efficient via individualized and adaptive learning plans.  You can connect and compare learner groups.  There is now evidence that online learning is more efficient.  Gains in knowledge, skills, and attitudes occur faster than through traditional instructor-led methods.  Online learning is more flexible and can accommodate diverse learning styles.  The best of all, online learners have demonstrated increased retention rates, better utilization of content and better achievement of knowledge, skills and attitudes as previously mentioned. 
• Faculty strategies.  Faculty must push learners into a new learning zone which assures psychological safety and accountability.  They must feel responsible for creating a learning environment that is positive.  Faculty must have administrative skills, leadership skills and know how to understand how a learning environment promotes learning and well-being.  The competency skills of learner feedback, scholarship, professionalism, assessment, program evaluation, remediation, clinical teaching and the science of learning are essential for all teaching faculty. 

In summary, Dr. McMahon emphasized that powerful learning experiences can be engineered using available technology.  Knowing your learner; building trust; incorporating assessment, feedback, active learning and using a team as a learning unit, are key to the medical education process. 

Resource: For a copy of Dr. McMahon’s slides, click here.

G. Robert D’Antuono, MHA is emeritus Assistant Dean for CME, formerly the Winthrop University Hospital Campus for SUNY Stonybrook SOM, now NYU Long Island Medical School, Mineola, NY and Co-Editor-in-Chief, SACME CE News.

Stanford CME Reimagines the Future of Work with its Online Conference
By Marilyn Mejia

This past September 15, 2021, the Stanford Center for Continuing Medical Education held an online conference on the Future of Work that aimed to address the ever-changing landscape of continuing education and reimagine work as the world gradually returns to pre-pandemic normalcy. This meeting of the minds resulted in a highly attended, thought-provoking event that focused on three themes: workplace practices, education, and events.  Conference attendees had the opportunity to learn from experts and colleagues during the concurrent sessions, join social sessions such as a live tour of St. Petersburg, Russia and encounters with land and sea creatures, and participate in the conference scavenger hunt to win prizes.  However, the most talked about sessions were the conference plenaries.  The Stanford CME team worked diligently to organize an incredible plenary line that included notable future of work thought leaders: Nicholas Bloom, Arthur Markman, and Yvonne Wolfe, each of whom discussed different facets of hybrid work.

The conference kicked off with Arthur Markman, PhD, the Vice Provost for Continuing and Professional Education at the University of Texas at Austin, and Yvonne Wolf, a Senior Consultant at the Neuro-Leadership Institute, both of whom had interesting perspectives on the hybrid workplace.

In his talk, Markman highlighted the importance of connecting to culture, purpose, and collaboration in the hybrid workplace. His overall message revolved around being intentional in our communication with others. He pointed out that bumping into others, seeing your work results, and moments of joy tend to happen naturally in a face-to-face environment. These moments may not happen when working with others online and must be created explicitly by orchestrating them. 

Markman suggested that highlighting successes, joyous occasions, and purposeful communication must be woven into day-to-day operations. He spoke about making sure to ask beyond ‘yes and no’ questions to get a better idea of how employees are doing and what their needs might be. He also made it clear that assumptions on work culture are detrimental and that social cues are harder to pick up remotely so employees should be trained on this when being onboarded. 

Markman was followed by Wolf who shared information fostering an inclusive team culture in a hybrid or remote environment. She explained that people can never completely divest themselves of their biases, but we can create processes without bias. Wolf went over hiring practices that accept those different from current employees including those that live far from work locations when it comes to remote work. She pointed out how this inclusion can strengthen teams by opening job roles to those most qualified rather than the closest physically. 

Wolf highlighted the need to create a work environment with an "all belong" mindset that actively works towards equity. She extended that mindset to remote workers and their homes, asking that leadership recognize not everyone has access to the same tools at home including fast Internet and private home offices. Wolf also suggested that in the case of remote workers and on-site workers, leaders need to actively bring in remote workers to avoid creating in and out-groups among different modalities. 

The conference was closed by Nicholas Bloom, PhD, world-renowned researcher on remote and hybrid work and Professor of Economics at Stanford University, who overviewed the transformation of the workplace during the pandemic and forecasted the permanent effects of this world-changing event. During the pandemic, the number of employees working from home quickly escalated from approximately 5% to 50%, which had a ripple effect on how employees view the importance of work flexibility. Bloom, who spent years researching the effectiveness of remote work, restated increased productivity and enhanced quality of life for employees.  Bloom’s suggestion for employers is to integrate a hybrid work model in developing return to office plans as hybrid work is the best of both worlds. Workplaces that have remote work as an option have shown an increase in output at least partially because employees are more likely to transfer commuting time into work and their personal lives. While building community and networking is better in person, employers have had to make at least partial concessions as businesses that asked employees to return to the office full time have seen a mass exodus and demands for more flexibility. 

While having a hybrid model is trending for the near future, it does come with its unique challenges that need to be managed thoughtfully. Bloom discussed how it can be easy to isolate remote workers from those on location and had strategies to mitigate that issue. A best practice for equalizing meetings is to make sure that if any employee is joining via video conferencing, everyone else also joins the meeting online to dissuade conversations that only those joined together can hear. Another best practice Bloom discussed to equalize remote workers and on-site workers is to make sure that working from home is not optional but mandatory in a hybrid model. This strategy dissuades employees from being competitive in demonstrating their willingness to show up at the office and possibly pass remote workers on promotions due to less visibility. Bloom also strongly recommended that employees be evaluated by output, or the final result of a worker’s effort, rather than input, or the amount of time it took to get the final result. This helps equalize workers in that no one is being judged for how long they sit at their desks but instead just how much they are getting done.

The plenary speakers, emphasized further by various panelists throughout the day, made a point of stating that many of the challenges that arise in hybrid and remote work are not new but merely presenting themselves differently and therefore, leaders should address these issues accordingly. Stanford CME’s Future of Work online conference showcased presentations from plenary speakers to panelists discussing, debating, and delving into ideas and best practices for our evolving work landscape.  Attendees reported signing off from the conference with nuggets of information and recommended strategies, better preparing them to confront potential challenges and embrace the sea of opportunities that comes along with hybrid and remote work.  The exploration of the Future of Work via Stanford CME’s online conference facilitated the reimagination of business, education, and event practices by illuminating a vision of a productive and collaborative workplace for employees both hybrid and remote.

For anyone interested in purchasing access to the recordings of this online conference, please contact stanford_cmelive@stanford.edu to learn more.

Marilyn Mejia is the Education Design Coordinator, Stanford Center for Continuing Medical Education, Stanford University School of Medicine, Palo Alto, CA