In this section:
Communities of coping: Using the ‘Extension of Community Health Outcomes (ECHO)’ model to support health providers during COVID-19
Presenters: Javed Alloo, MD, CCFP, MPLc, Chantalle Clarkin, RN, PhD, Allison Crawford, MD, PhD, FRCPC, Andrea Furlan, MD, PhD, Anne Kirvan, Mona Loutfy, MD, Sanjeev Sockalingam, MD, MHPE, FRCPC and Betsy Williams, PhD, MPH
Institution: University of Toronto
Summary - The impact of the COVID-19 pandemic on frontline healthcare workers has resulted in psychological distress and the need to support mental health. Continuing professional development can have an important role in supporting individuals’ ability to cope with the distress of the pandemic and can help sustain and build resiliency. Drs. Sanjeev Sockalingam and Allison Crawford, Co-Directors of the program, discussed the use of an evidence-based CPD intervention, namely Project ECHO, a “hub and spoke” community of practice with a membership approaching 3000 individuals and over 750 organizations. In March 2020, Project ECHO launched its COVID-19 curriculum to support healthcare professionals’ ability to cope with COVID-19 and its mental health sequelae. The experiences of ECHO Ontario Mental Health Coping with COVID-19 illustrate how CPD can pivot to address emerging mental health needs in frontline workers within a broader system of mental health support during COVID-19.
ECHO COVID-19 was developed in one week using previously established ECHO implementation tools and processes based on the Consolidated Framework for Implementation Research. It has had a significant impact on healthcare worker mental health causing issues with stress and moral distress. The ECHO COVID-19 program currently has an interprofessional cohort of 831 participating healthcare providers and 339 health organizations, nationally. ECHO uses virtual learning technology to leverage scarce community resources via teleconferencing. ECHO COVID-19 is characterized by a sharing of best practices in the care of distressed healthcare workers; it utilizes a case-based learning format which is focused on improving and monitoring care outcomes while increasing access and referral to community providers in mental health, as well other specialists. Education is self-directed and incorporates adult learning principles and strategies. The ECHO curriculum is based on a participant needs assessment survey and literature review, and is focused on self-care topics to promote provider resilience, skills and shared resources, and strives to foster a robust community of practice. Participants meet weekly for one hour sessions that consist of a mindfulness exercise, review of resources, Q & A, and sharing of personal experiences. Within this community of practice, it was quickly recognized that participants were distressed, anxious and felt fearful of COVID risks.
Key lessons learned for CME/CPD practice - Since implementation, program staff have turned their attention to reflecting and evaluating the model, collecting both quantitative and qualitative data, and using these data to make improvements accordingly. Evaluation is iterative and ongoing. Surveys reveal a very high satisfaction rate among participants with improved confidence levels. Key lessons learned are to be aware of the potential impact of COVID-19 on the mental health of providers and to carefully monitor the “distress curve” of our front-line healthcare workers. In addition to the ECHO COVID-19 program, two other national EHCO programs have been established. One is on Adult Intellectual and Developmental Disabilities, and another on Addiction Medicine and Psychosocial Interventions.
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Creating spaces filled with grace – reflections on race, inclusion and belonging
Presenters: Mohammad Salhia, HBSc, MEd, PhD, Nita Mosby Tyler, PhD, Will Ross, MD, MPH, and Ndidi Unaka, MD, MEd
Reported by: Mohammad Salhia, HBSc, MEd, PhD
Summary - Creating a Culture of Belonging and Inclusion was the second plenary at the 2021 SACME annual meeting. It featured a panel discussion with Drs. Nita Mosby Tyler (Chief Catalyst and Founder, the Equity Project), Will Ross (Associate Professor and Dean, Diversity, Washington State University, St. Louis) and Ndidi Unaka (Pediatric Hospitalist, Cincinnati Children’s Hospital). The session was facilitated in two parts. The first helped to level, set and create an understanding around issues of inclusion and belonging. Next, we explored what it takes to move the dial, and how to enact meaningful change in organizations like SACME, and the broader healthcare community. Conference attendees participated in a rich discussion online, sharing their own stories and perspectives, and, through online technology created a “word cloud” that showed us what was resonating most with them.
Words create worlds - This is the constructionist principle of appreciative inquiry that tells us reality is created through language and conversation. Indeed, we heard about the criticality of being explicit in our use of language to call out the actions and behaviors that need to stop or change, and that we need to see more of. Saying racism, anti-racism, diversity, belonging – the list goes on – is, in part, how our organizations and societies demonstrate putting a stake in the ground and making a commitment to interrogate our current systems. Saying these and other words will create a world where tackling the issues and planning for change are, as Dr. Julio Frenk described in his opening plenary, a better normal.
The session was underscored by the panelists’ authentic, vulnerable, and accessible approach to storytelling and narrative that facilitated a nuanced interpretation of the race dialogue in the context of continuing professional development. We heard about the profound experiences of people of colour in healthcare, and also the multi-faceted emotional, mental, and social effort required to push past current norms of racial inequity and prejudice. Compassion and patience are necessary to the process, with the panelist citing the battle against phenomena such as compassion fatigue and imposter syndrome whilst talking about race.
Our role as individual agents, professionals, educators, and human beings is to work together toward a better normal. It is to foster respect, empathy and compassion for our colleagues, students, patients, and, yes, ourselves. We learned from our guests that racism and other issues of equity manifest in different ways. Internalized racism is part and parcel of a broader system of institutionalized or systemic racism that have deep and far reach impacts on individuals and communities of color. Both may act differently, although the outcomes are often similar.
It is not lost on me, that I prepare this summary and reflect on our current geopolitical climate and race relations, that the EDI discussion is not new. It has evolved and changed, with new ideas folding into our current, multi-pronged definition of the space. We learned, in fact, that equity, diversity, and inclusion were each nearly a decade worth of work in their own right, ultimately influencing today’s dialogue on belonging.
The intention in this dialogue is historically different than in previous generations. As Dr. Tyler so simply put it, “this is the first time in my history that I have seen people not opt out of the work…. We have a generation of people now that don’t see this as optional,” going on to say that she “can see the chipping away at systems that don’t work. This is the right time to keep going without opting out.”
This plenary session was a call to action. It was an open and honest conversation that, through the eyes of the experts engaged, put a finger on, and named, many of the issues we find discomfort in articulating, or perhaps even acknowledging outwardly. It challenges us to live within, and eventually move beyond this discomfort. It implores us to focus on our commonalities. It calls for us to make the shift from being a bystander to an upstander; an ally to an accomplice. It demands that we re-evaluate and recognize our social contract as health care providers, educators, and researchers. We must be, as Dr. Unaka noted, “anchored to our purpose – to leave a mark as a generation to make a change for patients, families, learners and professional colleagues with whom we, and our systems of learning and care, will engage.”
We heard many poignant messages about belonging and how it can be achieved. Here is what we learned, and what we will be carrying forward as SACME embarks on its journey to create a culture of belonging.
- Equity is the goal: we seek to create equity in our practices and in our systems. We must interrogate the processes that allow the current system to thrive in order to make meaningful, sustainable change.
- Be data driven: getting to equity requires that we understand our baseline(s) so that we can appreciate where we are trying to, and how to get there.
- Acknowledge burden: those who are marginalized by a system are often tasked with the burden of changing that system, or of representing their communities. Many also experience the burden of representing whole communities.
- Foster community: a “collective” approach is essential. We need to do this work together, not in silo. We shouldn’t be recreating the wheel. We can and should learn and grow together.
- Use concrete language: our ability to talk about, for example, race, and being explicit about why we engage in equity work will is essential. This will help to drive how we identify and teach about the competencies, skills and capabilities needed to accelerate system change.
- Competencies, skills and capabilities: we cannot engage in this work without empathy, vulnerability, community engagement.
- Recognize intersectionality: our communities are diverse, and the equity issues faced are complex and multi-dimensional. Intersectionality is essential when contemplating work and planning in EDI.
We were left with a message of compassion to go deep within ourselves, and to find, encourage, and adopt the philosophy of spaces filled with grace. This is a more profound and nuanced message than the traditional safe space. Dr. Tyler described it as the space where we can be wholly and fully who we are. The space at which we are learning and growing together that is free of judgment and critique. This is the essence of the social contract referenced by Dr. Ross, and the anchoring and north star of a generation touched on by Dr. Unaka.
As we embark on this journey wherever we stand, and in whatever agency as professionals and global citizens, these spaces filled with grace are the points at which we will achieve equity. SACME is making the commitment to do this for our members through scholarship and professional development. Lastly, our hope is to enable meaningful and action-oriented dialogue to speak openly about these issues, and to create our better normal. Remember, after all, that words create worlds.
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Engaging with music in self-care, healthcare and medical education
Presenter: Lisa Wong, MD
Institution: Massachusetts General Hospital
Reported by: Joyce Fried, BA, FSACME
Summary - In keeping with the theme of the meeting, “The Art and Science of CPD,” Lisa Wong, MD, Assistant Professor of Pediatrics, Massachusetts General Hospital and Associate Co-Director of the Arts and Humanities Initiative at the Harvard Medical School, presented a session titled Engaging with Music in Self-Care, Healthcare, and Medical Education. Dr. Wong began and ended the session by playing a piece by J.S. Bach on her viola. She asked the audience to feel the music with all five senses and explained that music brings out emotions that might not be otherwise accessed.
Utilizing music in medicine can decrease loneliness, anxiety, isolation, and burnout, while increasing resilience, curiosity, and creativity both for healthcare providers and patients. “Physicians spend years learning technique, but the point of the healing arts is to transcend that technique. We transcend technique to seek out the truths in our world in a way that gives meaning and sustenance to patients, fellow physicians, and our wider community”, said Dr Wong.
Both the Association of American Medical Colleges and the National Academies of Sciences, Engineering, and Medicine are supporting initiatives to add and integrate arts and humanities into the curricula of science and medicine. COVID has required an important pivot in how music is utilized. The Longwood Symphony Orchestra, established in 1984 in Boston, is made up of musicians who are medical professionals. Pre-COVID they played concerts. During COVID, students and doctors from the orchestra played music for their colleagues during lunch breaks outdoors. Other projects during the pandemic include the Boston Hope Music Project providing musical programming that can be accessed on tablets by homeless individuals with COVID at a temporary shelter.
Key lessons learned for CME/CPD practice - Art in the curriculum can help to build empathy, communication, and teamwork. For example, music can teach comfort in silence, necessary to enhance listening skills. In addition to benefiting students and physicians, this project also benefited frontline workers. When the facility shut down, the musicians offered free private music lessons for healthcare workers and began playing virtual bedside concerts using Face Time for hospitalized COVID patients in isolation. They also began playing live music for patients waiting in vaccine lines. “Music heals”, Dr. Wong asserted.
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Understanding our niche: The value proposition of CME/CPD
Presenters: Annette Mallory Donawa, PhD, Morris J. Blachman, PhD, FACEHP, FSACME, Katasha N. Charleston, MPH, J. Matthew Orr, PhD, Allison Rentfro, PhD, Kurt Snyder, JD, MBA
Reported by: Helena Filipe, MD, MMEd, FSACME, AFAMEE
Summary - While all involved were invited to reflect on one’s own experiences and share personal views on the strategic value of the CPD Unit and their leadership within the institutions they serve and encouraged an active exchange of professional experiences in a supportive and trustful learning environment, this engaging SACME workshop shined social learning principles as well as a significant component of personal and collective reflection.
The focus was on reflecting about the CPD value proposition, how it has been changing throughout the years and identify and assess the strengths, niches and value that CPD provides to organizations.
Topics approached were a) how to have meaningful and intentional conversations with leadership; b) aligning with the organization's ROI, financial goals, and health outcomes; c) writing an elevator speech; d) sharing lessons on rapid system collaborations during COVID-19 and finally e) building a value-added toolkit.
From CME to CPD - The traditional CME office seen as a source of institutional revenue and funding needs linked with the regulation empowerment of accreditation and recertification and the paperwork shuffle involved has been progressing into the holistic and complex CPD conceptualization. Physicians lifelong learning current needs and preferential learning methods overflow the classic CME model in the multimodal formats and settings diversity where new learning can happen, with a clear preference for practice-based learning experiences and the wide variety of themes it should focus and embrace beyond the clinical.
As pointed out during the workshop and beyond any administrative role, physician’s leadership development is one of these needs to leverage the increasing complexity of quality healthcare delivery and what is increasingly expected from them. Dr. Moss underlined the importance of the concept underpinning the acronym VUCA (volatility, uncertainty, complexity and ambiguity) as a catalyst recently boosted by the pandemic to advance and uphold how CPD should best support physicians lifelong learning and institutional CPD units should reinvent themselves as strategic allies for physicians, teams and the healthcare systems they work in, ultimately for better patients’ outcomes and the public health.
VUCA is holistic by highlighting four contemporary components of our daily life a) volatility: the fast and unpredictable changes without an immediate clear pattern or trend, b) uncertainty, frequent disruptive changes where the past is not a very good predictor of the future, c) complexity comprising the multiple, complex, intertwined technological, societal, geopolitical and ecological evolutions, and d) ambiguity shining little clarity on what is real or true and difficult to predict the impact of action or initiative. The Physician Executive Leadership Institute project led by Profs. Orr and Blachman was shared as one action example of knowledgeably and strategically progressing the CPD unit, by meeting physicians’ roles as leaders besides clinicians, educators and researchers.
The future 21st century CPD office - The CPD unit team should strive to a) assume a position of agent of change through communication, collaboration to innovate; b) provide system leadership by embracing change and adapt and by adapting transform analyzing what is possible to control, influence or more peripherally adapt/accept and strategize towards what can be further brought to influence or control; and c) develop cognitive and behavioral strategic management skills. CPD educators and leaders should consider developing skills in a) providing expertise in learning; b) having needs assessment competency; and c) assessing multi-level needs (strategic alignment)- individual, unit and system. CPD should incorporate goals as a) being an institutional strategic asset by enhancing provider and leadership capabilities; b) being a player by coaching, consulting, and providing direct support; c) to be a change agent by developing CPD engagement and learning activities able to meet strategic direction and future needs; and d) being a Thought Leader by developing office capacity to support CPD mission.
Key lessons learned for CME/CPD practice - CPD has leapt from CME to meet the challenges of volatility, uncertainty, complexity and ambiguity (VUCA) of our times. The CPD unit of the future is a new office of academic and professional development. The CPD unit narrative should be C squared: Collaboration and Communication are key drivers for strategic value creation in CPD and the CPD unit. The CPD unit alignment with the institutional goals and needs is critical- the CPD Unit can strategically include well-being, mentorship and leadership in high quality education to impact innovation patient care and health outcomes. Key performance indicators are important to center the elevator speech and develop the CPD unit leadership. Let us end with quote: “Lifelong learning supporting organizations with no CPD unit: a building without architects?”
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The emergence of digital CPD: A new dawn, a new day
Presenters: Vernon Curran, DipAdEd, Med, PhD, Heather MacNeill, MD, BSc(PT), MScCH (HPTE), FRCPC, Yuri Quintana, PhD, John Sandars, MBChB, MSc, MD, MRCP, MRCG, FAcadMEd, CertEd,
Reported by: Vjekoslav Hlede, PhD
Summary - The plenary session The Emergence of Digital CPD: A New Dawn, a New Day was the main technology focus session of the Annual Meeting with a panel of distinguished experts in digital learning. Each offered different and useful perspectives on the digital revolution in medical education, the forces which brought about the current trends, and the strategies and methods to harness this massive redirection for the betterment of our learners across all levels of the continuum.
Dr. John Sandars, Professor of Medical Education, Edge Hill University, UK, began the session with a focus on the emerging trends in learning: personalization, transfer to practice, and active learning. Simultaneously, parallel emerging trends in technology include user-generated/social media, machine learning, and learning analytics using artificial intelligence (AI). A massive growth in medical education has been the result of an open-architecture educational platform, FOAMED, which stands for Free Open Access Medical Education. FOAMED is characterized by its user-generated content that is a result of collaborative and curated processes. Analysis and appraisal of FOAMED content indicates it is a reliable source for information. The Cochran Review is an excellent example of FOAMED at its best. Dr. Sandars went on to characterize the mastery of learning using machine learning, that is, artificial intelligence (AI). Learners go through various levels and work toward a mastery of knowledge. Machine learning is capable of capturing vast datasets of learning and performance analytics, that are used to assess and enhance learner achievement. The future of CPD indicates that each learner becomes “center stage” supported by a robust set of tools, a network of peers, and data sources.
Dr. Vernon Curran, Associate Dean for Educational Development, Memorial University of Newfoundland, continued with a discussion of digital CPD trends, strategies, and evidence-based, best practices for online learning. “COVID-19”, he noted, has given us a unique opportunity to help demonstrate the evidence-informed effectiveness of online CPD”. Online learning includes an array of multiple and similar terms: e-learning, web-based learning, digital, virtual learning. Online is a growing collection of different systems and platforms by which to learn. Modes of online learning include: synchronous (via Zoom, WebEx), asynchronous (discussion boards, recorded presentations), and blended-hybrid (a combination of online and live content delivery). The many advantages of online learning include its convenience and flexibility in terms of both the time and location of learning; it is independent; readily available; offers economies of scale and lower cost; and can be updated frequently. Some disadvantages are initial technology costs, internet access in remote areas, and learning curves for learners unfamiliar with digital literacy. But the advantages seem to far out-way the disadvantages for most groups of learners. This seems to be true if you review online learning data user data. The trend we see is a substantial increase in physician participation in online CME activities from 2012 to 2020, while studies have found no significant difference in learning outcomes using distance learning vs. live, more classroom learning. Digital CME/CPD is as effective as face-to-face traditional teaching, across topics and disciplines. Dr. Curran ended by highlighting that learner satisfaction and retention are enhanced significantly if the online instructional methods are varied to include cognitive interactivity exercises, instructor-learner discussions, feedback, homework assignments, patient case study discussions, practice exercises and self-assessment questions, and intentional repetition of learning sessions. In conclusion, Dr. Curran stressed that online learning makes it entirely possible to build-in both formative and summative assessment methodologies for a far more comprehensive evaluation of learner performance and retention.
Dr. Heather MacNeill, Faculty Lead, Educational Technologies, University of Toronto, began by making the point that learning itself has not changed. “We have many traditional and online tools in the educational toolbox to choose from”, she stated. What matters is if the educational objectives are achieved. It’s a combination of the right tool for the right purpose. She agreed with Dr. Curran and Dr. Frenk that blended-hybrid learning formats are the best approach for the future as it offers the most tools. Also, Dr. MacNeill stressed the importance of collaborative learning tools, such as “Chat”. Her final message was that we must plan carefully about how best to integrate all these tools into online learning. Faculty development is certainly going to be essential in the re-training of our activity directors to embrace the new environment of online learning.
The 2021 Annual Meeting was marked by these and other great presentations focused on innovative technology-enhanced CPD. Most of them were labeled as "Education Technology Innovations." However, many presentations from other categories had significant technological elements. They could easily be categorized as "Education Technology Innovations" or "Technology-enhanced CPD." For example, Farrell, Bassom, and Stoklosa's (2021) abstract presentation on interprofessional training for human trafficking educators was a good example of work that could simultaneously be classified as work in (1) Enhancing Education in CME/CPD and (2) Education Technology Innovations. Dr. Farrell et al. combined social cognitive, constructivist, and experiential learning theories with widely available technologies (WhatsApp and Zoom). If you are revisiting the 2021 conference website and looking for presentations and discussions on technology-enhanced CPD, the session group labeled "Educational Technology Innovations" is a great starting point. However, please do not forget to check sessions in other categories.
I will conclude with a reference from Dr. Julio Frenk’s keynote message Health Professions Education at the Crossroads. The Covid-19 crisis made a technological revolution in healthcare education inevitable. That revolution will require healthcare education providers to adopt an open architecture in which the educational system is not a closed system separated from practice, but a well-networked system neatly interwoven with our professional and private lives. That system should emphasize lifelong education focused on unique learners' needs, and deliver active, interactive, and personalized learning experiences.
Farrell, S., Bassom, R., & Stoklosa, H. (2021). Using Theory And Technology To Cultivate An Interprofessional Community Of Human Trafficking Educators Paper presented at the SACME Annual Meeting 2021.
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