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Virtual Facilitation is Here to Stay: Educational Design and Technologies to Promote Engagement, Diversity, and Co-creation in Synchronous Continuing Professional Development Activities

Facilitators: Marcio Gomes, MD, PhD, MHPE, Nancy White, BA, Keith McCandless, MAFernando Murray, BA, Carolina Ribeiro de Almedia

Reported by Vjekoslav Hlede, PhD, DVM

Good virtual facilitation makes a difference. It is the difference between boring web conference events where participants may be happy that they can turn off their cameras and check email, and events that empower and engage participants in activities that create new value for them as individuals and teams.

The art of facilitating learning events and teams has a long history and is well documented. Yet, it is a complex, profoundly social endeavor. Therefore, changes in context, like the digitalization of our society and changes in the mediums we use to enable collaboration (conference room vs. Zoom, for example), can profoundly impact how we facilitate online events.

In this workshop, our facilitators—Dr. Marcio Gomes, Keith McCandless, Fernando Murray, and Carolina Ribeiro de Almediar—masterfully guided us learners through engaging learning activities and empowered us to better facilitate in the ever-changing digital context. Through those activities, we had a chance to participate in a well-facilitated meeting and briefly experience what it means to be a facilitator.

The discussion was about how to properly balance the need for guidance and control from one side, with the need to empower learners to innovate and be authentic from the other side. It was about structures and rules that make participants feel safe, empowered, and liberated. Those are the contradictions that shape our events. Therefore, while brainstorming how to address them, we experienced many "Aha!" moments.

The facilitators used Liberating Structures concepts defined by Lipmanowicz and McCandless (2014) in their book and freely available on their website (www.liberatingstructures.com). These liberating structures empowered us to organize and provide feedback to each other on realistic problems almost immediately.

Therefore, as learners, we had the opportunity to learn about good virtual facilitation, experience it, practice it, and "go home" with resources that will help us practice good virtual facilitation in our unique local contest. It was a very well-organized 3-hour session.

In a follow-up session, it may be worthwhile to discuss ideas on facilitating asynchronous virtual collaboration, and how synchronous and asynchronous virtual and face-to-face communication channels can be used to create longitudinal learning events or communities. As our reality becomes increasingly networked and connected, it becomes harder to draw a line between various types of communication. Instead of focusing on a specific communication modality, we need to think more about how we combine various communication modalities.

In sum, this was an outstanding workshop focused on facilitating synchronous web conference events. It provides a hands-on experience in facilitating synchronous virtual events better, and it can serve as a good foundation for follow-up workshops or self-guided improvements on facilitation in different contexts.

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Virtual Focus Group Methodology: A Workshop for Current and Future Leaders in Healthcare

Speakers: David Wiljer, PhD, Rebecca Charow, MSc, Melody Zhang, MA, Gillian Strudwick RN, PhD

Reported by Helen Mawdsley, EdD 

Summary:
The learning objectives for this workshop were:

  • Design virtual focus groups for research purposes,
  • understand the world café methodology,
  • Conduct virtual focus groups by demonstrating the necessary skills needed to facilitate discussions and engage participants online
  • Have a working knowledge of the thematic analysis approach.

The presenters delivered the workshop with a reflective approach, where they shared how their own research study uses virtual focus groups, including an overview of their internal processes and experiences. Similar to their research study, the presenters deliberately chose not to record the workshop with the intention to model building a safe space for reflection on these processes, experiences, and activities. In addition to learning about the research team experiences, the workshop activities encouraged workshop participants to experience the research participant side of this methodology.

The workshop began with a menti-meter poll to assess confidence in design, moderating, data analysis, and usage of focus groups. Participants in the workshop were prompted with reflective questions and encouraged to share their own experiences with focus groups. We discussed how focus groups are unique from other data collection options, such as interviews. Following this, the group reflected on the advantages and disadvantages of conducting a virtual vs. an in-person focus group, while the presenters simultaneously provided a hands-on experience to various types of technology that can be used to capture data during virtual focus groups. A framework was provided for structuring a virtual focus groups, as well as a list of various types of technologies to consider when conducting virtual focus groups. The presenters shared their experiences with a virtual delivery of world café methodology, which is a way to capture progressive discussions. To tie all of these pieces together, the presenters walked us through their research project as a case study highlighting the messy reality and intentional decisions made at various stages of their project plan, and how these decisions supported the success of their research project, as well as their success as an effective research team.

Following this, participants in the workshop were encouraged to take the role of participants - not just in this workshop, but participants in a virtual focus group. This involved a free-writing activity followed by a demonstration of how to set-up a safe space and expectations for the activity, to facilitate engagement and code in real-time using a digital whiteboard. This brought a strong connection to the earlier part of the workshop where various types of technologies and research team roles and resources were introduced. A repeat of the menti-meter questions from the beginning of the workshop closed the workshop, and showed that participants did indeed increase their confidence in design, moderating, data analysis, and comfort in using focus groups as a result of attending and participating in this workshop.

Key lessons learned from CME/CPD Practice - Participants in this workshop had the opportunity to experience virtual group methodology through the lens of a research team member, a workshop participant, as well as through the lens of a research project participant. It is important to assess the tools and resources needed to ensure that there is a safe space in a virtual environment for all involved, and that the research team members have the support they need to successfully meet the potential of their roles. The insights experiences shared during this workshop, along with the tools and resources provided, demonstrated that virtual focus groups can successfully occur in a research setting.

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PACER Program - An Experiential Interactive Virtual Approach to Promoting Resilience and EDI during the Pandemic

Facilitators: Josephine Wong, RN, BScN, MScN, PhD, Kenneth Fung, MD, FRCPC, MSc, Jenny Liu, PhD

Reported by Mila Kostic, CHCP, FACEHP

Background
The COVID-19 pandemic has had a devastating impact globally. Healthcare Providers (HCP) are at high risk of burnout, with increased workload, fear of contracting the illness and spreading it to their family, shifting roles and work protocols, and compassion fatigue in caring for the sick and dying. With the COVID-19 pandemic, it has become more relevant than ever to find effective ways of promoting mental health resilience.

Based on Acceptance and Commitment Therapy (ACT), an evidence-based mindfulness psychotherapy, and Group Empowerment Psychoeducation (GEP), grounded in Social Justice and Equity promotion, this group of Canadian researchers have developed a unique integrated model, Acceptance and Commitment to Empowerment (ACE), which has previously been used to promote mental health in marginalized populations through group interventions. In response to the pandemic, they have adapted the model into the Pandemic Acceptance and Commitment to Empowerment Response (PACER) program for online implementation. The program is aimed at promoting resilience and empowerment among healthcare providers (HCP) and the Chinese Canadian community (CH-COM), two populations greatly impacted by the pandemic.

The intervention consists of 6 weekly interactive self-directed online modules complemented by 6 weekly facilitated virtual videoconference groups online. Participants are evaluated at pre, post, and 3-month follow-up in their resilience (MSMR), empowerment (ES), and mental distress (GHQ). Both psychological resilience training and Equity, Diversity, and Inclusion (EDI) training are integrated and taught together, as the two are inextricably linked. Preliminary results with over 600 participants that have gone through the program so far found significant improvements in all measures with positive qualitative feedback, supporting its feasibility and efficacy.

Target Learners

The SACME workshop was specifically designed for healthcare providers and educators and had built in flexibility for a range of participants, anywhere from 20 to 60 allowing for up to a maximum of 20 participants per expert-facilitated breakout group.

Learning Objectives

At the end of this session participants were able to: 1. Identify the complex individual and collective mental health needs of diverse populations during the pandemic inclusive of an Equity, Diversity, and Inclusion (EDI) lens 2. Describe the Acceptance and Commitment to Empowerment (ACE) model and its integration of Acceptance and Commitment Therapy (ACT) and Group Empowerment Psychoeducation (GEP) to promote psychological resilience and collective empowerment to champion EDI issues. 3. Discuss the process of designing effective interactive and experiential activities online to deliver resilience and EDI training

Workshop Format

The facilitators managed to skillfully engage and guide participants of this virtual workshop in reflecting on the ACE processes using experiential learning through some of the PACER exercises, original and adapted specifically for this workshop, to help us think of developing an approach towards designing interactive virtual learning activities to improve psychological resilience and promote Equity, Diversity, and Inclusion.

This included guided meditation, self-reflection, small breakout group discussions, large group sharing, and special virtual activities, conducted by presenting a virtual A/V stimuli and engaging participants to reflect, make choices, and respond in some manner, such as typing a response in the chat.

Takeaways

As a participant of the workshop, I really enjoyed the design of this workshop that modeled the best use of the online learning and teaching. Multitude of expertly facilitated exercises grounded in mindfulness practice underscored the importance of psychological flexibility that includes not just the focus on what is here and now but also awareness of nonjudgmental action – the concept of diffusion. The understanding of the intrinsic nature of such action where both value and reward come from the act of doing. An impactful and memorable visual metaphor served to prime the discussion about the diffusion starting with letting go so that we can embrace the experience and transcend it by acting in line with our own values as well as empower the group to reach to others in need, such as patients, for example.

While the focus of the PACER Program was on meeting the needs of a specific group pf healthcare providers (HCP) and the Chinese Canadian community, the workshop conducted as part of this year’s virtual annual SACME program was devised to showcase the principles of the design approach that could be applied in any specific group to promote wellness and resilience through building psychological safety. Unfortunately, the need for this type of programming seems only to be increasing in today’s world riddled with societal insecurities, division, injustice and prejudice and marginalization of many. I found it effective, extremely well designed and delivered and would recommend inviting the group back soon. You can find more about the program and the outcomes in the published literature included here.

Supporting literature

Fung K, Liu JJ, Vahabi M, Li AT, Zurowski M, Wong JP. Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment. JMIR Res Protoc. 2021 Dec 6;10(12):e33495. doi: 10.2196/33495. PMID: 34726602; PMCID: PMC8651179

Fung KP, Vahabi M, Moosapoor M, Akbarian A, Jing-Wen Liu J, Wong JP. Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol. JMIR Res Protoc. 2021 Sep 13;10(9):e31211. doi: 10.2196/31211. PMID: 34515642; PMCID: PMC8694237.

Vahabi M, Pui-Hing Wong J, Moosapoor M, Akbarian A, Fung K. Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial. JMIR Form Res. 2022 Jan 27;6(1):e32136. doi: 10.2196/32136. PMID: 35084337.

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Establishing CPD as an Essential Part of the Health Science Educational Continuum

Speakers: Betsy Williams, PhD, MPH and Frederic Haffery, PhD

Reported by Eleftherios Soleas, PhD

“I don’t think this is going to win the award for insightful statement, but if you ask a room full of CPD enthusiasts if CPD is underappreciated, they’re going to answer ‘yes’. And they’ll still be right.”

I had the joy of learning with Drs. Betsy Williams and Frederic Haffery about Establishing CPD as an Essential Part of the Health Science Educational Curriculum. After some brief introductions, the facilitators Betsy and Frederic asked the attendees for how they came to CPD. Their answers varied, but they all led to a shared truth. As Frederic put it, CPD is treated as the third wheel on a bicycle. It is easy to see this in practice. UGME and PGME are often front and centre at institutions, whereas CPD is treated (and funded) an afterthought. Some of the stories swapped by attendees would have been funny if they weren’t saddening realities of ending up in pigeon-infested buildings, forgetting what sunlight looks like during workhours, or having an actual closet as an office. Maybe this is the difference between hefty tuition driven programs like UGME and PGME and a cost-recovery mandate like CPD. Or it’s because CPD is a slow burn instead of cohort based with classes. Either way, CPD it was discussed, is not at the pinnacle of resource expenditure despite being the largest learning period in any professional’s life. There was agreement that this is a point worth harping on when making our case. If we look at the learning lifespan, CPD is the largest chronological section with the largest pool of learners, with the widest array of necessary topics. Despite this there are hidden and loud signals that CPD is not front of mind in the leadership of institutions and organizations. Does CPD have the same connections to the holders of power or the relative influence of shorter, but better funded aspects of medical education? The answer it was agreed is flatly no. What does this mean for CPD as a field? Do the politics and dynamics of institutions force CPD to act from the sidelines?

Accepting this old deal is a path to irrelevance. It seemed to be in the minds of facilitators and learners alike that a new deal was necessary. One that we would have to negotiate and protect. CPD must create a space for itself in our home institutions and that might mean having to be proactive, but it also certainly means being collaborative to build our value and strengthen the position that CPD holds in our home organizations. The question remains what must we do to convince holders of power that CPD is worthy and a crucial part of the learning lifespan of health professionals?

Some of the solutions proposed by learners and facilitators revolved around creating value for the institution through absorbing responsibilities and base-budget to facilitate training at the home institution as well as taking a more expansive approach to what counts as CPD broadening the portfolio of potential programming and therefore cost-recovery.

I was fortunate enough to leave this workshop with more questions that I had going in and despite it being a virtual workshop, I found myself indulging in food for thought and making plans for making my case at my home institution.

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How Can Continuing Professional Development Programs Support Achievement of Clinician Educator Milestones?

Presenters & Facilitators: Nels Carlson, MD, Gary Smith, PhD, Ajit Sachdeva, MD, Yvonne Steinert, PhD, Janine Shapiro, MD, Ginny Jacobs, PhD, Randa Kutob, MD, MPH

Reported by by Mila Kostic, CHCP, FACEHP

Background

Most physicians at academic medical centers (AMCs) are clinician educators. Although there has been a historical focus on updating of practice to improve patient care and outcomes, continuing professional development (CPD) embraces all aspects of the growth and lifelong learning of physicians. CPD at AMCs must engage the clinician educator’s development as a teacher, scholar, and leader in addition to being a health-care provider. The recently released draft of clinician educator competencies and milestones (ACGME, ACCME, AAMC, and AACOM, August 2021) provides a consensus framework for describing the longitudinal growth and competency in the domains of administration; diversity, equity, and inclusion; educational theory and practice; and well-being.

The next step is to assure that medical schools plan to support progressive achievement of the milestones within these clinician educator competency domains. CPD programs should lead this effort. What are they doing now? What can they plan for the future? Those questions drove the learning for this workshop.

Target Learners

This SACME workshop was designed for anyone involved in CPD, especially those with experience and interest in CPD in support of the teaching, administration, DEI, and wellness roles of their learners. The workshop was limited to a maximum of 40 participants allowing for meaningful work in expert-facilitated breakout groups.

Learning Objectives

At the end of this workshop, participants were expected to be able to demonstrate the ability to define CPD programs that support the clinician educator milestones.

Description

Workshop participants created and shared draft CPD plans to support the milestone pathways defined by The Clinician Educator Milestone Project (ACGME et al., 2021). The workshop provided an opportunity for CPD providers to share experiences in holistically supporting clinician educators as well as collectively innovating programs that match the milestones, including potential leverage of other resources and stakeholders at their institutions. The intended outcome of shared ideas for integrating CPD with the clinician educator milestones may lead to broader dissemination to SACME members and the CPD community.

Workshop Format

1. Pre-work: Registered workshop participants were provided in advance with PDFs of the Clinician Educator Milestones (CEM) draft and supplemental guide of milestones. They were encouraged to select 3-5 sub-competencies where they have greatest expertise and/or interest in developing CPD plans.

2. During the initial part of the 2-hour workshop, the lead co-facilitators Dr. Nels Carlson and Dr. Gary Smith briefly described how their CPD programs supported continuing education professional development as educators. Follow-up discussion solicited additional current practices from participants and other facilitators.

3. Breakout rooms were established for related groups of sub-competencies. Participants self-selected participation in the pre-determined expert-facilitated work group based on their interests and expertise. Each work group had a recorder and used a pre-formatted Google Doc page to collect ideas for how to support the milestone growth of clinician educators within the assigned sub-competencies. After a brief break, the whole group reassembled to discuss any challenges encountered with the process (not content) of their assigned sub-competencies. The same groups then reconvened in breakout rooms to further discuss the practices, add ideas, add comments.

4. The final segment saw the whole group reassembled to report key findings and discuss opportunities and challenges for providing CPD in support of the CEM.

Some of the key questions discussed included the following: Who are the additional stakeholders at our institutions? How do CPD programs promote the importance of the educator development role to counterparts in UME and GME and to senior leadership in various institutional contexts? How might SACME provide resources/clearinghouse to support AMC CPD programs in this work? Participants were able to retain access to the Google Doc to review and continue to comment on draft plans created in each group.

Evaluation Plan

In addition to standard workshop evaluation, participants were asked to make a commitment-to-change statement related to enacting CPD in support of the Clinical Educator Milestones and to express their interest in working with the facilitators to further disseminate the ideas generated at the workshop.

Key Learnings for CME/CPD Practice

As a participant of the workshop, I really enjoyed the active design and the interaction with colleagues who have devoted significant time and effort to thinking about connecting clinical educator competencies across the continuum of medical education and more specifically about the role of CPD in that work. It was interesting to hear from colleagues who bridge the roles of faculty development and more traditional CPD and their institutional experience. In my small group focused on well-being, we discussed some specific ideas and examples from our institutions about what we have in place in support of our clinicians. While most existing programs include episodic courses, it was encouraging to learn that many of our institutions now also have Chief Wellness Officers who, if truly supported, hold the promise that we could imbed wellness as part of the organizational culture, as an expectation and not a remediation tool. Bridging and integrating programs in medicine and nursing, for example, was seen as another benefit of organizations who have jointly accredited programs. The need for coaching in the clinical setting in the wellness space becomes a question of capacity building and is closely related to leadership. Some of our thoughts about how to best support and evaluate these efforts emphasized the importance of thinking about designing longitudinal and institutional level programing and using the milestones as outcomes framework.

There is an opportunity for SACME to continue to support and promote this important work by both collaborating with key organizations across the Clinical Educator Milestone project to advocate for CPD role in it, and by disseminating the framework across our member organizations and creating opportunities for collaborative projects that may lead to longitudinal curricula and outcomes measurement. Maybe one day we will have a nationally or, even better, internationally shared curriculum in the areas of administration; diversity, equity, and inclusion; educational theory and practice; and well-being that will include the best of what we collectively have to offer and we will continue to study it with rigor so that we may meaningfully support our clinician-educators in their complex roles as teachers, scholars, leaders as facilitators of their patients’ health and well-being.

For more information about how to get involved, I would suggest you contact the lead facilitators of this workshop Nels Carlson, MD and Gary Smith, PhD.

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Foundations of Research Methodology: Qualitive and Mixed-Methods Inquiry 

Speaker: Bita Zakeri, PhD

Reported by Vjekoslav Hlede, PhD, DVM

In this workshop focused on qualitative and mixed-methods research principles, Dr. Bita Zakeri guided us learners through reflective inquiry on what it means to do qualitative research. The first question we tackled was: What is our stance, and how do our previous experiences shape our research?

Our jobs, professions, educations, personal lives, and our worldviews and beliefs shape who we are and how we do research. The goal is not to neutralize those forces or to ignore them. They are part of who we are. The goals are to recognize them and ensure that they have only a positive influence on our research and that readers are aware of them.

The first step for researchers is to recognize and document these forces. Later, if needed, authors can share their underlying research assumptions with readers, so readers can understand how authors craft answers as they research the complexity of CME/CPD.

This was a small workshop. Therefore, we had a chance to get to know each other, understand our different perspectives, and talk about how each of us might tackle a similar problem from a different angle. We discussed how using different research perspectives can help us create a comprehensive picture of the phenomena of interest. However, we (as researchers) must describe our "viewpoints" so we can map how different perspective adds to that big picture.

The second big part of the workshop was a collaborative, hands-on experience. Divided into small groups, we reviewed three papers and assessed their main messages, importance, and target audiences, as well as how their authors attempted to convey their messages, and how those messages resonated with our experiences and beliefs.

The workshop provided an excellent introduction to qualitative analysis, as well as the opportunity to use our new skills to assess qualitative and mixed-methods research. It can serve as the first step for CME/CPD professionals who are new to research in general or new to qualitative and mixed-methods research. Therefore, I hope that this is the first in a series of learning activities SACME provides to support young researchers (to be). Let me be ambitious and say that this workshop may serve as a start for the SACME CME/CPD Research Academy.

Reference

Lipmanowicz, H., & McCandless, K. (2014). The surprising power of liberating structures: Simple rules to unleash a culture of innovation. Liberating Structures Press. https://www.liberatingstructures.com/

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Writing Up a Scholarly Project: Transforming Ideas into Words

Presenter: Dr Savithiri Rataplan, MBBS, PhD

Reported by Helena Filipe

We may ask ourselves why writing about our experience, our ideas. Motivation might be extrinsic and based on academic requirements to professionally progress. Ideally the former should at least have some combination with an intrinsic need to reach for an individual space for reflection and critical thinking and an inner interest to share with others new findings, views, and experiences with a subsequent feeling of joy and accomplishment .

A feeling of lack of time, skills, training, purpose, and recognition may avert clinicians, educators, and researchers involved in health education from scholar activities.

The SACME 2022 preconference workshop on “Writing Up a Scholarly Project: Transforming Ideas into Words” was an exciting invitation to refocus scholarship as culturally embeddable in daily practice.

Wonderfully crafted by Savithiri Ratnapalan, who created an engaging, effective, and supportive educational environment, this workshop provided an insightful interactive opportunity to “try with feedback” and improve writing skills. Unravelling the complexities of effective writing, our facilitator followed the rule “of three” to highlight the principles of writing a manuscript.

The first one was “Know your audience”, which uncovers the importance of choosing the appropriate journal to submit and frame the writing into the manuscript requirements.

The second focused on explaining the purpose and significance of the message we wish to convey. The novelty and the “so what” to sustain and contextualize our writing topic can be decisive to publish a paper and or achieve a grant.

The discussion gets back to the problem purpose and significance and if reduced to results reiteration, study limitations and future research, this section will be incomplete. The third principle puts the spotlight on the compelling format of storytelling, on the importance of “story(ing) your discussion”. Good papers tell a story, contextualize, and critique the results.

Throughout our learning journey we could find glimpses of the four categories of scholarship of Boyer’s model expertly highlighted by our facilitator the scholarship of Discovery-original research that advances knowledge, Integration - synthesis of information across disciplines, topics and or time, Application or Engagement as the accurate application of theory into practice, and the Teaching and Learning as requiring work publication, peer review and be possible to be replicate .

The stepwise approach of 1) knowing the topic, 2) researching about it, 3) outlining a plan, 4) start writing, 5) reviewing, and editing shows to be practical and useful as a systematic plan to start a future manuscript.

When prompted to start writing, keeping it clear, correct and concise, and tell our story right there, our learning group experienced a mixture of simultaneous disbelief, excitement and reassurance. Dr. Rataplan mentored and role modelled by sharing her personal writing experience and no matter the more reticent we were at the start of our 3-hour journey about successfully meeting the goal of writing an abstract to be “further developed and presented at a scientific conference”, we really did!

Why writing? We completely agree with Octavia E. Butler’s response “I just knew there were stories I wanted to tell.”

References

  1. Savithiri Rataplan, MBBS, PhD (University of Toronto, Hospital for Sick Children,) SACME 2022 Preconference Workshop on “Writing Up a Scholarly Project: Transforming Ideas into Words” by Savithiri Ratnapalan. 3:00 PM - 6:00 PM WET on Thursday, February 10
  2. University of Nottingham. Studying effectively. Why do we write? Kings Meadow Campus. Lento Lane, Nottingham, NG7 2NR. Available at

    https://www.nottingham.ac.uk/studyingeffectively/studying/writer/whywrite/index.aspx last accessed in 20 March 2022

  3. Boyer, E. L. (1990), Scholarship reconsidered: Priorities of the professoriate. (PDF), Carnegie Foundation for the Advancement of Teaching

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