In This Section:
Presenter: Stuart Slavin, MD, MEd, Senior Scholar for Wellness, Accreditation Council for Continuing Medical Education
Reported by Robert D’Antuono, MHA
Stuart Slavin, MD, MEd, gave a powerful talk on Keys to Well-being: Reclaiming Agency in an Out-of-Control World. A fascinating topic presented by a fascinating and informed speaker. Dr. Slavin began by saying that things in the world seem to have gone crazy and the reality is that at least one thing we can control is what goes on in our own heads and how we filter our thinking to make sense of the world. Victor Frankel, MD, a WWII psychiatrist stated that “People are trying to thrive and be our best selves”. But this isn’t a reasonable goal.
Slavin suggests that instead of using the term well-being, the term satisfaction is much more appropriate. People struggle with three satisfaction goals: 1) satisfaction with work, 2) satisfaction with life overall, and 3) satisfaction with self. As a culture we have focused too much on well-being. We also tend to talk about well-being and mental health as being binary, as opposed to a “satisfaction continuum”. The goal is to move up along this continuum. Another issue related to well-being is mitigating the negative forces in our lives. At this juncture, Dr. Slavin introduced his theory on problematic mindsets and cognitive distortions our minds go through which contribute feelings of inadequacy, maladaption, embarrassment and shame. He studied these in medical students and residents.
These Common Problematic Mindsets are:
These Cognitive Distortions/Automatic Thoughts are:
Slavin introduced two tools to deal with problematic mindsets: meta cognition and mindful awareness. Cognitive restructuring is the basis for cognitive behavioral therapy. It teaches individuals to better understand their thoughts of embarrassment, inadequacy and shame and label them appropriately filtering out cognitive distortions which lead to depression. The goal is to recognize these mindsets and change your thinking so that you are more productive and happy. Mindful awareness is another tool to develop your ability to deal with negative thoughts.
Slavin then turned to feelings of profound negativity, pessimism, and even anger and how we mange these feelings. Managing negatively bias, cultivating positive emotions, embracing and actively working toward optimism vs pessimism. Train you self to let go of negative feelings via emotional self-regulation. Human connection with others is important. Using compassion and finding gratitude in conversations with others will make you feel good and ‘come back to you’.
Presenter: Brenda Bursch, PhD, professor of psychiatry and biobehavioral sciences and pediatrics, David Geffen School of Medicine at UCLA and medical and clinical psychologist, Mattel’s Children Hospital
Reported by Joyce Fried, BA, FSACME
“We have endured a lot of uncertainty, a lot of change, a lot of loss. There has been this collective trauma and stress that people have had to cope with over time. Trying to take care of yourself in the middle of all that is a challenge for nearly everybody.” Those were the opening remarks from keynote speaker, Dr. Brenda Bursch, who in addition to her academic titles at UCLA has been sought after for her expertise on burnout and well-being by other high stress industries, including firefighters, Space X, and elite sports professionals, including the Los Angeles Lakers. During the pandemic, she has served on the lead team for the UCLA Health COVID-19 Wellness & Emotional Support Workgroup, training and coordinating the unit-based mental health support staff as well as providing direct support services for frontline health providers.
In her interactive session, Dr. Bursch acknowledged how stressful 2021 was due to uncertainty, change, loss, collective trauma and stress, and the need to “figure out when to say yes or no”. This caused many people to act out (for example, on airplanes or behind the wheel of a car). She hypothesized that even if Omicron is the last COVID wave, it may still be another two years before many are likely to start to feel like themselves again.
Her recommended remedy for finding the path back to joy and meaning is to “Remember, Recover and Renew”.
“Remember” includes honoring the challenges and sorrow from the past year. She reminded her audience that people have lost more than loved ones. Other losses included missing out on life events, trips, conferences, and seeing people. These losses produce feelings of grief. Dr. Bursch said Kubler-Ross’s five stages of grief (in this case, loss) are applicable to the feelings evoked by the pandemic: denial, anger, bargaining, depression, acceptance. She asked everyone to reflect and share their feelings and then provided tips on coping with grief and trauma such as accepting support from people who care about you, cultivating gratitude, and looking for silver linings.
“Recover,” in which individuals optimize their chances of feeling joy at work, can occur utilizing the PERMA Model of Well-Being: Positive Emotion (happiness, joy, and pleasure—positive emotions can help undo negative ones), Engagement (being in the flow of work, absorbed by it, losing track of time—leads to empowerment, job satisfaction), Relationships (healthy collaborative relationships with colleagues and a positive relationship with one’s self—permission to be compassionate toward self), Meaning (values aligned with one’s job, contributing to something bigger than yourself—studies show that finding meaning 20% of the time during work produces less burnout in health providers), and Accomplishment (success, mastery, and achievement).
“Renew” includes reflecting on one’s own well-being and opportunities to flourish. Effective self-care includes healthy routines, personal policies, and learning and using coping skills. She explained that burnout is a complicated problem and should be treated by combining
interventions such as improving communication skills, teamwork, participatory programs, and the provision of self-care programs.
After describing these frameworks, Dr. Bursch turned her attention to providing practical tips to improve organizational capacity for people to support each other. She stated that when she met with SACME leadership, they told her they derived a lot of support from each other. She emphasized that SACME is a resource for members to find support, resources, and training which can then help them support and offer evidence-based training to others. She was particularly impressed with the COVID-19 resources on the SACME website.
Dr. Bursch explained that peer support programs can steer individuals to a culture of sharing, to acceptance of human fallibility, to increased psychological safety which allows individuals to learn from their errors, and to acknowledgement that self-care is a responsibility (not an indulgence). Peer support programs can be either formal or informal. She cautioned that barriers to seeking support include lack of time, stigma, lack of confidentiality, and access.
Dr Bursch provided a primer on informally supporting peers which she dubbed “Peer Support 101.” She reminded her audience that the goal of peer support is not to “fix” your peer’s pain. The broad strokes of supporting a peer are to invite them to briefly meet; ask how they are doing; focus on emotions (not event details); LISTEN; reflect: honor, validate, normalize, very briefly share; remind colleague of competency and trust; ask about coping and self-care; ask what would be helpful; offer resources; follow-up by asking “can I check in with you again?”
She reminded the audience that it is helpful to ask a peer are: Are you ok? What do you need? How are you feeling about what happened? On the other hand, unhelpful comments include: Tell me what happened. Everything will be ok. Don’t worry about it. It is important to maintain boundaries and confidentiality in these conversations and to practice active listening. She described the CALM approach to active listening—remain calm and non-defensive, use a soft voice, minimize distractions, watch your non-verbal communication. “Calmness is contagious,” she said. The acronym stands for Calm, Active Listening, Make it better.
At this point in her session, Dr. Bursch opened the floor to comments, tips, and shared experiences from the audience. One person commented that paraphrasing lets a person know you are listening, you heard them, you care. Another person replied that what you pay attention to really does matter. Someone cautioned to be careful to not start talking about yourself. Another person shared that feedback is so important not only during evaluation but given often, saying, “It’s pretty lonely at the top”. Others agreed that it is nice to get positive feedback at any level of the hierarchy. Finally, someone opined that having a sense of purpose may be more understandable than finding “meaning” and more relatable.
Dr. Bursch added to her recommendations that routines are very helpful especially for those who remain at home where it might be good to create new routines. She asked her audience to share what kinds of routines they found that they have adopted during the pandemic. There were many answers: meditation, driving around the block in the morning and at night to simulate separation of work and home, pets, exercise, music, stretching, swim, ballet, yoga, gardening, piano, and long walks. Other comforting activities people have embraced include relating to others again, trying to be optimistic, appreciating time with family (grandkids), Zoom, starting to venture out, and personal calls to team members every few weeks just to find out how they are.
Presenter: James Makokis, MD, MSch, family medicine physician and winner, Amazing Race Canada
Reported by Robert Dantuono, MHA
As half of the first Two-Spirit Indigenous couple to win The Amazing Race Canada, James Makokis, MD (Saddle Lake Cree), a family medicine physician, told his story including his vision for bringing together Western and Indigenous medicine to improve health and well-being, truth and reconciliation, and how the concepts of indigenous health impacted his own wellness during the pandemic.
This was an extraordinary conversation. Rich in new information and insights into the care of Indigenous populations, Dr. Makokis explained the context which must be considered in order to treat disease successfully for inhabitants of Turtle Island, Canada where he currently practices family medicine and teaches residents. Dr. Makokis stated that Indigenous medicine is the original medicine that was brought to Turtle Island. As such, we can’t cure Indigenous illness with western medicine alone due to the “emotional dislocation” of Indigenous people. There is a need to create space for healers and spiritual practices that help to improve the trust of western medicine by Indigenous patients. As a means of educating future physicians to the cultural and social norms and beliefs of Indigenous patients, Dr. Makokis invites his family practice trainees to his home to learn about Indigenous medicine. He stresses the importance of nurturing a shared understanding of the patients’ needs and wants, working collaboratively, and using a shared decision-making approach which incorporates Indigenous medicine with western medicine health techniques, in particular adding spirit and emotion to the western medicine style of care.
Dr. Makokis turned to a discussion of his work with the Canadian Truth and Reconciliation Commission. This Commission was established to reconcile the abuse of school-age Indigenous children that began in the early 20th century. For over 100 years, Indigenous children were taken from their parents, homes and communities and transferred to state-funded, religious residential schools run by the Catholic church in Canada. The premise was to assure that Indigenous children would adopt to western ways and cultural norms, leaving behind all aspects of Indigenous life. In the process of their education, the children suffered physical, mental and sexual abuse at the hands of the priests, nuns and others running these facilities. The Commission was established to reconcile the grievances suffered by survivors of residential facilities and to provide them with the ability to sue the government and religious orders for the abuse inflicted upon them as young children and students.
Dr. Makokis concluded the conversation by stating that we must persevere and create an exclusive space for Indigenous medicine in order to promote Indigenous health and healing. Training a new generation of physician providers who are knowledgeable and understand the cultural imperatives of Indigenous patients is key to improving care.
Presenter: Laura Edgar, Accreditation Council for Graduate Medical Education (ACGME) Vice President, Milestones Development
Reported by Robert Dantuono, MHA
The new Clinician Educator Milestones are designed to aid in the development and improvement of teaching competence by assessing educational skills of faculty members across the continuum of medical education. An important joint initiative of the ACGME, Accreditation Council for Continuing Medical Education (ACCME), Association of American Medical Colleges (AAMC), and American Association of Colleges of Osteopathic Medicine (AACOM), a pilot version of these Clinician Educator Milestones is currently posted for public comment, with a comment deadline of April 30, 2022.
Laura Edgar, EdD, CAE addressed the important nuances of this new Milestones set, which has important distinctions from the ACGME’s standard Milestones for specialty and subspecialty program evaluation of residents and fellows.
Importantly, the Clinician Educator Milestones are not an ACGME accreditation requirement and are not intended to become one in the future. Rather, they provide a framework for assessment of educational skills of faculty members to improve and enhance their effectiveness in certain areas of their role as educator.
Experienced faculty members may assume they are at a high level of competence as educators, but the Clinician Educator Milestones provide the opportunity for self-assessment in 18 sub-competencies, allowing all faculty members to assess themselves on a range of educational skills. Faculty members can start by using the Clinician Educator Milestones as a self-assessment. They may also choose to involve a trusted peer to provide an objective assessment of their skills in a particular area.
“This is one of the first times that we have common language that goes across the UME [undergraduate medical education], the GME [graduate medical education], and CPD [continuing professional development] world, which makes this a really exciting new program,” stated Dr. Edgar.
She went on to note that the Clinician Educator Milestones are designed to help with professional development, and not to be any sort of requirement. They are not intended to be high stakes, but were developed to be used by individuals to improve in specific sub-competency areas. Though self-reflection is not easy, these Clinician Educator Milestones are an opportunity for individuals to assess their skills as educators in a variety of specific areas.
Four Competency Milestones
Dr. Edgar listed four competencies: educational theory and practice; diversity, equity, and inclusion; well-being; and administration. Within the competencies are 18 sub-competencies.
The educational theory and practice milestone is at the heart of what clinician educators do every day. The intent of this milestone is to ensure the optimal development of competent learners through the application of the science of teaching and learning to practice.
The overall intent of the diversity, equity, and inclusion milestone is to acknowledge and address the complex intrapersonal, interpersonal, and systemic influences of diversity, power, and inequity (power, privilege) to promote equity and inclusion in all settings so all educators and learners can thrive and succeed.
The well-being milestone is intended to apply principles of well-being to develop and model a learning environment that supports behaviors that promote personal and learner psychological, emotional, and physical health. It was noted that the epidemic of physician burnout has been made worse by the COVID-19 pandemic, and that the National Academy of Medicine Collaborative on Clinician Well-Being and Resilience includes resources in this area, many of which are referenced in the companion Supplemental Guide to the Clinician Educator Milestones.
The administration milestone covers leadership. The concept of administration is broad and diverse in its appearance. Educators do not need to be in a senior position or hold a formal administrative title to benefit from this domain and its sub-competencies.
Sub-competencies for each Clinician Educator milestone can also be divided into three areas based on faculty member roles, and making the Milestones valuable for educators, educational scholars, and educational leaders (administrators and program directors). To ensure the optimal development of competent learners through the application of the science of teaching and learning to practice, the Milestones are divided into nine sub-competencies: feedback; learner assessment; professionalism; remediation; learner professional development; program evaluation; science of learning; scholarship; and teaching.
Each sub-competency is structured to provide a road map for educators to think through their ongoing professional development. The Supplemental Guide offers examples at every sub-competency level, and at every level across the medical education continuum.
Currently in Pilot Phase
The Clinician Educator Milestones are currently in an active pilot testing phase. The pilot will be open for comment through April 30, 2022, and the Milestones are scheduled to be available for use in May 2022.
For more information about the Clinician Educator Milestones, visit the Milestones page of this website. To review these Clinician Educator Milestones and provide comments, visit the Milestones Engagement page. Email Milestones@acgme.org with any questions.
Presenter: Lisa Howley, PhD, Sr. Director, Strategic Initiatives and Partnerships, AAMC
Lisa Howley PhD gave an insightful overview of the 2021 Harrison Survey data. A summary of the report follows.
Overview of Survey
This descriptive report shows data, including trends when applicable, from participating U.S. and Canadian medical schools and specialty societies. While there are many similarities between these types of CME/CPD providers, there are important unique characteristics as well. Overall, the survey data suggest some identifiable trends in the CME/CPD responses to 1) supporting clinicians’ health and well-being, 2) addressing DEI, 3) shifting to online delivery, 4) responding to the needs of the global pandemic, and 5) engaging in research and scholarship about CME/CPD.
Supporting Clinicians' Health and Well-Being
An emphasis on the health and well-being of clinicians is evident in CME/CPD unit offerings and priorities. This was especially true during 2020, according to respondents, when 69% of medical schools and 93% of specialty societies named provider wellness/burnout a moderate or major focus of their CME/CPD educational programming. Clinician burnout has risen since the beginning of the COVID-19 pandemic, and health care professionals are at a higher-than-average risk for the negative effects of chronic stress. These unprecedented times call for CME/CPD units to collaborate across their systems of health care, academic institutions, or organizations to support clinicians’ well-being.
Addressing Diversity, Equity, and Inclusion
Health care disparities along with DEI ranked as high-focus areas for the vast majority of medical schools and specialty societies. The ongoing pandemic of racism in health care has been brought to new light over the past 18 months and is an area for all educators to focus attention on. DEI, and anti-racism are inherent in all aspects of academic medicine, and CME/CPD units should continue to prioritize efforts to improve in those areas. Respondents reported collaborating with their DEI colleagues and should be encouraged to continue to improve their own practices and policies to support equitable, inclusive, and just CME/CPD offerings.
Shifting to Online Delivery
The shift to online delivery between 2018 to 2021 was significant. Traditional, in-person CME/CPD conferences were canceled due to the pandemic, causing the need for virtual, online delivery. This led to changes in educational formats as well. While the lecture format remained stable, the more interactive, small-group activities decreased. Those showing substantial decreases included simulation, small-group discussions, and peer observation and feedback. As everyone continues to adapt to this new virtual environment, CME/CPD units and educators are encouraged not to default to passive learning methods but to be creative, implement interactive virtual methods, and conduct research on optimal teaching, learning, and development approaches for clinicians in online and hybrid environments.
Responding to Needs of the Global Pandemic
CME/CPD units responded to the call for action to disseminate new information and education amid the COVID-19 pandemic by changing their delivery methods significantly. The majority of respondents cited COVID-19 diagnosis and management as either a major or moderate focus in the past year. We commend these units and educators for their ability to pivot to a different approach in support of clinicians and their patients when they needed flexible, high-quality educational programming.
Engaging in Research & Scholarship for CME/CPD
The majority of CME/CPD units were involved in a variety of education-related scholarly activities, with conference presentations being the most frequently reported activity. Sole or joint authorship in peer-reviewed journals was reported by about one-third of all respondents. There was a marked decrease in presentation of quality improvement work from 2018 to 2021. Unfortunately, lack of funding for education research remained a barrier. The events of the past two years call attention to several areas in need of further research, including the best ways to translate CME/CPD learnings into changes in clinical practice; use data to improve learning and yield equitable health outcomes; assess learning and evaluate programs; and use team-based CME/CPD to increase patient safety. More time and resources, including funding, continue to be needed to support educational scholarship in the field of CME/CPD.
Medical schools and specialty societies and their CME/CPD units are all facing rapid changes and challenges in health care. Many factors are affecting CME/CPD units and their educators, including the ongoing global COVID-19 pandemic, systemic and institutional racism, changes in health care delivery and practice, and worsening clinician well-being. This Harrison Survey report is a descriptive analysis of the current work and future priorities of academic CME/CPD units in medical schools and medical specialty societies. We hope this information sparks ideas and questions that lead to advances in how learning and change in the field of CME and CPD are supported and facilitated. The ongoing study of CME/CPD unit efforts, rapid assessment of needs, and design and delivery of quality educational interventions are important to improving and supporting the growth and development of health care professionals.
SACME members may sign-in to review the full text report and data. Click onto this link.
Presenters: Branka Agic, PhD, MHSc, Barbara Anderson, MS, Asha Maharaj, MBA, Grace Shelby, PhD, Laura Werts, WEd, MS, CMP
Moderated by: Jann Balmer, PhD, RN
Abstract Title: Evaluation of the University of Wisconsin-Madison Diversity, Equity, and Inclusion Toolkit for Interprofessional Continuing Education
Study Team: Barbara Anderson, MS, Marianna Shershneva, MD, PhD
Institution: Office of Continuing Professional Development, University of Wisconsin School of Medicine and Public Health
Purpose/Problem Statement/Scope of Inquiry
In January 2021, the University of Wisconsin–Madison Interprofessional Continuing Education Partnership (ICEP) implemented the Diversity, Equity, and Inclusion (DEI) Toolkit for Accredited Continuing Education to foster inclusive learning throughout our accredited continuing education program. This study focused on user feedback from early experiences with the Toolkit and a baseline assessment of applied strategies for creating inclusive learning environments in regularly scheduled series (RSS) and other activity formats.
Approach(es)/Research Method(s)/Educational Design
The Toolkit design, developed by the ICEP team in collaboration with a School of Medicine and Public Health (SMPH) Shapiro Summer Research student, is based on the foundational work UWSMPH Presenter’s Guide, and is comprised of four components:
DEI Competencies inform professional practice gaps analysis, educational needs assessment, and learning objectives formulation.
Consistent with the experiences of other academic centers , our Toolkit is designed to support inclusive learning environments by fully embedding its components into the planning, delivery, and evaluation process of accredited CE activities.
Following Kirkpatrick's four-level evaluation model, we collected feedback from Toolkit users (reaction and learning), analyzed planning documents and committee meeting notes (behavior), and examined responses to DEI-related questions in program-wide and activity evaluations (results).
The Toolkit was officially released through our planning application, faculty communication, and evaluation in 2021. However, a full awareness-building campaign was not implemented that year because the ongoing COVID-19 pandemic slowed faculty engagement in accredited education.
In the annual survey of participants in the ICEP-accredited activities, respondents were asked to rate their satisfaction regarding the diversity of perspectives and experiences presented within the activity they were evaluating.
On a scale from 1=very dissatisfied to 5=very satisfied, 87.18% of respondents were either satisfied or very satisfied with the diversity of perspectives presented (Figure 1). Further investigation of the data showed the average satisfaction response by activity type fell within the “satisfied” domain, although the rating appeared to be lower for the performance improvement activities:
As an interprofessional continuing education program, our planning process emphasizes learning from, with, and about members of the healthcare team. Possibly, the high level of agreement was influenced by our work to promote interprofessional learning and collaborative practice rather than inclusive learning environments in the context of DEI. Qualitative responses provided some insights into how respondents may have interpreted the questions. The examples below describe satisfaction from the DEI and team-based learning perspectives.
Others are examples of suggestions for improvement:
The official roll-out of the Toolkit to the RSS community began in February 2022. In preparation for the renewal process, RSS planners responded to survey questions about their familiarity with the Toolkit (Figure 2). Not surprisingly, many respondents indicated this was the first time they were learning about the Toolkit.
Notably, several RSS committees identified specific steps they would take to facilitate creating inclusive learning environments, such as conducting DEI-focused needs assessments, incorporating cases of underrepresented populations, increasing speaker diversity, developing metrics to measure the effectiveness DEI strategies used by speakers, and collaborating with DEI specialists.
Reflection and Debrief
Three planning committees responded to the reflection/debrief questions via the Activity Planning Debrief tool. Two of three committees indicated they included all patients who might be impacted by the disease through thoughtful faculty selection and content development. Committees shared strategies for how they integrated the voices and priorities of all affected by the issue, such as:
In 2021, 72% of 18 activities elected to address DEI competencies in the activity practice gaps, educational needs, and learning objectives. This included 60% of live or virtual live activities and 87% of new RSS. Planners selected the competencies on an equal basis. Engaging in self-reflection was selected seven times, addressing health disparities, eight times, and valuing diversity in the clinical encounter, six times. Outcomes data related to these competencies are not yet available for these activities.
SME tools have been underutilized to date. A total of 28 speakers/authors submitted the DEI checklist. RSS faculty used the checklist most often. These faculty wrote notes describing steps they would take that will support inclusive learning environments.
Evaluation tools have continued to evolve since the initial release of the Toolkit. Through anecdotal feedback, it was determined that the limited number of the DEI-related evaluation questions did not provide adequate opportunities to measure the intended outcomes and/or perceived inclusivity of learning environments at the individual activity level. As a result, we have expanded the pool of questions, from two to six, that planning committees can select from when building their activity evaluation. In addition, planners are also encouraged to write a new question that best measures the achievement of intended outcomes.
The study documented progress in the Toolkit implementation, high interest in the DEI tools among education planners and faculty, and opportunities to improve the tools and increase awareness of these resources. For example, to increase utilization of the Debrief Tool, we need Accreditation Specialists to encourage planners to review the tool when closing out the activity and/or we need to centralize the distribution of this tool.
Key Learnings for CME/CPD Practice
We observed a favorable uptake in the Toolkit utilization, and we continue to collect and analyze data that indicate needed improvements. The Toolkit is available for review and use at the ICEP Learning Portal . Our institution’s experience illustrates the need for DEI tools that are accessible to the CE community. We learned that requests for support from early adopters of best DEI practices need to be honored. This could be accomplished through professional development to increase the knowledge and skills needed to effectively use resources, like the ICEP DEI Toolkit, and to practice meaningful DEI discussions. Considerate implementation of resources organized in a toolkit could serve as a framework that empowers CPD practitioners’ efforts to develop inclusive and equitable continuing education.
1. Bussan H, Hoang T, Villaruz J, Hernandez JB, Rajan S. University of Wisconsin School of Medicine and Public Health Presenter's Guide. (2019) SMPH Intranet. https://intranet.med.wisc.edu/building-community/. Accessed June 1, 2020.
2. Centre for Addiction and Mental Health (2021). Health Equity and Inclusion Framework for Education and Training. Toronto: CAMH. https://kmb.camh.ca/eenet/resources/health-equity-and-inclusion-framework-education-and-training. Accessed March 1, 2022.
3. Nytes C, Shershneva M, Anderson B. UW-Madison ICEP Diversity, Equity, and Inclusion Toolkit for Accredited Continuing Education (2021) https://ce.icep.wisc.edu/content/uw-madison-dei-toolkit-accredited-continuing-education.