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Academy of Medical Educators – Winter Meeting
February 3, 2012
Small Group Discussion
Session A - 3:45-4:15 pm
• Engaging with the Educational Wing of your Professional Society: Why, When
and How (Hyland, Topp, Harper, Shinkai)
• Technology and Teaching in the Clinical Environment: The iPad, APeX and
Beyond (Teitel, Wamsley)
• Adventures in Assessment (Teherani, Promes)
Session B - 4:20-4:50 pm
• Linking Education and Clinical Quality (Green, Young)
• New Curricular Content for the 21st Century (Reeves, Lai, Aronson)
• Novel Uses of Educational Technology (Video, ARS, etc.) (Burke, Mayfield, Lin)
Notes from each session follow, with resources as applicable and a partial list of
participants.
Please contact Cynthia Ashe at ashec@medsch.ucsf.edu if you participated in one of the
groups and wish to have your name added.
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Engaging with the Educational Wing of Your Professional Society: Why,
When and How
Facilitators: Mike Harper, MD; Kathy Hyland, PhD; Kanade Shinkai, MD, PhD; Kim Topp, PT,
PhD
Participants:
• Chen, Lee-may
• Dhaliwal, Gurpreet
• Diab, Mohammad
• Fernandez, Alicia
• Jain, Sharad
The Question
What is the best way to interact with the educational sector of a professional society to meet the
goal of getting specialized content (i.e. orthopedic surgery, dermatology) into the medical school
curriculum?
Topics of Discussion
What?
How?
Why?
• Get more lecture time (challenging)
• Online modules
o pros: can be integrated into established rotations/ courses, easy to create, easy
to collaborate
o cons: a cop-out/ not ideal learning tool, asks students to do it on their own time if
not integrated into a course or mandatory
• Ways to contribute to your society’s efforts to develop national curricula and the
challenges of incorporating such curricula into one’s home institution
• Challenges of assigning curricula developed within professional organizations to preclinical,
clinical and GME levels of training
• Creating national standardized curriculum (derm as example)
• May be able to create a curriculum that is then integrated into other non-specialized
curriculum
• Example #1: on-line modules in dermatology relevant to pediatrics can be moved into
pediatrics rotation
• Example # 2: through professional society (i.e. geriatric medicine), establish
competencies through consensus conference, get them endorsed by AAMC, and then
use these to start conversations with other disciplines (family practice) to initiate
collaborations to create curriculum together
• Who gains?
o Programs that have less established curriculum or no curriculum can learn
through shared experience joining forces with more established curriculum; i.e.
don’t reinvent what’s already been created.
o Anatomists/clinical anatomists: sharing information re: trends, problems/solutions
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o Gain strength in #’s: i.e. gyn onc -> small programs (with 1-2 trainees) joining
forces to do something for the larger group of trainees -> such as group skills
training at the professional society meeting
• Who loses? “special” programs have more to lose than they gain because they share
something they created with programs in need (but nothing to offer back)
Final thoughts:
• Group member reiterate that coming from UCSF -> we are able to contribute a lot of
insight and resources at the professional society meetings and are often actively
contributing members
• Need to consider whether offering competencies is enough. How do you translate
competencies into curriculum?
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Technology and Teaching in the Clinical Environment: The iPad, APeX
and Beyond
Facilitators: David Teitel, MD; Maria Wamsley, MD
Participants (partial list):
• Aronson, Louise
• Burke, Christian
• Cooke, Molly
• Gelb, Alan
• Mayfield, Chandler
• Poncelet, Ann
• Sanchez, Henry
• Souza, Kevin
• Steinauer, Jody
Key Discussion Points:
• Access to EMR
• Access to personal and shared data
• Medical information/Educational tools
• Interaction with peers and team members
• Evernote as a way of keeping track of learning issues
• CANTO on iPAD; HAIKU on iPHONE
• Medical records currently used as a repository, not able to collect interesting cases in a
file.
• Creating a teaching case – is there a way to tag it with key words so you can search for it.
• HEAL library was a mechanism for being able to tag cases, but according to Kevin Souza,
this may soon be defunct.
• Consider the idea of the Academy creating our own asset library.
• iBOOK author
• Could put syllabi into the iPAD (preclinical years) – KNO a platform that will work across
devices
Resource: See slide set that follows
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Academy of Medicine
Winter Meeting 2012
Technology and Teaching in the Clinical Environment
David Teitel, MD

Areas of Interest
• Access to EMR
• Access to personal and shared data
• Medical Information/Educational
tools
• Interaction with peers and team
members

Access to EMR
• Control remote terminal
✦
UCare, WebESA, Muse, PACS, etc
‣ rdc: Desktop Connect, iTeleport etc
✦
APeX
‣ citrix session: Citrix Receiver
• Local App
✦
Epic Canto/Haiku

Access to Data
• Local
✦
within various apps
‣ QuickOffice, Docs to Go, Keynote, etc
• Distant
✦
Existing servers (P, S and T drives, own
computer, SOM, etc)
‣ File Browser
✦
Cloud storage - DropBox, iCloud, etc

Information
• General Medical Information
✦
LexiComp, PALS Advisor, Epocrates,
Medscape
• Teaching Tools
✦
iRocket, eBrary, individual Apps, iBooks
Textbooks

Interaction
• Social Media
✦
CLE, Wiki@UCSF, Doximity

Adventures in Assessment
Facilitators: Arianne Teherani, PhD; Susan Promes, MD
Participants (partial list):
Autry, Meg
Brzezinski, Marek
Cardis, Betsy
Hauer, Karen
Loeser, Helen
Lowenstein, Dan
McCowin, Marcia
Reeves, Scott
Rutherford, George
Key Discussion Points:
• Individualization
o Individualizing assessments based on a learners’ level of prior knowledge
and expertise.
o How feasible is that?
o How does that play into ensuring students achieve competency?
• Standardization (Validity)
o Assessments should be standardized, particularly in areas where they
currently are not (e.g. clerkship evaluations, MSPEs).
o Language should be provided that would ensure consistent focus on
specified skills and knowledge (competencies) for all learners.
o Efforts to standardize must be validated against other markers of
performance.
• Multiple tools; Triangulate evidence (Portfolio)
o Assessment should be derived from multiple sources and never rely heavily
on a few sources that are measuring 1 or 2 outcomes.
o The portfolio provides for important venue of self-assessment, which can be
subsequently channeled to provide individualized and aligned teaching to our
learners.
• What are we measuring?
• What are the outcomes we care about?
• Assessment drives learning
o Assessment is ultimately a socially constructed outcome.
o The value we place as a society and as educators on those outcomes
provides it with meaning.
o Assessment should be used primarily to prompt and ensure learning.
• Identifying competency
o Ensuring that assessments designed are in fact valid and sensitive enough to
identify how competent our learners are.
o Also ensuring that competencies and not focusing on and perpetuating the
culture minimum standards.
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Linking Education and Clinical Quality
Facilitators: Adrienne Green, MD; John Young, MD
Participants (partial list):
• Brzezinski, Marek
• Campbell, Andre
• Chen, Lee-may
• Chou, Calvin
• Josephson, Andy
• Loeser, Helen
• Maa, John
• Marmor, Andi
• Masters, Susan
• Robertson, Patty
• Rollins, Mark
• Sehgal, Niraj
• Topp, Kim
• Vener, Margo
Key Discussion Points:
• This topic often has a tendency to go off in one of two directions:
o What is the relationship (often assumed to be a benefit by educators) of having
learners in clinical settings and how can we document it effectively? and
o What do learners need to know and experience about the field of PS/QI and
what it is the best way to create these learning opportunities?
• There is considerable interest on the part of learners in developing QI/PS skills, driven by
intrinsic interest and the fact that new residency graduates are often offered positions that
include a QI role. The Department of Medicine has developed several responsive
programs:
o Two-week procedures/QI&PS rotation that every medicine intern does;
o
o
A QI/PS elective for residents and, coming on line, one for students;
A highly subscribed “Quality and Safety Challenge” that encourages and
showcases mentored resident projects.
• Multi-site programs have the significant challenge of minimizing unwanted redundancy
and optimizing cohesion when their trainees rotate through multiple hospital systems,
each of which has its own approach to QI/PS, handoffs, EMR, etc.
o The Department of Medicine’s creation of a chief resident for quality/safety was
noted as an exciting innovation – with a focus on developing cohesion across the
sites/years.
• Given that this is an ACGME requirement, and that ACGME competencies are already
migrating into UME, can the Academy collaborate with UCSF content experts in the
design and creation of developmentally progressive materials/sessions to support QI/PS
learning?
• The structure of our clinical education, based on rotations, while conducive to exposing
learners to many different settings, disease conditions, and teachers, may impede their
understanding of the complex work-intensive clinical environments in which they find
themselves and retard their ability to engage in systems-based practice, including PS and
QI activities.
o Is this something that would happen more naturally in more longitudinally
organized educational programs?
o The literature suggests that QI/PS curricula with a requirement to develop and
implement a project works best in the context of a longitudinal clinical
experience.
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• We need to foster more conversations among people who define themselves as largely
medical center/clinical people and those who define themselves as largely medical
school/education people. This has the potential for many synergies. For example:
o QI/PS initiatives can be better aligned and integrated between clinical operations
and education. The UCSF Medical Centers Housestaff Incentive Program was
cited as an example.
o Henry Ford was also cited as an example where much of the ‘PS/QI’ curriculum
is provided by the medical center through intensive training in handoffs, QI, PS,
teamwork communication and participation in RCA/MM, etc… that is
standardized across all specialties.
• As the work practices change, the insights of educators may be useful beyond the
traditional audiences of medical students and residents. For example, Molly’s example of
Activity Theory in understanding the change process around management of referrals
between internists and IM subspecialists:
• Clinical educators could foster alignment by understanding more clearly where there are
opportunities to improve the quality and efficiency of clinical care and developing
teaching modules to address these topics or areas
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New Curricular Content for the 21 st Century
Facilitators: Louise Aronson, MD; Cindy Lai, MD; Scott Reeves, PhD
Participants (partial list):
• Daikh, David
• Dhaliwal, Gurpreet
• Elkin, David
• Harper, Michael
• Hauer, Karen
• Hyland, Katherine
• Julian, Kathy
• Khayam-Bashi, Shieva
• Lowenstein, Dan
• Rohde, Dana
• Rutherford, George
• Sanchez, Henry
• Satterfield, Jason
• Sawaya, George
• Souza, Kevin
• Wamsley, Maria
• Zimmerman, Leslie
Key Discussion Points:
What should it be?
• Interprofessional education
• Training beyond clinical care/systems
• How to teach empathy
• Preparing future primary care providers
• Caring for the aging population
• Public and population health
• Use of devices/computers to gain knowledge
• Increase behavioral science training
• Managing the way knowledge and information are handled with computers
• How to make education relevant in a rapidly changing world
• Combining clinical medicine with anatomy/basic science
• Student-run clinics as a place to do formal curriculum & assessment
• Genetics into all parts of curriculum
• How to prepare learners for where medicine is going in the basic science curriculum
• Using medical humanities to teach compassion and self care
• Developing critical thinking skills
• Active engagement and technology to reduce wrong diagnoses
• How to assess all these new topics
• Longitudinal education what does it mean in terms of the doctors trained?
• Clinical decision-making: how to apply so much info to individual patients
• Elevating how decisions are made to a basic science that doctors are aware of
• Helping make key content/learning interprofessional
• Preparing learners for even more info than we are bombarded with today
• Sustaining junior faculty as teachers
Questions/issues/other thoughts:
• Can’t add new content without “cleaning out the garage” of current content
• Handling more information
• Used to be Dr+Pt Now Dr+Pt+APeX
• Will there still be depth of learning in anything?
• Would earlier subspecialization help?
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Top 3:
• Access to info changes what people remember what should they remember?
• Use technology to liberate faculty to the higher level & more humanistic aspects of the
curriculum
• What then do we test?
• Teaching isn’t just fact transmission but also contextualization, so can’t put all that on
iPad
• Faculty as a QI framework/check/filter
1. Technology
2. IPHE
3. Empathy
Resource:
“Don’t Lecture Me: Rethinking the Way College Students Are Taught”
http://americanradioworks.publicradio.org/features/tomorrows-college/lectures/rethinkingteaching.html
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Novel Uses of Educational Technology (Video, ARS, etc.)
Facilitators: Christian Burke (Assistant Director, Technology Enabled Learning); Chandler
Mayfield (Director, Technology Enabled Learning); Michelle Lin, MD
Participants (partial list):
• Chin, Rachel
• Chin-Hong, Peter
• Fernandez, Alicia
• Gelb, Alan
• Lampiris, Harry
• Marmor, Andi
• McCowin, Marcia
• Shinkai, Kanade
• Smoot, Betty
• Teitel, David
• Wolfe, William
Key Discussion Points:
The group focused on issues of education technologies, both at the bedside and in the curriculum.
Currently, downsides of technology include:
• perhaps shifting too much of the learning away from the teacher (as the facilitator), such
as with online lectures
• less face-to-face with patients
• variable faculty proficiency with using technology
Looking at the big picture, technology should be infused into what is already part of the workflow
(eg. electronic medical records) and education process, rather than being in the forefront. It
should help facilitate collaboration and getting faculty out from working in silos.
An example provided was that faculty members are collecting clinical images for their own
teaching records and on their own database platforms. How do we capture the power of the
collective wisdom so that we aren't reinventing the wheel, while also valuing their efforts on the
academic promotions level? Examples of peer-reviewed websites where faculty could submit
educational material include MedEdPortal and MERLOT (Multimedia Educational Resource for
Learning and Online Teaching).
Many questions and issues arose from the discussion:
• What educational components mesh well with technological enhancements and perhaps
"gaming" theories? What components don't?
• How can we harness technology to make our educational work more efficient and
collaborative?
• How can our work on educational technologies also add value to our academic efforts to
get promoted?
• How can we find out what other Academy members are working on so we can share and
leverage our collective work?
• Face Time vs Screen time – how to manage this with students, is there a danger to have
them staring at screens while on clinic or working together?
• Kahn Academy - what is good for this mode?
• Planned curriculum (ahead) vs. live with APeX records
• Tools: use Evernote and Dropbox
• Even with more technology, the faculty needs to be the guide; how to promote this with
technology?
• Telemedicine as a new platform to leverage and build upon
• MERLOT and MedEdPortal – ways to get peer review and share materials (and find
materials to use)
• Socialism – was mentioned several times (need shared resources, platforms)
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