Trust and Remediation: Entrustable Professional Activities and Trust Decisions
Presenter: Bryan Martin
March 16, 12 PM ET

Professionalism is difficult to define, and both professionalism and unprofessional activities are too often described in terms that resemble the old adage: “you will know it when you see it.” Activities that are difficult to define and quantitate are also difficult to remediate, and leave the educator with the difficult and frustrating task of accessing a remedial endpoint for an attribute that is difficult to define. This program will examine the important role of trust in the training of medical professionals. How do we develop, evaluate and remediate trust in the training of medical professionals? The new paradigm in undergraduate medical education assessment: Entrustable Professional Activities (EPAs), has made the incorporation of trust a vital part of medical education. Medical Educators and patients both want the same thing in student health care providers. The patient needs to trust that the team member who is in a learning role is knowledgeable, yet understands the limits of his/her knowledge, is compassionate, can communicate with them in a way they can understand, who will be there when needed; in a word, one they can trust. The preceptor also needs to know the learner has these attributes, and wants a student who is able to ask for, receive and react to, feedback. While it may seem obvious that trust underlies all educational and medical decision making, trust is difficult to access and even more difficult to remediate if it is lacking or lost. There is evidence that physician-learners are poor at accessing their own capabilities, making feedback a critical part of their education, and yet, honest, constructive feedback is both difficult to give and difficult to receive. EPAs may help educators give this feedback by breaking down Entrustable Professional Activities into individual competencies which can be evaluated and discussed. Using a series of case examples this webinar is designed to help the educator develop an emotional intelligence based strategy to help provide better communication and remediate trust based decision making.

For more information and to register for the Spring 2017 Audio Seminar Series, please click here.

In case you missed last week’s Webcast Audio Seminar Series, here’s the highlights of the session:

Cultivating Resilience and Reducing Burnout for Health Professionals: The Power of Presence, Reflective Practice and Appreciative Dialogue
Mick Krasner MD
University of Rochester School of Medicine and Dentistry

Summary:

• The current crisis in the practice of Medicine is influenced by crises of meaning, identity, purpose and role.
• To offset burnout, it is imperative to create capacity as individuals and organizations to build resilience and a sense of accomplishment in work life.
• Resilience is an integrated way of learning, a capacity that can be cultivated and grown. Humans are uniquely designed for this.
• Cultivating resilience involves reimagining how one views stress and how one sees his/her capacity to cope with stress.
• In order to build resources for resilience, one must engage with the environment, acknowledge uncertainty, face difficulties head-on, appraise one’s relationship with stress and develop perspective-taking skills.
• Physician well-being and burnout inform both quality of care and quality of caring.
• Three domains characterize burnout: emotional exhaustion, depersonalization and low personal accomplishment. Negative physical, social and psychological environments influence these domains.
• There is no “one size fits all” for interventions to address burnout. However, the literature provides many examples of different interventions that have had positive effects in the burnout domains. (Kearney, JAMA, 2009, West et al. Lancet, 2016, West et al. JAMA, 2014, Krasner et al. JAMA, 2009, Beckman et al. Academic Medicine, 2013).
• Strategies for addressing burnout and cultivating well-being include: mindfulness, appreciative inquiry and communication and narrative medicine (crafting stories).
• Participation in a mindful communication program yielded positive results. Participants identified three domains for enhancing wellness: establishing a sense of community, skills development and self-care (giving oneself permission to take time for self-development).
• Wellness is not just for the “at risk” and “floundering;” it needs to be integrated into the formal and hidden curricula and prioritized and institutionalized at all levels of education.

Registration for the Spring WAS Series is now open! Click here for more information or to register today.

In case you missed last week’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

The Imperative for Incorporating Mind-Body Medicine in Health Professions Education
Aviad Haramati PhD
Georgetown University School of Medicine

Summary:

• There is abundant evidence in the literature underscoring the prevalence and impact of physician burnout.
• Physician burnout is a serious issue that is preceded by declines in empathy and well-being in medical school.
• Medical schools have a responsibility to prepare graduates for the rigors of the medical profession through curricular interventions that help to manage stress, foster empathy and build resilience. Mind-Body Medicine is one such approach. These interventions need to be fully integrated into the institutional culture.
• Practicing mindfulness can reduce burnout and increase empathy by modulating the physiologic stress response to help individuals “de-stress” and bring their stress hormones back to baseline.
• Mind-Body therapies include the following: Meditation, Imagery, Biofeedback, Self-Hypnosis, Breathing Techniques, Exercise, Yoga/Tai Chi and Group Support.
• Georgetown University instituted a voluntary Mind-Body Medicine program for medical students which utilizes a skills development platform that is designed to cultivate self-awareness, self-care and personal growth. Key components of this Mind-Body Medicine intervention include: fostering engagement by faculty and medical students, non-marginalization of Mind- Body participants, maintenance of confidentiality and group support. Data collected indicate that an increase in mindfulness correlates with a decrease in perceived stress. For further information about this program, contact Dr. Haramati at haramati@georgetown.edu.
• Mindful practice and enhancing self-consciousness, self-care and a sense of meaning in work are elements that need to be actively integrated into the curriculum and culture at academic health centers.
• Burnout is an issue that extends across all health professions. It is an issue that needs to be taken seriously with the understanding that the status quo is not acceptable.

For more information on the final session or to register, please click here.

Registration is now open for the Spring 2017 Audio Seminar Series! Sessions start on Thursday, March 2, 2017.

Remediation in Health Sciences Education

As a follow-up to the IAMSE fall 2016 web seminar series on assessment, the spring 2017 IAMSE web seminar series will continue with exciting, informative sessions focusing on remediation. The goal of remediation is to correct the course of students who have gone astray in their journey to become a health professional. However, because of the varying components in a professional health science curriculum including basic science knowledge, clinical skills, and professionalism coupled with ever changing curricular modifications; effective remediation in health science education has become a complex issue with many challenges. To explore some of these issues, the spring web seminar series will provide a series of presentations by speakers who will share their experiences and expertise in remediation. The fundamental groundwork for the understanding of the importance of successful remediation will be laid and examples of programs who have applied these principles to integrated basic science courses and clinical skills will be provided. A timely presentation on the approaches to remediation of the new paradigm in undergraduate medical education assessment: Entrustable Professional Activities (EPAs) will be included. Licensing exam failures are a major concern in health professions education and one session will be dedicated to a panel presentation of identification of students in jeopardy of not passing and/or remediation of these exams from the perspectives of allopathic (USMLE Step-1), osteopathic (COMLEX), and physician assistant (PANCE) medical programs. The series will also contain a session on the many issues (philosophical, educational, and legal) of “forward-feeding” assessment information on learners to faculty in subsequent courses. The audience will be invited to contribute to the series by sharing their experiences and insights using the phone line or our newly implemented back-channel communication.

March 2 – Remediation of Basic Science in Integrated Blocks – Presented by Giulia Bonaminio and Jeanette Guerrasio

March 9 – Remediation of “High Stakes” Professional Exams – Presented by Aubrey Knight, Nicole Wadsworth, and Pat Kenney-Moore

March 16 – How to Remediate Trust Issues Related to EPAs – Presented by Brian Martin

March 23 – Forward Feeding of Assessment Information: Should We Do It? – Presented by Lynn Cleary

March 30 – Clinical Skills Remediation – Presented by Cate Nicholas and Camilla Curren

Click here to register or for more information on the Spring 2017 Audio Seminar.

In case you missed last week’s Webcast Audio Seminar (WAS) Session, here are the highlights of this session:

Improving Medical Student Mental Health: A Multi-faceted Approach
Stuart Slavin MD, MEd
Saint Louis University (SLU) School of Medicine

Summary:

• Statistical indicators for moderate to severe depression and anxiety rates across the spectrum of physician training (medical students, residents, physicians) are alarmingly high.
• Investing in well-being improves cognitive functioning.
• Rather than mistreatment, medical students are mostly demoralized by working with unhappy residents, unhappy faculty and the subjectivity and perceived unfairness of grading.
• It is imperative to improve the clinical learning environment and enhance the well-being of the residents and faculty who train medical students.
• Making improvements across the clinical learning environment includes a focus on: workload, control, rewards, community, fairness and values.
• The SLU Mental Health Initiative, which began in 2009 sought to develop a new model for mental healthcare for medical students that is not limited to the preclinical years. This model is designed to decrease the unnecessary stressors in the learning environment, create opportunities for students to find and sustain meaning in their work and increase students’ ability to deal with stress.
• Curricular interventions were designed to cultivate mindfulness, metacognition and resilience without a huge investment of time. Key constructs of resilience include: cognitive restructuring (maladaptive perfectionism, imposter syndrome, cognitive distortions) negativity bias, optimistic vs. pessimistic explanatory styles, positive emotions and emotional self-regulation.
• Current data from the SLU Mental Health Initiative indicate reduced levels of depression and anxiety for first and second year medical students.
• Lessons learned: more is not necessarily better and overloading students has a negative impact on their mental health, an emotional reaction can modify the outcome of an adverse event, toxic learning environments override resilience, the origins of mental health are multi-factorial and synergistic; changing one variable is not sufficient.
• For further details about the SLU Mental Health Initiative, contact Dr. Stuart Slavin slavinsj@slu.edu.