master adaptive learners
TRANSCRIPT
Master Adaptive Learners
Lou Edje, MD, MHPE, FAAFPAssociate Dean, Graduate Medical Education
University of Cincinnati Medical CenterDepartment of Family & Community Medicine
Department of Medical Education Professor Educator
University of Michigan Medical SchoolMD 1995, MHPE 2017
Faculty Disclosure
None
The content of this material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices.
Background
• University of Michigan Medical School (UMMS), MD, 1995• Program Director, formerly Dually Accredited Program • Masters Health Professions Education (MHPE), Michigan Medicine, 2017• Family Medicine Review Committee, Accreditation Council for Graduate
Medical Education (ACGME)• Peer Reviewer, Journal of Graduate Medical Education (JGME),• Peer Reviewer, Family Medicine• Former Admissions Executive Committee, UMMS• Past President Michigan Medicine Alumni Society• Associate Dean, Graduate Medical Education, University of Cincinnati
Objectives
• To understand the master adaptive learner conceptual framework
• To be able to articulate the characteristics of a master adaptive learner
• To define adaptive expert• To be able to articulate three applications of master adaptive
learning
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₤1.4 Million
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Adaptation During Rapid Change
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Medical Knowledge
26 seconds
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https://www.weforum.org/agenda/2020/03/speed-science-coronavirus-covid19-research-academic
Sorting Through Speed Science
Fasting labs
Daily glucose monitoring
Annual pap
Manual BP cuff
Ebell MH, Shaughnessy AF, Slawson DC, “Why are we so slow to Adopt Some Evidence-Based Practices?” American Family Physician December, 2018 Vol 98, 12
Slow Uptake of best practices
Adaptation During Rapid Change
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Medical Knowledge
How do you learn that a drug has been recalled?
1. I learn about it when a colleague asks me what I’m using with patients instead.
2. My inbasket will have a message from a patient who is asking to be switched to another med.
3. It’s been recalled? Good to know!4. I receive a push notification from the FDA.5. If I take it myself, my pharmacist will call me.
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What does the literature claim about learning after residency?
“Many clinicians may NOT be learning effectively in practice.”
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Regehr G, Mylopoulos M. Maintaining competence in the field: Learning about practice, through practice, in practice. J ContinEduc Health Prof 2008; 28 1 suppl1):S19-S23Mylopoulos M. Brydges R, Woods NN, Manzone J, Schwartz DL. Preparation of future learning: A missing competency in health professions education? Med Educ. 2016;115-123
Theories on Expertise
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Dreyfus, SE The Five-Stage Model of Adult Skill Acquisition, Bulletin of Science Technology & Society 2004 24: 177
ProficientCompetentAdvanced Beginner
Theories on Expertise
Ericsson (1993)10,000 hours
Ericsson, Psychological Review 1993, Vol. 100. No. 3, 363-406
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Theories on Expertise
Gobet, Chassy (2009)
Intuition
17 Gobet, Chassy Expertise and Intuition: A Tale of Three Theories Minds and Machines 19(2):151-180 · May 2009
Routine expertise
Mastering performance to the level of efficiency and accuracy based on skills and knowledge learned over time.
18 Cutrer WB, et al. Fostering The Development of the Master Adaptive Learner, Acad. Med Vol. 92, Iss 1, Jan, 2017
Adaptive Expert
• Physician who balances routine expertise with innovative problem solving in response to practice challenges
• Explores new concepts• Invents new solutions
19 Cutrer WB, Fostering The Development of the Master Adaptive Learner, Acad. Med Vol. 92, Iss 1, Jan, 2017
• Capacity to learn new information
• Make effective use of resources
• Invent new procedures to support learning and problem solving in practice
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Preparation for Future Learning
Preparation for Future Learning
• Openness to reflecting on practice
• Recognition that routine expertise is not working
• Critical thinking to challenge current assumptions
Goal of Medical Education?
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Develop Adaptive Experts
How do we develop adaptive experts?
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By DevelopingMaster Adaptive Learners
Master Adaptive Learner
PLANNING
LEARNINGADJUSTING
ASSESSING
Master Adaptive Learner
PLANNING
Planning
• Identifying GAPS in knowledge (what?)• Selects an OPPORTUNITY for learning (when?)• Searches for RESOURCES for learning (how?)
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Planning
•Identifying knowledge GAPSchön’s “surprise”Cognitive dissonanceOptimal learning
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Knowledge Gaps
• Aggressively seeks and fills them• Does critical self-reflection• Elicits feedback
Siddiqui ZS, Jonas-Dwyer D, Carr SE, Twelve Tips for Peer Observation of Teaching, Medical Teacher, 29:4,297-30028
Planning
• Selects an OPPORTUNITY for learning
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U = useful R = relevantV = valid (correct)W = work (requires little effort to obtain)
Planning
• Searches for RESOURCES for learning
0
Planning
• Searching • Includes human and material resources• Driven by level of cognitive dissonance• 7-pancake example
Master Adaptive Learner
PLANNING
LEARNING
Learning
• Ineffective learning strategies:Highlighting UnderliningRe-reading
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• More durable learning strategies:Knowledge Retrieval PracticeSpaced Repetitious Learning Concept Interleaving
Knowledge Retrieval Practice
Axillary frecklesNeurofibromas
Café au lait spots Lisch nodules
Mental retardationShort stature
von Recklinghausen Neurofibromatosis (NF1)
RESTATE LIST FROM MEMORY
34 Glen D, Close the Book, Recall, Write It Down. Chronicle of Higher Education, Vol 55, Iss. 34, May 1, 2009, pg A1
Spaced Repetitious learning
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Hermann Ebbinghaus
Single-topic noon conference
Mon COPDTues ABC’s of PFTs Wed Asthma
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vs
Rohrer D, Interleaving helps students distinguish among similar concepts Educational Psychology Review, 24, 35-367
Concept Interleaving
Master Adaptive Learner
PLANNING
LEARNING
ASSESSING
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INFORMED SELF-ASSESSMENT
Assessing
https://www.ncbi.nlm.nih.gov/pubmed/20375832
Tries out what was learned
“No matter how well-trained people are, few can sustain their best performance on their own. That’s where coaching comes in.”
Atul Gawande
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https://www.newyorker.com/magazine/2011/10/03/personal-bestSiddiqui ZS, Jonas-Dwyer D, Carr SE, Twelve Tips for Peer Observation of Teaching, Medical Teacher, 29:4,297-300
Assessing
Master Adaptive Learner
PLANNING
LEARNINGADJUSTING
ASSESSING
•Incorporates what was learned into practice
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Adjusting
Master Adaptive Learner
PLANNING
LEARNINGADJUSTING
ASSESSING
MAL Characteristics
Curiosity
Motivation
Mindset
Resilience
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MAL Learning Environment
Embraces Vulnerability
Values Feedback
Fosters Growth Mindset
Nurtures New Ideas
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Growth Mindset
A “growth mindset,” thrives on challenge and sees failure not as evidence of unintelligence but as a heartening springboard for growth and for stretching our existing abilities.
Growth Mindset
https://profiles.stanford.edu/carol-dweck
Application #1
Re-Envisionsing Family Medicine Education
ABFM Diplomate Survey Supports Need for MAL
• >70% late career ABFM diplomates have worked in >3 practices
• >50% late career diplomates have changed populations they care for
• >50% of late career diplomates identify need for new emphasis in:
• Telehealth• Integrated behavioral health• Leadership in communities and health care systems• Social Determinants of Health/Disparities
Application #2
Curricular Review Working Toward Equity
MHPEMHPE Summer Retreat 2020
Lou Edje, MD, MHPE, FAAFPMHPE Faculty, Alumna: MD 1995, MHPE 2017Associate Dean, Graduate Medical Education
Professor-Educator, University of Cincinnati Medical CenterDepartment of Medical Education
Department of Family & Community Medicine
John Vasquez, PhD, MHSAMHPE Faculty
Director of Assessment & Professional Development Van Andel Institute Graduate School
Working Toward Equity in Medical Education
MHPE
To become familiar with definitions used in discussions of equity and race
To able to define growth mindset and understand its usefulness as a platform for courageous conversations
To engage in robust, case-based discussion around potential curricular pitfalls and learner interactions
Objectives
MHPE
As it relates to implicit bias and systemic racism, our GAPs as educators are not just Schoen surprises
…they can harm our learners
MHPE
Pluripotentiality
Wellbeing
MHPE
First, do no harm
MHPE
Pluripotentiality
Truncate fund of knowledge
MHPE
https://www.nejm.org/doi/full/10.1056/NEJMp1915891
First, do no harm
MHPE
Definitions
MHPE
Growth Mindset
& Race
MHPEFacilitatorNote-taker
Breakout Room
MHPEYou are giving a lecture on sexually transmitted
infections using the following case:
A 45 year old Black female presents with a yellow vaginal discharge four days after unprotected intimate contact with a complete stranger. She complains of a low grade fever and some pelvic pain as well as dysuria.
1) What could a Black female learner be thinking during this scenario?
2) How could you improve this scenario?
Case
MHPE
At Your Home Institution
What signals have you picked up that under-represented trainees in your department or discipline may have similar experiences as those in the case?
How has your department or program formally gathered information about the experiences of URM trainees?
Have you undertaken comprehensive review of your curriculum through the lens of URM trainees?
MHPE
At Your Home Institution
How are you centering the voices of and protecting against undue emotional labor by under-represented colleagues and trainees in this process?
What peer support initiatives are in place for trainees in your program, department, division?
Go Blue!
MHPE
Resources
PLANNING
LEARNINGADJUSTINGMaster
Adaptive Learner
ASSESSING
Application #3
Twitter as a adaptive resource
Applications
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@ = handle = @ddress
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# = hashtag • Community of
individuals having a discussion
• Looks like a net• Click on it to follow
discussion• Engage by including
hashtag in your tweet
Applications
Applications
• Passive: just follow, receive alerts• May plug into someone’s handle and
see who they are following
• Active: post, join discussions, “live tweet”
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Who’s in the Twitterverse?
Medical Journals
Medical Institutions
Medical Schools
Medical Organizations
Medical Learners
ColleaguesPatients
Influencers
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Who’s in the Twitterverse?
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Who’s in the Twitterverse?
Patients
Influencers
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Summary
Master Adaptive Learner: Plan, Learn, Assess, Adjust (PLA)
Adaptive Expert: Routine expertise + innovative problem solving in response to practice challenges
Possible Applications for the MAL conceptRe-Envisioning Family Medicine Residency EducationWorking Toward Equity in Medical EducationTwitter a an adaptive resource
