PELC - Educational Scholarship: Expanding Beyond Curriculum Development

Name: PELC - Educational Scholarship: Expanding Beyond Curriculum Development
Uploaded: 2025-04-10T16:23:33.2566667Z
Duration: 1 h 6 min 23 s
Description: April 7, 2025 Speakers: Melissa Langhan and Donna Windish

April 10, 2025

April 7, 2025

Speakers: Melissa Langhan and Donna Windish

Information

ID: 13029
To Cite: DCA Citation Guide

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00:04Hello.
00:07Oh, hi. Let me here
00:08we go.
00:10So really quick, I couldn't
00:12change the series
00:13because it said
00:15series cannot be changed due
00:18to message changing or something
00:20like that. And I kept
00:21trying, and it wouldn't let
00:21me. So I just went
00:22all the way through to
00:23January
00:24moving the ones that needed
00:26to be moved. So it's
00:27pretty much Oh, you're talking
00:28about hours,
00:30hour meetings. Yeah. Yeah. Yeah.
00:31You know, I saw that.
00:32And I I was like,
00:33oh, it must have not
00:34been a series Yeah. Because
00:35I got a bunch of
00:36them. But that's totally fine.
00:37It was a I I
00:38think some of them were
00:39a series and some weren't,
00:41and I think that's why
00:42it wasn't letting me just
00:43batch them.
00:45Right. Plus, like, these upcoming
00:47weeks, it wouldn't have worked
00:48because
00:49she has stuff anymore. Different
00:50times. Yeah. Yeah. That's totally
00:52fine. As long as we
00:53that's good. You looked ahead
00:55and Yeah. I just did
00:57it all the way to
00:57January because I was like,
00:59whatever. It's the same. So
01:00it's basically every other week.
01:01It's a Wednesday or a
01:02Thursday.
01:04Okay.
01:04Sounds good. Whatever works for
01:06her. Yeah. Okay. Hopefully,
01:09because we're only four minutes
01:10out. I know. I'm con
01:12I'm like, where is everybody?
01:15Did you confirm via email
01:16with Melissa? Or Yeah. I
01:17talked to her this morning
01:18because Okay. Because
01:20the Zoom link was different.
01:22Yeah. And she actually caught
01:23it, and then I
01:25was like, oh,
01:26just follow the one on
01:28the,
01:29education calendar.
01:31But the one on Beatrix,
01:32the education calendar,
01:34everything is the same, so
01:35people should be coming on.
01:37Okay. Sounds good.
01:39I hope.
01:40It always makes me so
01:41worried.
01:42I know. Let me,
01:43I'm just gonna text her
01:45just to make sure.
01:51Oh, there's Panina.
01:53Oh, there's Melissa. Hi. Good.
01:55Hello.
01:57Hi, guys. How are you?
01:59Melissa, did you wanna introduce,
02:01Donna, or do you want
02:02me to?
02:04Whatever works, Peniela. We kind
02:06of self introduced in the
02:07beginning of this too,
02:09so
02:10easy enough.
02:12Sorry. What did you say?
02:13For some reason, I I'm
02:14not wearing my earphones. Oh.
02:16What did you just say?
02:17We kind of self introduce
02:19ourselves in the beginning of
02:20this too. So
02:22That's great. And I kinda
02:23feel like Melissa is,
02:26it's
02:27you're equal in this thing.
02:30It's not like I feel
02:31like I need to introduce
02:33you, but I'm happy to
02:35introduce you too.
02:37Think pretty much people should
02:38know who I am.
02:43How are everybody?
02:45Good. How are you? Stephanie.
02:47Hi. This might be the
02:48first time I'm seeing your
02:49face. Oh my gosh. Yeah.
02:51How are you? I'm good.
02:53How are you?
02:54You look like you were
02:56closed in with, like,
02:58curtains. Oh, I know. Because
03:00it's too bright behind me.
03:01Oh. It, like, washes me
03:03out.
03:04I'm just gonna make sure
03:05my sharing is okay. So
03:20Alright.
03:21Perfect.
03:22Looks good.
03:26You know what? I'm gonna
03:27introduce
03:28because I'm all like
03:29I'll I'll make, like, a
03:31one minute introduction.
03:32That's good. It's fine.
03:48Stephanie,
03:49any chance of graduate
03:51grabbing
03:53Sage?
03:54She's
03:56sound asleep.
03:58Alright. Amazing.
04:01Yep. She was on a
04:02meeting earlier, though Yes. She
04:04was. Had, and she was
04:06precious.
04:07She's so cute.
04:09Yeah.
04:11Hey, everyone. Hey, Donna. How
04:13are you? A long time
04:15no say.
04:16I know.
04:17How are you doing? What's
04:18what's hanging out in the
04:19pediatric world?
04:22Which is awesome.
04:24Which is awesome. Awesome.
04:27Speaking of awesome, I have
04:29a pediatric issue. And if
04:30I get a phone call,
04:31Melissa, can you cover for
04:32me? Of course. Yeah.
04:36Long story, which you guys
04:37don't have two hours for.
04:38But yeah. Oh, gosh.
04:42Everything okay, though?
04:44I've had better days. Let's
04:46put it that way.
04:49Hold on. If there's anything
04:50that any of us can
04:51do, you're gonna have, certainly,
04:53like, reach out to us.
04:55I know. I have Veronica
04:56Manesis
04:57on my side, which has
04:58been great. So
05:01Great. Awesome.
05:03That's good. So what tell
05:04me about this group.
05:06Oh, this group,
05:08in terms of pediatric education
05:10learning community? Yeah.
05:12Oh, so we have been
05:14meeting for maybe
05:16three
05:17years or so. Three, four
05:19years. I'm trying to think
05:20about how long we started
05:21it. Oh, probably longer.
05:23Four or five years.
05:26And it's basically a monthly
05:27meeting, and we cover all
05:29sorts of
05:30educational
05:31topics from
05:33curriculum
05:35to systems issues,
05:39to educational
05:40scholarship,
05:41teaching skills.
05:43Sometimes we have outside speakers
05:46and, yeah. And then those
05:48who attend are,
05:50you know, somehow usually affiliated
05:53with Yale or sometimes Janet
05:55will have some of her
05:56students,
05:57attend, which is always lovely.
06:00Hey, Janet. Speaking of which
06:03Hi.
06:04I just had to come
06:05here. And what Donna and
06:06Melissa,
06:07they did something for us
06:09recently and got, like, off
06:11the chart amazing
06:12feedback. So thank you for
06:14them doing it again for
06:15us. That's way too much
06:16higher expectations.
06:17I know. And we gotta
06:18lower the bar. Yeah.
06:22Well, rumor of their excellence
06:24preceded them and so scurfed
06:26them up for this.
06:28But anyway, in Sudan, we
06:29have anywhere between,
06:32you know, I would say,
06:34six, seven of us to,
06:37you know,
06:38ten,
06:41twelve, fifteen. So it's usually
06:43in a fairly intimate group.
06:46Yeah. Which allows the opportunity
06:48just for
06:50some discussion.
06:52Great. Usually people come on
06:54somewhere like, you know, twelve
06:56zero five, twelve ten.
06:59So we'll kind of go
07:01from there.
07:02So
07:04yeah, but,
07:05super happy to have you
07:06guys doing, this. Melissa's a
07:09regular.
07:10So she's very often either
07:12leading one of these sessions
07:14or,
07:14attending.
07:16And I don't know if
07:17you know Donna.
07:19So Karina is
07:21our associate director
07:23of,
07:24the office of education,
07:27and Stephanie
07:28is our program coordinator who
07:30runs grand rounds and also,
07:33you know,
07:34supports pediatric education learning community.
07:39Great. I know, Dan, and
07:40I I've got my lunch
07:41kind of sitting here, so
07:42I'll be popping grapes and,
07:45eating. And, Brian, it's a
07:47pleasure to have you here.
07:49Brian is one of our
07:50new,
07:52section chiefs in endocrinology.
07:54So super happy to have
07:56you here. Thanks for including
07:58me.
07:59Appreciate it.
08:00Great.
08:02Yeah. And I'm not sure
08:03who,
08:05Akita is. Just double checking.
08:07But it's totally cute. I
08:09love the eyes.
08:10Yeah. And it's nice to
08:11see with the ear match.
08:13I like that.
08:17Great.
08:18I'll just wait about another
08:19minute and then I'll do
08:21like the briefest of introductions
08:23because I know that, you
08:24both are going to kind
08:26of talk more,
08:27during the sessions. So
08:30awesome.
08:37Oh, Margaret.
08:41Nice to see you or
08:42at least a a, avatar
08:44of you.
08:46That's cool. I wanna know
08:47how to do that.
08:51Great. Well, let me, I'm
08:53just gonna go ahead and
08:54get just, you know, as
08:55a just a,
08:58what do I say? North
08:59star.
09:01So
09:02welcome. I know we get
09:04joined kind of in the
09:05next ten minutes by,
09:07you know, by, some of
09:09our other colleagues.
09:11But it's really my pleasure
09:13to have,
09:14Melissa, who, as you all
09:16know, is really a staple
09:17of our,
09:20pediatric
09:21education
09:23community.
09:24Melissa
09:25has really kind of distinguished
09:27herself, as I would say,
09:29the go to individual in
09:31our department
09:32in terms of,
09:34research and scholarship and really,
09:37develop the medical education research
09:39collaborative,
09:40which provides
09:42mentoring,
09:43consultation,
09:44and grants,
09:45to individuals
09:47in our department.
09:49And
09:51she's joined today by Donna
09:52Windisch, who
09:54I don't wanna say is
09:55the counterpart in internal medicine,
09:58but that's kind of the
09:59way that I think about
10:00it. You know, I met
10:02Donna
10:03years ago,
10:05in the kind of in
10:07the medical education
10:08fellowship. She was
10:10extremely
10:11passionate
10:12about educational research and educational
10:15scholarship,
10:17and really has kind of
10:19become, I think, integral in
10:21the medical school
10:22in terms of supporting
10:24educational
10:25scholarship.
10:27She is now let me
10:29see your official title, the
10:31associate chair of educational
10:33scholarship in the department of
10:35internal medicine
10:36and the director of the
10:38educational
10:39scholar fellowship.
10:40Many of our faculty had
10:42previously gone through the medical
10:43education fellowship,
10:46which,
10:47you know, was very happy
10:49now to have Donna really
10:51transform and be involved with.
10:53So I'll let you guys
10:54introduce yourselves further, but, again,
10:57thanks
10:58so much for doing this
10:59session. Our slides started, and
11:01I definitely have appreciated,
11:04getting to know and working
11:05with Donna as we've taken
11:07this this show on the
11:08road for a couple groups
11:09so far. It's been really
11:11nice.
11:12And we'll talk about ourselves,
11:14but and I'll also say,
11:15you know, this is a
11:16small group. As we get
11:17into this, you'll see it's
11:18meant to be very interactive.
11:20We're gonna talk about,
11:22different types of study design,
11:24but, also, like, we'll bring
11:25up examples. If you have
11:28ideas and questions or, like,
11:30things that you wanna talk
11:31about with your own studies,
11:32we're happy to, like, do
11:34that in this group too.
11:35There's not that many of
11:36us. So please feel free
11:38to interrupt, but we really
11:39are gonna rely on you
11:40to drive some of this
11:41session.
11:43And so thanks, Penina, for
11:45the welcome.
11:46You guys know me. I'm
11:47in PEM. I love med
11:49ed research.
11:50I've been looking at trainee
11:52assessment,
11:53and things around bias and
11:54recruitment, and my big hot
11:56topic now is remediation.
11:58And, Donnie, you wanna fill
11:59in that? Yeah. I'm so
12:01glad someone does remediation, not
12:02my not my company.
12:05Yeah. I mean, I've been
12:06in medical education scholarship for
12:09twenty five years now. I
12:11love survey research and curriculum
12:13development, and it's it's fun
12:15to mentor
12:17people across, you know, all
12:18departments now.
12:20So this is good. And
12:22and as Melissa said, this
12:23is not for us. It's
12:25for you guys. And some
12:26of you might this might
12:27be, like,
12:28you know, too
12:30adolescent. I don't know. But
12:32we're we want you guys
12:33to help direct the session.
12:36Yeah.
12:37And so for our objectives
12:39today,
12:40we hope that by the
12:41end of this, you'll be
12:42able to identify at least
12:44three types of study design
12:46that can be used in
12:47med ed scholarship,
12:49name various forms that one
12:50type of study design can
12:52take,
12:53and talk about outcomes used
12:54in med ed scholarship.
12:56And with that, we'll present
12:58you with our jeopardy board.
13:00And you can see we
13:00have different kind of topics
13:02on the top,
13:03qualitative
13:04stuff, instruments and interventions,
13:06quantitative studies, and potpourri.
13:08And each of the purple
13:10boxes is essentially a different
13:11type of study design.
13:13And we'll go through a
13:14little bit what that is
13:15and give you an example
13:16of a med ed study
13:18that's been published,
13:20in this area. And you'll
13:21see a lot of people
13:22throughout Yale as authors on
13:23these studies. So we try
13:24to use a lot of
13:25institutional research,
13:27to show you what people
13:28are doing as well.
13:29But this is where, like,
13:30we put you in the
13:31driver's seat. So if you
13:32wanna pop off mute for
13:34a second or put something
13:35in the chat about what
13:36you wanna hear about, we'll
13:38kind of go through,
13:39the topics based on your
13:41interests.
13:43And you'll notice there's nothing
13:45about curriculum development up here
13:46because I think everyone knows
13:48curriculum or at least that
13:50that can be scholarly. We
13:51try to look at things
13:52that
13:53or anything but that.
13:59I'll start us off with
14:00mixed methods for
14:02two hundred.
14:05Awesome.
14:06Yeah. So mixed method studies
14:08are great. In meta, they
14:09combine both the quantitative and
14:11qualitative research approaches
14:14to really provide a more
14:15comprehensive
14:16understanding
14:17of educational phenomenon.
14:19And so by integrating both
14:20numerical data that you can
14:21get from, like, surveys and
14:23assessments
14:24with that kind of rich
14:25descriptive insight from interviews and
14:27observations,
14:28mixed methods can really offer
14:30a deeper and more holistic
14:32perspective.
14:34And the example here is
14:35from Rachel Johnson in the
14:36PICU. I mean, so she
14:37did this great mixed method
14:39study,
14:40which was looking at the
14:41medical student experience in the
14:42PICU.
14:43And this just got published
14:44recently. So go and look
14:45it up if you want
14:46a lot more details. But
14:48this study aimed to describe
14:50perceptions of pediatric interns
14:52about their PICU rotations during
14:54medical
14:55school and to see whether
14:56PICU rotations
14:57could better prepare medical students,
14:59like, for the core EPAs
15:01that the AMC is setting
15:02out.
15:03And in terms of the
15:04mixed methods, so Rachel did
15:06a survey of our interns,
15:08our pediatric interns.
15:10She asked them to list
15:11all their pediatric rotations,
15:14in medical school and then
15:15asked them for each of
15:16those rotations
15:18to rate how well
15:19they thought they prepared them
15:20for each of those EPAs
15:22on a four point scale.
15:23She looked at responses for
15:24both PICU rotation to the
15:26non PICU rotations.
15:27And then the, you know,
15:29qualitative part, she had this
15:30free text part where she
15:31was asking about
15:33perceptions of their medical school
15:34rotations, and those were coded
15:36and themes were developed.
15:39And so she got seventy
15:40one percent of the interns
15:41to participate, so that was
15:42great. There was, you know,
15:44over two hundred rotations that
15:45were involved.
15:46Not that many of them
15:47were PICU rotations.
15:49But what she found was
15:50that PICU rotations prepared participants
15:52better for eight of the
15:54thirteen core EPAs better than
15:56the non PICU rotations. So
15:57for differentials,
15:59tests, presentations,
16:00handovers, and professionalism recognizing sick
16:03and informed consent.
16:04And a lot of people
16:05would recommend a PICU rotation
16:07to a medical student. So
16:09that was the good part.
16:10How the qualitative part fit
16:12in is, like, you think
16:13this is awesome. Maybe, like,
16:14everyone should do a PICU
16:15rotation,
16:16But PICU rotations,
16:18even though they're perceived to
16:19prepare students better, they can
16:21be challenging and intimidating learning
16:24environments where students feel marginalized.
16:26And so we certainly don't
16:27wanna put all students into
16:29a rotation that can be
16:30intimidating where they feel marginalized.
16:32So if you took all
16:33this information together,
16:35you'd really have to think
16:36about that learning environment and
16:38how to get the benefits
16:40out of it, but maybe
16:41modify it so that people
16:42felt
16:43students in particular felt better
16:44while they were there. So
16:46this was a great example
16:47of how you can kind
16:48of use both of those
16:49and get a better picture
16:51if versus if you had
16:52only one part or the
16:53other. Hopefully, that makes some
16:55sense there.
16:58What's next, friends?
17:02Put it in the chat.
17:03Otherwise, it's like I like
17:05playing this game.
17:12How about implementation?
17:14Yeah. You're picking all my
17:15favorites, Benita. This is always
17:17happens. Melissa's always good. Well,
17:19you'll get your turn. I'm
17:21sure, Donna.
17:22So,
17:23implementation science and med ed
17:24scholarship
17:25focuses on studying methods to
17:27promote that systematic uptake of
17:30evidence based educational interventions into
17:32practice. So it aims to
17:33bridge the gap between research
17:35findings and the real world
17:37application to improve
17:38on teaching and learning and
17:40outcomes. So, right, we create
17:41something, and then we actually
17:42have to adopt it and
17:44use it. So thinking about
17:45what are the resources we
17:46need to do that, what
17:48are barriers and facilitators that
17:49we need for that, and
17:51think about, like, all the
17:52new tools. Right? AI is
17:53the hot one now. We
17:55heard a lot of talk
17:56at the APBD meeting, but
17:57we've done this with simulation,
17:59with different assessment methods, milestones,
18:01EPAs. You name it, we've
18:02had to think about how
18:03to implement them, and then
18:05how those tools are adapted
18:06for different environments.
18:08So this example,
18:12has Penida on it and
18:13myself.
18:14See? I told you. It's
18:15all local people. So here
18:17we were exploring factors for
18:18implementation of EPAs
18:20in pediatric subspecialty fellowships,
18:22and we wanted to understand
18:24those fellowship director perspectives
18:26about facilitators and barriers to
18:28using EPAs in, fellowship training.
18:32So this was a qualitative
18:33study. We were talking to
18:35fellowship program directors through one
18:37on one interviews,
18:38and we wanted to know,
18:40like, people who did and
18:41didn't use them, what supported
18:43or prevented their use. So
18:45really talking about getting it
18:46on the ground and using
18:47it. Then those interviews were
18:49coded and transcribed, and we
18:50went through the thematic analysis.
18:54And we looked at eleven
18:55pediatrics of specialties. We interviewed
18:57twenty eight, fellowship program directors,
19:00half of whom were using
19:01EPAs, and the other group
19:02wasn't.
19:03We had five major themes.
19:05One was that, you know,
19:06facilitators
19:07included that EPs were intuitive,
19:09and they had simple wording,
19:10so they were easy to
19:11use.
19:12But barriers like workload burden
19:14and a lack of regulatory
19:16requirements, like, no program director
19:18wants to do more than
19:19they have to. We have
19:19enough on our plates.
19:21There was also variable knowledge
19:22and training around EPAs, so
19:24people had different levels of
19:25understanding.
19:27Current use was limited
19:28even for people that were
19:30using it, depends on how
19:31they were using it. And
19:33the EPAs and milestones were
19:34kind of complimentary. So that's
19:35what came out of this.
19:37So those themes can inform,
19:40implementation strategies. How are we
19:41gonna get fellowship programs to
19:43use this? So we have
19:44to support and educate them.
19:46We have to think about
19:47the ongoing assessment, that value
19:49in EPAs, and how to
19:50integrate it into the workflow
19:52to reduce some of that
19:53workload burden. So, hopefully,
19:55like, the stakeholders and people
19:57that are gonna make us
19:58use EPAs, right, ABP,
20:00maybe ECGME,
20:02will think about this and
20:03provide the supports to ease
20:05the implementation
20:06process when this rolls out
20:07for everyone in the future.
20:11Alright.
20:13Melissa, can I ask a
20:14question?
20:15Of course, Jessi. What's up?
20:17And I'm gonna tag, Clara
20:19Lampy, who's one of our
20:20hospitalists,
20:21here,
20:23who,
20:24we've been talking about,
20:25some work that she did
20:27prior to
20:28coming at Yale, and she's
20:30gonna unmute and explain it
20:31better than than me. But
20:32we were wondering if what
20:33you talked about with mixed
20:34methods was a fit here.
20:36Yeah. It was basically around,
20:38MOC
20:40where she created kind of
20:41a curriculum
20:42to help faculty
20:44document better,
20:45use epic better, clean up
20:47their in baskets, and so
20:49so there was modules
20:50that she got
20:52satisfaction
20:53and then
20:55some free text responses.
20:57Mhmm.
20:58And we had been talking
21:00about how to how can
21:01we, help her to turn
21:02this into scholarship.
21:04Oh, I love that.
21:05Clara, do you wanna add
21:06anything? I don't know if
21:07I summarized that correctly.
21:09Sure. Thanks, Jaspreet. And, gosh,
21:11thanks everyone for,
21:13being willing to hear about
21:14my project. I
21:16I started this, where I
21:17completed
21:18the
21:19implementation part over at the
21:21University of Washington and Seattle
21:22Children's.
21:23And we,
21:25over there in particular, their,
21:27providers
21:28had a lot of frustration
21:29and, like, survey dissatisfaction
21:32with Epic.
21:34And there that was probably
21:34multifactorial
21:35about how it was implemented
21:37in COVID and other things.
21:39But the the end result
21:40was providers were quite unsatisfied
21:42with with Epic, and particularly
21:44Seattle Children's is a freestanding
21:45children's hospital. So we were
21:46using
21:47the children's contacts, and I'm
21:49a hospitalist. So I focused
21:50on the inpatient,
21:51domains because a lot of
21:53different
21:54epic tracking and the training
21:56is done in outpatient
21:57systems and talks about, like,
21:59you know, closing your charts
22:00on the same day or
22:02being done within an hour
22:03of the end of your
22:03clinic day, but that's really
22:04a lot more difficult to
22:05do when your patients are
22:06there for multiple or quantify
22:08when your patients are there
22:09for multiple days because you
22:10might be on call at
22:11night.
22:12And so what we did
22:13was a series of four
22:15sessions that we received approval
22:16to grant MOC credit,
22:19for these four sessions that
22:20were,
22:21physician and trainer partner led.
22:23So they were in person
22:24at the elbow support.
22:26And they had a rough,
22:27you know, like, agenda or
22:28curriculum
22:32live environment so people could
22:33make these changes,
22:35to EPIC,
22:36their production environment,
22:38and essentially leave class with
22:39their new
22:41changes ready for them to
22:42go with the next patient
22:43they saw. Yeah. So we
22:45surveyed people as MLC does
22:47at each kinda in before
22:48and then after each of
22:49the classes and on a
22:51scale
22:51and
22:53got that feedback. And then
22:54we got a little bit
22:55of
22:57free text feedback then.
22:59And then for the, MOC
23:01attestation
23:02part at the end of
23:03the the sessions,
23:05the MOC committee at Seattle
23:07Children's sent them, what was
23:09largely a qualitative,
23:11you know, like, all free
23:12text questionnaires.
23:14And so then we got
23:15all of the information from
23:16that, which I didn't really
23:17realize we were,
23:20since I I'm not the
23:21one who, like, sent that
23:22email, the MOC committee did.
23:23I didn't realize how much
23:24qualitative
23:25information we were gonna get
23:26back from that, but it
23:27was really encouraging and helpful,
23:30you know, as was along
23:31the way. But,
23:33now we're trying to figure
23:34out, you know, this is
23:35at least this cycle is
23:36done. They may do this
23:38again next year.
23:39But we we kinda have
23:40our
23:41our information,
23:43and I think it will
23:44be useful locally for them
23:46to,
23:47promote repeating this. Yeah. But
23:49we were trying to figure
23:50out, Jaspreet was, helping me
23:53try and figure out if
23:54there's ways that we could
23:54also turn this into some
23:56scholarship beyond the institution.
23:58Yeah. Well, a hundred percent.
24:00And I'll I'll give you
24:01some of my thoughts, and
24:02then I'll have Donna jump
24:03in too. I think, like,
24:05you already have so much
24:06data.
24:07And as I talk about
24:08in some of these, like,
24:09I I love doing things
24:11with data that's already there.
24:13So, like, if you have
24:14all these responses, whether you
24:15can go back and get
24:16some IRB approval and even
24:18think are there epic measurements
24:20you can make
24:21around, you know, some of
24:23these measures to to also
24:25document improvement?
24:26But I think that is
24:27great because and think about,
24:28like, MedEd portal. Right? Right
24:30there, you've already created something
24:32to put out there, and
24:33you have some of these
24:34satisfaction free text. You have
24:36outcomes.
24:37So that seems like an
24:38easy win right there using
24:39all the data you
24:40have. And I would also
24:41think about, like, as we
24:42talk about implementation, right, moving
24:44it to now a different
24:45setting. Now you're here at
24:46Yale.
24:47Like, looking at those same
24:48modules,
24:50are they gonna be,
24:52like, in that same needs
24:53pile? Like, are these things
24:55that would be helpful to
24:56a different group of physicians
24:57in a different setting and
24:59getting some information about that
25:01or how they would need
25:01to be potentially modified?
25:03I mean, I'm certainly in
25:04the same boat in the
25:05ED. Like, everything epic, I'm
25:07always like, make sure the
25:08fellows get the right training.
25:09We don't need this, like,
25:10outpatient stuff. So it is
25:12really interesting to think about
25:13that setting piece.
25:15And even if you work
25:16with other groups here, like,
25:18would they it'd be helpful
25:19for ED physicians or other,
25:21you know, the ICU physicians
25:23or the outpatient team. Like,
25:24what do they need?
25:26So I think Yeah. Epic
25:27have an an accelerando project.
25:28I don't do outpatient, so
25:29I don't know as much
25:30about it, but they definitely
25:31have some projects for outpatients.
25:32What we thought was unique
25:34about this was that it's
25:35inpatient, and that you didn't
25:37get CME credit, but you
25:38got MOC credit, which we
25:40couldn't find a lot that
25:42that did. And then,
25:43you're absolutely right. We hope
25:45that, you know,
25:46like, if I had been
25:47there longer that eventually we
25:48could have expanded this to
25:49other domains. We take inpatient
25:51first because that's what I
25:52know the most about.
25:54And we knew we were
25:55gonna have to narrow our
25:56scope for only fours. And
25:57even with four sessions, we,
25:59you know, had to narrow
26:00our scope a little bit.
26:02And we just couldn't handle
26:03the ED or the ORs
26:05or anything like that in
26:06this particular
26:07one. But,
26:08but it does beg the
26:09question, right, whether
26:11that would be
26:12be helpful for individuals. And
26:14then we focused
26:15for this one, we focused
26:17just on, like, fellow we
26:19didn't have any fellows, but
26:20we we invited them. And
26:22then for our attendings and
26:23APPs,
26:26and so,
26:30because we had to start
26:31somewhere, one. And two, we,
26:33were offering MOC credit. And
26:35then, I think, three, we
26:36felt like the people that
26:37felt like
26:39the most
26:41unsure how to do these
26:42things or unsure how to
26:43find help for were the
26:44nonresidents. The residents are pretty
26:46resilient about figuring it out,
26:47and
26:49awesome. And some of these
26:50providers are inpatient, but don't
26:52do so that's why we
26:53focused it with, you know,
26:54the hope that we could
26:55eventually
26:57roll it out
26:59longer or, like, once the
27:00interns start, do you do
27:01something six months in once
27:02they have their basic workflow
27:03and their basic epic and
27:04kinda give them a level
27:05up? Like, here's how to
27:07do these things. But,
27:09yeah, anyway, it was interesting.
27:11Like, one of the big
27:12sessions was on documentation, and
27:14we didn't make, you know,
27:15smart phrases or smart text
27:17during that session.
27:19We talked about a lot,
27:20though, about what they are
27:21and demoed them and
27:22and helped people understand why
27:24you might want a smart
27:25text,
27:26and not a smart phrase.
27:27And, with the idea that
27:29if your division kinda creates
27:31those,
27:33they can trickle down to
27:34your learners, right, and help
27:35make sure that you're meeting
27:36compliance and billing and data
27:38mining,
27:39speaking of research, and all
27:41of these different things. But
27:42you have to, you know,
27:43think a little prospectively and
27:45understand what they do.
27:47And so that was actually,
27:47I think, one of the
27:48ones that was really,
27:50challenging because it wasn't as
27:52hands on as the other
27:53ones where you were, you
27:54know, savor putting your favorites
27:55in and, like, changing your
27:57track board Yeah. But actually
27:58have, like, long term,
28:00things. So, anyway, I, you
28:02know, wanna when you present
28:03all of this, but I
28:04would love,
28:06love some thoughts or I'm
28:08happy to meet would love
28:09to meet and share with
28:10you the data that we
28:11have.
28:13And my mentors at University
28:15of Washington are aware that
28:16we're working on this and
28:17are happy to support,
28:19and partner, but I have
28:20personally never published anything Oh,
28:22gosh. Ever. I'm very much
28:23a clinician.
28:25I'm looking at this from
28:26Epic from, like, a functionality
28:27standpoint. I'm like, this cannot
28:29be this hard. Like,
28:31there has to be this.
28:33You know, you could also
28:34consider this as a QI
28:36project where you don't need
28:38IRB.
28:39It's it's really hard to
28:40get retrospective
28:41IRB approval.
28:44But if you go
28:46prospectively and bring it here,
28:48you could talk with the
28:49IRB about whether this is
28:51QI or not. Mhmm.
28:53Even if you're gonna do,
28:54like,
28:56Epic mining,
28:57a lot of that is,
28:58like, de identified.
28:59Right? So there's no really
29:00like, I'm not looking into
29:01patient x. I'm just looking
29:02at how a provider did
29:04y. Yes. And so we
29:05are following that. There's an
29:07application in Epic EPIC called
29:08signal that,
29:09runs in the background and
29:13is used a lot in
29:14outpatient. Again, like, it can
29:15tell, like, what hours a
29:16clinician is in EPIC, which
29:17is great if you have
29:18a clinic during the day.
29:20It's not so great if
29:21it doesn't it doesn't sync
29:23with QGenda to know if
29:24you're,
29:25you know, on an overnight
29:26ED shift, and therefore, you're
29:28in epic at midnight, not
29:29because you're still finishing charts
29:30from five PM. And so
29:32they have a couple other
29:33metrics. So we're
29:36hoping that we can see
29:37if this validates or correlates
29:40with what Epic thinks they
29:41can track for inpatient, like,
29:42if there was the enthusiasm
29:44or the pain points
29:45that our learners identified. So
29:47that's, like, level two because
29:48we're collecting that now for
29:49a couple months.
29:51Kinda correlates with what what
29:52Epic,
29:55hopes or thinks they can
29:56can collect.
29:58But, yeah, because it's MOC
29:59and MOC is QI, that's
30:01Jess and I had talked
30:02a little bit about whether
30:03it would be more of
30:04a QI
30:05for this one or even
30:07if but, again, how and
30:08it's both education. It's kind
30:10of a funny bucket.
30:11Well, maybe we can just
30:12say talk to the
30:15I'm sorry.
30:16No. I was gonna have
30:17you go over the QI
30:18one, Donna, next, and this
30:19will kind of compare.
30:21So I'll open that one
30:22for you.
30:23Let's see. Yeah. I mean,
30:25I I think this is
30:25just a great example of
30:27you know, it doesn't have
30:29to be a curriculum or
30:30not a curriculum, but it
30:31could be some little PDSA
30:33cycle. Right? So an educational
30:35intervention is the main component,
30:37which is what you kinda
30:38described.
30:38And then you wanna measure
30:40change and outcomes over time.
30:42There's all kinds of ways
30:43to measure that. Sounds like
30:44you have some good data.
30:45The MOC thing is awesome.
30:47You know, before and after
30:48surveys, I definitely think mixed
30:50methods for yours is is
30:51a good one too. So
30:53QI, you can do all
30:54kinds of stuff with
30:56see what our example is.
30:58So,
30:59this one,
31:00is looking at unfortunately, it's
31:02one I cannot find from
31:03our institution, but I was
31:04looking at educating
31:06nurses to improve awareness
31:08using human milk feeding care.
31:10It was a pathway
31:12in their EMR,
31:13looking at, opioid exposed neonates.
31:16But I kept the pediatric
31:17trend, so don't worry.
31:19And so what they wanted
31:20to do is increase nurses'
31:22awareness,
31:23in human milk feeding and
31:25folks who had opioid use
31:27disorder.
31:28They so they created this
31:29standardized care pathway,
31:31and they did some training.
31:33It's a QI project, obviously,
31:36and wanted to see if
31:37they could train these nurses.
31:39Will we have better, adherence
31:39to human,
31:43milk feeding care?
31:47So they actually had a
31:48pretty big study. They did
31:49all their staff nurses in
31:51the women and infants department.
31:53They did asynchronous
31:55online educational module looking at
31:57awareness,
31:58talking about how to use
32:00the pathway.
32:01They basically bombarded them, which
32:03was great. Right? Monthly infographics.
32:05Hey. Don't forget. You know?
32:07Put posters up reinforcing what
32:09they learned in their modules.
32:11And then they had pre
32:12and post education surveys to
32:13look at their knowledge.
32:15And,
32:16it was great. I mean,
32:17after the the education, they
32:19actually found increased rates of
32:21of these neonates receiving human
32:23milk at, discharge.
32:26And they got it just
32:27from the electronic health record,
32:28which is what you described
32:29too. Right? You can get
32:30some of these things there.
32:31This was a particular
32:33more for patient
32:35outcome, but it's still kind
32:36of the same. So So
32:38it was a nice QI.
32:39It had it had that
32:41extra level of some patient
32:43outcomes,
32:44but it was able to
32:45improve awareness of nurses and
32:47then had the most important
32:49thing as patient outcomes improved.
32:52Cool.
32:54Alright.
32:56What else do you wanna
32:56hear about folks?
32:59Patient intervention.
33:02Patient intervention. You got it.
33:06So patient intervention's
33:07kind of what we talked
33:09about a little bit with
33:10QI. Right? The the goal
33:11of anything we do in
33:12education is to have impact
33:14on patient outcomes.
33:15But we can do this
33:16using an educational
33:18environment and as our lens.
33:22So this one I did
33:23a long time ago with
33:24one of my, fellows in
33:26medical education,
33:27and we looked at geographic
33:29localization.
33:31And what we did is
33:32we took all of our
33:33house staff, and we we
33:35were all over the place.
33:36We were on three floors,
33:37sideways, upside down. We were
33:39just
33:40the communication was not ideal.
33:42So we had an opportunity
33:43to bring all of our
33:44house staff on an inpatient
33:46one unit, and we tried
33:48to see, would that have
33:50any effect on communication
33:53with patients, other providers, and
33:55then satisfaction in the culture
33:57of care?
34:00So
34:01we actually,
34:03it was kind of an
34:04interesting
34:05way that we did this.
34:06We looked at patients who
34:10admitted to the hospital, had
34:11their team, and we said,
34:13do you know why you're
34:14even here?
34:15Very sad. Not a lot
34:17of people knew why they
34:18were there.
34:19So prior to localization,
34:21it was it was very
34:23low. I don't have a
34:24number here, but it was,
34:25like, twenty six percent.
34:27But
34:27afterward, it was eighty percent
34:29of people actually knew their
34:31diagnosis because the providers weren't
34:32running all over the place.
34:34Same thing we talked about
34:36with fears and anxieties. It
34:38went from thirty nine percent
34:39who,
34:40felt much better
34:42after localization to eighty five
34:44percent. Like, they they felt
34:45their physicians were
34:46addressing their fears and anxieties.
34:50They actually felt that providers
34:51were spending more time with
34:52them.
34:53Half
34:54three localizations said doctors spent
34:56four minutes or more daily,
34:58but that went up to
34:58ninety one percent.
35:00So then we looked at,
35:02again, a nice mixed methods.
35:03We looked at physician and
35:05nurse opinion
35:06to see if they thought
35:07collaboration,
35:08teamwork, patient safety,
35:11handling of errors, essentially, culture
35:13of safety improved, and all
35:14of that was yes for
35:16all of those.
35:18We did length of stay,
35:20didn't see any change in
35:22in that or in readmission
35:23rate,
35:25but we did find some
35:27really important
35:29improvements in patient knowledge and
35:30satisfaction
35:31with some aspects of the
35:33inter professional
35:35communication improving.
35:36So it was a fun
35:37thing. It was kind of
35:38a natural,
35:40way to do this because
35:42we were
35:43localizing
35:44anyway.
35:45So we took advantage of
35:46this change in the educational
35:48environment to see if we
35:49can find some measurements.
35:52Nice.
36:02Hi. This is Brian. I
36:03don't know if, feel free
36:05to redirect me if this
36:06is,
36:07not the appropriate format. But
36:08one of the reasons I,
36:11thought this was an exciting,
36:13thing to join is One
36:15thing I've been struggling with
36:16overall is,
36:18the selection of projects where
36:21the trainees
36:22have sort of a
36:23preconceived
36:24conclusion or notion about,
36:27you know, their view and
36:28perspective. And,
36:31the design is really, you
36:32know, has a lot of,
36:35I I would call it
36:36bias,
36:37in just overall concepts. And
36:40thinking about ways, you know,
36:42besides
36:43just being dogmatic about, you
36:45know, trying to
36:47teach scientific method,
36:49and make sure that the
36:51trainees are are are sort
36:53of approaching their questions
36:56in what I would consider
36:57a more scientific way. It's
36:59it's so pervasive,
37:01that I didn't know if
37:02this was the appropriate format.
37:04So so feel free to
37:05to just redirect if it's
37:06not. But I I just
37:07thought I would throw that
37:08out there as I'm listening
37:09to to some of the
37:10other, points being made.
37:13I think it's a great
37:14point, Brian. And I I
37:16I can't remember who,
37:17but I was just talking
37:18to a trainee about a
37:20project.
37:21And what what struck me,
37:22which I think is getting
37:23to some of your point,
37:24was that it was, like,
37:25very one-sided. And I was
37:26like, well, like, you have
37:27to balance it. Like, you
37:28have to like, if you're
37:29all you think it's all
37:30bad,
37:31but you don't know that.
37:32Like, let's ask how it's
37:33good also.
37:35And so even maybe if
37:36the perspective is off, making
37:38sure the balance
37:40is there so that they're
37:41getting kind of both sides.
37:42I mean, it's like a
37:43p value. Right? You wanna
37:44know if it makes it
37:44better or worse.
37:46So so so thinking about
37:47it from that point of
37:48view. And, hopefully, as they're
37:50doing,
37:51that first part like that,
37:52you know, literature assessment and,
37:54like, digging in,
37:55they'll maybe broaden that perspective
37:58a little bit. But I
37:58think
37:59that's really a lot of
38:00our job is to help
38:02them kind of think through
38:03all those things. And I
38:04always feel like the more
38:05people they talk to,
38:06the more perspectives they'll have,
38:08and, hopefully, it'll get them,
38:10to that broader lens.
38:14Thank you. Yeah.
38:23Other topics that look appealing
38:24to folks?
38:26Oh, I would take the
38:27learner survey, if that's okay.
38:29Yeah. Yeah. On that.
38:33I mean, I think
38:35I think about our entire
38:36lives in medicine. How many
38:37surveys have we, you know,
38:39taken?
38:40And to to do a
38:41survey and do it well
38:43can be very publishable.
38:45And you can use any
38:47learner you can think of
38:48if you're doing something with
38:49the medical students, nursing students,
38:51our our residents, fellows.
38:53And you don't have to,
38:54you know, do a curricular
38:55intervention
38:56to make a survey work.
38:58You could do,
39:00you know, wellness, quality of
39:01life, competencies,
39:03learning environment, faculty assessments or
39:05program assessments, career choices. I
39:07mean, you you've seen them
39:08all in the literature. Right?
39:10So we'll give you an
39:11example here of of a
39:12learner survey, which you folks
39:14might remember David Vermette,
39:16a med peds person.
39:18So he was looking at
39:19flourishing among internal medicine residents,
39:22and he did a cross
39:23sectional multi institutional
39:24study.
39:25This is my favorite type
39:27of study. I've done so
39:28many of these, and I've
39:29been very
39:31productive in getting them published
39:33because it offers some nice
39:35opportunity
39:36to look at a wide
39:37range of individuals from across
39:39the country
39:40and try to see if
39:41we can find some information
39:43out that's maybe more global.
39:46So
39:47David is the expert in
39:48flourishing.
39:49Oh, it's Dave's birthday today?
39:51I didn't know. Now I'll
39:51send him a text. Thanks,
39:52Jeffrey.
39:55Flourishing is just an it
39:57when David brought it up
39:58to me, I'm like, what's
39:59flourishing? You know? It's it's
40:01such a different way of
40:02thinking about well-being.
40:04And what he was trying
40:05to look at was, you
40:06know, what aspects
40:08of,
40:09well-being,
40:10psychological,
40:12social
40:13that we could measure for
40:15our residents.
40:16So he had the flourishing
40:18index and the secure flourishing
40:20index, which I'm not even
40:21gonna be able to describe
40:23to you, but it's basically
40:24measures to look at flourishing.
40:26It has five domains,
40:28including happiness, life satisfaction,
40:30physical and mental health, meaning
40:32and purpose, character and virtue,
40:34close relationships.
40:35And the secure flooring interest
40:37just adds financial and material
40:39stability. So let's think about
40:41anything you can think about
40:42for how one flourishes.
40:48So he wanted to see
40:49if these the FI and
40:50SFI and their domains were
40:53were able to be measured
40:54as functions of resident characteristics
40:56and measures of well-being for
40:58residents.
41:01So he looked at fourteen
41:03residency
41:04programs
41:05in
41:06three different states, Connecticut, Illinois,
41:08and Pennsylvania.
41:10And
41:10what he did was a
41:11convenience sampling, and I love
41:14convenience samples. It gives you
41:15a better response rate because
41:17you're sitting in front of
41:19a convenient group of people
41:21usually.
41:22So if you if you
41:23set up a noon conference
41:24and you say, hey. Can
41:25I go talk to your
41:25residents at a noon conference?
41:27Whoever's there is your baseline,
41:30and it's convenient
41:31for you to talk with
41:32them versus
41:33can I just can I
41:34go to all of your
41:35residents in your program? Well,
41:37that's a harder
41:38group to get because everyone
41:41is inpatient, outpatient, vacation, wherever.
41:43Right?
41:44So convenience sampling can help
41:46you with your response rate
41:48and get a a better
41:49overall sense of what's going
41:51on
41:52at that time.
41:54So they,
41:55what David did was look
41:57at this SFI
41:59and,
42:00FI
42:01and tried to figure out,
42:03whether or not
42:05through piloting
42:06and re doing cognitive interviews
42:09by experts, whether or not
42:10he can come up with
42:12this great
42:13community
42:14well-being survey. Do people know
42:16what cognitive interviews are?
42:21I I can talk a
42:22little bit about that.
42:24When you're developing a survey
42:26I mean, and we we
42:27all do this, like, oh,
42:28I I know what I
42:29wanna measure. Right? But
42:30what you think you're trying
42:32to get at and what
42:33the person who's taking the
42:35survey is is reading may
42:36not be the same.
42:38So the goal of cognitive
42:39interviewing is to
42:41get a few people who
42:42are similar to your target
42:44audience
42:45to actually read through your
42:46survey, take the survey, take
42:48notes, and then you sit
42:50down with them and you
42:51say, tell me what you
42:53thought this question meant.
42:56What do you think about
42:57this question
42:58when we asked this and
42:59you saw the answers?
43:01So, basically,
43:02you're going through their brain
43:04and making sure their brain
43:06lines up with what you
43:07are trying to get at.
43:09So it's a it's a
43:09great strategy,
43:11and I promise you, you'll
43:12actually make changes to your
43:13survey because
43:14you thought one thing and
43:16people taking your survey think
43:17something else.
43:24I don't think we have
43:25the results on this one,
43:26Alyssa.
43:27Oops. You're on mute there.
43:29Hey. Sorry about that. I
43:31was, like, doing the same
43:31thing. I don't think we
43:32have
43:33anything.
43:40I'm curious about RCT only
43:42because I very rarely see
43:44those studies in Oh my
43:46god. Penina, everyone should be
43:48doing RCTs.
43:49Everyone.
43:51I love RCTs. I've done
43:53a few of them now.
43:54There is no reason
43:56why we can't aim for
43:58randomized control trial in education,
44:00really.
44:02You have head to head
44:03comparisons you can do. It
44:04really prevents this confounders and
44:07the impact of time and
44:08learning.
44:09And there's different ways you
44:10can do it. You can
44:11do it with the same
44:11group of people, like the
44:12same class of residents, or
44:14you could get a control
44:15group, and I've done it
44:16in many different ways.
44:18Looks good when you try
44:19to publish it, by the
44:20way.
44:22So oh, you guys know,
44:24Katie Gilson,
44:26maybe you know Sarita Soares,
44:28Brian Brown, Jeri Moller,
44:30Catherine Gao. So we
44:33we meaning Brian Brown
44:35was trying to look at
44:36this very complex word anthropomorphic
44:39character animations
44:40versus digital chalk talks and
44:43trying to teach residents about
44:45diabetes pharmacotherapy.
44:47So we ran this as
44:48a randomized control trial. Trial.
44:50Every time I tell someone
44:51to do it as a
44:51randomized control trial, their eyes
44:53roll back and, like, why
44:54would I do that?
44:56But, really, he was just
44:57trying to figure out which
44:58one of these two aspects
45:00of,
45:02education,
45:03two animated video styles, totally
45:05different styles,
45:06could help residents learn the
45:08information better.
45:12So he actually randomized
45:14our internal medicine residents to
45:16receive one of two versions
45:17of the same multimodal
45:19didactic curriculum.
45:22They have into,
45:23identical lectures, group activities, and
45:25quizzes,
45:26but they either got this
45:27digital chalk chalk, which was
45:29essentially a video,
45:31or they got what Brian
45:32created, and he's very good
45:34at animation. He created the
45:35sugar coated science
45:37video, which is an animated
45:38series using these characters. You
45:40can see our folks here
45:41and go with the flow.
45:43And he used stories and
45:45mnemonics
45:45based on these characters,
45:47and then they he measured
45:48knowledge
45:49at multiple time points, pre,
45:51immediate post,
45:52and post post,
45:54and looked at,
45:55resident self reported comfort using
45:58this medication class that was
45:59covered for each of those
46:01sessions.
46:02And they also wanted to
46:04know what were these videos
46:06acceptable? And
46:07they he measured what he
46:09calls telepresence, but it's basically
46:10where you engage. You can
46:12tell how long people
46:13were, on the video and
46:15whether or not they just
46:16kept plus pressing next next
46:17next, which we all do
46:18for HIPAA compliance. Oh, I
46:20didn't say that right.
46:21But the key themes were
46:22identified, and he used open
46:24ended feedback too. So, again,
46:26it was kind of a
46:26mixed methods.
46:29And, you know, he actually
46:31found that those who had
46:33his animations
46:34actually did better.
46:36Their scores and knowledge,
46:40not significantly different, but they
46:41did perform better.
46:44Let's see. Delayed post test,
46:46they actually had some
46:48improvement in their knowledge gains,
46:50gains
46:51and similar between the two
46:53different animation types he used.
46:55So he was doing a
46:56lot in this.
46:58So to unpack his stuff
46:59is hard, but I think
47:00he get the sense of
47:02what he was doing. You
47:03can randomize a group.
47:05I've done it
47:06lots of different ways. You
47:08can,
47:09you know, randomize them by
47:11block. Like, we have people
47:13that run through blocks through
47:15the whole year together,
47:16and you can do block
47:18a gets curriculum
47:19first, block b is the
47:21control. And then at the
47:22second half of the year,
47:23if you're worried about people
47:24who
47:25they they heard that you
47:26had this great curriculum that
47:27they didn't get, you can
47:28give them
47:29that the second half of
47:31the year. There's so many
47:31ways.
47:32That was a crossover study
47:34that I just described so
47:35that everyone gets the same
47:37intervention.
47:42So, Pena,
47:43I'm waiting for your next
47:43RCT. Let me know.
47:46Thanks, Donna.
47:53What else?
47:58I'd love to hear the
47:59linguistics one.
48:01Yeah.
48:02Well, all of your friends
48:03are on this one, Jasper.
48:05You'll see.
48:06So
48:07sometimes, like, thinking about different
48:09fields of science and applying
48:10them,
48:11to areas of med ed.
48:12And, you know, the use
48:13of sociology and linguistics
48:16and med ed scholarship can
48:17provide some valuable frameworks for
48:19understanding
48:20communication dynamics within med ed
48:23training and practice.
48:25And thinking about word choices
48:26or phrases,
48:28we can apply these to
48:29visual formats.
48:30And for our study, we're
48:31looking at agentic and communal
48:33terms, which we'll talk about.
48:35But, you know, in sociology,
48:36that that will focus on
48:38social structures, like roles and
48:40cultural norms that shape meta
48:42ed. We can explore things
48:43like professional identity formations,
48:46power dynamics, right, hierarchy and
48:48a clinical team that hidden
48:50curriculum.
48:52And just thinking about insights
48:53into broader societal factors, race,
48:55gender, inequality,
48:57and how they can influence
48:58the environment and outcomes.
49:01And with linguistics,
49:02like, really getting into, like,
49:04language and communication,
49:06doctor patient interactions, team communication,
49:09feedback exchanges,
49:11and just how, again, language
49:13can shape professional identity and
49:15knowledge transfer, clinical reasoning.
49:17And so some of these
49:18analyses I just find, like,
49:20really fascinating.
49:22And and so this was
49:23a study that, like, a
49:25lot of PDs and I
49:26did with Hannah,
49:28and we were identifying
49:29gender and racial bias in
49:31fellowship letters of recommendation
49:33and looking at word choices.
49:35So, right, we have to
49:36read all these letters of
49:37recommendation, and we have to
49:39decide who we're gonna invite.
49:41But the language in there
49:43could impact our decision, so
49:44we wanted to look at
49:45it in a little bit
49:46more depth.
49:48And so we took letters
49:49of recommendation for eight of
49:50our fellowships here at Yale,
49:52and we looked at,
49:55agentic and communal terms. And
49:57agentic terms
49:58generally,
50:00are,
50:02I'll say they're typically assigned
50:03to white men more. They're
50:05like, you know, the achievement
50:07terms versus communal terms, which
50:08are typically
50:10assigned to females are the
50:11relationship building terms.
50:13And there was a validated
50:14dictionary.
50:16We Hannah and Hannah's husband,
50:18like, figured out how to,
50:19like, create this tool that
50:21we were using to,
50:22measure the frequency in all
50:24these letters. And we determined
50:26a letter of bias. And
50:27so we put all these
50:28letters through this tool. We
50:29figured it out,
50:31and we were looking at
50:32that. So, right, over fifteen
50:33hundred letters of recommendation we
50:34looked at for four hundred
50:36nine applicants.
50:37Most of our letters had
50:39a higher frequency of agentic
50:41terms. Some of them were
50:43sixteen percent were more communally
50:44biased, and twenty percent were
50:46neutral about, meaning they had,
50:49kind of equal amounts of
50:50both terms.
50:51So we didn't find any
50:53difference
50:54in those kind of breakdowns
50:55based on gender,
50:57race, or ethnicity.
50:58And despite,
50:59like, this lower frequency of
51:01agentic terms and letters of
51:02recommendation for,
51:04applicants that were invited for
51:05interviews,
51:07like, they it didn't pan
51:08out later. So I thought,
51:09you know, this was just
51:10really interesting looking at the
51:12letters and their impact, at
51:13least for pediatric fellowships,
51:15on the, applicants.
51:18So the frequency
51:19of terms didn't impact the
51:21decision to invite candidates to
51:22an interview. But we just
51:24wanted to also raise awareness
51:25of bias because
51:27some fellowship directors may be
51:29drawn to people that are
51:30talked about with more communal
51:32language or agentic language.
51:34And as many of us
51:35are letter writers,
51:37just being thoughtful about how
51:39we're using language. And you
51:40could plug these into these
51:41online calculators to look and
51:42see how you describe people
51:44as well.
51:45So kind of really different
51:46take on, again, data that
51:48we already had. That's what
51:49I meant. I love using
51:50data we we already have
51:52to think about how, we
51:54can look at that and
51:55how it might impact the
51:56people that we're trying to
51:57bring into,
51:58our institution from a diversity
52:00perspective.
52:12Well, I'd love to hear
52:13about the qualitative.
52:15Sure. I'm gonna pause. I
52:17was just reading the chat.
52:18Claire, do you wanna,
52:20tell us a little bit
52:20more about the list that
52:22you pull out for your
52:23biases?
52:25Well, I'm,
52:28I'm very much a clinician,
52:29and so I don't have
52:31not had the opportunity to
52:32write very many letters of
52:33recommendation. And I was asked
52:35to write a couple at
52:35my last job, and so
52:36I reached out to somebody
52:38and was like, how can,
52:39like,
52:40this individual not be at
52:41a disadvantage because they have
52:43a a rookie letter writer.
52:45Yeah. And,
52:48my mentor said, oh, I
52:49have a great tutorial
52:51I'd like to look at.
52:52So she sent me the
52:52link to the tutorial, but
52:54then she also sent me
52:55this,
52:56it's like an infographic type
52:59thing. I, like, have it
53:01saved to my, you know,
53:03work photo album on my
53:05phone, and I can try
53:07and figure out. But it
53:08it has, like, some different
53:09I'm trying to pull it
53:10up here.
53:13I think it's under medical
53:15reference here.
53:17It's from a different institution,
53:19once I find it, but
53:20it here it is.
53:23It's from the commission on
53:24the status of women at
53:25the University of Arizona, and
53:27it says avoiding gender bias
53:29in reference writing.
53:30You know? And it has
53:31some tips, like mention research
53:33and publications.
53:34On average, don't, like,
53:36keep going. On average, letters
53:37for men are longer than
53:38women. It has, like, data
53:40or numbers. You know?
53:41Emphasized accomplishments, not effort.
53:46And then it has, like,
53:48their opinion of adjectives to
53:50avoid and include, which kind
53:51of is what speaks to
53:53Yeah. To that,
53:56the study you had anyway.
53:57So, I was just really
53:58thankful that when I was
53:59first even starting,
54:01and maybe there's new data
54:03now. But as somebody trying
54:04to write
54:05letters, even now when I
54:07write I mean, I still
54:08haven't written that many, but
54:09I, you know, write my
54:11thing, and then I pull
54:11this up and kind of
54:13check to see if I
54:14can do better based on
54:15some of those,
54:18recommendations. And then the tutorial,
54:20I don't have Twitter, so
54:22I think I screen I'll
54:23have to see if I
54:23had a screenshot. Twitter used
54:25to be, like, more open
54:26so I could just look
54:27at it, and now it's
54:28harder for me to find
54:29the tutorial.
54:31Understandable.
54:33But maybe somebody else who's
54:34Twitter can find it and
54:35screenshot it and share it
54:36to me again.
54:37Yeah. I'm not a Twitter
54:38person, so that won't be
54:39me, Clara, at this point.
54:41Yeah. I I don't
54:43That's run by Elon Musk
54:45now. So, you know, that's,
54:46you know, that's all I
54:46can say. Despite my epic
54:48like I said, it came
54:48to epic from a, like,
54:49this has to be easier
54:50for us novices to use,
54:51and so I'm not quite
54:53sure how to make my
54:54phone go into the chat,
54:55but I will, like, email
54:56it to Melissa and the
54:57other person in the chat,
54:58and then
55:00we can find a way
55:01to get up. That's exciting.
55:02That'll be great. Thank you.
55:03Again, I'm sure there's other
55:04things, but that was just
55:05helpful to me when I
55:06started and I reached out
55:07for help and to have
55:08something to, like, just pull
55:09up and say, like,
55:11you know, are there some
55:12of these words that you
55:13aware of the differences. That's
55:14great. That's great, Claire.
55:16Awesome. And I love your
55:17comment in here too, Margaret,
55:18about Duolingo and the animation.
55:21Sets another, like, practical one
55:23to think about. That's a
55:24good one. And thanks for
55:25sharing that, other work in
55:27there, David, too.
55:28Awesome.
55:29Alright. We'll jump into some
55:31qualitative
55:32real quick, and I know
55:33you like this stuff too,
55:34Janet. So feel free to
55:37to jump in here with
55:38this. But, you know, qualitative
55:39research
55:40offers some really key benefits
55:42for med ed scholarship because
55:43it explores the how and
55:45why behind behaviors
55:47and experiences and processes and
55:49really those, like, those complex
55:51topics that aren't easily described
55:53or studied. And some of
55:54those are these examples that
55:56we talked about with letters
55:57like professional identity,
55:59or flourishing.
56:00Like, again, those are can
56:01be really hard to describe,
56:04and so qualitative methods can
56:05be helpful to provide those
56:07rich insights into those processes.
56:09Generally, they're used to help
56:11generate hypotheses, right, not to
56:13prove them, but you can
56:15use that data for later
56:16studies to help, do some
56:18more testing.
56:20We think about doing this
56:21with one on one interviews,
56:23focus groups, ethnographic studies,
56:26and then later on using
56:27kind of that rich data
56:29for coding and thematic analysis.
56:31And, Victor, I know you're
56:32on here. I'm not gonna
56:33talk about ethnography, but, you
56:35know, it takes a lot
56:35of work, so be careful
56:36with that one.
56:38And, again, this was, the
56:40a lot of people you
56:41know, Katie and Dave and
56:42Ben Doolittle.
56:44And, again, thriving among primary
56:46care physicians of qualitative study.
56:48So they wanted to identify
56:50factors contributing to both career
56:52and life satisfaction
56:54through qualitative interviews.
56:56And you can imagine all
56:57the factors that might go
56:58into qualitative or career and
57:00life satisfaction,
57:02maybe just not easy to
57:03put into a survey, and
57:05we certainly would leave things
57:06out and to describe that
57:08could be really hard in
57:09a quality in a quantitative
57:10fashion.
57:12So they perform interviews with
57:14the primary care physicians,
57:15and they use snowball samplings.
57:17Right? You find one person
57:19who's a rich participant,
57:20really great about talking, like
57:22knows a lot about the
57:23subject, and you're like, hey.
57:24Do you know someone else
57:26who would be good to
57:27talk to about this subject?
57:28And that's how the snowballing
57:29goes
57:30and how to identify some
57:32future participants.
57:33So they completed a validated
57:35instrument about job and life
57:37satisfaction
57:38and burnout, and then they
57:39did these semi structured interviews.
57:41They talked about what parts
57:43of their career and life
57:44contributed to thriving,
57:46work environment,
57:47social networks, family life, institutional
57:50support, coping strategies, extracurricular
57:53activities. So a whole lot
57:54of topics, and these are
57:56generally driven by the participants
57:58and what they wanna talk
57:59about.
58:01Right? You get all this
58:02rich data from these interviews.
58:04You transcribe them. You can
58:06do some thematic content analysis,
58:08which is, again, thinking about
58:10what are
58:11really those
58:12themes that are coming out
58:13from the participant and kind
58:15of trying to group them
58:16together with your study team.
58:18That's where all the work
58:19and the qualitative analysis get
58:22into. And they looked at
58:23personal, professional, and life factors
58:25that contributed to achieving career
58:26and life satisfaction
58:28and solutions for burnout.
58:32My buttons to work. So
58:34they interviewed thirty two physicians.
58:36Mean age was around,
58:37fifty four, and they've been
58:38in practice for a long
58:39time.
58:41None of these physicians
58:42met the criteria for burnout,
58:44so they really had some
58:45good life and career satisfaction.
58:48The themes they identified,
58:50intrinsic love for work, a
58:52rich social network, fulfilling doctor
58:54patient relationships,
58:56a value oriented belief system,
58:58and, like, like, just thinking
59:00about that at work environment.
59:01So, again, you can imagine
59:02if you read this study
59:04in more depth, the data
59:06that they found in there,
59:07like, to describe these these
59:09themes that they came up
59:10with, which, again, could be
59:12really hard to measure in
59:13a a quantitative way.
59:15And so really, again, those
59:16complex,
59:17processes
59:18that are really best explored
59:20by talking to people and
59:21talking about their feelings and
59:23their beliefs, their perceptions
59:24about different aspects.
59:26So that was a good
59:27one.
59:28Oh, and thanks for sharing
59:29that, Clara.
59:34Not sure if it works.
59:35I,
59:37I will email you. Sorry.
59:38Wait. I wanna pay attention
59:39to this, so I'll email
59:40you when I'm done with
59:41the a picture of the
59:43screenshot.
59:44Sounds good.
59:45Alright. Victor, I see you
59:46put perspectives in there. I
59:48think we can get to
59:49that one more.
59:51So in this one,
59:52you know, perspective pieces can
59:54take lots of different forms.
59:56For example, like, through evidence
59:58and expert opinion,
60:00authors can synthesize
01:00:01complex data,
01:00:02provide insights that can make
01:00:04medical research and concepts accessible
01:00:06to a broader audience.
01:00:08So some examples are medical
01:00:09teachers twelve tips or j
01:00:12JGME perspective pieces, which are
01:00:14really
01:00:15nice. Can also think about
01:00:16personal essays that offer an
01:00:17opportunity to share our experiences
01:00:20and foster empathy.
01:00:21They can humanize medicine
01:00:23and just connect with readers
01:00:25on emotional level. We don't
01:00:26always wanna read about science.
01:00:29JTME offer also offers an
01:00:32on teaching
01:00:32personal essay.
01:00:35As they haven't written written
01:00:36some of these, they're really
01:00:39kind of nice to, like,
01:00:40take this
01:00:41feeling or topic that's bothering
01:00:43you or that you're passionate
01:00:45about and put it in
01:00:46writing and get it out
01:00:47there in a different way.
01:00:49And then there's visual stories.
01:00:50So you can incorporate figures
01:00:52and inf ographics or images
01:00:53that can enhance storytelling.
01:00:55These can improve comprehension
01:00:58and engage readers more effectively
01:01:00by illustrating these concepts,
01:01:02that can be complex and
01:01:04adding some emotional depth to
01:01:05personal narratives.
01:01:07And academic medicine's last page
01:01:09is an example of that
01:01:10one.
01:01:11But here we have, again,
01:01:14Katie is is represented up
01:01:16here at twelve tips for
01:01:17integrating
01:01:18podcasts into med ed curriculum.
01:01:21So they found a gap
01:01:22in the literature. Right? So
01:01:24the gap in available resources
01:01:26to help educators incorporate an
01:01:28already existing and growing library
01:01:31of med ed podcasts into
01:01:32their curriculum rather than creating
01:01:34their own. There's lots of
01:01:35stuff out there about how
01:01:36to create them, but they
01:01:37figured out what this gap
01:01:38is.
01:01:39So they,
01:01:41provided twelve tips on how
01:01:43to integrate podcasts into teaching
01:01:45sessions
01:01:45grounded in these fundamental,
01:01:47principles of our own curriculum
01:01:49development and accessibility.
01:01:51And so that's just one
01:01:52way to do it using
01:01:53what's already out there, but
01:01:55finding a gap and, like,
01:01:57helping people
01:01:58figure things out in a
01:01:59different way. And, like, twelve
01:02:00tips are pretty straightforward.
01:02:02They're just easy to digest.
01:02:04So that's,
01:02:05another another simple one. And
01:02:08I'll just tell you, it's
01:02:09so hard to get into
01:02:10twelve tips, but I've written
01:02:11so many of them, and
01:02:12all I do is morph
01:02:13them and put it in
01:02:14another journal.
01:02:16Just don't say twelve tips
01:02:17on it because that's your
01:02:19giveaway that you already tried
01:02:20to submit it for twelve
01:02:21tips.
01:02:22Yeah.
01:02:27Thank you, guys. Melissa, I
01:02:29did wanna put in a
01:02:30plug and just have you
01:02:31kinda talk about,
01:02:32some of the venues for
01:02:34individuals
01:02:35who may have questions like
01:02:37Clara, including our innovation lab.
01:02:40Yeah. No. A hundred percent.
01:02:41Right.
01:02:42Exactly. And we have the,
01:02:44pediatric medical education and research
01:02:46collaborative. It's on the Yale
01:02:48ped website, so you can
01:02:49link to it through there.
01:02:50I don't have a a
01:02:51quick way to get to
01:02:52that and put it in
01:02:53the chat right now.
01:02:54But there's through there, you
01:02:56can get, like, personal consultations.
01:02:57If you just wanna talk
01:02:58through ideas or methods or
01:03:00other stuff, you can also
01:03:01just email me.
01:03:02And we have our,
01:03:04like, Panina mentioned on Friday
01:03:06afternoons.
01:03:07It it has been the
01:03:09third Friday of the month
01:03:10at noon, but we've been
01:03:11running into conflicts with the
01:03:12yes sessions. So we're trying
01:03:14to figure out a different
01:03:15date for them.
01:03:17But, usually, we meet every
01:03:18fry Friday the third Friday
01:03:19at noon. And, really, it's
01:03:21like an open forum.
01:03:23People come. We just talk
01:03:24about ideas and projects, and
01:03:26then some of it is
01:03:27about helping each other, providing
01:03:28support, and having some accountability.
01:03:30So it'd be like, okay,
01:03:31Clara. You decided you're gonna
01:03:33do this project.
01:03:34Next month, you're gonna come
01:03:35and tell us, like, what's
01:03:36the journal you're gonna you're
01:03:37gonna bring this to and,
01:03:38like, what are your next
01:03:39steps? And really small chunks
01:03:41that make this just seem
01:03:43very doable.
01:03:44But, yeah, there's so many
01:03:45people around as you see
01:03:47all these people on these
01:03:48calls to help with med
01:03:49ed scholarship.
01:03:50And like I said, I
01:03:51certainly am available. I know
01:03:53Donna is there and has
01:03:54all the PEEDS people in
01:03:55the ESF program.
01:03:57So we really wanna help
01:03:58people, find this easy and
01:04:00be successful in their scholarly
01:04:02pursuits. Pursuits. And plug the
01:04:04education scholar,
01:04:05fellowship program if you're interested.
01:04:09It's it would be a
01:04:10great opportunity
01:04:11to to get feedback from
01:04:13your peers and to learn
01:04:15more
01:04:15specific
01:04:16scholarship. There's also the the
01:04:18masters of medical education,
01:04:21to the MHS
01:04:22med ed pathway. That's a
01:04:24two year degree program that
01:04:26Janet runs. So those are
01:04:27two through the Center of
01:04:28Medical Education to consider.
01:04:31And if you're not on
01:04:32our center website for or,
01:04:34list, you know, make sure
01:04:36just send your name and
01:04:38make sure you're on it
01:04:39because
01:04:40for all the sessions,
01:04:42there's a lot of scholarship.
01:04:44And I've gotten invites to
01:04:46things like this, so I
01:04:47think I'm on the list.
01:04:49It's always hard to know
01:04:50what list you're not on
01:04:51because you're Right. You know?
01:04:52Sure. I think I am,
01:04:53but I'll, try to work
01:04:55on verifying that,
01:04:57because my, yeah, my other
01:04:59epic my skills are epic
01:05:01and then, actually, this communication
01:05:02course that I, am trained
01:05:04to facilitate from the University
01:05:05of Washington and hoping to
01:05:07bring here.
01:05:08But we have we have
01:05:09a head of communications, Tara
01:05:11Samf. Do you know have
01:05:12you met her? No. And
01:05:14she runs that course for
01:05:16us. Yeah. And Kirsten Bechtel,
01:05:18who's in Peds Emergency, is
01:05:19one of the facilitators for
01:05:21the course too, Clara. So
01:05:22I'm sure she'd love to
01:05:23talk with you about what
01:05:25you've done.
01:05:26Yeah. Oh, great. Yeah. I've
01:05:27been in touch with the
01:05:28palliative care group because it's
01:05:29usually
01:05:31adult internal medicine,
01:05:33palliative care
01:05:34has partnered to teach it
01:05:36in the adult,
01:05:38inter in the internal medicine
01:05:39residency, and I am hoping
01:05:41that I can help support,
01:05:42however they wanna do it
01:05:43in peds. Excellent. That's great.
01:05:45Thank you. Well, thank you
01:05:46so much, Melissa and Donna.
01:05:48Really appreciate you bringing your
01:05:50show to pediatrics. As you
01:05:51could see, there's a lot
01:05:52of interest from our group.
01:05:53And I was actually super
01:05:55psyched to see a couple
01:05:57of section chiefs on because
01:05:59I think, you know,
01:06:01and so, Rakesh, thanks, friend.
01:06:03But I think it's, like,
01:06:04super and just great,
01:06:06because I think it's just,
01:06:07like, so important for section
01:06:09chiefs to know all the
01:06:10resources so that they could
01:06:11also help, you know, kinda
01:06:13guide their faculty. So
01:06:15thanks, team. Really appreciate it,
01:06:17and, have a good day.
01:06:19A nice day. Take care
01:06:20for having us. Take care.