Guest blog by Kent Stobart, Vice-Dean Medical Education

I’m pleased to say that “what happens now” is in fact already happening. Several people are progressing on the work we have before us to ensure a successful accreditation outcome this fall. There is still a great deal to do, however.

First, though, I want to emphasize some basic, but very important, messages with regard to UGME accreditation:

• Our program is not on probation.
• Our program is fully accredited and always has been.
• We are confident that we will not be on probation after the 2017 full site accreditation visit.
• For the 2017 accreditation visit, our goal is to achieve a full eight-year accreditation, the best possible result – we are shooting for a “PB” (personal best), as the dean wrote in his recent blog just after the mock visit.
• Our ultimate goal, however, is a quality UGME program, and accreditation is a means of keeping us accountable and structured in achieving our goal.

Please help your college out by sharing the above messages at every opportunity!

Also, some further clarification regarding our college’s accreditation history: we have been on accreditation probation twice in the past, but we are not on probation now and haven’t been since October 2015. Probation does not mean “not accredited.” It’s a warning status that indicates accreditation is at risk. Medical education programs remain fully accredited when on probation, but must work to resolve the accreditation issues that have resulted in the probationary status. Thus, though we have been on probation twice in the past, our school has always been fully accredited.

Now, back to the work we have to do between now and the full visit.

That work will include improvements in how we do things and we will be sharing these improvements and our progress towards a successful accreditation visit with you on a weekly basis. We will also be doing more to prepare all our visit participants well in advance of the visit. Ensuring that our students have current and useful information to support their success and that our faculty have the information and resources needed to do their jobs are part of this work. We can’t achieve this in a vacuum, though—we need your help. If there is a problem, we need to know.

Generally, much of the information that supports our students and faculty in their roles is found on the college website as well as in One45. For students, important information to be familiar with to support your success in the UGME program includes curriculum information, program and learning objectives, the Student Information Guide and the Student Guide to Clerkship, syllabi and student policies. For faculty, knowing curriculum information and processes, program objectives, collegial processes and policies and procedures are key areas that support your success. Undeniably, we have ongoing improvements to make in our processes and how we communicate with you to support your roles.

So, how are we approaching the accreditation-focused work of the next several months?

We have a plan in place and people identified to lead all of the areas of work.

There are some clear priorities we must set, as we have a pressing deadline to meet: we must update and submit our Data Collection Instrument (DCI) by June 19, 2017.

Our students have played an important role already in our post-mock work with their recent completion of a Modified Student Survey. The level of participation from our students—80 percent!—was extraordinary given the timelines involved, so a huge thank you to all our medical students for your support through completing the survey. It will supplement the Independent Student Survey (ISA) completed last spring by providing updated information from our students in key areas.

We have an Accreditation Executive Team (AET) that is meeting to discuss and update progress three times a week from now until the accreditation visit, and is composed of: myself; Athena McConnell, assistant dean quality; Pat Blakley, associate dean UGME; Marianne Bell, accreditation specialist; Greg Power, chief operating officer; Sinead McGartland, Senior Project Leader; Alyson Rees, executive assistant to the dean; and Kate Blau, communications specialist. The dean joins us at these meetings, as well.

Focus areas for improvements and leaders for each have been identified. They are:

• Curriculum Improvements – Regina Gjevres, assistant dean curriculum
• Learning Environment/Student Services – Bindu Nair, assistant dean student services
• Educational Resources – Meredith McKague, assistant dean academic
• Faculty – Sheila Harding
• Admissions – Barry Ziola, director, admissions
• Administration – Greg Power
• Modified Student Survey – Athena McConnell
• Student Improvements Resulting from the ISA – Pat Blakley
• Quality Accreditation Visit – Sinead McGartland

Our June submission deadline is approaching fast! That means you may be hearing from one or more of our focus area leads or others as we work together to ensure we have solid information pulled together in the DCI. Please, support all requests effectively and efficiently and be sure to ask for more information if you need it, in your work to respond.

We have identified certain accreditation elements as critical and we will tackle these first. Next, we will focus on elements deemed urgent, followed by those deemed high priority. Communication about progress towards our accreditation visit will be shared with you through weekly updates in our college e-news, in this blog, through monthly Medical Student Updates, and through college website news stories that will serve to highlight involvement of different participants in this work. General information is also provided on the UGME accreditation web page on our college website.

For our actual visit participants, we will provide you with significantly more time, support and focused preparation. Watch for information coming directly to you via email—as few and as streamlined as possible; we have several improvements already planned here—that includes save-the-date information, invitations with automated RSVPs for both preparation sessions and actual visit meetings, and orientation materials. With some exceptions, actual visit participants will be primarily those who participated in the mock accreditation visit last month.

Finally, questions can be directed to me, to Athena McConnell and to Pat Blakley, as well as our focus area leads and any member of the AET.

I thank the dean for providing space to me for this message.

I was invited to speak at the Dalhousie Postgraduate Medical Education professional day for program directors and program administrators. The title above was one of the talks I was asked to present.

What is the “learning environment?”

The “learning environment” has been defined as “everything that is happening in the classroom or department or faculty or university.”^1,2

In our work, where at least two-thirds of our medical education takes place in the clinical setting, our learning environment extends to the entire province. In fact, we have a responsibility to ensure our students have a safe learning environment anywhere—even when taking electives out of province.

So if that is the learning environment, what is a safe learning environment? For me, a safe learning environment is a place you (or your son or daughter) would like to go to medical school. I believe excellent clinical education is dependent on a safe clinical learning environment.

In my talk, I divided the characteristics of a safe learning environment under five headings: Physical, Program, Learning, Clinical, and Behavioral. I provide here my presentation from that day.

Physical includes obvious things like safe house calls by residents, for example. Program includes things like fair and transparent promotion policies. Learning includes things like learning objectives that are attainable. Clinical includes very important principles, like appropriate graduated responsibility and supervision of learners.

The Behavioral heading gets complicated and the discussion at my talk in Halifax developed into a long list. I believe many of us of a certain age were exposed to teaching techniques that are unacceptable today.

I recall an experience in my clerkship with a supervisor who was a fan of scotch and jazz. Tradition was for the house staff to gather in his office late on Friday afternoon, share a “wee dram;” give an assignment to the two clerks to find an obscure piece of trivia about jazz; and share plenty of male jocularity! The irony was that he was an incredible clinical teacher, but the behavior was inappropriate even then. (I am not that old!)

Accreditation is highly dependent on student feedback through the Independent Student Analysis and the Canadian Graduation Questionnaire. Historically, the CGQ documented both locally and nationally that about 30 per cent of students reported mistreatment over the course of four years. The Association of Faculties of Medicine of Canada no longer provides the national comparator on the basis of the fact that zero mistreatment is the only acceptable goal.

Unfortunately, we are not yet down to zero. While the pre-clinical learning environment is not immune, most reports are in the clinical environment. The source is most often clinical faculty but also includes hospital staff, residents and fellow students.

The most common form of mistreatment is public humiliation. This could be shaming over an incorrect diagnosis or public fact-based questioning of increasing difficulty. I include a link to my previous blog on “pimping.” Distressing to me were incidents of racially based comments directed at students.

I know the vast majority of faculty abhor any form of student mistreatment. On the other hand, I am also sure some instances are unintended and that sometimes people are simply unaware of their impact on learners.

We encourage students to come forward with concerns and we guarantee their confidentiality. We can only fix what we know about.

I believe the CoM must be proactive in eliminating mistreatment. I believe it is incumbent on all of us to work every day to ensure our students have the educational experience we would like to have ourselves.

Among my final words at Dalhousie was that we all must be prepared to speak truth to power in addressing these issues.

The CoM has plenty of experienced faculty who can provide faculty development or lead workshops for departments, etc. We have invested more in Faculty Development and welcome the opportunity to assist in making this college a place where zero tolerance for mistreatment is not simply a belief, but also a result.

As always, I look forward to your feedback.

[1] Genn JM. AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education – a unifying perspective. Med Teach. 2001;23(5):445–54.  [PubMed] [2] Roff S, McAleer S. What is educational climate? Med Teach. 2001;23(4):333–34.  [PubMed]

Two weeks ago, I undertook a course at the Harvard Kennedy School in Cambridge, Massachusetts. HKS is Harvard’s school of public policy and public administration. I’ve had the good fortune to now have completed five professional development programs at Harvard University over the last six to seven years—some at the medical school, but others affiliated with the business school, the education faculty and now two at HKS. I must say I have experienced some of the best classroom teachers in my life at these programs.

This time the course was Leadership Decision Making. As many of you may know, I have quite an interest in the neuroscience of decision making, especially as it applies to how we teach diagnostic reasoning. This course used the same fascinating research to review how leaders can optimize decision making. One very interesting aspect was an afternoon in their Decision Science Laboratory that provided me feedback on my own decision making.

Dr. Jennifer Lerner, the leader and founder of the course, was an incredible teacher and an inspiring leader. Jenn is a professor of Public Policy and Management at HKS, with a PhD in Psychology from U of C – Berkeley. She describes her role as scholar/practitioner and has held numerous roles advising leaders at the highest levels of government, business and military, around the world. The other faculty were equally impressive, and the 60 participants were fascinating people from around the world.

Part of our preparation for the course was a reference (I’ve provided a link below). Jenn surprised me on day one, when she appealed to all participants to not use laptops. Her reasons included the obvious distractions that these tools entail, but primarily focused on the research that shows students taking notes on laptops retain less material than those who do it the old-fashioned way!

Careful perusal of this paper will reveal that there is more to it than that. The evidence is that most people can type faster than they can write but written notes outperform laptops! While overall pen and paper notes outperformed laptop notes, in fact within and across both groups, note takers who took concept-based and summarizing notes outperformed learners who took verbatim notes.

So we should do all we can with our pedagogy to avoid conditions that promote verbatim note taking.

As with most blogs for the rest of this year, I will bring you back to accreditation of our undergrad program. One area of student concern that was very clear to our mock accreditors was the issue of lectures. The two concerns raised were those lectures where the slide deck was not available before the lecture and those that were not recorded.

Making the slides available before the lecture allows students to prepare for the lecture and actually plan their note taking. The research clearly shows that the opportunity to reframe the content, move from words to concepts and summarize the material leads to deeper learning. Furthermore, we know one of the reasons students attend lectures in person or by viewing a recording is concern that material in the lecture will be on the exam. In those lectures where the students know there is no recording, they are obliged to revert to verbatim note taking.

We also know that students doing review of recorded lectures are predominately doing focused repetitive review of specific segments of the lecture, usually on complex topics and often to complement the notes taken in the lecture. This review is done as much by the students who were in the room as those who were not.

I do know it is disheartening as a lecturer to work hard to prepare a lecture and deliver it to a sparsely populated room. However, students tell me that the prime driver of lecture attendance is actually a well-designed unit or course where all the curricular components—including the lecture—tie together and, most importantly, an excellent lecturer who cares about the students. They all speak glowingly of the hematology module as an example of excellence, and they asked our accreditors why all units or modules could not learn from that module.

Recall that we do not make lectures mandatory and there are many quite legitimate reasons for being unable to attend a lecture. Besides, students always have options. Just Google “YouTube, heart failure.” Wouldn’t we all hope they were watching our lectures?

I know that it is at our faculty member’s discretion to pre-circulate lecture slides and/or record the lecture. However, our students have repeatedly put forward this request. I think there is research supporting the benefits of both of these best practices in providing lectures and lecture materials. I would appeal to all faculty members to consider our students wishes and honour their beliefs in what is best for their learning.

The Pen Is Mightier Than the Keyboard: Advantages of Longhand Over Laptop Note Taking

As always, I welcome your feedback and my door is open!