T1 #meded I see #medstudents perk up more during the clinical years. Some have had issues and I wonder if it relates to uncertainty of their career choices or opportunities or both
In reply to
@Alliance4ClinEd, @COMSEPediatrics, @Surg_Education, @AAIMOnline, @apgonews, @STFM_FM, @CDEMfaculty
T1: #Medstudent Depersonalization, poor sense of autonomy, and stagnation of the pace of achievement all leading to the the single most important factor: isolation #meded
In reply to
@Alliance4ClinEd, @COMSEPediatrics, @Surg_Education, @AAIMOnline, @apgonews, @STFM_FM, @CDEMfaculty
#MedEd I think connecting to clinical work can help. However--research showing that empathy *decreases* during clinical years shows that connections to pts are not enough.
In reply to
@GLBDallaghan, @Alliance4ClinEd, @COMSEPediatrics, @Surg_Education, @AAIMOnline, @apgonews, @STFM_FM, @CDEMfaculty
We published a paper that touched on how broken systems lead students to develop cynicism and, basically, burnout. So yes, the medicine is hard, but the broken system may be just as bad. #mededhttps://t.co/7kAby2ULP7
It may lessen stress, but it is somewhat artificial- they all know it it is ultimately competitive. In my experience w residency admissions, most students seem to end up ranked one way or another. #meded
T1: It may be better when #USMLE step 1 becomes pass/fail. Forces residencies to choose applicants based on things that really matter. like #competencies beyond just medical knowledge. #meded
The PA helped get me gowned/gloved, and instructed me to walk around the CPB machine.
"Try not to break scrub, but if you do no worries we'll get ya sterile again!"
That forgiving attitude persisted all case. Nothing to prove, everything to give. What a woman!
T1 #meded The frightening thing is that if the program directors don't have #USMLE they will find another arbitrary metric. Not sure what could be done....
In reply to
@RichmondDoc, @MedEdChat, @myheroistrane
It isn't surprising at all -- what is unfortunately true is that imposter syndrome will only continue and be exaggerated through all levels of training. We shouldn't expect students to have significantly different experiences than our own, after all. #MedEd
#MedEd I do think a P/F USMLE regimen would seem to make things better...but will be heavily dependent on residencies doing the hard work of holistic evaluation.
But we’re fooling ourselves if we think pre-clerkship grades matter in any meaningful way to most program directors. USMLE step 1 is king for screening applications #meded
T1: We are still learning re specific factors driving student distress; pass/fail preclinical curriculum improved student distress at our institution https://t.co/X18YMdQm0N
t1: why not integrate healthy lifestyles into school? time each day for working out; time each day for healthy eating; time each day to study etc... #meded
Prevailing notion of empathy decrease in med school has been challenged - it seems to be more complex, scales may not capture this -my students tend to disagree with this formulation See "reconsidering decline in empathy" Roff 2015) #meded
#MedEd I think connecting to clinical work can help. However--research showing that empathy *decreases* during clinical years shows that connections to pts are not enough.
In reply to
@GLBDallaghan, @Alliance4ClinEd, @COMSEPediatrics, @Surg_Education, @AAIMOnline, @apgonews, @STFM_FM, @CDEMfaculty
Not trying to be clever here, but it is a continuum. We try to create an ideal environment for them - I do every day - but in the end, their experience will be the same as ours. Shielding or training them is less helpful than fixing the systems in which they'll work. #meded
In reply to
@MedEdChat, @Alliance4ClinEd, @hedy_wald
This might be a good time to share I’m looking forward to speaking at @StanfordMed@StanfordMedX this Spring about critical thinking in #journalism and #MedEd. It’s impressive that the organizers consistently apply the theme of #innovation to both cognitive & gender #diversity 😊
That's the concern: that a tool with little value is being endowed w/ great importance, and driving student behaviors in ways that are dysfunctional, and may be harmful. #MedEd
T2 #meded@jprunuske has it right. We need to build in time for healthy living. Set aside time for wellness that is unstructured so #medstudents can do what is healthy for them!
Can we think abt reasonable expectatns&expected levels of "stress" in med school?-part of blding coping...may B able2exercise 1 wk but not another, etc Prepare self4tough study weeks, etc. but within reasonable learning env. Good2have peer resilience role models4support #meded
#MedEd Need to address multiple issues: how residencies eval applicants. How students are assessed in meaningful ways. Reviewing med school curricula to see if we can better focus teaching efforts on high-value content.
T2: more support for students. Decreasing stigma. Finding ways to make med school more affordable. My loans still depress me. Med students work and get abused so much 3rd and 4th year. The cost should be lower since they are working. #Meded
if you gave me this time, I'd study or find some kind of research to do, because it is ultimately competitive and someone else will use that time in such a way. #MedEd
T2 #meded This is where there is a difference with preclinical education. The learning environment can be a huge factor in 3rd & 4th years. How can clerkship directors influence that?
T2: more support for students. Decreasing stigma. Finding ways to make med school more affordable. My loans still depress me. Med students work and get abused so much 3rd and 4th year. The cost should be lower since they are working. #Meded
Agreed. That’s what I’m saying. Transition to P/F doesn’t “do” anything to the step 1 importance because the preclerkship grades are already basically meaningless to PDs. #meded
We cannot create ideal environments. We can strive to create reasonable learning environments. We cannot erase "stress." We can work2help fix systems& we should...& we can try2inspire their advocacy but that is a long-range plan. #meded
Not trying to be clever here, but it is a continuum. We try to create an ideal environment for them - I do every day - but in the end, their experience will be the same as ours. Shielding or training them is less helpful than fixing the systems in which they'll work. #meded
In reply to
@MedEdChat, @Alliance4ClinEd, @hedy_wald
T2 We can encourage our institutions to take a holistic view of student wellness: not just more free time (often becomes study time), but to change how we guide students in their studying and in setting priorities. #MedEd
#MedEd Some of our med students have shown me there Step 1 study plans: 6 weeks. 1/2 day off each week. Specific content to study each and every day. I don't see how they can do it w/o burnout.
Not trying to be clever here, but it is a continuum. We try to create an ideal environment for them - I do every day - but in the end, their experience will be the same as ours. Shielding or training them is less helpful than fixing the systems in which they'll work. #meded
In reply to
@MedEdChat, @Alliance4ClinEd, @hedy_wald
Completely agree, but we should be more honest with our students-- they see through the charade. We should definitely give them the space and time to learn as they need, and the best clinical experiences they can get. #meded
T2 #MedEd do we really need (in many cases) 1-2 semesters of teaching basic science content which will not directly impact future practice? What is the minimum necessary understanding of this content which has value--focus there, perhaps?
MayB can help students understand there is a devl progression within training and that "imposter" feelings may B experienced even at residency & beyond -see students' voices on PIF https://t.co/cxQpl0ckUS#meded
T2 #MedEd time = prioritization. If given more time question is what will students do? Study more or do the things that bring meaning/purpose with colleagues, since of autonomy/control and competence? #JGME#4welldocs@AuroraMedEd
T2 #meded@jprunuske has it right. We need to build in time for healthy living. Set aside time for wellness that is unstructured so #medstudents can do what is healthy for them!
T2 #MedEd In M3/M4 we need to encourage our schools to address the hidden curriculum, and behaviors from teachers that add to student stress. What is the current rate of med student mistreatment? And how much behavior doesn't meet that threshold, but is a problem?
T2 #meded So this relates to the #HMIChat discussion last night about the trustworthiness of medical educators. Does transparency and trustworthiness of faculty help #medstudents feel connected and cared for in school?
T2 I would hope that if we re-focus expectations away from exam scores, and towards higher-value and meaningful assessments, then maybe space and time opens up in the schedule to allow more down time. #MedEd
T2: trust students to learn, inspire them to learn. They arrive curious, #MedEd schools beat it out of them and teach study to boards & match. Allow true #selfdirected learning
Medical students are savvy. It doesn't take long for them to see through charades. The opposite is also true-- in my experience, they flock to authenticity (but not cynicism). #meded
T2 I agree: "Culture eats strategy for lunch." We can have plans, but at the end of the day, we need our systems where we work and where are students learn to focus on human wellness. #MedEd
In reply to
@laxswamy, @MedEdChat, @Alliance4ClinEd, @hedy_wald
That is true. We need to work to fix the healthcare system bc no matter how much we help them in med school, as an attending, the system is still contributing to burnout #meded
In reply to
@laxswamy, @MedEdChat, @Alliance4ClinEd, @hedy_wald
T2 #meded - puzzling all discussion is about what do for students and curriculum - what about #faculty and their well being as live and create the environment = #Wellbeing
Ok I totally agree with #MakeUSMLEPassFail.
Let’s try this one, too: what if all course directors coordinated w/ each other so that daily assigned work could actually be completed by the average student. Then students wouldn’t have to guess or triage.
#meded
T2 I agree: "Culture eats strategy for lunch." We can have plans, but at the end of the day, we need our systems where we work and where are students learn to focus on human wellness. #MedEd
In reply to
@laxswamy, @MedEdChat, @Alliance4ClinEd, @hedy_wald
T2 - wellness is complex. Can’t “resiliency our way out of the problem. Nice model here. Many potential targets for improvement. #mededhttps://t.co/6BxWajvnzM
T2 #meded This is the hot question right now. We are focusing on #medstudent wellness, but overlook faculty wellness. How can the system be changed to help all health care providers?
So moved, inspired, & humbled by this wonderful event on so many levels. Congrats to @SandrijnM as first holder of the Baum Family Presidential Chair for Experiential Learning! Loved the stories & the parallels btwn #meded & aviation sims. Excited about what's next @UCSFMedicine!
Well, I think there is solid reasoning in "protecting" the students -- to a degree. We do need to be honest with them without being cynical, which is rare. #meded
In reply to
@RJmdphilly, @GLBDallaghan, @MedEdChat, @jprunuske
Ok I totally agree with #MakeUSMLEPassFail.
Let’s try this one, too: what if all course directors coordinated w/ each other so that daily assigned work could actually be completed by the average student. Then students wouldn’t have to guess or triage.
#meded
T2 #meded So this relates to the #HMIChat discussion last night about the trustworthiness of medical educators. Does transparency and trustworthiness of faculty help #medstudents feel connected and cared for in school?
#MedEd This presumes that we have health systems that value education and teaching on par with clinical work. If in an RVU-based comp plan that does not value teaching, then many good teachers will find themselves focused on RVU-generating work.
T2 #meded - puzzling all discussion is about what do for students and curriculum - what about #faculty and their well being as live and create the environment = #Wellbeing
Guided reflective writing &other humanities endeavors can be helpful w/recognizing one's strengths&triumphs in clinl wrk along the way, connecting authentically w/faculty&receiving formative feedbk, need facdev #meded
#MedEd and what if med student assessments focused on meaningful learning tasks and high-value skills/knowledge, and not faculty areas of research focus or particular niche expertise?
T2 #meded Key to this is formative feedback. We've had some reflective writing in our new curriculum with little or no feedback offered. That has to change.
#MedEd I think that focusing on students here is in part b/c as faculty, we have some additional flexibility in our schedules and additional resources (time, $) to get away from stress--at least from time to time (1/2).
#MedEd (2/2) This is NOT to say that the systems in which we work/teach are flawless: major changes are needed. But students are more vulnerable, perhaps, or more at-risk then faculty are?
How easy is it to get a same-day appt with a counselor/psychologist? As a recovering clerkship director, I would say this is much harder than getting a day off. #meded
When I chose to focus on teaching vs. clinic, my workload did not decrease, my at-home work increased, and my salary dropped. Incentives and priorities seem clear. #MedEd
In reply to
@jamee_walters, @MedEdChat, @jprunuske
T3 #meded I have struggled with this in having to resolve student mistreatment at my institution. It's not easy to do because I have to pull out my dean title to get any forward motion.
In reply to
@Alliance4ClinEd, @BJBRoman, @DrHowardLiu, @_Roberts_Laura, @COMSEPediatrics, @Surg_Education, @AAIMOnline, @CDEMfaculty, @apgonews, @STFM_FM
T2 #meded Key to this is formative feedback. We've had some reflective writing in our new curriculum with little or no feedback offered. That has to change.
#meded giving faculty the time to teach. We are professors yet in the clinical world, we don’t get any time. So the students suffer. Also, think about redesigning 1st year. It’s so redundant from the pre-reqs in college. #meded.
#MedEd Reading our students' assignments where they considered self-care activities and then wrote about the barriers they faced in making that happen has been one of the more difficult assignments to grade. So bleak.
T3: create a culture where vulnerability is openly shared, learning communities cultivate shared experiences to minimize isolation, and recognize the need to create time and space for reflection and resilience for #medstudents#meded
#Meded Many models to think about individual and system issues - the new @theNAMedicine graphic may provide a common vocabulary for how to discuss both as a "yes and..." that crosses all players in clinical learning environment. #JGME@AuroraMedEd#4welldocs
In reply to
@MedEdChat, @theNAMedicine, @AuroraMedEd
Yes! Teaching is a full time job in college and the primary years. But for some reason we are supposed to fit it in with a full-time clinical job. #meded
When I chose to focus on teaching vs. clinic, my workload did not decrease, my at-home work increased, and my salary dropped. Incentives and priorities seem clear. #MedEd
In reply to
@jamee_walters, @MedEdChat, @jprunuske
Wonder how much it’ll help in reality, but seems like @CMSGov is finally listening & allow teaching faculty to verify & use med student notes for E/M services. #meded
In reply to
@RichmondDoc, @jamee_walters, @MedEdChat, @jprunuske, @CMSGov
I don’t think we are that focused enough on understanding and deep learning. Dan Pratt’s work suggests that most medical educators have a transmission perspective, when the methods we try to do are more aligned with the developmental perspective. https://t.co/wiTYTmvjFw#meded
@mmteacherdoc so true! Even people who are suicidal cannot find help. Not enough docs, not enough support, not enough resources. outside looking in: you're in med school, you're doing fine and have it made! #meded
How easy is it to get a same-day appt with a counselor/psychologist? As a recovering clerkship director, I would say this is much harder than getting a day off. #meded
#MedEd Sort of. My understanding is that the student documentation only helps if documented by the student with the faculty member present throughout...
In reply to
@mmteacherdoc, @jamee_walters, @MedEdChat, @jprunuske, @CMSGov
I don’t think we are that focused enough on understanding and deep learning. Dan Pratt’s work suggests that most medical educators have a transmission perspective, when the methods we try to do are more aligned with the developmental perspective. https://t.co/wiTYTmvjFw#meded
I cannot wait! It will help in my practice, if nothing else, it will drive me to be a more effective teacher and more engaged in helping students write stronger notes! #MedEd
Wonder how much it’ll help in reality, but seems like @CMSGov is finally listening & allow teaching faculty to verify & use med student notes for E/M services. #meded
In reply to
@RichmondDoc, @jamee_walters, @MedEdChat, @jprunuske, @CMSGov
Check out these dissemination metrics #MedEd peeps! Keep in mind, this preprint has been on the street for 1 week. Kind of incredible. Preprints, hmmm..... @LaurenMaggio@erikwdriessen
In reply to
@biorxivpreprint, @LaurenMaggio, @erikwdriessen, @LaurenMaggio, @erikwdriessen
#MedEd I think the potential resolution goes beyond any one school: need a national reassessment of what we value in med school (memorizing data? working with patients? clinical reasoning?), how we assess those skills, and how residencies assess students.
T3 #meded I met with a student for 90 minutes yesterday to help with academic issues (and also emotional ones). As the #edpsych person in the college, I am doing more and more of this. You're right....there aren't enough people to help!
Such a complex issue. Years ago, we hoped the work hour limitations would help. Now the wellness and resiliency initiatives, yet concerns persist. As far as student mistreatment, must be zero tolerance. #meded
In reply to
@Alliance4ClinEd, @DrHowardLiu, @_Roberts_Laura, @COMSEPediatrics, @Surg_Education, @AAIMOnline, @CDEMfaculty, @apgonews, @STFM_FM
I think work hour restrictions may have made it worse. Less engagement, stress with handoffs, rigid rules, rather than supporting doctor (#meded student) and patient relationships leads to increased burnout.
Such a complex issue. Years ago, we hoped the work hour limitations would help. Now the wellness and resiliency initiatives, yet concerns persist. As far as student mistreatment, must be zero tolerance. #meded
In reply to
@Alliance4ClinEd, @DrHowardLiu, @_Roberts_Laura, @COMSEPediatrics, @Surg_Education, @AAIMOnline, @CDEMfaculty, @apgonews, @STFM_FM
T3 Individual schools can certainly work to make things better...but may fear unilateral disarmament. If we stop focusing on Step 1, will our students still match? To good programs? Does that affect credentialing? #MedEd
Since my hospital 'could not afford' to buy equipment ( ~$4000) to help my anaesthesia department 4 difficult cases, I bought stuff from Amazon worth $15 and made a make-shift version.
Worked excellently today in an unanticipated difficult airway patient.
T3 #meded Nothing of focus for faculty well being that I've seen in the LCME Standards. I review them weekly and have not come across anything related to what ACGME is doing.
In reply to
@debsimpson3, @MedEdChat, @AAMCMedStudent, @AmerMedicalAssn
Final thoughts: we should all work to make our individual schools more humanistic, but also work to change the broader system. "Start where you are, use what you have, do what you can." -- Arthur Ashe #MedEd
We hoped limiting their weekly in-hospital work hours to twice a normal work week would be helpful. What would you say to a patient who is struggling and working 80 hours (sometimes more) a week? #meded
Such a complex issue. Years ago, we hoped the work hour limitations would help. Now the wellness and resiliency initiatives, yet concerns persist. As far as student mistreatment, must be zero tolerance. #meded
In reply to
@Alliance4ClinEd, @DrHowardLiu, @_Roberts_Laura, @COMSEPediatrics, @Surg_Education, @AAIMOnline, @CDEMfaculty, @apgonews, @STFM_FM
understood @RichmondDoc ...we've integrated interactive guided reflective writing w/faculty feedback within doctoring course&fam med clerkship, it's part of the culture. #meded
Here are some of the key points from my talk on #JoyinWork@TheIHI this year. I opened w mentorship advice from @AmaliaCochranMD -recently shared @UMichSurgery. Institutions may see you as an interchangeable widget. Find your people. Find culture. #ihiforum
Such a great thought. We would never want our patients to work 80 hrs/week. But for some reason we think it’s helpful for us. #meded#medtwitter#takeourownadvice
Here are some of the key points from my talk on #JoyinWork@TheIHI this year. I opened w mentorship advice from @AmaliaCochranMD -recently shared @UMichSurgery. Institutions may see you as an interchangeable widget. Find your people. Find culture. #ihiforum
Burnout and depression are crises in health care. They are complex problems that will be hard to fix. But we can’t kick the can down the road on this. Optimize the clinical learning environment. Prioritize key skills. Deprioritize multiple choice exams. #meded
