Master Adaptive Learners

Master Adaptive Learners

Lou Edje, MD, MHPE, FAAFPAssociate Dean, Graduate Medical Education

University of Cincinnati Medical CenterDepartment of Family & Community Medicine

Department of Medical Education Professor Educator

University of Michigan Medical SchoolMD 1995, MHPE 2017

Faculty Disclosure

None

The content of this material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices.

Background

• University of Michigan Medical School (UMMS), MD, 1995• Program Director, formerly Dually Accredited Program • Masters Health Professions Education (MHPE), Michigan Medicine, 2017• Family Medicine Review Committee, Accreditation Council for Graduate

Medical Education (ACGME)• Peer Reviewer, Journal of Graduate Medical Education (JGME),• Peer Reviewer, Family Medicine• Former Admissions Executive Committee, UMMS• Past President Michigan Medicine Alumni Society• Associate Dean, Graduate Medical Education, University of Cincinnati

Objectives

• To understand the master adaptive learner conceptual framework

• To be able to articulate the characteristics of a master adaptive learner

• To define adaptive expert• To be able to articulate three applications of master adaptive

learning

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₤1.4 Million

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Adaptation During Rapid Change

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Medical Knowledge

26 seconds

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https://www.weforum.org/agenda/2020/03/speed-science-coronavirus-covid19-research-academic

Sorting Through Speed Science

Fasting labs

Daily glucose monitoring

Annual pap

Manual BP cuff

Ebell MH, Shaughnessy AF, Slawson DC, “Why are we so slow to Adopt Some Evidence-Based Practices?” American Family Physician December, 2018 Vol 98, 12

Slow Uptake of best practices

Adaptation During Rapid Change

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Medical Knowledge

How do you learn that a drug has been recalled?

1. I learn about it when a colleague asks me what I’m using with patients instead.

2. My inbasket will have a message from a patient who is asking to be switched to another med.

3. It’s been recalled? Good to know!4. I receive a push notification from the FDA.5. If I take it myself, my pharmacist will call me.

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What does the literature claim about learning after residency?

“Many clinicians may NOT be learning effectively in practice.”

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Regehr G, Mylopoulos M. Maintaining competence in the field: Learning about practice, through practice, in practice. J ContinEduc Health Prof 2008; 28 1 suppl1):S19-S23Mylopoulos M. Brydges R, Woods NN, Manzone J, Schwartz DL. Preparation of future learning: A missing competency in health professions education? Med Educ. 2016;115-123

Theories on Expertise

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Dreyfus, SE The Five-Stage Model of Adult Skill Acquisition, Bulletin of Science Technology & Society 2004 24: 177

ProficientCompetentAdvanced Beginner

Theories on Expertise

Ericsson (1993)10,000 hours

Ericsson, Psychological Review 1993, Vol. 100. No. 3, 363-406

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Theories on Expertise

Gobet, Chassy (2009)

Intuition

17 Gobet, Chassy Expertise and Intuition: A Tale of Three Theories Minds and Machines 19(2):151-180 · May 2009

Routine expertise

Mastering performance to the level of efficiency and accuracy based on skills and knowledge learned over time.

18 Cutrer WB, et al. Fostering The Development of the Master Adaptive Learner, Acad. Med Vol. 92, Iss 1, Jan, 2017

Adaptive Expert

• Physician who balances routine expertise with innovative problem solving in response to practice challenges

• Explores new concepts• Invents new solutions

19 Cutrer WB, Fostering The Development of the Master Adaptive Learner, Acad. Med Vol. 92, Iss 1, Jan, 2017

• Capacity to learn new information

• Make effective use of resources

• Invent new procedures to support learning and problem solving in practice

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Preparation for Future Learning

Preparation for Future Learning

• Openness to reflecting on practice

• Recognition that routine expertise is not working

• Critical thinking to challenge current assumptions

Goal of Medical Education?

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Develop Adaptive Experts

How do we develop adaptive experts?

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By DevelopingMaster Adaptive Learners

Master Adaptive Learner

PLANNING

LEARNINGADJUSTING

ASSESSING

Master Adaptive Learner

PLANNING

Planning

• Identifying GAPS in knowledge (what?)• Selects an OPPORTUNITY for learning (when?)• Searches for RESOURCES for learning (how?)

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Planning

•Identifying knowledge GAPSchön’s “surprise”Cognitive dissonanceOptimal learning

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Knowledge Gaps

• Aggressively seeks and fills them• Does critical self-reflection• Elicits feedback

Siddiqui ZS, Jonas-Dwyer D, Carr SE, Twelve Tips for Peer Observation of Teaching, Medical Teacher, 29:4,297-30028

Planning

• Selects an OPPORTUNITY for learning

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U = useful R = relevantV = valid (correct)W = work (requires little effort to obtain)

Planning

• Searches for RESOURCES for learning

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Planning

• Searching • Includes human and material resources• Driven by level of cognitive dissonance• 7-pancake example

Master Adaptive Learner

PLANNING

LEARNING

Learning

• Ineffective learning strategies:Highlighting UnderliningRe-reading

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• More durable learning strategies:Knowledge Retrieval PracticeSpaced Repetitious Learning Concept Interleaving

Knowledge Retrieval Practice

Axillary frecklesNeurofibromas

Café au lait spots Lisch nodules

Mental retardationShort stature

von Recklinghausen Neurofibromatosis (NF1)

RESTATE LIST FROM MEMORY

34 Glen D, Close the Book, Recall, Write It Down. Chronicle of Higher Education, Vol 55, Iss. 34, May 1, 2009, pg A1

Spaced Repetitious learning

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Hermann Ebbinghaus

Single-topic noon conference

Mon COPDTues ABC’s of PFTs Wed Asthma

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vs

Rohrer D, Interleaving helps students distinguish among similar concepts Educational Psychology Review, 24, 35-367

Concept Interleaving

Master Adaptive Learner

PLANNING

LEARNING

ASSESSING

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INFORMED SELF-ASSESSMENT

Assessing

https://www.ncbi.nlm.nih.gov/pubmed/20375832

Tries out what was learned

“No matter how well-trained people are, few can sustain their best performance on their own. That’s where coaching comes in.”

Atul Gawande

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https://www.newyorker.com/magazine/2011/10/03/personal-bestSiddiqui ZS, Jonas-Dwyer D, Carr SE, Twelve Tips for Peer Observation of Teaching, Medical Teacher, 29:4,297-300

Assessing

Master Adaptive Learner

PLANNING

LEARNINGADJUSTING

ASSESSING

•Incorporates what was learned into practice

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Adjusting

Master Adaptive Learner

PLANNING

LEARNINGADJUSTING

ASSESSING

MAL Characteristics

Curiosity

Motivation

Mindset

Resilience

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MAL Learning Environment

Embraces Vulnerability

Values Feedback

Fosters Growth Mindset

Nurtures New Ideas

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Growth Mindset

A “growth mindset,” thrives on challenge and sees failure not as evidence of unintelligence but as a heartening springboard for growth and for stretching our existing abilities.

Growth Mindset

https://profiles.stanford.edu/carol-dweck

Application #1

Re-Envisionsing Family Medicine Education

ABFM Diplomate Survey Supports Need for MAL

• >70% late career ABFM diplomates have worked in >3 practices

• >50% late career diplomates have changed populations they care for

• >50% of late career diplomates identify need for new emphasis in:

• Telehealth• Integrated behavioral health• Leadership in communities and health care systems• Social Determinants of Health/Disparities

Application #2

Curricular Review Working Toward Equity

MHPEMHPE Summer Retreat 2020

Lou Edje, MD, MHPE, FAAFPMHPE Faculty, Alumna: MD 1995, MHPE 2017Associate Dean, Graduate Medical Education

Professor-Educator, University of Cincinnati Medical CenterDepartment of Medical Education

Department of Family & Community Medicine

John Vasquez, PhD, MHSAMHPE Faculty

Director of Assessment & Professional Development Van Andel Institute Graduate School

Working Toward Equity in Medical Education

MHPE

To become familiar with definitions used in discussions of equity and race

To able to define growth mindset and understand its usefulness as a platform for courageous conversations

To engage in robust, case-based discussion around potential curricular pitfalls and learner interactions

Objectives

MHPE

As it relates to implicit bias and systemic racism, our GAPs as educators are not just Schoen surprises

…they can harm our learners

MHPE

Pluripotentiality

Wellbeing

MHPE

First, do no harm

MHPE

Pluripotentiality

Truncate fund of knowledge

MHPE

https://www.nejm.org/doi/full/10.1056/NEJMp1915891

First, do no harm

MHPE

Definitions

MHPE

Growth Mindset

& Race

MHPEFacilitatorNote-taker

Breakout Room

MHPEYou are giving a lecture on sexually transmitted

infections using the following case:

A 45 year old Black female presents with a yellow vaginal discharge four days after unprotected intimate contact with a complete stranger. She complains of a low grade fever and some pelvic pain as well as dysuria.

1) What could a Black female learner be thinking during this scenario?

2) How could you improve this scenario?

Case

MHPE

At Your Home Institution

What signals have you picked up that under-represented trainees in your department or discipline may have similar experiences as those in the case?

How has your department or program formally gathered information about the experiences of URM trainees?

Have you undertaken comprehensive review of your curriculum through the lens of URM trainees?

MHPE

At Your Home Institution

How are you centering the voices of and protecting against undue emotional labor by under-represented colleagues and trainees in this process?

What peer support initiatives are in place for trainees in your program, department, division?

Go Blue!

MHPE

Resources

PLANNING

LEARNINGADJUSTINGMaster

Adaptive Learner

ASSESSING

Application #3

Twitter as a adaptive resource

Applications

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@ = handle = @ddress

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# = hashtag • Community of

individuals having a discussion

• Looks like a net• Click on it to follow

discussion• Engage by including

hashtag in your tweet

Applications

Applications

• Passive: just follow, receive alerts• May plug into someone’s handle and

see who they are following

• Active: post, join discussions, “live tweet”

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Who’s in the Twitterverse?

Medical Journals

Medical Institutions

Medical Schools

Medical Organizations

Medical Learners

ColleaguesPatients

Influencers

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Who’s in the Twitterverse?

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Who’s in the Twitterverse?

Patients

Influencers

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Summary

Master Adaptive Learner: Plan, Learn, Assess, Adjust (PLA)

Adaptive Expert: Routine expertise + innovative problem solving in response to practice challenges

Possible Applications for the MAL conceptRe-Envisioning Family Medicine Residency EducationWorking Toward Equity in Medical EducationTwitter a an adaptive resource

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edjelc@umail.uc.edu

Louito Edje, MD, MHPE, FAAFP@ledje