By chance or by design? How clerkship and course directors navigate academic medicine

poster abstractAcademic medical centers (AMCs) are complex, bureaucratic organizations with multiple, interconnected missions and constituencies (Brater, 2010). What happens in the classroom affects the operating room and lab. As the responsibilities to treat patients, discover new medical knowledge, and train future physicians become more complex, it is critical to define and situate the pathways to and roles of medical education leaders within the system, so that institutions can fully benefit from their contributions. This study uses an organizational communication lens to develop a theoretical understanding of the relationship between faculty members who are clerkship and course directors (CDs) and AMCs in the U.S. Clinical faculty who become CDs often do so because they are gifted educators. They are responsible for developing faculty, as well as managing curriculum and assessment. These complex roles often lack clear position descriptions and expectations. Though CDs value education, they may face economic pressures to spend more time in clinical duties at the expense of their education responsibilities (Cooke et al., 2006). This can create conflicts in organizational identity and values, as well as an unclear path to tenure, promotion, and rewards (DeAngelis, 2004). This study uses in-depth interviews to explain how CDs manage the multiple (sometimes competing) values and priorities of their roles. Semi-structured interviews were conducted with eight CDs, from institutions of similar size and type, to investigate three interrelated concepts: how faculty become CDs; how they make sense of their roles and values in relationship to those of the institution; and how the structure of AMCs shapes the roles and values of CDs. A qualitative approach, as applied in this study, is useful to understand behavior in complex organizational contexts (Castillo-Page et al., 2012). Interview findings were aggregated into significant narratives and organized by theme, including: pathways to the role; a conflict in values; inconsistent funding; and structural challenges. A grounded theory was developed to explain the process by which CDs manage their complex roles. Findings from this study indicate that CDs are critical to the education mission and can be powerful in shaping the institution, though they face significant challenges. They can feel isolated, because each institution might only have a few individuals that serve these functions. Diverse responsibilities of CDs might also mean that their paths to promotion are unclear or tenuous. Further research is necessary to understand the process of socialization and impact of the reward structure for CDs. Clerkship and course directors do seem to value their sense of organizational identification within multiple contexts, including the medical school, discipline, and the hospital system. In the same vein, it would be helpful to have a better understanding of the connections among their multiple identifications. Additionally, exploring the identification of university faculty in multiple settings may serve to expose subtle differences for identification management used in different contexts for faculty with different roles. Results of the study can be used to shape policies and faculty development efforts for CDs, leading to a clearer sense of purpose and reward system. A deeper understanding of the experiences of CDs benefits both faculty and institutions. Faculty receive more role clarity and individual agency, and AMCs receive information on how to better meet the needs of this population, thus improving the efficacy of medical education

Hearing Is Believing: Using Audio Feedback in the Online Interpersonal Communication Course

The introduction to interpersonal communication course (IPC) is popular for both communication majors and nonmajors alike, and as such, many departments have designed online versions of the course. Teaching IPC in this format has challenges, given its dual emphasis on theoretical understanding and skill-building. This reflection essay explores the efficacy of providing audio feedback on essays in the online IPC course, as a way to create a positive online presence, manage the grading load, and encourage students to implement the feedback. The rationale for this approach to feedback and implementation strategies are provided, as well as a discussion of outcomes from the intervention. A review of course data and perceptions indicated gains in student application of course material and satisfaction with the audio feedback mechanism

Making Science Make Sense: Applied Improvisation in Health and Life Sciences

poster abstractAbstract Both in and out of the classroom, physicians and scientists must speak in a way that generates excitement about their disciplines (Berrett, 2014). They also must communicate vividly to funders and policy makers about their work and why it matters. In every context, these experts must tell engaging stories, respond spontaneously to the needs of the moment, and explain their work in terms nonscientists can understand. In response, some universities have turned to the techniques of improvisational theater to help scientists to speak more spontaneously, responsively, and engagingly. Over the past year, we have conducted a series of workshops (N=54) for a variety of audiences including, doctoral and post-doc students in the sciences, for educators, for physicians and research scientists, and for doctoral nursing students. The workshops help participants make stronger connections to their multiple audiences. They include content on improvisation skills such as presence and listening, acceptance, recognizing offers, and storytelling to help scientists translate their research in ways that engage their audiences. This approach moves faculty toward understanding communication as a process of collaborative meaningmaking, thus helping them to address the “curse of knowledge” by which experts forget the time when they were novices in their field (Bass, 2015). This poster will report on four key areas of the intervention and evaluation: 1) the need for communication training in the health professions and sciences, 2) the development of the programs, 3) the program efficacy and outcomes. Higher education presents unique challenges for the practice of applied improvisation. While enthusiasm for the work has grown in industry, some audiences within the academy seem resistant to the methods, especially within the sciences. This poster will also address the ways expertise, prestige, and rank affect the practice of applied improvisation in higher education, and we will propose strategies for mitigating resistance

Narrating Patienthood: Engaging Diverse Voices on Health, Communication, and the Patient Experience

Biomedical researchers are trained to use positivistic approaches to develop efficacious treatments and pursue cures for illness and disease. Accordingly, they rarely engage persons living with the disease in the development of research questions and protocols (Sacristán et al., 2016). Just as patient narratives can create therapeutic partnerships in delivery of treatment (DasGupta & Charon, 2004), they offer value to the research process as a means to emphasize the person with the disease, rather than the disease, in isolation. We are interested in the role of patient stories as tools for influencing the biomedical research process (Greenhalgh, 2009; Panofsky, 2011). Applying Ellingson’s (2009) approach to crystallization in qualitative research, we explore intersections in the literature on patient advocacy, our own narratives, and those from biomedical researchers and patients. We seek to uncover the meaning of involving not only patients, but patients’ stories (Hyden, 1997), in creating an agenda for research in healthcare

Twelve tips for using applied improvisation in medical education

Future physicians will practice medicine in a more complex environment than ever, where skills of interpersonal communication, collaboration and adaptability to change are critical. Applied improvisation (or AI) is an instructional strategy which adapts the concepts of improvisational theater to teach these types of complex skills in other contexts. Unique to AI is its very active teaching approach, adapting theater games to help learners meet curricular objectives. In medical education, AI is particularly helpful when attempting to build students’ comfort with and skills in complex, interpersonal behaviors such as effective listening, person-centeredness, teamwork and communication. This article draws on current evidence and the authors’ experiences to present best practices for incorporating AI into teaching medicine. These practical tips help faculty new to AI get started by establishing goals, choosing appropriate games, understanding effective debriefing, considering evaluation strategies and managing resistance within the context of medical education

The Work/Life Portal: An Innovative Navigation Tool for Faculty Benefits & Policies

Project Benefits and policies of large academic medical centers can be challenging for faculty to navigate. A recent survey of faculty at our institution reported large gaps in their knowledge about and use of benefits and policies related to career flexibility. For example, nearly half of our faculty didn’t know about clock stoppage policies and expressed concern about how polices were communicated. Thus, the goal of this project was to develop a web-based solution to clearly convey work life benefits and policies. Methods In partnership with our school of art and design, a two-phase project was developed to design a new web portal for benefits/policies. In phase one, we conducted qualitative, usability testing of current web and print resources with the goal of further explaining the survey results. Semi-structured interviews were conducted with new and veteran faculty, as well as campus HR staff. They reviewed the current resources; provided feedback on what was unclear or hard to find; and finished by drawing their “dream website.” Results In phase two, the team used the design-thinking methodology to develop a prototype of the website. After systematically testing ideas, the team settled on a modified natural language user interface, where a faculty member types in a question or idea (e.g. “I’m having a baby”) and a series of policies is returned, associated with keywords within the question. The simple design of the interface allows faculty affairs office staff to assign word tags to policies/benefits that may appear in the user’s questions. A free online tool (http://wordpress.org) was used to create the portal. Conclusion The new portal allows our institution to create a clear online presence for work life benefits and policies, demonstrating our institutional commitment to supporting faculty. At the same time, the program uses resources efficiently. The only expenses incurred have been faculty and staff time to conduct the study and develop the portal. Implications While the portal is still in development, it demonstrates a promising shift in how faculty affairs offices can collaborate with faculty and internal partners. By designing and testing ideas with faculty and HR professionals, we created buy-in for the project early on. These individuals have the potential to become early adopters of the new portal, sharing their positive experiences with others

If I Quit in the Clinic and Do Nothing but Teach, I'm Going to Be Looking for a New Job: An Exploration of Uncertainty Management in Medical Education

Academic medicine in the United States is a complex field, changing regularly in response to new healthcare knowledge, emerging technologies, and evolving funding models. Uncertainty management theory (UMT) provides scholars a lens to make sense of how individuals experience uncertainty. This study employs UMT to explore the experiences of clerkship and course directors (CDs), faculty in U.S. medical schools who serve in education administration roles. Fifteen semi-structured, in-depth interviews with eight CDs over 14 months indicate complicated relationships with uncertainty at work. Interpreted through UMT, these results reveal that some CDs manage uncertainty discursively, and at times, leverage uncertainty to maintain agency within their roles. These findings indicate that it may be important to recruit CDs who feel comfortable with and can manage uncertainty and provide them with appropriate socialization and ongoing support. Broadly, the results suggest that a more nuanced understanding of uncertainty management experiences can benefit both employees and institutions; as employees gain more role clarity, institutions receive information on how to better meet employees’ needs