Wednesday, May 20, 2020

The COE course empowers trainees to change public health policy


Karissa Hammer, MD
Reproductive Endocrinology & Infertility Fellow
Department of OBGYN, MGH
PGY-5

03/24/2020

Karissa Hammer, MD
The COE public health policy course lifted the veil covering our complex medical system. As a physician, my training thus far has focused on disease processes and providing excellent evidence based care. However, I never completely understood why our country still struggled to give healthcare coverage and access to care to everyone. 

I am still frustrated when I frequently find myself spending excessive time on the phone to get insurance companies to cover medications for my patients, have patients not comply with medical recommendations for cost purposes, or patients come to me late into a disease process since they did not have access to a primary care provider for disease screening. 

This course allowed me to understand how our health system became so fractured and what efforts are being made to attempt improving it. I learned how I could play a role in improving access to care. The mystery of how to “fix” our broken healthcare system still exists, but it is clearer to me now what the breaks are and I feel empowered to be involved in changing it.

The redesign toolbox


Chijioke C. Nze, MD
Resident in BWH Internal Medicine
PGY-3

03/20/2020

Attendees of the COE Health Policy Course
“In business as in life, You don’t get what you deserve, you get what you negotiate.”


During medical school, it became obvious that of what we do in the hospital and individual interactions with patients, though meaningful only address a very small piece of the larger problems that cause illness and morbidity. It is obvious that we need population level interventions.

In order to Change or influence the system, we have to understand system; Interrogate our ignorance;  Kick the tires and abandon our biases. In the Last exercise, we went to negotiation table and try to emulate the process. It became
obvious that all actors in the system are just acting in what is perceived to be their best interest. In seeking individual best interests, the system is unfortunately harmed! The system isn’t broken by wicked evil people but by rational actors seeking their best interest. It is our job as policy makers and advisers to help steer the ship towards Prado optimum.

The COE Health Policy Course was an absolute gem. The insights into the current state of the healthcare system domestically and internationally was incredible. Despite my MPH in health policy, I learned an immense amount. The room was full of people with diverse experiences and contributions to the course. The wealth of knowledge in the room was invigorating. Ryan and Zirui are absolutely irreplaceable. Though we did not solve the mysteries of healthcare reform, I feel like I left with a toolbox to start thinking about and hopeful addressing my slice of the pie. I am re-energized to know how I as a physician can pull some levers in the system.

They taught me that it is not you cannot influence behavior by simply showing that it is the right thing to do. You must convince stakeholder that certain actions are in their best interest and align incentives to drive change. Another great quote “if it doesn’t make dollars it doesn’t make Sense (cents)”

Partners Health Policy Course was Inspiring!


Susannah Rudel, MBA/MPH
Deland Fellow at Brigham & Women’s Hospital
PGY1

03/19/2020

Susannah Rudel, MBA/MPH
The Partners Health Policy Course, offered through the Centers of Expertise, provided a fantastic learning opportunity! Hearing from leading health policy researchers and Partners administrative leaders made me feel inspired to keep more up-to-date on current health policies and policy changes, because I have a better understanding of how both national and state-level policy impacts the work we do within our healthcare system. More specifically, I now have a much better understanding of how the health policy context, such as different payment rates for different types of insurance, affects the day-to-day hospital operations that are so crucial to enabling us to continue providing care to our community.

The course was also valuable in providing both a macro and micro lens into health policy. For example, we learned a simple framework for the different levers that can be pulled to impact total healthcare spending, which was helpful for thinking about the macro-level, national conversation about controlling healthcare costs. At the same time, we heard from local Partners leaders about the different levers we have available at the hospital or health system level.

Looking ahead to how I will be able to apply what I learned in my career, I believe the course content will enable me to be a more effective administrator, because I better understand the policy context in which Brigham & Women’s Hospital operates. I think the knowledge I gained through the course will be crucial in making well-informed decisions throughout my career, and will also allow me to be a better consumer of health policy information and changes because I have a base understanding of the institutions and policies at the foundation of our healthcare system.

A necessary supplement to patient care!



Mariel E. Bailey, MD
Resident in BWH/BCH Medicine/Pediatrics
PGY-3

03/18/2020

A typical day inpatient for the house staff involves caring for
individual patients' on teams and presenting medical information
to their peers 
I was thrilled to be selected for participation in the health policy and management course offered by Partners GME Centers of Expertise.  As housestaff, I primarily spend my time in the hospital or sometimes ambulatory clinics learning about specific disease pathology, the myriad ways the individual patient can become ill or become well.  I rarely get the opportunity to take a step back and think about how we as a health care system can adjust our infrastructure to better serve these patients as a whole.  There aren’t many opportunities to learn from the head of Massachusetts General hospital, or the director of Blue Cross/Blue Shield about the way they approach patient care, but the health policy and management course performs just that.  

By giving a larger framework for understanding what kinds of care our patients have access to, and how their care is paid for, I feel that I can now better serve my patients on th  Knowing more about how these decisions about distribution of care and funding of care are made helps immensely as we try to navigate this complicated health care landscape with our patients, and contemplate our role in changing the way health care is delivered in the future.
e front lines as they make complicated decisions about their own care. As trainees we spend more facetime with these patients than many executives and policy makers, and we view policy decisions and insurance changes through the lens of our patients in the hospital or in clinic.

ACGME in San Diego: Meaning of Medicine in 2020


Leben Tefera, MD
Vascular Medicine Fellow at Massachusetts General Hospital
PGY – 5

03/15/2020

ACGME National Conference 2020 in San Diego
The theme of this year’s 2020 ACGME Conference was “Meaning in Medicine.”The conference was attended by over 4000 physician educators and those that support residencies and fellowships from around the country.

A major theme that was hit throughout the conference was physician wellness and the increasing utilization of social media in medicine. With regards to wellness, several sessions highlighted several factors weighing on physicians and contributing to burnout. A recurring finding was time. Simply put, physicians do not have enough time. Increasingly, physician’s work follows them home, requiring them to finish notes or respond to patient portal messages in the evenings. In doing so, hours have been taken from the physician’s family or personal recovery time. So what can we do about it? Simply put, support. Be it in the form of ancillary staffing or decreased patient burden, additional staffing and work load support have been proven to decrease physician burnout. Additionally, social media has become a means of physicians outreach/communication and more recently, has proven to be a means of collegial support, acting almost as a form of therapy.

#ACGME2020 was an incredible conference. It opened up my eyes to the struggles faced by physicians and health care providers, but more importantly, to the work being done not only by the ACGME to amend these struggles, but by the global medicine community to support one another in a growing age of connectivity.

COE - Health Policy Conference 2020


Yuvaram Reddy, MBBS
Clinical and Research Fellow in Nephrology at BWH/MGH
PGY-5

03/14/2020

COE Health Policy Course
I was fortunate to attend the CoE Health Policy conference in March with a class of over 30 residents and fellows across the Harvard system. It was an engaging experience packed with experienced faculty from health policy
researchers to health policy administrators and several guest lecturers.

It was particularly inspiring to hear from the “disruptors” of the healthcare industry as they talked about ways to change the system to work for their providers and patients, as opposed to the current status quo. We were part of a mock negotiation session that helped me better understand the various opinions of stakeholders in the health care system. It helped me understand the intricacies of health policy. It allowed me to reconsider methods to influence policy in nephrology through developing an understanding of the history of the existing system, the powers that control the system, the rationale behind the system and successful (and failed) attempts to change the system.

If other residents and fellows are interested in health policy, I would recommend this course. Most of the audience had little to moderate background knowledge of health policy, which was perfectly fine/encourage. Don’t be shy about this rare opportunity to leverage your clinical knowledge to understand and hopefully influence health policy!

Reflections from the COE Health Policy Course


Jennifer E. Yeh, MD, PhD
Resident in Dermatology at Harvard Combined Dermatology Residency Training Program
PGY-3

03/11/2020

Exercise at the COE HPC
Throughout the course of my medical education and training, I realized that I did not have a firm grasp of healthcare policies and consequently felt uncomfortable conversing on these topics with other healthcare professionals as well as friends and family. Meanwhile, I had become very interested in ideas surrounding healthcare reform due to current events. Attending this week-long course in health policy was a great decision and something I would highly recommend to all trainees, no matter how little or how much background they have in healthcare policy.

The engaging lectures from world-renowned leaders in Health Policy, as well as the unique role-playing activity of contract negotiation between health care system/physician group/payers really opened my eyes to the functions of healthcare systems and accountable care organizations, as well as the impact of recent health policy legislation.

Exercise at the COE HPC
This Centers of Expertise (COE) Health Policy Course is also one of the few instances during which trainees from all specialties interact with each other. As the careers in health policy panel discussion highlighted, all physicians regardless of specialty are direct providers of healthcare and therefore have valuable insights and key roles to play in healthcare reform.

I can confidently say that my participation in this COE course has made me a better-informed and well-rounded dermatologist who looks forward to sharing what I’ve learned with my program by inviting speakers from this course to give talks during our didactic sessions. I’m also excited to dive into books recommended by speakers including “The Price We Pay” by Marty Makary and “Man’s Fourth Best Hospital” by Samuel Shem.

COE Health Policy Course – think rapid infusion protocol for healthcare policy knowledge


Alexander Blood, MD
Fellow in Cardiovascular Medicine at BWH
PGY-5

03/11/2020


Learning from the best - Zirui Song, MD
The COE course on Healthcare Policy was a fantastic overview of our healthcare system, the legal and policy framework that brought us to where we are today, and the challenges and opportunities that we face in shaping healthcare delivery system that we will practice within. Not only did this course allow me to understand how we got to where we are in healthcare policy, but also where we are likely to evolve given the financial, legal, and logistical challenges that our current system is grappling with. I believe that experiences like this are instrumental in allowing us to move from ideas into action both in advocacy roles during training as well as future leadership roles in healthcare.

Career Changing Course!



Neelam A. Phadke, MD
Fellow in Allergy/Immunology at Massachusetts General Hospital + Torchiana Health Policy and Administration Fellow through MGPO
PGY-7

03/09/2020

Ready for Day 1 at BWH/Day
3 of  the Course!
I had a blast at the Health Policy course last week!  Having previously taken the Value-Based Healthcare Delivery course (also through COE), I was already interested in the topic and knew that I wanted my career to move in that direction.  I had some understanding of our healthcare system and its complexity, but this course delved into details and helped me truly appreciate so many of the intricacies!  Better understanding the current system helps give me a better sense of how to improve upon it and make meaningful changes.  I appreciated learning the history of what has been tried in the   As a policy and administration fellow, this is a huge part of what I do, and I appreciate that attending the course will help me better understand many of the meetings I attend.  Though obviously not intentional, I also appreciated being able to take the course in the midst of the coronavirus pandemic as it’s such a unique situation in which to apply what we are learning.
past and how seemingly appropriate solutions have gone wrong.

I would advocate for all trainees in all specialties to take this course—our healthcare system is so complex and unique, and it’s hard to imagine how we can most effectively deliver healthcare in such a system without understanding its complexities. 

Thank you, COE, for the opportunity to take this course!

VBHD Course – A Wonderful Experience!


Kathleen McFadden, MD
Resident in Internal Medicine at MGH
PGY 3

02/24/2020


Boston MA
I had the most wonderful experience taking the Value Based Healthcare Delivery Course at Harvard Business School. This course afforded me the opportunity to interact with peers across all specialties, learning about the relevance of specific financial techniques which can be applied to our clinical practice. This course compelled me to think about the relevance of business to medicine, the fact that physicians are often underinformed not only about the cost of care—but also the impact of this cost on the entire system and the patients who live within it. This course inspired me to consider further business training in my future career, but beyond this, it also will change the way I practice medicine on a day to day basis. As I continue to practice medicine in this beautiful city pictured above, I will be thinking more deeply about the cost of care and the ways we can make the system which drives so many of the careers in this city, more functional.

17th Annual Harvard Business School Healthcare Conference.


Mary D. Maher, MD
Fellow in Neuroradiology at MGH
PGY-4

02/23/2020

Harvard Business School Healthcare Conference

My most important lesson learned at the 17th annual Harvard Business School Healthcare Conference is how important it is for physicians to participate in the present healthcare conversation. The conference was fascinating. I never dreamt of a healthcare conference existing that was not framed in the perspective of medicine! Yet, there I was surrounded largely by business women and men discussing the delivery of patientcare. Realizing that an entire economic system creates and fuels the delivery of medicine (seen as the delivery of a healthcare product) can go so right or so wrong, and we have seen both.

Learning about the difference models for healthcare delivery, the challenges of gender and social inequity, cultural differences and the importance of access to mental health care and nutrition highlighted niches that leadership and innovation can make the greatest impact.

The theme of the conference focused on caring for patients as whole persons. The committee beautifully chose eloquent, successful speakers who felt called to “make their mark” on humanity as encouraged by opening speaker Mr. Javier Rodriquez of DaVita. Those who are blessed with opportunity and intelligence can use their gifts to benefit others and genuinely improve the lives of people as we will each one day take turns being patients.

Business women and men bring important skill sets to healthcare delivery innovation and infrastructure to design systems that are sustainable. While appropriate and high-quality medical care is the responsibility and the privilege of physicians, nurses and medical staff, successfully access and delivery of healthcare requires infrastructure and the re-invention of that infrastructure based on the close collaboration of all healthcare workers. The best models require the minds and skill sets of all, and clinical input is critical to ensure successful implementation of theory into practice.

Several panelists were physicians who expanded their personal mission of caring for patients to a broader systems-based and policy-based approach. However, from the entire Massachusetts General/Brigham system, an important institution for the development of future physician leaders, there were only three physician trainees. We need greater participation from the medical field if we want to have a say in how medical care is delivered. The relationship of medicine and business can be symbiotic and should be used to push the current state of healthcare into a truly healthier and happier future for all. If we want our experience, opinions and data to help mold the future of healthcare, we need to start participating in this conversation in the present.

What did I learn from attending The HBS Healthcare Club Conference?

Hassan Mashbari, MD
Acute Care Surgery Fellow, MGH
PGY-7

02/21/2020

Group picture with the other winners of the Centers of
Expertise (COE) scholarship to attend the Conference. 

With all the changes in the cost of the Healthcare and the impact of living longer and the increase of the prevalence of the Non-communicable disease in USA, the importance of addressing that has been a very important topic. What a great educational opportunity that I got from attending this conference. Very good debate about the cost of home hemodialysis and morbidity of this, different opinions about to international difference of healthcare reform and how to deal with the elderly population from cost-effective approach. Many great new friends and connections for combined projects toward HealthCare reform. I look forward to being able to apply many of the skills learned during this COE in the coming years in my work a healthcare provider.

Learning to Teach



Cyrelle Fermin, MD
MGHfC Pediatric Resident
PGY 1

02/20/2020

Chalk talk in paper form. 
By taking this course, I was able to further explore my own interested in med ed, an interest that I did not quite appreciate or realize previously. This course allowed me to engage with other physicians interested in medical education. I also got to see how other trainees interested in medical education engage their own learners, whether it be through chalk talks, case discussions, etc. 

This course further bolstered my desire to stay in academic medicine as a way to engage with trainees and students. If I do not stay in academics, I would still be motivated to find ways to engage with learners (hosting trainees/students in outpatient rotations, etc). I think there are a lot of missed opportunities in clinical medicine today to teach and find joy in the process of teaching / learning. This course helped me identify concrete ways to engage with learners effectively. It also made me more mindful of optimal ways of doing so. I look forward to continue using these skills moving forward!

Learning How to Teach



Alice Yu, MD, CM
Fellow, Urologic Oncology at Mass General Brigham
PGY 7

02/18/2020

Enacting a 5 minute teaching scenario
Teaching is one of the pillars of academic medicine, yet clinicians rarely receive any training in pedagogy or teaching techniques. The faculty of the Clinical Teaching Skills Course, Drs. Baker, Milligan and Shields put together an incredible one-day workshop for residents and fellows to hone our teaching skills.

Though the COE course, I learned that there is vast amount of literature on cognitive science and learning that has been studied empirically but is underutilized in medical education. GME curriculums typically focus on “what” to teach rather than “how” to teach. This course challenged me to think about my own teaching style, and the feedback culture that I want to create as a clinician educator.


Changing Strategies in Interprofessional Rural Health Education



Vikas Gampa, MD
Fellow in Rural Health Leadership at MGH
PGY 4

02/18/2020 

Vikas Gampa, MD using
new skills to conduct
a teaching session in Rosebud
South Dakota
I work as an outpatient provider at an Indian Health Service hospital in rural South Dakota where I have the incredible privilege of working alongside NP/PA/medical students, residents, and colleagues to collectively care for our patients. I attended the CTS workshop to learn skills to structure teaching sessions in a challenging learning environment.
As an outpatient provider, I staff my own patients with students and occasionally help my colleagues with care of complex patients, which sometimes requires teaching. Attending the CTS course has allowed me to think about designing teaching topics that are focused and intended to be beneficial for learners at various stages in their careers in medicine. Ultimately, this requires flexibility to attend to the needs of the learners and to understand the limitations of the environment. In an environment such as ours where learners often experience cognitive overload, I've been more cognizant of the information that I share and have learned to be concise in the material I discuss with other learners.

Teaching is a Team Sport.


Noelle Christine Cooper, NP 
NP Palliative Care Fellow at MGH

02/18/2020

Noelle Christine Cooper, NP
As a fellow in an interprofessional program, I am constantly seeking to better understand how medical education interacts with the multi-disciplinary lenses we all use to provide high-quality patient care. Over the course of my fellowship year, it has been clear that learning how to be an effective teacher, is equally as important as seeking mastery over sub-specialty content.

While I am fortunate within my fellowship to have a heavy emphasize on interprofessional collaboration and learning, I am also just as fortunate to have access to additional educational opportunities within the Center of Expertise. The Clinical Skills Teaching Course fostered a day-long experience where like-minded individuals were allowed to gather and explore their passion for education. Regardless of discipline, there was quick consensus regarding the importance of clinical teaching, as well as recognizing the disparity of time dedicating to teaching us how to teach within medical and nursing education. My biggest takeaway was the unquestionable level of investment, and curiosity that everyone offered in each session. I would highly recommend this experience to anyone who is even contemplating applying! It’s worth every second!

Tuesday, May 19, 2020

All About that Feedback!


Adam Tanious, MD, MMSC
Vascular Surgery Integrated Resident – MGH
PGY 7

02/17/2020

Adam Tanious, MD, MMSC
Feedback has been the main thing on my mind since finishing the Clinical Teaching Skills course through the Partners GME Centers of Excellence in Medical Education.  There were so many wonderful things we learned during that day, but the concept of feedback stuck with me.  In fact, I got back to the hospital that day and sought out my medical students, excited to give feedback.  In my excitement, I may have forgot a few of the skills that were taught during the course (i.e. don’t give personal feedback while standing in front of a learners peer-group). 

The course really helped me realize how critical feedback is to the learning process to help round out the educational experience.  I often utilize the Socratic method in my teaching which has been received in various ways previously. However, by adding feedback during and after my sessions, students seem to be more receptive and engaged during the teaching. 

Thanks to the video opportunity during the course, I will say that I have decreased the amount I hand-gestures I use during my teaching (which may be another reason why my teaching sessions have better received)… see picture below for example. 

I will say that I wish the concepts taught during this course could be applied to medical school curriculum, as residency is a time when all of us must become educators to those under us.  Perhaps even adding this as hour of this education every 6 months of residency just to help keep us on track to truly educate those coming up behind us to be the best students and residents possible.

COE “Critical Teaching Skills”


Ogorchukwu Faith Omede, MD
Internal Medicine Resident at NSMC
PGY – 2

02/17/2020

5 Minute Teaching Series
The course empowered me to take the front sit in teaching residents and medical students. Being my first ever teaching course, it has prepared me to be more intentional about teaching on the wards. I realized it is not in the volume of material but more about more about preparedness, methods of delivery and understanding the learners. The course also gave me the required skills in giving feedback, which I came to realize is an essential part of clinical teaching.

It made see how rewarding teaching can be to both the teacher and learner. I plan to be involved with teaching residents and medical students in global health and addiction medicine.

It is paramount residents are exposed to experiences like this in training because it forms an integral part in the making of a clinician. I believe every clinician at some point must serve in some capacity as a teacher and learner. Understanding how effective learning happens (backed with data which was presented at the conference), how to foster a growth-oriented culture and the art of giving effective feedback is an invaluable tool every clinician must possess.

Immediately after the COE CTS course, I had to present a journal in program. In preparing my slides, I was careful to list the objectives of my talk, ask questions at the beginning and at the end to encourage recall, and in cooperate clinical scenarios in my bid to tell a story.

I will be working on the wards and in the unit with interns, I hope to before-hand prepare for my teaching sessions and in some cases employ the flipped classroom model so as to promote teaching on the go (which will be greatly needed on the busy wards).

Prior to the course, I had not understood the growth-mindset, I plan to foster the culture in my team, by treating questions/learners with curiosity and respect, avoiding peer comparisons and encouraging linear growth measurement.

As a future attending, I plan to be more intentional as a teacher not only with the above listed but also encourage a feedback culture.

HBS 17th Annual Health Care Conference


Junzi Shi, MD
Resident in BWH Radiology Diagnostic
PGY-5

02/17/2020

The 17th Annual Health Care Conference at Harvard Business
School brings together students, industry and HBS Faculty. 
What are the next big trends in healthcare? Who is going to take care of the elderly? How does gender disparity limit our effectiveness? These are all questions that were discussed at the HBS annual healthcare conference. The conference was organized by HBS students in the Healthcare club. Attendees included HBS students, college students, along with some representatives from industry, and most of the speakers were HBS alumni and invited industry leaders.

The themes of the conference that struck me the most include Javier Rodriguez’s concept of the “healthcare amoeba.” Just like how a family may face decision quagmire when attempting to go out to dinner, healthcare has many components that tend to go in different directions. Like an amoeba, healthcare has components that are amorphous, ill-defined, with many different needs and desires. Moreover, every patient is unique and has different needs. So how do we address individual health better? The answer may lie in figuring out a better healthcare delivery model.

Disruptive healthcare is different from general parlance – it is being able to decentralize healthcare and still provide good or better care. Perhaps delivering care in the home, adapted to an individual’s needs, is arguably better than “one size fits all.” Is there a way to locally manage care, and then scale that to reach more patients? There are thoughtful questions that help us take the lessons learned from other industries such as the automotive infrastructure to rethink healthcare. Uber and Lyft have disrupted the taxi industry by decentralizing the service of giving rides, better addressing needs by utilizing smaller pockets of resources (using your own car) and better technology (an app to track the ride).

Another good model from industry is the airline industry that has been able to streamline quality control and safety that far outshines healthcare for decades. Perhaps what we need are “care traffic controllers” to help manage all the moving pieces in the large healthcare machinery. These are amongst the positive ideas that I took away, however there were also unsettling narratives.

Quite a few speakers spoke about physicians as if they were obstructive barriers to change as annoying weight: disruptive change led by millennials vs the entrenched privileged class. Lauren Lisher from Mount Sinai Health Partners spoke about finding the pain point in discussions with orthopedic surgeons developing a bundled care package in order to build common language, because “doctors don’t want to change.” The conversation was how do we get the doctors to come around, or alternatively, how to achieve our objective with...or without them. Start-ups look at population-wide health problems in innovative ways that physicians focused on the day-to-day work may be blind to. However, this does not mean that physicians do not want to change and incorporate new ideas if they help patient outcomes. Physicians need to be true partners in joint decision-making about healthcare innovation. I found the negative attitude towards physicians to be unfortunately a common theme at healthcare conferences, and this may guide business leaders to miss out on a huge opportunity to engage physicians as shareholders. If you are hoping to leader disruptive healthcare change, ask yourself, “Are business incentives actually aligned with patient care?” Physicians are the on-ground experts who actually do the work and we need to be both good stewards of our resources as well as gatekeepers to patient care.

If only you knew the power of the Dark Side... Developing Skills for Radiology Education


Simone Montoya, MD
Fellow in Neuroradiology at MGH
PGY-6

02/17/2020

Radiology Trainees bonding over a shared passion for
education!
Despite the ubiquity of Radiology, no one really knows what we do. We even refer to other providers as “clinicians” as if we are not clinicians ourselves. Radiology still is not a required component of the curricula of many medical schools, which (in my opinion) results in a misunderstanding of the role of a radiologist in a patient’s overall care. Those who do take a Radiology clerkship often find themselves sitting in the dark behind someone who stares at thousands of images and talks about them in a weird halted and excessively punctuated way. If we want to change how our specialty is perceived, we must be able to effectively teach so that others can appreciate what we do.

Since my face-to-face interactions are limited, I’m used to not knowing anyone at COE events, so I was more than pleasantly surprised to see other radiologists in attendance. I was even happier to have another radiologist in my micro-teaching group, as well as Keith Baker, one of the course leaders, so that we could demonstrate challenges that are unique to Radiology education. I chose to give a radiology lesson without any imaging, while the other radiologist gave a very typical radiology didactic. I think that the others in our group were surprised about how inherently difficult it is to teach Radiology and how different it is conceptually from other areas in medicine – how do you teach how to see something, know what it is, and recreate that finding in words? – and I found it extremely valuable to have input from those outside Radiology.

The micro-teaching session allowed us to apply the day’s lessons to a real teaching scenario – the ultimate “see one, do one, teach one.” I gained a lot of insight from the course, but moreover I have a better idea of how I can implement what I’ve learned specifically to Radiology education.

Learning to cultivate growth mindset and promote feedback culture


Jena Depetris, MD
Radiology Resident and Cardiovascular Imaging Minifellow at MGH
PGY-5

02/17/2020

Teaching about the aortic valve sinuses
of Valsalva and their appearance on Caridac
CT
The Partners Centers of Expertise Clinical Teaching Skills (CTS) course was a fantastic opportunity to dedicate time toward both understanding the science of adult learning as well as improving my own skills as a medical educator.

 For as long as I can remember, I have gravitated toward activities related to education. Whether it was undergraduate peer-to-peer tutoring, volunteering in an educational capacity, or simply being inspired by the incredible educators with whom I have been so lucky to become acquainted, I always felt most fulfilled and personally motivated when I had my hands in education. It wasn’t until recently, however, that a career specifically focused on medical education became something I concretely aspired to build. Having attended several of the Centers of Expertise in Medical Education dinner sessions in the past, the Clinical Teaching Skills (CTS) course seemed like a unique and valuable opportunity to build my skills as an educator and to meet other like-minded residents and fellows within the Partners system.


First and foremost, the CTS course was incredibly effective at helping me to identify areas for improvement in the way I approach teaching. We had the opportunity to practice a brief teaching scenario in front of our peers and practice receiving feedback on our teaching style, clarity, and effectiveness. This exercise allowed me to understand my personality as an educator in a new light and opened my mind to the power of feedback. The course has directly impacted the way I will approach giving, seeking, and receiving feedback in my future as a medical educator.

Enjoyed working with and learning from several other
Radiology trainees at the CTS Course. 
Furthermore, the CTS course has changed the way I think about my responsibilities as a clinical educator. It seems to me that many in medicine fall into “teaching roles” accidentally, or even haphazardly, because of the way our medical education system is built. The course has given me invaluable tools that I can apply toward the goal of becoming an effective and intentional clinician educator, including tips for how to build credibility with learners and how to effectively deliver feedback.

As a PGY-5 radiology resident, I am already applying what I learned in the course to my everyday clinical work in the reading room. I am working on building a growth mindset as an educator and learning to cultivate the same among my peers and colleagues. I hope to take what I learned from the course and find concrete ways to apply it during the rest of my training and beyond.

Everyone is a Teacher


Jonathan Chang, MD, MPH
Resident in Internal Medicine at Brigham and Women’s Hospital
PGY: 1

02/17/2020 

Explaining how to read an EKG during the 5-minute teaching
session. 

I had the privilege of attending the COE course on clinical teaching. As a medicine intern, sometimes it is hard to view myself as a teacher, especially as I am myself still learning how to make optimal medical decisions. However, this course inspires me to start practicing effective teaching skills as an intern to prepare for greater teaching roles as a future resident and attending.

In one of the sessions, we were asked as a group to brainstorm what words we associated with an effective teacher we had in the past. At the end of the exercise, the instructor noted how most of the words we had offered were simply qualities of a good leader (such as “motivating,” “passionate,” and “prepared”). This has changed the way I think about teaching; what undergirds the effective transmission of knowledge is as much the team environment that is fostered as the actual way ideas are communicated. In the future as a resident and team leader, I will strive to be clear in the way I lead my team, setting expectations up front, boosting morale when needed, and creating a safe team environment.

One of the other experiences during the seminar that was particularly valuable was the delivery of a 5-minute teaching scenario. This practice in teaching has allowed me to think about how to distil what could be a complicated down to 5-minute sized tidbits perfect for teaching on the wards. During this session, I was able to distil the basics of reading an EKG in 5 minutes. Using the same kind of thought process to simplify medical topics, I have since been able to teach a medicine sub-intern how to think about and manage atrial fibrillation with RVR, even in the midst of busy clinical duties. After the teaching, he gave me feedback about how useful the teaching was, even though he had previously received teaching about the very same topic. The 5-minute teaching experience has given me tools to effectively teach on the fly.

Overall, the course was very well organized and executed, and it has and will continue to serve me well as a developing clinician-educator.

Evidence-based and Interactive Learning on the Art of Teaching


Jacqueline Schulman, MD
Resident in Neurology at MGH/BWH
PGY - 4

02/16/2020

Explaining the concept behind the
vestibulo-ocular reflex and the Head Impulse
Test in the 5 minute "micro-teaching" session

I have had a longstanding interest in medical education, but it was not until the last few years of my neurology residency that I realized how much I enjoy teaching. Having never had any formal education in teaching, I saw the COE Clinical Skills Teaching Course as an opportunity to develop my approach to teaching, with the goal of becoming a more effective and engaging educator for medical trainees in the future.

Throughout the day, we participated in various interactive sessions. Volunteer patients were brought in to role-play with us, allowing us to practice our communication skills. Later, we were paired up with our fellow course participants to exercise giving feedback. We culminated the day with “micro-teaching”, an activity that had us teach a topic of our choice in five minutes to a small group. These activities highlighted to me the importance of communication as a foundation of effective teaching. Moreover, I realized that the way I transmit information must be adapted to the recipient and the circumstances we find ourselves in, whether I am carrying out a didactic session in a classroom, supervising a resident in a new procedure, or educating a patient on their new diagnosis.
One of the morning sessions taught us about the evidence behind different methods of learning. I was surprised to find that learning abstract material is more effective and less misleading than learning from concrete examples, yet par
adoxically, our entire medical training is based on learning from individual patient cases we encounter on the wards and in clinic. I hope to apply this information in my role as an educator in the clinical setting to help fill the gaps in trainees’ medical education and facilitate their growth and development.

I walked away from the course with a new perspective on the art of teaching and I am thankful to the COE for giving me this opportunity!

Clinical Teaching Skills Course


Natasha Merali, MD
Internal Medicine Resident at MGH
PGY-1

02/14/2020 

Giving a "micro-teaching" talk.
I had a wonderful time at the clinical teaching skills COE course! As an intern, it is easy to fall into the trap of just focusing on how to become an efficient learner and “task-doer.” However, in a profession where the majority of our learning comes from our peers, learning how to teach is just as vital as other actively acquired skills during intern year. It was therefore extremely pertinent to hear about evidence-based teaching and adult learning practices that will help me teach medical students and residents in a variety of settings. Discussing learning-oriented versus performance orientation was particularly relevant in a climate where grades, competitiveness, and comparing yourself to others is unfortunately commonplace in medical training. This course has provided me with a framework to help promote a more learning and growth-oriented environment, and in doing so hopefully increase joy in learning and decrease physician burnout.

Additionally, giving a five-minute micro-teaching session within a small group was a uniquely helpful in that it allowed for both receiving and giving directed feedback with peers who share a similar passion for teaching. I will undoubtedly harness what I learned through that process to be more purposeful in cultivating my teaching skills and styles throughout residency and my career. I hope that I have the opportunity to be a part of similar training programs in the future, and continue to learn from other expert clinician educators!

The 2020 National Health Policy Conference/Health Datapalooza



Yuvaram Reddy, MBBS
Clinical and Research Fellow in Nephrology at BWH/MGH
PGY-5

02/13/2020  

Yuvaram Reddy, MBBS at the National Health Policy
Conference in Washington D.C. 
In February of 2020, I attended my first National Health Policy Conference through a Centers of Expertise grant. It was exciting to be in DC at a conference attended by key stakeholders in policy - patients, policymakers, research foundations, industry and clinicians. There were interesting talks on interoperability of the electronic health records, social determinants of health and value-based payment models.

I presented the findings of my pilot Markov model of strategies in end-stage kidney disease care delivery at a poster session on confronting costs and spending. It was a unique opportunity to present my viewpoints on trying to improve peritoneal dialysis utilization in the US to various stakeholders from different career backgrounds and I received great and meaningful feedback on their perspectives. There was a surprising interest in kidney disease at this conference, with at least 4 different presentations focused on kidney disease. Clearly, the Advancing American Kidney Health initiative is motivating stakeholders to critically analyze this policy to find innovative methods to achieve success.

I would recommend this conference to providers interested in changing policy through their research. It is important to keep your ear to the ground and understand if the question you are asking is relevant to stakeholders and politically feasible for implementation.

Will data liberation help patients feel better? A view from Washington D.C.


Yannis Valtis, MD
Resident in Internal Medicine and Pediatrics
Brigham and Women’s Hospital
PGY 2

02/12/2020

Yannis Valtis, MD
Over the past weekend, I attended the National Health Policy Conference organized by Academy Health in Washington D.C. Two main themes kept coming up in keynotes, plenaries, and side conversations among attendees: 1) the importance of data liberation and, 2) the need to focus on the patient experience of healthcare delivery.

Data liberation can refer to facilitating patient access to their own medical records, provider access to records from other systems, or public transparency around quality and price for different healthcare services and providers. Patient advocates, health systems leaders, policy makers, researchers, and government officials champion it broadly. While it is clear to me how a young millennial patient who grew up in the age of the Internet would make use of such data availability, the picture is less clear when it comes to elderly medically complex patients.

The second theme that permeated discussions was that most patients rate most of their interactions with the healthcare system poorly. One CEO commented during a plenary – “most health care systems have net promoter scores of zero.” (The net promoter score is calculated from the proportion of people who are very likely to recommend a service to a friend.) This idea was alarming to me – if people already find interacting with the healthcare system mostly frustrating, will data liberation help or exacerbate this? I think the answer depends on how we as healthcare providers respond to increasing data transparency.

When I think of my complex elderly patients in primary care clinic, I doubt that access to raw medical record data or long spreadsheets with price lists across different health systems will make their experience of getting care much better. PCPs, however, have a unique role in shaping this experience and can use increased data transparency to empower their patients to make better choices. A PCP will, for example, be able to take price into account when recommending a specific imaging procedure or specialist consultation. As with most policy interventions in healthcare, the buy-in and commitment of frontline clinicians will be critical to the success of data liberation.