Cast & Curious

Category: Learning and Development

  • Peer feedback among healthcare professionals on social media

    Peer feedback among healthcare professionals on social media

    I admit, giving and receiving feedback aren’t my strongest points. All these years I gave and received all sorts of feedback – some informal, mostly formal while a few times brutal, to and from almost everyone in the industry. I can tell you that receiving and giving feedback never gets easier with time.

    Feedback is the breakfast of champions.

    Ken Blanchard

    Few weeks ago a well respected colleague and friend gave me a feedback. He underpinned a nagging problem highlighting my inefficiency as an institutional manager. My reaction? Mixed. I am so glad he pointed out the lapse and triggered a cascade of corrective measures on our part. Sad, because a very good friend decided to end his professional service with us. On top though I felt weirdly happy because someone I respected and look up to gave the feedback. I took time off to process this reaction. Is my reaction because of the person who gave the feedback or the manner in which he gave one?

    Why health care needs a feedback

    Feedback is the fuel that drives improved performance.

    Eric Parsloe

    Often incorporated into assessments, all human performance fields needed some form of feedback to improve. “Improving health outcomes and lowering cost of delivery hinge on a dynamic and regular feedback system” echoes many health experts. Feedback compels healthcare professionals and scientists to answer the most pressing problems besetting healthcare. Given properly and consistently, feedback identifies and narrows gaps in health care.

    Who gives feedback in health?

    Years back, a mentor shared a tip about improving my own “skill” of giving feedback. This is what he said:

    “Be a mirror. Listen. Most of the time that’s all you need to do”.

    Healthcare professionals value feedback from peers more than anyone else, studies have shown. Feedback helps build confidence and competence among healthcare professionals especially if it came from well respected peers. I can tell you being an orthopedic surgeon for some years, it ain’t easy receiving advise from someone who neither went under your bone drill nor is wielding one. But I am very happy. Indeed that feedback from an “outsider” changed a lot in me both personally and professionally.

    Social media feedback

    While formal assessment and feed backing happen mostly in the confines of healthcare, spillage into social media are not uncommon. Given the new culture of radical transparency and accountability, social media invariably complicates the health care feedback environment. One needed a host of new skills to be an effective feedback giver and receiver over social media. Why? Studies have shown patients and relatives value healthcare professional’s online health opinions more than anyone else. To some degree, social media postings of a healthcare professionals affect the public’s opinion on our overall competencies.

    Take the vaccine or the specialty certifying controversy. These controversies rocked the medical profession and spilled over into social media. Some of this country’s well respected medical experts sat on opposing ends of a social media debate, giving and taking feedback from each other, under vigilant public scrutiny. This public display of feedback (PDF) while undoubtedly a very healthy debate amongst peers, often befuddle the public mind. #HealthXPh previously discussed patients social media feedback in a previous tweetchat some years ago here. What picked my curiosity is how social media feedback between peers affect the personal and professional lives of healthcare professionals.

    Join #HealthXPh chat this Saturday August 31, 9:00 PM Manila time as we discuss how healthcare professionals give and receive peer feedback on social media.

    • T1: Is social media an effective platform for giving and receiving peer feedback? Explain.
    • T2: What are the challenges to giving or receiving feedback from peers on social media?
    • T3: How do you give an effective peer feedback over social media?
    • T4: How do you process a peer feedback given over social media?

    Social media is probably here to stay. So is feedback. How should healthcare professionals, give or receive feedback on social media platforms is a matter of preference. The fact remains though that improving outcomes and lowering cost of delivery hinge on a dynamic, actionable and consistent feedback system. Social media offers is an emerging platform for peer to peer feedback in healthcare

    Without any sort of feedback, there would not be a “care” in healthcare.

    Image by freepik

    Further readings:

  • Five important reasons why health leaders need social media

    Like it or not, internet and social media are part of today’s health environment. Understanding social media is key to surviving this environment. Flexible leaders harness social media to meet better health care experience for patients. Here are the five important reasons why health leaders need to learn and harness social media:

    1. A social media post made you or your institution (in)famous.

    Most unfortunate route to learning the ropes of social media. Many health leaders stumbled social media this way. Its never too late though. Stay calm. Plan a prompt, well thought out social media response strategy.

    2. You’re not health information’s sole gatekeepers anymore thanks to internet and social media.

    Gatekeepers hold the key to information and provisions of care in the 20th century. That’s not the case in this generation. Health information is accessible to many people. Some patients wants greater participation in managing their health. Fortunately, a health professional- patient partnership is not only feasible via social media. The partnership showed better health outcomes in some areas, while lowering cost of delivery in others.

    3. Your value system is in conflict with the new value system arising from internet and social media empowered generation.

    New value system with internet and social media

    We’ve hone our leadership skills and toolboxes before internet and social media. Radical transparency a value the current generation espouse, annoys many leaders. Understanding this new value system is key to providing better health care outcomes, at a reduced cost for this generation.

    4. New and social media amplified health expectations is different from what existing system provides.

    Patients expect better healthcare experience

    With readily available information and new value system comes new health care expectations. Unmet health expectations lead to clashes and divorce in health partnerships. Fragmented health systems called silos, provide irrelevant care at skyrocketing cost.

    5. Patients and their support group wanted greater participation in managing their health.

    Internet and social media made health information accessible to everyone. Providing care though, is still in the hands of trained professionals. This may not be the case for long as many patients including their family and support groups, wanted greater participation in managing their health. It’s no surprise that social media is the platform of choice. The sooner we accept this, the better prepared we are in harnessing social media for better health care.

    Social media is here to stay. I may have painted a bleak picture but there’s a way to harness social media for better health. Leaders should be flexible enough to partner with patients in this regard. It is their health after all.

  • Strategies and technologies healthcare professionals use for learning

    Why are you still studying? Are the years of medical school and training not enough?

    Barely an hour before writing this post, a neighbour knocked on my door asking if I could look at his 9 months old nephew. His nephew is weak, have an on and off fever for a week, and is vomiting since this morning. “Your nephew is dehydrated” I said. “Bring him to the nearest hospital now. ” I couldn’t remember the last time I managed a pediatric acute gastroenteritis. As an orthopedic surgeon, I rarely deal with such cases unless one of my family member contracts the disease. Even then, I rarely manage pediatric AGE.

    This is why healthcare professionals need to continually learn even after med school and training. You’ll never know what disease or which patient will come “knocking” on your door. Besides, many of us tend to forget clinical skills we haven’t use for some time. Society also expect us to be competent practitioners, irregardless of the specialised field you’re into. My neighbour for example, believed I’m competent in managing pediatric AGE, despite him knowing I’m an orthopedic surgeon for years!

    Learning also benefits us and our patients even in our narrow fields of practice. Learning is a moral and ethical responsibility embedded in the many oaths we took entering this profession.
    The ever changing landscape of diseases, research findings, healthcare issues and clinical management skills favours health professionals who consistently learn or upgrade their knowledge and skills. The information explosion and affordances of new technologies might also help us cure some disease, alleviate the ills or empathise with our patients. Simply put, we need to continually learn for our patients.

    T1. What inspires you to learn?

    We learn for our patients, but we are the learner. Society expects healthcare professionals to be lifelong learners- perpetually proficient and competent in the medical field. In practice, our learning environment shifts from formal school to include, informal, out of school, face to face, at a distance or a mix of all these. Different environments have varying nuances for learning. Some strategies work best for a certain learning environment. Most of us couldn’t simply drop our professional practice to go back to formal school. We have to find other ways learning befitting four learning or practice context.

    T2. What is your strategy for learning?

    While we use many similar technologies for learning across these different contexts, recent technologies afforded us newer non traditional ways of learning. Online technologies for example allowed us to learn without leaving our practice. With appropriate technologies, we can now choose when, how and where to learn. Feedly for example allows me to aggregate, curate and organize medical information efficiently.

    T3. What technologies do you use for learning?

    As healthcare professionals, patients inspire us most to continuously learn. When our learning shifts from formal school alone to include many other environments, we must be able to examine and employ strategies and then find appropriate technologies to maximize learning. It is then that “we direct ” or take control of our own learning.

    In this November 10, 2018 9PM Manila time #HealthXPh chat, we will explore paradigms and technologies by which healthcare professionals learn today. By paradigm I mean a theory, a strategy, a method or “lens” by which we anchor what and how we learn. Technologies refer to any tool, mainstream or emergent that you use to learn or maximize learning. These are our guide questions:

    • T1. What inspires you to learn?
    • T2. What is your strategy for learning?
    • T3. What technologies do you use for learning?

    (If you want to learn more about my paradigm of learning and technologies I use to support it, read this article)

  • Teaching the “right” attitude and values to would be doctors

    There are several methods of curriculum development in medical education. I’m familiar with Kern’s Six Step Approach to Curriculum Development which I discussed  briefly in this post. This approach is far from perfect but components of medical education ( knowledge, skills, attitudes and values) may be effectively taught using this approach.

    Kern's 6 Step Approach
    Kern’s 6 Step Approach to Curriculum Development

    On top of of this Six Step Approach is a well conducted general needs assessment of the community where health professionals are to be deployed. This needs assessment also determines the context that wrap health issues in that specific community. Implementing a health education program without prior contextual needs assessment is like running a car without a definite destination. Resources are spread thin across multiple objectives, draining resources and produce graduates who are “misfits”- physicians who just don’t fit the target community’s context of health issues. A misfit health professional so to speak.

    For years I believe, our goals for educating health professionals didn’t change much and remained true to the ideals of health profession. We still want to train ethical and moral health professionals serving our country in the most excellent and conscientious way. Our instruments in achieving these goals however have changed dramatically in todays digital age. Access to information greatly improved but processing these information lags behind. We have access to western health research but such data just don’t fit especially in the countryside where the context of health issues is radically different. We train our would be physicians that western medical knowledge and skills is the way to go in medicine but what is in the books and journals are vastly different from what we have here on the ground. The stark difference is even more palpable in the attitude and values being taught at healthcare academe. We have forgotten the socio cultural context of our health issues. We train highly skilled and knowledgeable physicians yet they don’t seem to fit the community they’re placed in. Most of them just gravitate towards the urban tertiary centers where western medicine, the context of how we train them, resides.

    Teaching medical knowledge and skills has evolved so much in recent decades.  Attitudes and values however remains the hardest, most elusive component teach and assess. Thus we hear of health professionals who’s attitudes and values are way off what’s expected of a health professional. Whispers of “lazy, easily discouraged, whiner, scum” health professionals  can sometimes be heard on performance evaluations.  The lack of a clear context and need assessments predisposes a program to produce such health professionals.  The lack of validated instruments to impart and assess our methods of teaching attitudes and values in our health education programs remains challenge to the medical academe. We’ve tried teaching methods like “fellowships” or paired didactic/clinical exposures, increasing patient exposures, community immersions  and other but we yet to figure out exactly how to teach and assess desirable attitudes and values to our health professionals.  We knew teaching methods are customised  on the context of the community and cannot be standardized across regional difference. Perhaps a basic framework to work on and modified regionally according to context would be a good way to start.

    So far, a standard method of evaluating attitudes of health professionals needs to be implemented and validated widely.  The closest we can get after going through the rigodon of trying to each time, is the multi peer assessment. This is an assessment method wherein everyone in the health professionals working environment gives an assessment as to the attitude of that health professional.   The assessment is quite comprehensive and is reflective  the working atmosphere of that health professionals. It is however tedious. Categorising components of this assessment tool and making sure everyone in the working environment uniformly understand its content requires training.

    In summary, our goals in teaching the “right” attitude for health professionals, hasn’t changed much in the past decades. The lack of clear context and needs assessment plus the scarcity of teaching and assessing ” attitudes and values ” among our health professionals is contributing much to “misfits” in the health community. A multi peer assessment is the closest tool we can use but is tedious and time consuming. A basic framework for training should be created on a national level but modified regionally according to the specific context of health issues present in that region.

  • Addressing generational medical learning stereotypes

    Does generational learning stereotypes affect  graduate medical education?

    Consider these medical educator- medical student thoughts:

    Medical Educator: Some of this generation’s medical students lack interest and commitment to their medical training. With all the health information inside their laptops and tablets, they find it hard to answer my questions confidently.

    Gen X student: I hate professor A! He expects us to read chapters in our textbook, do research on the side, while simultaneously go on clinical duty 48 hours a week!
    First observation is common among medical educators, although local documented research on this is lacking. Observation number two is a common complaint among medical students, often perceived as lack of interest by many health educators.

    Meyer and Weiner in 2002 Journal of American Medical Education pointed this out:

    Empirical evidence shows that college students are becoming less interested in attending medical school. The number of applicants to medical schools in the United States has dropped approximately 20% during the last 10 years.

    In short, unless new research would point to otherwise, generational stereotypes do (negatively?) affect learning in graduate medical education.

    There are many ways to develop and improve a medical curriculum. I am only familiar with Kern’s Six Step approach(in picture below) to curriculum development for medical education. (Here’s a link to the book at Amazon. See disclosure).

    Kern's 6 Step Approach
    Kern’s 6 Step Approach to Curriculum Development

    A health educations study applying Kern’s six step is discussed in this article. Here is a more detailed presentation of Kern’s Six Step to developing med ed curriculum by Joanne Lynn, MD, MPH Department of Neurology, Associate Dean of Student Life Ohio State University Wexner Medical Center. Suffice to say, there are hundred of ways to address the generational learning stereotypes in medical education. It’s never easy, but it can be done says. Dr. Lynn.

    Natalie May of St. Emelyn’s Emergency Medicine #FOAMed sums up beautifully in post, the generational stereotypes ( she called “challenges in medical curriculum”) and the corresponding learning environment adjustments we can make to address these challenges.

    Yes, of course it’s exhausting and hard work to rethink our education strategies – it’s much easier to stick up a two hundred slide lecture and read it from the screen but we owe the next generation of doctors more than this. And if we stick to teaching the way that worked for us, we are forcing them to do the hard work of trying to fit into our schema – and isn’t that against the very essence of education?

    In one tweetchat episode (Residency Training in a Millenial World) hosted by Dr. Helen Madamba, a medical educator herself, we also tackled generational learner stereotypes among residents of a training program. In this Saturday’s edition of #HealthXPh chat, we dig deeper into the medical curriculum and discuss possible solutions to this challenge. Our guiding questions are:

    • T1.  As a healthcare student or healthcare professional, do you believe generational stereotypes affect learning in medical education? Why?
    • T2. Does your institution’s medical curriculum acknowledge these generational stereotypes exist and have done steps to address it? How?
    • T3. Which of Kern’s Six Step approach do you think is the best step to intervene and address this challenge? Least? Why?

    Please give your final thoughts after discussing these Qs.

    Join us this Saturday July 8, 2017 9PM Manila time as #HealthXPh discuss generational learner stereotypes on #healthXPh twitter chat!

    #meded #healthed #healthprofed #medicaleducation

    ( Disclosure: The author used an Amazon affiliate link for one of the book cited in this post.)

    References:

    1. Meyer AA, Weiner TM. The Generation GapPerspectives of a Program Director. Arch Surg. 2002;137(3):268-270. doi:10.1001/archsurg.137.3.268
    2. Kern DE, Thomas PA, Hughes MT. Curriculum Development for Medical Education: A Six‑Step Approach. 2nd ed. Baltimore, MD: The John’s Hopkins University Press; 2009.
    3. Sweet LR, Palazzi DL. Application of Kern’s Six-step approach to curriculum development by global health residents. Educ Health 2015;28:138-41.
    4. Natalie May.”Generation Why – Challenges in Medical Education at #NSWMET”. August 10, 2016. Blog : St.Emlyn’s Emergency Medicine #FOAMed

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