Educating for adaptive expertise: case examples along the medical education continuum.

Adaptive expertise represents the combination of both efficient problem-solving for clinical encounters with known solutions, as well as the ability to learn and innovate when faced with a novel challenge. Fostering adaptive expertise requires careful approaches to instructional design to emphasize deeper, more effortful learning. These teaching strategies are time-intensive, effortful, and challenging to implement in health professions education curricula. The authors are educators whose missions encompass the medical education continuum, from undergraduate through to organizational learning. Each has grappled with how to promote adaptive expertise development in their context. They describe themes drawn from educational experiences at these various learner levels to illustrate strategies that may be used to cultivate adaptive expertise.At Vanderbilt University School of Medicine, a restructuring of the medical school curriculum provided multiple opportunities to use specific curricular strategies to foster adaptive expertise development. The advantage for students in terms of future learning had to be rationalized against assessments that are more short-term in nature. In a consortium of emergency medicine residency programs, a diversity of instructional approaches was deployed to foster adaptive expertise within complex clinical learning environments. Here the value of adaptive expertise approaches must be balanced with the efficiency imperative in clinical care. At Mayo Clinic, an existing continuous professional development program was used to orient the entire organization towards an adaptive expertise mindset, with each individual making a contribution to the shift.The different contexts illustrate both the flexibility of the adaptive expertise conceptualization and the need to customize the educational approach to the developmental stage of the learner. In particular, an important benefit of teaching to adaptive expertise is the opportunity to influence individual professional identity formation to ensure that clinicians of the future value deeper, more effortful learning strategies throughout their careers.

Reimagining Learning Spaces of the Future: An Interprofessional, Virtual Workshop Utilizing Rapid Idea Generation and Lean Startup Methodologies.

INTRODUCTION: The needs and expectations of health professional educators and learners are evolving. Therefore, physical and virtual learning environments will look and function differently in the future. Understanding desirable, feasible options for educators and learners, including online, in-person, hybrid, and extended realities, is critical. We designed and facilitated a faculty development workshop that adapted Lean Startup methodologies and role-modeled effective virtual teaching skills to engage stakeholders in generating ideas to inform future development of learning spaces within one national academic medical center. METHODS: We facilitated the 3-hour workshop with an interprofessional group of health professional educators, learners, and administrative staff. The workshop included asynchronous prework and synchronous microlectures, small-group activities, and large-group report-outs. We employed Lean Startup methodologies to promote divergent thinking. Each small group had a dedicated convener and scribe. A designated chat moderator, social media facilitator, and several audiovisual staff provided support during the workshop. RESULTS: More than 4,000 ideas were generated by the 350 participants. Participants reported that prework, microlectures, and small-group activities were successful in preparing them to engage in rapid idea generation and propose potential solutions for future learning spaces within health professions education. DISCUSSION: The workshop, which utilized a rapid idea generation and Lean Startup methodologies format, was successful in producing an abundance of original ideas and potential solutions for future learning spaces within health professions education. As reported through postsession evaluation, participants valued the opportunity to contribute ideas and co-create potential solutions to guide future planning and feasibility studies.

Distributed Autonomous Organization of Learning: Future Structure for Health Professions Education Institutions.

Current health professions education (HPE) institutions are based on an assembly-line hierarchical structure. The last decade has witnessed the advent of sophisticated networks allowing the exchange of information and educational assets. Blockchain provides an ideal data management framework that can support high-order applications such as learning systems and credentialing in an open and a distributed fashion. These system management characteristics enable the creation of a distributed autonomous organization of learning (DAOL). This new type of organization allows for the creation of decentralized adaptive competency curricula, simplification of credentialing and certification, leveling of information asymmetry among educational market stakeholders, assuring alignment with societal priorities, and supporting equity and transparency.

Establishing an expert consensus for the operational definitions of asthma-associated infectious and inflammatory multimorbidities for computational algorithms through a modified Delphi technique.

BACKGROUND: A subgroup of patients with asthma has been reported to have an increased risk for asthma-associated infectious and inflammatory multimorbidities (AIMs). To systematically investigate the association of asthma with AIMs using a large patient cohort, it is desired to leverage a broad range of electronic health record (EHR) data sources to automatically identify AIMs accurately and efficiently. METHODS: We established an expert consensus for an operational definition for each AIM from EHR through a modified Delphi technique. A series of questions about the operational definition of 19 AIMS (11 infectious diseases and 8 inflammatory diseases) was generated by a core team of experts who considered feasibility, balance between sensitivity and specificity, and generalizability. Eight internal and 5 external expert panelists were invited to individually complete a series of online questionnaires and provide judgement and feedback throughout three sequential internal rounds and two external rounds. Panelists' responses were collected, descriptive statistics tabulated, and results reported back to the entire group. Following each round the core team of experts made iterative edits to the operational definitions until a moderate (≥ 60%) or strong (≥ 80%) level of consensus among the panel was achieved. RESULTS: Response rates for each Delphi round were 100% in all 5 rounds with the achievement of the following consensus levels: (1) Internal panel consensus: 100% for 8 definitions, 88% for 10 definitions, and 75% for 1 definition, (2) External panel consensus: 100% for 12 definitions and 80% for 7 definitions. CONCLUSIONS: The final operational definitions of AIMs established through a modified Delphi technique can serve as a foundation for developing computational algorithms to automatically identify AIMs from EHRs to enable large scale research studies on patient's multimorbidities associated with asthma.

STEM crisis teaching: Curriculum design with e-learning tools.

The COVID-19 pandemic and subsequent social distancing protocols have accelerated the shift to online teaching across the globe. In Science, Technology, Engineering, and Mathematics (STEM) programs this means a shift from face-to-face laboratory instruction to self-directed learning with e-learning tools. Unfortunately, selecting and integrating an e-learning tool into a curriculum can be daunting. This article highlights key questions and practical suggestions instructors should consider in choosing the most effective option for their course and learners.

Applying multiple frameworks to establish effective virtual collaborative teams in academia: a review and recommendations.

Recently, academic health professionals have been increasing collaboration with peers at a distance for activities such as research, scholarship, and faculty development. Novel virtual technologies enable academic professional teams to overcome time and distance barriers to facilitate collaboration, but little research is available to guide academicians on how to effectively organize and manage virtual collaborative teams using these technologies. Based upon a literature review and six years of experience as a virtual collaborative team, the authors use Boyer's Scholarship of Integration paradigm to identify and critique four models for virtual collaboration. The literature search devised from the four identified models found references that had a theoretical foundation for peer virtual collaboration and have been adopted in some professional context. The authors present a review of this literature, describe the benefits for adapting these models to academic health profession contexts, and provide a reflective critique about the challenges for their adaptation in these contexts. They also provide a hypothetical scenario to exemplify the application of these models for health-care professionals along with important considerations and tips when forming new virtual peer collaborative teams or problem-solving teams who are not optimally functioning.

Working Toward Consensus on Sporadic Vestibular Schwannoma Care: A Modified Delphi Study.

OBJECTIVE: To address variance in clinical care surrounding sporadic vestibular schwannoma, a modified Delphi study was performed to establish a general framework to approach vestibular schwannoma care. A multidisciplinary panel of experts was established with deliberate representation from key stakeholder societies. External validity of the final statements was assessed through an online survey of registered attendees of the 8th Quadrennial International Conference on Vestibular Schwannoma. STUDY DESIGN: Modified Delphi method. METHODS: The panel consisted of 16 vestibular schwannoma experts (8 neurotology and 8 neurosurgery) and included delegates representing the AAOHNSF, AANS/CNS tumor section, ISRS, and NASBS. The modified Delphi method encompassed a four-step process, comprised of one prevoting round to establish a list of focus areas and three subsequent voting rounds to successively refine individual statements and establish levels of consensus. Thresholds for achieving moderate consensus, at ≥67% agreement, and strong consensus, at ≥80% agreement, were determined a priori. All voting was performed anonymously via the Qualtrics online survey tool and full participation from all panel members was required before procession to the next voting round. RESULTS: Through the Delphi process, 103 items were developed encompassing hearing preservation (N = 49), tumor control and imaging surveillance (N = 20), preferred treatment (N = 24), operative considerations (N = 4), and complications (N = 6). As a result of item refinement, moderate (4%) or strong (96%) consensus was achieved in all 103 final statements. Seventy-nine conference registrants participated in the online survey to assess external validity. Among these survey respondents, moderate (N = 21, 20%) or strong (N = 73, 71%) consensus was achieved in 94 of 103 (91%) statements, and no consensus was reached in 9 (9%). Of the four items with moderate consensus by the expert panel, one had moderate consensus by the conference participants and three had no consensus. CONCLUSION: This modified Delphi study on sporadic vestibular schwannoma codifies 100% consensus within a multidisciplinary expert panel and is further supported by 91% consensus among an external group of clinicians who regularly provide care for patients with vestibular schwannoma. These final 103 statements address clinically pragmatic items that have direct application to everyday patient care. This document is not intended to define standard of care or drive insurance reimbursement, but rather to provide a general framework to approach vestibular schwannoma care for providers and patients.

The Flipped Classroom in Medical Education: Engaging Students to Build Competency.

The flipped classroom represents an essential component in curricular reform. Technological advances enabling asynchronous and distributed learning are facilitating the movement to a competency-based paradigm in healthcare education. At its most basic level, flipping the classroom is the practice of assigning students didactic material, traditionally covered in lectures, to be learned before class while using face-to-face time for more engaging and active learning strategies. The development of more complex learning systems is creating new opportunities for learning across the continuum of medical education as well as interprofessional education. As medical educators engage in the process of successfully flipping a lecture, they gain new teaching perspectives, which are foundational to effectively engage in curricular reform. The purpose of this article is to build a pedagogical and technological understanding of the flipped classroom framework and to articulate strategies for implementing it in medical education to build competency.