The past several decades have witnessed a major shift in medical school faculties that have prioritized the hiring and development of ‘clinician educators.’ However, excelling in educational endeavors (much like clinical ones) requires training. It is essential to develop an understanding of theories that inform educational approaches, curriculum and assessment. On the one hand, this facilitates the process of teaching for the busy clinician educator. On the other, it also helps students flourish by maximizing their learning potential.
MedEd Models is an initiative that provides quick and in-depth primers on various educational theories relevant to medical education. By synthesizing the vast amounts of MedEd literature into visually appealing graphics and tweetorials, it holds great value not just for clinician educators, but also for medical students and trainees aspiring to get involved in medical education and scholarship.
In this Q&A, we feature the founder of MedEd Models, Dr. Timothy Dyster. Currently a fellow in pulmonary and critical care medicine at the University of California, San Francisco, Dr. Dyster also serves as a resident editor for the Journal of Graduate Medical Education and is the lead contributing editor for the first edition clinical handbook, Huppert’s Notes. He shares his thoughts on medical education and advice for medical students looking to foray into this field.
Q: How did you get interested in medical education research and scholarship?
A: I became interested in medical education scholarship during a year off in medical school that I took to pursue research in a neurosurgery lab. Around that time, a few important things were happening all at once. First, the White Coats for Black Lives movement was highlighting the presence of racism in clinical care and in medical training. Second, professional identity formation, a construct focusing on how a layperson forms the identity of physician via medical training, was gaining traction as a key framework for re-thinking structures and systems in medical education. Finally, and more personally, I had just finished my own clerkship year, and during it had heard stories from many of my closest friends about how their own personal identities — their race, their gender, their sexuality — had impacted the way they experienced their clerkship year, including their interactions with other medical professionals and the assessments they received from clinical supervisors. In addition, some of my friends shared that they had considered reporting the experience of differential treatment because of their identities or reporting their experiences of bias, but they felt they should not because they lacked “hard evidence,” and thus felt they would go unheard — or worse: face retribution — and that no actions would be taken in response to their report.
All of these factors coming together made me interested in doing research about the clinical learning environment, professional identity formation, and how personal identities impact our experience of medical education. In retrospect, I think what I was trying to do was honor the narratives and lived experiences that my closest friends had shared with me by exploring them through education scholarship, with the hope that this scholarly exploration could generate the “hard evidence” needed to promote action and systems-level change.
Q: What was the inspiration behind starting MedEd Models?
A: Over the course of medical school and residency, I have been lucky to be part of many meetings and discussions about programmatic design, including some that centered on relatively important decisions about program structures. At times, I found myself in these meetings recognizing that discussions were actually about ideas that existed in the education and medical education literature, but that we were not naming that connection. For example, discussions about cognitive load theory, pedagogical caring, critical theory, self-conscious emotion theory — and I found myself wondering how the content of those discussions and their outcomes might have been impacted if everyone in the room had a shared understanding, even a rudimentary one, of some of those ideas. In a conversation with my best friend about this observation, we began to riff on ideas for using social media to spread key ideas in medical education. That conversation was the birthplace of MedEd Models.
Q: Many medical schools in the United States have introduced medical education tracks. What is your advice to students interested in leveraging such opportunities?
A: The most important advice I would give to anyone interested in medical education is to make sure you are doing the work of an educator. If we turn to the educator’s portfolio for guidance on this idea, we would find ourselves looking for opportunities in the domains of direct teaching, mentorship, curricular design, education leadership, and learner assessment, as well as for opportunities to engage in scholarship in any of those five domains.
I am borrowing this example from Wenger, but in the same way that taking a high school physics course does not make you into a physicist, taking classes on teaching will not make you into an educator. So, if your institution’s clinician educator track (or, if your institution does not have a track, whatever programming it offers) does not include built-in, authentic educator experiences from multiple domains, I would encourage you to seek them out locally, regionally, or nationally. This is a particularly good time to do that search, since we have all adjusted to a world that relies on Zoom.
Q: Also, there are students looking to get into medical education research but lack such opportunities or mentorship at their schools. Any suggestions you have for them to expand their network to build such opportunities?
A: This is an important question, and I think highlights that the opportunities that exist for young professionals are not equitable across institutions. My advice is not to be afraid to build a mentorship cabinet for yourself that includes mentors outside of your home institution. A wonderful feature of the medical education community is that it comprises professionals who are excited about helping Early Career Educators to grow and find their niche within medical education, and so it never hurts to send an email to someone whose work you admire and to see where it goes.
Q: With the COVID-19 disruption, what are some of the ways you personally see medical education adapting to this situation?
A: I think the COVID-19 pandemic has forced us to engage with the ways that technology can enhance accessibility in educational spaces, and it has forced us to consider how we use in-person sessions, as well as the role those sessions play in community-building. I’m not sure exactly where we go from here, but I imagine virtual meetings are here to stay.
Q: More and more people are becoming aware of biases across the continuum of medical education. How do you think we can further this conversation and advocate for inclusion as medical education scholars/researchers?
A: The most important thing in my opinion is to expand our perceptions, and others’ perceptions, of what constitutes rigorous research and reliable data. Most physicians are trained first as natural scientists, in a post-positivist paradigm. This means that we are taught to believe that you can never prove anything, only that you can reject hypotheses in an effort to approximate reality, and that rigor in research is achieved by eliminating the mess of difficult to measure factors through the isolation and control of experimentation.
Post-positivism is not the only paradigm of science, though. For example, paradigms like social constructivism and critical theory more readily embrace the subjective experience as a source of data, while still having criteria for rigor. So I think the first step is to open our minds to what it means to “prove” something and to the role that well-gathered and well-analyzed narratives can have in growing our knowledge and understanding of reality. This embrace of other paradigms, which often involves embracing qualitative data, can broaden medical educators and administrators’ toolkits for researching and rigorously documenting the presence of bias and its impact in their medical education institutions. If we do not recognize the incredible value of narratives as data, it will be much more difficult to move forward the conversation on bias in medicine.
Q: Personally, what have been some of the most memorable experiences for you in your journey conducting research in MedEd?
A: I did a set of interviews in medical school with other medical students about their sense of belonging. I think the most unexpected finding from that study was the role that humor played in making learners feel like they belonged on a team. Multiple students noted how when a team could joke with one another, it created a sense of easy comfort and belonging. It may not seem like a profound finding at first, but it suggested to me that small interactions can build into the feel of an environment in unexpectedly large ways.
Another finding from that study was the impact of individual-institutional alignment. We found that when learners felt that their own core values were reflected in their institution’s values, they had a greater sense of belonging there. The effect was also seen in the reverse situation: if a learner was attracted to an institution because of its espoused values, but they ultimately discovered institutional policies or practices were not aligned with those values, they described a particularly strong sense of not belonging at the institution.
Q: There is a huge risk of a lot of our scholarly conversations getting too theoretical and construct-focused. Do you see this as a potential hurdle? How do you think we could address this and make ‘theory’ more ‘practical?’
A: I don’t. I think that in the same way that basic science becomes translational research, and translational research becomes clinical research, that the key theories in education have an important role in informing what we do.
I think a helpful construct for “making it practical” would be the idea of a conceptual framework. Conceptual frameworks draw on theories as well as practical experiences to inform how we engage in scholarship, problem-solving, and the practice of education. I like drawing on the idea of conceptual frameworks because it highlights that theories can help us make good choices, and still they don’t have to completely steamroll what we might know through our own practical and lived experiences.
Q: Many students and faculty advocates have called for reassessing our assessment methods in undergraduate and graduate medical education. How do you think we should move forward, especially with regards to standardized tests that remain widely used in schools today?
A: In some ways this is an easy question: things evidently need to change. If I presented you with a diagnostic test and I told you it wasn’t intended to diagnose a specific condition, and then you proceeded to use it to diagnose that specific condition, we might call that malpractice. In the same way, it is striking how our community has used standardized exams that have consistently been shown not to predict performance in the clinical environment as metrics to choose who we accept into our clinical training programs.
In other ways, this is a difficult question: how to move forward is not entirely clear yet. I think that holistic review, the practice of looking at the entirety of an application including lived experiences and distance traveled, is one antidote for the current state. But it is resource-intensive, and I know not every institution has those resources. For that reason, I think my answer is that the best next step is for us to keep talking about it at-large and being open to novel approaches and solutions.
Q: Finally, how do you think your involvement in medical education research has influenced your growth as a physician?
A: I think it’s made me a more deliberate educator and physician. When I’m faced with a difficult problem in the clinical learning environment, it is rare that I feel entirely helpless or clueless. Usually, there is at least one framework or theory that I can use to help myself tackle the complexity of that problem. I feel lucky for this, because without those frameworks there are many situations I would encounter that I might struggle to solve on my own de novo. It’s wonderful the way the education literature can help us stand on the shoulders of Education Giants.
Column image credit: Custom drawing by Akanksha Mishra for this column.
Headshot image courtesy of Dr. Timothy Dyster.
Medical education today struggles to keep pace with actual medical practice. Moving from an information-driven curriculum to a value driven one has propelled a vast array of research and scholarship in teaching methods, assessments and competencies. In this column, I hope to share insights on some of these areas as well as call for learning that is more adaptive and less standardized.