a learning community of learning communities

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Medical Science Educator © IAMSE 2013 Volume 23(2) 293 MEDICAL SCIENCE EDUCATOR The Journal of the International Association of Medical Science Educators Med Sci Educ 2013; 23(2): 293-298 MEETING REPORT A Learning Community of Learning Communities 9 th annual Learning Communities Institute (LCI) meeting, San Francisco, CA, USA, November 3 th , 2012. The 9th annual Learning Communities Institute (LCI) meeting was held in conjunction with the Association of American Medical Colleges annual meeting in San Francisco, California on November 3rd, 2012. The LCI meeting was divided in two venues: a morning at Moscone Center in San Francisco, followed by an afternoon and evening in Palo Alto at Stanford University School of Medicine. Mirroring the significant growth of learning communities within medical schools the LCI meeting had its largest attendance to date; the morning session included 111 participants representing 52 schools of medicine from the United States and Canada. Sixty-five individuals continued with the group to Stanford for further collaboration, learning, and scholarship. Learning communities (LCs) in medical schools are gaining momentum across North America. Although learning communities vary greatly from school to school their framework offers a supportive learning environment for students based on longitudinal relationships between faculty and students who share “common values and beliefs and are actively engaged in learning together and from each other.” 1 Many schools have implemented advising, mentoring, traditional curriculum, clinical skills teaching, and social-wellness support into an LC foundation creating a community of learners that spans generations and levels of training. The meeting was convened by the two conference hosts, Joel Gordon (U. Iowa-Carver) and Amy Fleming (Vanderbilt University), who welcomed the participants and reviewed the history of the growing LCI group. Rob Shochet (Johns Hopkins University), the current LCI Chair fostered the community atmosphere by giving the group time to meet new members and begin conversations. The morning Keynote address “From High School to Professional School: The Learning Community Experience” was given by Jeff Gilbert, Principal at Hillsdale High School a learning community based school in San Mateo, California, and Rachel Lotan, Ph.D. from Stanford University School of Education. This keynote session was chaired by Lars Osterberg the local conference host (Stanford University School of Medicine). Their exploration of Hillsdale’s success in high school education through LCs, the underlying educational theory behind LCs, and the educational parallels in medical education were the main themes touched on in this keynote presentation. Gilbert highlighted the importance of institutional values and beliefs that are consistent and well articulated. He emphasized a focus on the potential of each individual student and a learning environment that is personalized, rigorous (with support), equitable (to break the patterns of predictability around success), and allows shared decision making so all in the community are heard. Dr. Lotan’s presentation helped the group explore the importance of sustained and trusting relationships. Dr. Osterberg ended by addressing the principal question… “What can LCs do for you? They can create a supportive teaching environment, with a productive community of learners, educators and caregivers engaged in a dialog about patient care and medical science.” 2,3 The morning research session highlighted LC innovations from 20 institutions. Four oral presentations were selected where authors led 20 minute facilitated discussions in rotating small groups. An additional 16 abstracts were presented as posters. The morning session concluded with working collaboration in small groups focusing on ideas that piqued interest and questions for the future. Over 60 participants then traveled by bus to Stanford University in Palo Alto to continue the conference at the beautiful Li Ka Shing Center for Learning and Knowledge, Stanford’s medical education facility.

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Page 1: A Learning Community of Learning Communities

Medical Science Educator © IAMSE 2013 Volume 23(2) 293

MEDICAL SCIENCE EDUCATOR The Journal of the International Association of Medical Science Educators Med Sci Educ 2013; 23(2): 293-298

MEETING REPORT

A Learning Community of Learning Communities 9th annual Learning Communities Institute (LCI) meeting, San Francisco, CA, USA, November 3th, 2012. The 9th annual Learning Communities Institute (LCI) meeting was held in conjunction with the Association of American Medical Colleges annual meeting in San Francisco, California on November 3rd, 2012. The LCI meeting was divided in two venues: a morning at Moscone Center in San Francisco, followed by an afternoon and evening in Palo Alto at Stanford University School of Medicine. Mirroring the significant growth of learning communities within medical schools the LCI meeting had its largest attendance to date; the morning session included 111 participants representing 52 schools of medicine from the United States and Canada. Sixty-five individuals continued with the group to Stanford for further collaboration, learning, and scholarship. Learning communities (LCs) in medical schools are gaining momentum across North America. Although learning communities vary greatly from school to school their framework offers a supportive learning environment for students based on longitudinal relationships between faculty and students who share “common values and beliefs and are actively engaged in learning together and from each other.”1 Many schools have implemented advising, mentoring, traditional curriculum, clinical skills teaching, and social-wellness support into an LC foundation creating a community of learners that spans generations and levels of training. The meeting was convened by the two conference hosts, Joel Gordon (U. Iowa-Carver) and Amy Fleming (Vanderbilt University), who welcomed the participants and reviewed the history of the growing LCI group. Rob Shochet (Johns Hopkins University), the current LCI Chair fostered the community atmosphere by giving the group time to meet new members and begin conversations. The morning Keynote address “From High School to Professional School: The Learning Community Experience” was given by Jeff Gilbert, Principal at

Hillsdale High School a learning community based school in San Mateo, California, and Rachel Lotan, Ph.D. from Stanford University School of Education. This keynote session was chaired by Lars Osterberg the local conference host (Stanford University School of Medicine). Their exploration of Hillsdale’s success in high school education through LCs, the underlying educational theory behind LCs, and the educational parallels in medical education were the main themes touched on in this keynote presentation. Gilbert highlighted the importance of institutional values and beliefs that are consistent and well articulated. He emphasized a focus on the potential of each individual student and a learning environment that is personalized, rigorous (with support), equitable (to break the patterns of predictability around success), and allows shared decision making so all in the community are heard. Dr. Lotan’s presentation helped the group explore the importance of sustained and trusting relationships. Dr. Osterberg ended by addressing the principal question… “What can LCs do for you? They can create a supportive teaching environment, with a productive community of learners, educators and caregivers engaged in a dialog about patient care and medical science.”2,3

The morning research session highlighted LC innovations from 20 institutions. Four oral presentations were selected where authors led 20 minute facilitated discussions in rotating small groups. An additional 16 abstracts were presented as posters. The morning session concluded with working collaboration in small groups focusing on ideas that piqued interest and questions for the future. Over 60 participants then traveled by bus to Stanford University in Palo Alto to continue the conference at the beautiful Li Ka Shing Center for Learning and Knowledge, Stanford’s medical education facility.

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A second keynote address by Dr. Abraham Verghese introduced educators to “The Stanford Medicine 25 – A means of continuing Bedside Medicine Education.” Dr. Verghese and two of his colleagues, John Kugler, MD and Errol Ozadalga MD, gave in-depth demonstrations of clinical skills teaching from traditional physical exam skills to use of hand held ultrasound devices at the bedside. The afternoon oral presentations included four hot topics in learning communities. Dr. Ban Allos (Vanderbilt University) discussed the potential for conflict when mentors have roles in academic evaluation and medical student advising. Danica Lomeli (Stanford University) discussed innovative exploration of critical incidents using faculty guided reflections within a learning community. The evolution of Hybrid Learning Communities was reviewed by Dr. Meg Keeley and Dr. Christine Peterson (University of Virginia). And finally, the contribution of 4th year student co-facilitators of preclinical curriculum was reviewed by Dr. Sunny Smith (University of California San Diego). The second poster session featuring an additional 12 abstracts related to learning communities research and innovations followed the oral presentations. Cumulatively, abstracts from Learning Communities at 24 schools of medicine were presented. Concurrent with the poster session were rotating tours of Stanford’s Center for Immersive and Simulation Based Learning led by David Gaba, MD. Breakout sessions in collaborative research, inter-professional education, faculty development, and student issues concluded the programming. During the research session two ongoing multi-institution projects were discussed and new ideas were generated for future collaboration. The wrap-up session was led by Zac Cordner, a student at Johns Hopkins University, who facilitated discussion of lessons learned and new ideas from the student perspective. A dinner reception followed and the meeting adjourned with a tour through the Stanford Rodin Sculpture Garden. There was clearly energy and enthusiasm as participants gathered ideas and enthusiasm to return to their home learning communities. The 10th LCI annual meeting will be held next year in conjunction with the AAMC meeting in Philadelphia, PA.

Notes on Contributors Amy E. Fleming, MD is an Associate Professor, Director of Medical Student Education in the Department of Pediatrics, Master Clinical Teacher, and Gabbe College Mentor, Vanderbilt University School of Medicine, Nashville, TN, USA. Joel A. Gordon, MD is a Professor of Medicine and the Faculty Director, Lois Boulware Learning Community, in the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, IA, USA. Innovations Abstracts ORAL PRESENTATIONS Through the Patient’s Eyes: Medical Students’ Navigation of Healthcare Systems in Learning Communities. Makia Powers, MD, MPH, FAAP, Deborah Lyn, Ph.D., Brandi Brandon Knight, Ph.D., Carey Roth Bayer, EdD, RN, CSE, Morehouse School of Medicine Introduction: Medical school curricula contain content and experiences designed to develop the next generation of physician. A notable challenge in medical education has been to explain the complexities of the healthcare system from the patient perspective.1-4

Program Description: Learning Communities (LCs) were established in 2011 for the doctorate of medicine (MD) program at Morehouse School of Medicine. Fifty-six first year MD students were divided into four LCs, led by clinical and non-clinical faculty mentors. Mentors created the interactive session, “Patient Navigation in Healthcare,” where each LC was divided into four groups and given a clinical scenario. The rationale was to allow students to analyze and navigate several healthcare cases from the patient’s viewpoint. Each small group was assigned a scenario and a list of practitioners that the patient would likely encounter. Students were allotted a set time to analyze, identify and present the practitioners in a flow map of the patient’s experience. Program Evaluation: Faculty facilitators challenged the students with questions to promote discussion as they created the patient navigation maps and recognized the complexities faced by patients. Students evaluated the session using an online survey, comprised of Likert-type questions (1-poor;

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5-outstanding). Fifty-two students (93% response rate) gave an average rating of 4.02 out of 5 potential points indicating a high level of satisfaction with the interactive experience. Discussion: Student participants were able to learn about the complex nature of the healthcare system from the patient’s perspective. They used the list of practitioners to apply the interactive exercise to real patient cases during a subsequent shadowing experience at Atlanta’s largest safety net hospital. They reported their findings in subsequent LC sessions. Lessons Learned: Medical students value interactive learning sessions as educational tools to gain knowledge on navigating complex and fragmented healthcare systems from a patient’s perspective. Longitudinal Advising in Learning Community in a School with Geographically Separate Campuses--Crossing the Divide. Kathleen Watson, MD and Lilian Repesh, PhD—University of Minnesota Medical School Introduction: The University of Minnesota Medical School has two campuses separated by 150 miles, in the Twin Cities (TC, 170 students per class) and Duluth (DU, 60 students per class). After the first two years, students combine in the TC. The Duluth campus is a track with a distinct mission to provide physicians for rural family medicine and Native American health care. The AAMC reports that 91 medical schools now have regional campuses (1). We have developed a model for student advising across geographically separate campuses, missions, and the medical school curriculum using a learning community model individualized for our unique missions, culture and curriculum (2, 3). We report the organizational model, faculty development, and early outcomes. Program description: The aims of the University of Minnesota Medical School learning community (called Faculty Advisor (FA) program) are to 1) build long term relationships among students and faculty, 2) identify students’ needs and connect them to useful resources; and 3) promote professional formation throughout medical school. Since 2010 the FA program has advised cohorts of students through years one and two separately on both campuses. In April 2012 we launched the third phase of the program to continue advising during students’ third and fourth years. Students are assigned at matriculation to a FA from their home campus and FA activities include biannual

individual meetings, group sessions, and other learning activities. Major differences in FA groups between campuses are size (24 students in TC vs. 10 students in DU); number of FA’s (7 in TC vs. 6 DU); roles (pure advising in TC, teaching in DU); and FA clinical specialty (multiple in TC, all Family Medicine in DU). The third year FA program was designed to align with program aims such that all students continue with their FA and cohort. FA dyads were formed across campuses such that the DU FA is the designated advisor and the TC FA serves a backup role. Roles and responsibilities were determined by consensus among all FAs and discussed with students. The program ensures that 1) FAs can access a central web-based secure academic tracking system for their own students and communications; 2) FA’s holds biannual individual meetings with their advisees during year three; 3) FA group sessions are held for all year three students on the TC campus focused on “significant events reflections” conducted by TC FAs in conjoined groups of TC+DU advisees; and 4) TC FA’s meet with and write MSPE Summary section for all students incorporating DU FA comments on students. Faculty develop is essential. An annual retreat using a learning community model focuses on key advising need, e.g. year three scheduling, academic enrichment, and career selection. Program evaluation is done formally annually based on the three FA program aims. Informal evaluations are done after each group session and shared with all FAs and the medical school. In our 2011 LCME Independent Student Analysis, 98.6% of students reported being satisfied with advising. Discussion and Lessons Learned: Preliminary results after 6 months show that FA dyads are sharing responsibilities for student academic advising, career development, rotation scheduling and writing MSPE Summaries. FAs and students are using central processes and shared resources for academic tracking, career planning, student educational enrichment opportunities and faculty development. There is preliminary acceptance by students and we await formal evaluations. Geographic distance remains the largest challenge. Through program development and mutually shared responsibilities, the Faculty Advisors themselves have formed trust and a learning community whose practices, culture, aspirations and outcomes have been genuinely rewarding and gratifying for all involved.

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The Use of Learning Communities to Teach Medical Students Teamwork, Professionalism and the Determinants of Health in a Community Setting. Joseph Kiesler, MD, Zélia M. Corrêa, M.D., Ph.D., Anne Gunderson Ed.D, GNP University of Cincinnati College of Medicine Introduction/Aims: In 2011, the University of Cincinnati College of Medicine implemented an organ system-based curriculum, which included faculty facilitated learning communities (LC) of 12 students and longitudinal courses relating to primary care, interprofessional care and the physician’s role in society. The Physician and Society curriculum emphasizes professionalism, ethics, community and population health, the business and law of medicine and medical humanities. To teach first-year medical students about the determinants of health of a community, foster professionalism when working with colleagues and the community, and develop teamwork skills, the Physician and Society course linked each learning community with a neighborhood and community agency in Greater Cincinnati. Program Description: In the fall, each LC completed a community health assessment of their neighborhood, focusing on one determinant of health. This culminated in an adjudicated poster session, with each LC presenting. In the winter, each LC rejoined their community partner for a service-learning project, based on the needs of the community and the needs assessment. Learning communities presented the service-learning outcomes to community members, faculty and peers in the spring. Program Evaluation: At the end of each module, students completed a Team Climate Survey, reflections, and course evaluations. The initial Team Climate Survey and reflections were discussed in LC’s to facilitate development of teamwork. LC scores improved in 11/15 areas on the Team Climate Survey. Discussion: Learning community team identity increased through completion of the modules, working through the phases of team development (forming, storming, norming, performing, re-orienting). The modules allowed the course to use experiential learning to teach the determinants of health, professionalism and teamwork in a community setting utilizing the learning communities.

Lessons Learned: Challenges included coordination and communication with community partners, communication and development of team building skills within the learning community groups, and division of work within teams. Developing a Cadre of Learning Communities Mentors. Michael Ennis, MD and David Hatem, MD University of Massachusetts Medical School Introduction/Aim(s): At UMass, LC’s were established in 2010. Incoming students are randomly assigned to a House Mentor who currently follow a total of 25 students (6-7 from each class year). Mentors teach their students clinical skills and also have individual advisory meetings with their students 3 times annually (minimum). These sessions focus on personal adjustment, professional development, academic achievement, and career guidance. Our aim is to describe the faculty development program designed to support skills of our mentors. Program description: We have 20 House Mentors from internal medicine, pediatrics, family medicine, emergency medicine, OB/GYN, and psychiatry with a mean of 25 years clinical experience (range 5 - 45). Considering such diverse backgrounds we instituted a weekly program focused on the development of teaching and mentoring skills addressing topics such as teaching clinical skills, effective feedback, characteristics of effective mentoring, typical medical student development, etc. Medical student career development is a longitudinal thread. Specific topics were next covered including preparation for upcoming PD sessions as well as helping students with academic, mental health, student maltreatment, and professionalism issues. We featured sessions on the unique aspects of advising LGBT, URM, or MD/PhD students. To enhance effective networking skills, House Mentors developed extensive knowledge about services, resources, and extracurricular opportunities available at UMass. As Mentors gathered each week they evolved into their own learning community. This relationship was powerfully manifested in our 'Mentoring the Mentors' sessions, when Mentors presented (de-identified) students whom they were having challenges with and got advice from their peers. Program evaluation: Participants completed written evaluations following each session.

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Discussion: Mentors from a wide range of backgrounds bring many strengths to a learning communities program, however, intensive faculty development covering a wide range of topics is required to ensure that students receive consistent services from their mentors. For example, a mentor who is a psychiatrist may be poised to recognize a student with depression but may require a more intensive refresher to teach physical diagnosis. Lessons Learned: Development of competent LC Mentors requires ongoing intensive faculty development balancing didactic content with interactive sharing of experiences. Successful implementation of a consistent LC mentoring program also requires significant faculty development on use of on-line resources. POSTERS The “POD System”: An Innovaive Strategy to Reform GME Teaching Sessions. Scott J. Stevens, MD; Alice Fornarum ED.D, R.D.; Ronald Kanner, MD, Hofstra North Shore-LIJ School of Medicine

Second-Year Medical Student Reflections: A Pilot Study to Prevent Decline in Empathy. Jana K. Zaudke MD, MA, University of Kansas Medical Center

Medical Student Learning Communities: Developing Professionalism, Clinical Skills, and Mentoring Relationships. Gauri Agarwal, M.D., F.A.C.P. University of Miami Miller School Maintaining the “Family Atmosphere” through Learning Communities amidst an Increasing Class Size. Carey Roth Bayer, EdD, RN, CSE, Deborah Lyn, PhD, Martha Elks, MD, PhD, Morehouse School of Medicine A Tale of Two Curricula: The Merger of a Doctoring Course and a Mentoring Program. Mary E. Rocha, MD, MPH, Christina St. Michel MD, Crystal Wright, MD, Cayla Teal PhD, Elizabeth Nelson, MD, Baylor College of Medicine Analysis of student attitudes about learning community structure and efficacy. Alan E. Harzman MD, Rolling Nagel PhD, Jennifer Burgoon PhD, Joanne Lynn MD, Daniel Clinchot MD, David Way MEd, Catherine Lucey MD, Robert Ruberg MD, The Ohio State University

Functional Mentorship in one Learning Community: Inception, Growth, and Continuity. Meaghan Dehning, Serena Edwards, Gerald Wickham, Linda Birkhofer, Vincent Liu, University of Iowa Carver College. Learning Communities at a New Medical School with a Small Class: Lessons Learned after the First Year of Implementation. Julie C. Servoss, MD, MPH, Suzanne Weiner MD, Joseph Ouslander MD, Stuart Markowitz MD, Lindsey Henson MD, PhD, Florida Atlantic University Evaluating an Advisory Dean Program: A Program Evaluation Strategy. Aubrie Swan Sein, MD, Lisa Mellman MD, Boyd Richards MD, Columbia University I’m right, you’re wrong: Teaching effective conflict management among peers using Learning Communities. Aleeia Johnson MD, Brandi Knight, Carey Bayer EdD, RN, Deborah Lyn, PhD, Makia Powers MD, MPH, Morehouse School of Medicine Determining need for a structured advising program. Courtenay Holscher BSE, Terri Blevins MA, Maureen Garrity Ph.D, University of Colorado “Wards to Words” Using Learning Communities and Critical Clinical Events to Assist in Professional Development of Medical Students. Crystal C. Wright, MD; Mary Rocha, MD, Cayla Teal PhD, Linda Stellies, Christina St Michael MD, Elizabeth Nelson MD, Baylor College of Medicine Creating a Learning Community pilot, “Energize your Medical Education (EME)” program, for underrepresented, underprepared Medical School Incoming students. Christine Reichert, M.A., Patricia Metting, PhD, Patricia Hogue, PhD, Joni Trempe MEd, University of Toledo Health Science Campus Learning communities within learning communities: Benefits for students and faculty. Barbara Sheline MD, MPH, Victoria Kaprielian, MD, Duke University Using Academic Communities as a Structure for Multifaceted Approach to Discussion Challenges in the Clinical Learning Environment. Daniel Tarman, Carolyn Kelly MD, Sunny Smith MD, University California San Diego

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Competitions in Medical School Learning Communities. Van T. Nguyen, Zac Cordner, Robert Shochet MD, Amy Fleming MD, Johns Hopkins University and Vanderbilt University. Innovations in Learning Community-based Clinical Skills Evaluation. Paul Gordon, MD, MPH, Kevin Moynahan, University of Arizona 'E-Harmony' in the Colleges peer mentoring system – analyzing and improving the effectiveness of Vanderbilt Medical School’s Big/Little peer mentoring program. Jana Bregman, Sarah Coggins, Mitch Odom, Amy Fleming MD, Vanderbilt University Novel Strategy to Re-Engage Third and Fourth-year Medical Students in Learning Communities: Overview and Outcomes of the “Learning Community Grand Rounds”. Joel A. Gordon, MD, Gerald Wickham MA, Paul Meirick, BA, University of Iowa Efficacy of a developmental biology learning community on promoting and strengthening interdisciplinary collaborative behaviors. Elise R. Pfaltzgraff, Richard Samade PhD, Rebecca Adams, Daniel Levic, David Bader PhD, Amy Fleming MD, Vanderbilt University The Johns Hopkins University learning environment survey (JHULES): Development and validation of an efficient tool to assess student perceptions of the medical school environment. Robert Shochet, MD, J. Colbert-Getz PhD, Scott Wright MD, Johns Hopkins University Medical Student Distress And The Impact Of A School Sponsored Wellness Initiative. F. Joseph Real MD, Matthew Zackoff MD, Mario Davidson PhD, Beth Ann Sastre MD, Vanderbilt University Reflecting through learning communities: A unique opportunity to provide instruction while maintaining student openness. E. Michael Powers, MBA, Amy Fleming MD, Quentin Eichbaum MD, PhD, MPH, Vanderbilt University Educational Outcomes Associated with a Learning Community Implementation. Jim Wagner, MD, MSc, University of Texas Southwestern Medical School

Curriculum Variation in Implementing a New Physical Diagnosis 2 Course through Learning Communities. David Hatem MD, Timothy Gibson MD, University of Massachusetts Spheres of Influence: Faculty Benefits and Costs Beyond the Learning Community. Erika Schillinger MD, Bahij Austin, Paula Adams Hillard MD, Kambria Hooper MEd, Lars Osterberg, MD, MPH, Stanford University. Mock Residency Interviews: Preparing Students for Success in the Residency Application Season. Michael A. Pilla, MD, Amy Fleming MD, Elizabeth Sastre MD, William Cutrer MD, Ban Allos MD, Scott Rodgers MD, Vanderbilt University Development Of A Comprehensive Model And Implementation Guide For Medical School Wellness Programs. Matthew W. Zackoff MD, Scott Rodgers MD, Beth Ann Sastre MD, Vanderbilt University

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