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Educator Well-Being Plenary Session at ChangeMedEd 2023

Learning Objectives
1. Identify the systemic and cultural factors that impact educator well-being, inclusive of allopathic and osteopathic institutions and across the undergraduate and graduate medical education continuum
2. Articulate why educator well-being is critical to address
3. List recommendations and guidance meant to resolve issues of well-being at the individual institutional level as well as heal US medical education at the systems level
1 Credit CME

Much attention has been devoted to the well-being of physicians, residents, and medical students, but the well-being and unique stressors of medical educators has been largely ignored, including graduate medical education and pre-clinical educators. As the multidimensional factors that diminish the well-being of educators continue, an epidemic of burnout has the potential to broadly impact the availability of the educator workforce. The AMA recently supported a publication focused on educator well-being. This book emerged from a thematic discussion series hosted early in 2021 by the American Medical Association Accelerating Change in Medical Education Consortium entitled “Supporting Medical Educators During Disruption and Beyond.” Sixty different medical institutions participated and identified the need to better address the value of medical education and the well-being of educators. The presentation is a continuation of the discussion.

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The AMA ChangeMedEd initiative works with partners across the medical education continuum to help produce a physician workforce that meets the needs of patients today and in the future. Learn more

Video Transcript

David Henderson, MD: Thank you all for joining us. This is the first of two interactive plenaries that will occur this afternoon, and this session is focused on wellness among medical educators. And wellness is a topic that I think a lot of us have had a lot of experience with and a lot of dialogue around, but I think the specific population that we represent has not gotten as much love as as many other of our peers.

To begin I'll just ha I'll just ask I'd like to invite each of the panelists to to introduce themselves and we'll start with with you, Andrea.

Andrea Leep Hunderfund, MD: Sure. Hi everyone. I'm Andrea Leep. I'm a neurologist at the Mayo Clinic in Rochester, Minnesota. I've been part of the AMA Change Med Ed effort for a long time. I'm medical director for our Office of Applied Scholarship and Education Science and lead efforts in UME and GME related to learning environments.

Allison Knight, MD: And I'm Allison Knight. I'm a clinical and educational psychologist by training. I'm currently the Student Affairs Dean at Eastern Virginia Medical School all the way on the coast of Virginia. I also spearhead our student wellness activities and have been working with Maggie and others in the wellness space here for the AMA and was fortunate enough to be co-editor of the book that we'll be talking some about today.

Margaret Rea, PhD: And I'm Maggie Rea, also known as Margaret Rea up there. I'm also a psychologist, excited we have two psychologists here today. And I'm the director of wellness at the UC Davis School of Medicine, and I oversee wellbeing efforts for our UME learners, our GME learners. And have been working with Alice, and actually we started in the space of, through the AMA--thank you very much, AMA-- around UME well-being, and then we were given this opportunity to address the issue of educator well-being. So it's exciting to be here in a room full of educators where we're gonna, really think about how we can keep you and the efforts that you do well. And we're hoping we'll have a good conversation today around this topic. And then, and we've provided, thanks to, and I can't--we cannot see anybody, just so you know, it's completely...I know you're there and I have a feeling that some of our authors are here in the audience as well, who have provided what we really wanted to be a very problem-based toolkit for you to use to take back to your schools and institutions to see how you might best address the well being of yourselves and your fellow educators.

Really glad to be here for this conversation.

Henderson: Thank you all. This panel discussion evolves from a workgroup that was formed by the AMA focused on wellness among educators. As I said before, there had been a lot of attention on wellness among physicians in general, and additional attention on faculty in general, but not a lot of attention on educators specifically. And the COVID pandemic, I think really highlighted the sort of unique position of educators.

And this is just I am very visual and this is just an image that struck me. So academic medical centers are sort of complex systems and a good deal of the sort of work and the focus of academic medical centers is on the clinical side because that's where revenue is generated. And I think often we as educators find ourselves off in parking lots largely unattended to. And I think things became particularly dire for us during COVID when we were not only in in some parking lot but the lights also went out. And the working group began to discuss this and the textbook. So we've evolved from the work of and the discussions in the work group. And there will be a QR code at the end for those of you who haven't seen the book that'll allow you to download it. But and as Maggie said, we owe a great deal of thanks to the authors who contributed because it was a good deal of work and a good deal of good work.

And so that said we'll just launch into the session and we'll begin with a discussion of stressors and challenges which Allison will share with us.

Knight: Yeah when we were, and... So thankful to the AMA for creating the space to have this important conversation and, as we all know, well-being is contextual, right? It's contextual to the individual, to our social and cultural norms, and to our institutions. And so one of the things, while we I'm so appreciative of this volume, we know that there's no way one volume can cover all of the stressors that our individual units, our institutions, our individuals, people, our educators could be experiencing, and so what we'd really be interested in is getting your thoughts right off the bat. We'll share with you ours as well, but we invite you to—hopefully we can go ahead and launch the Mentimeter.

So we're going to do a word cloud. And there should be instructions you can see over here on this screen. So we'd love to hear from you. Again, this will be a word cloud format. So maybe just a couple of words. One, two, maybe three words. What are you seeing? And again, if we really ground ourself in the space of educators, and we want to think holistically about educators, obviously our basic science faculty and our clinicians as well, but also residents and fellows who are engaged in teaching. When you think about the stressors that are impacting you or, and your work or your institution, what comes to mind? We're going to just let some time to have you generate those ideas. Hopefully it's working. It's not working.

Leep Hunderfund: I just have to advance the slide. There you go. There you go.

Knight: Yeah. So here we are. Again, in the space of educators, what are the stressors and challenges to face? Burnout.

Rea: Time's coming in strong.

Knight: Yes, time is definitely coming in strong. Yes. Balance. Time is coming in a lot of different ways. RVUs, similarly. Resources, priorities. I wonder if we can, on the, on our slide, can we just show the Mentimeter? Funding. That's great. Thank you. Appreciate that. Retention. Unstructured time. Negative feedback.

Rea: Learner attitude. Yeah.

Knight: Politics. Disgruntled students. Competition.

Leep Hunderfund: I see moral injury, lack of legitimacy, underappreciation.

Knight: Red tape.

Leep Hunderfund: Conflicting demands.

Knight: And we and if we look at some of the most prominent time balance I think that one of the things we, in this space we think about is all the demands and the cognitive load of that, that educators are managing. Demands, change, priorities, resources, expectations, yeah. Anybody else?

Rea: Cancel culture. Had a good session on that yesterday. That was really interesting. Yeah.

Knight: So if we advance one of our slides here. Why is that? Is that advancing? Yeah, if you can advance. Thank you. Thank you.

So when we looked at, when we looked at the book, we categorized our stressors. And we want to spend more time on solutions here, but I think it's important to ground what we're talking about in our stressors. So these were the real overarching themes that came out of our work with the book. So the value of education, and we're looking here, you're seeing it, funding, integration into decision making, do educators have voice in the spaces in which decisions are being made as educators? You might have voice in other roles, but are you having voice as educators in the demands that are all on this wonderful slide here?

When we talk about looking at institutional structure and actually the most prominent of which here are time, when we talk about, the value of education and institution, is there time that's being devoted that reflects the value of those, of that important need for education?

And we're looking at structure, things like competing reporting systems. Do you report, clinical departments into a department of medical education or, a basic science department as well? Lack of alignment with the mission of education with the overall mission of the institution and how does that fit in again in decision making?

Promotion tracks, I'm not sure if we saw anything in here. If I missed it, I apologize. One of the things that we're looking at and I'm going to be interested in thinking about, do your institutions value education and promote education in the A&P process? Is that an explicit value of the institution? And if not, how can that, how can we look at that?

I did notice with the larger picture of academic medicine, talking about accreditation demands and curricular demands, right? Keeping up with what is new and innovative, which is things that I think excite us, but then again, getting back to time, do we have the time to explore those things? Do we have the resources to engage in them well? Are we being asked to juggle an accreditation on top of an already very busy week and on top of, multiple roles in, in preparing for our site visits you and me, Angie and me. Looking at, throughout all of it, the very important piece of diversity, equity, inclusion, and belonging. Again, not sure if we saw that as much in here, possibly.

Leep Hunderfund: I saw the word belonging come through. [cross talk]

Knight: Belonging was belonging there.

Rea: Diversity.

Knight: Yep, diversity, great. Respect. And thinking about. the different roles that we play and the identities that we bring to this work and are all of those identities being supported in the global identity of educator? Intergenerational differences and interpersonal differences. One of the things we really looked at there were tensions and differences in mental models between learners and our educators. Things like, different comfort with technology or pedagogy, preferences along those lines even disclosure, personal disclosure. Educators feeling I wanna support, you know my learners as best as I possibly can, but do I have the training to do that, are there the resources to support me and all of that as well?

And then of course, really looking at how we measure well-being, and are we looking at it in macro aspects but also micro aspects, knowing that, that contextual piece of well-being is really critical and that educators do have different needs around well-being and is that being looked at even in institutions that are doing a great job of looking at measurement of well-being? So those were some of the things, and I think you all highlighted all of those really beautifully. A lot of universal themes that we're seeing across the board in terms of stressors.

That is just to lay the foundation. We obviously want to spend most of our time talking about solutions, and we're really interested in hearing more about your thoughts here. I'm going to turn it over to Maggie.

Rea: Yeah, so now we'll pivot, as we say, the conversation to talking about solutions. And we'd love to hear from you about many, from many angles. One, solutions that you have landed on that are working, because we are here to share and grow and learn from each other. Aspirations for things that you would like to see at your institution that could best impact your well-being and the well-being of your colleagues. So take a moment and share with each other potential solutions, and then let's have that conversation together. See where we land on this.

And the answer is... Transparency. Protect DEI. Yes. Boundaries. Reasonable clinical buy down. Communication. Education RVUs, that came up in our book in several chapters. Yeah, trust yourself and lean on the other.

Leep Hunderfund: More money, less problems. That's my favorite so far.

Margaret Rea, PhD: Though as a psychologist I like this conversation about community, connections, supporting each other, mentorship. I'm wondering, are we seeing the rest of it?

Knight: Is it possible to move forward?

Henderson: Can it crawl?

Rea: There could be amazing solutions underneath there. Oh, here we go. Thank you. Streamline processes. Honest expectations. Reward. Incentivize. The educators.

Knight: A lot about communication. And community. Coaches.

Rea: Inclusive environments. Coaching for faculty--we'll talk more about that. We really saw that as a real need in terms of professional development. RVUs for education. Hm. Administrative support. Oh, authentic communication. Hm.

Henderson: Protecting time.

Leep Hunderfund: I appreciate these comments about improving support in personnel too, that's been particularly challenging after COVID, I think, with workforce shortages and turnover and that can really be an under-recognized strain on educators for sure.

Rea: I'd love, at some point today, whoever is talking about boundaries, I'd love to talk more about that. Is it boundaries between the different roles that you play? Because we certainly feel like that can be a big issue, or is it boundaries for yourself as an individual?

Knight: We'll try not to expel all the students. That would probably be...

Rea: Oh, I didn't see that one. I missed that. Okay. But how would you educate? Who would you educate? Pragmatism. Support groups. Yeah. Child care, absolutely. Academic leaders outwardly supporting teaching, right?

Leep Hunderfund: Expand definitions of success. Yes. That touches the promotion criteria you mentioned before.

Rea: Do we need to--at my lunch, my breakfast table yesterday, we talked about redefining what scholarly means.

Knight: Prioritize faculty for change. Compensation. Compensation, yes, absolutely. Being heard, okay. Guidance of student evaluation.

So one of the stressors in the accreditation curricular space is how the, the role of student evaluations not only in directing the educational process but in the A&P process for faculty and the extent to which that is valued.

Rea: We've got an all cast—term limits for administrators. [laughter]

Leep Hunderfund: That one's getting some applause.

Knight: That's just—journal productivity. Breaking down hierarchy. Yes to Term Limits. Reform LCME. Okay. Yeah.

Rea: Thank you all. These are amazing. Yeah, this is terrific. So now what we'd like to do is, I don't think, is my advance working? Yes, so we want to offer you a framework, if you will, that we included. I shouldn't say we, the authors of this chapter, I can't decide that I made this up myself—that we borrowed from Bowman and Diehl, about a way to conceptualize potential areas for change, for opportunity.

I know, I wrote this morning after listening to the talk, I wrote hope. We're hoping that you feel hopeful with when you think about ways that you could make change. And give me one sec, sorry. So the idea of symbolic, we saw that in some of the things you were talking about. Feeling heard, feeling seen. Feeling valued, recognized for your educational contribution, structural changes. I saw a lot of those going by. I'm not sure where getting rid of term limits would go in that conversation, but I will figure out a place for it at some point.

Leep Hunderfund: That's probably political.

Rea: Right. But we did see in our human, and this landed in the human resources bucket a bit, but I heard it from all of you a lot. Peer support, communities of practice, mentorship, engaging with each other, which seems like a really key place.

So if we can go to the next slide for a minute, and we'll show you a little bit about where we saw some of the things—it's hard for me not to look back there, I'll try not to where we saw some of the things that we think are important. So, the structural piece. We saw a lot from what you said as well about funding around medical education, right? The promotion process, huge, right? And I think that's a, and I'll, talk a little bit more about that later, but, investment in education, right? So it's ironic in a somewhat dark way that all of you in this room have some role in medical education and education, but often in your institutions it doesn't get the emphasis that one would want to see, and one would, for all of you, and I think we saw that in some of your responses. And as we said before, symbolic recognition, reward. Really important, right? And with that comes that, we saw a lot of conversation, what you said here about, how do we be sure that there's a feeling of belonging, inclusion, that feeling accepted, and is it representation as well? So that's key.

And then your political issues as well. Advocacy, pay equity. Are we, in one of the, one of the authors in our book talked a lot about do we support our educators in, knowing how to get grants, how to…is there a mechanism, there's an infrastructure for that? Same thing around the educational mission. Is there an infrastructure in the institution to help you be the best educator that you can be? So just pause, and what we hope for you to get from this lens, if you will, about solutions, is hopefully getting that sense of, wait where could there be a place that I could think about going back to my institution and advocating for change? And as we heard in the talk this morning, it might very well be chipping away at something, but looking at where is there a space? Maybe you're doing some of this really well and you should share it with each other, or is there something you want to take back to say, oh no, this is an area that we really could, I'm looking right now like peer coaching. That would be something and we saw that in several ways in the Mentimeter a few moments ago.

So that's what we're hoping today for you to feel hopeful about taking some of the content that we're sharing today with, back to your institution. And perhaps one of the, the first steps is I'm going to turn it to my colleague, and I don't know if we also introduced you as one of the authors in the book who really focused a and helped guide us in terms of how do, where do we begin? And one place we begin is with assessment. So I'm going to turn it over to you to talk about that, Andrea.

Leep Hunderfund: Yeah, sure. Thank you. So if it's not obvious by now, at this point in the conversation, we really hope that you are thinking about this topic and relating it to your local context and appreciating this opportunity to think of: how do we connect the potential solutions that we see here back to our places, our people back home? And what we hope to do over the next few minutes is invite some reflection about the role of measurement, the value of measurement, and how assessing educator well-being can inform those types of local improvement efforts.

So we know as educators we're often situated, I love that highway illustration because it speaks to the fact that we're situated at the, crossing headwinds of education, practice, research quite often and those missions don't always line up. And measurement can illuminate how our educators are doing and even more potential barriers and facilitators in the environment that might be unique to that role. Measurement can uncover variation across groups. I have a quality background. We think about variation. There's an opportunity to ask a question there if there's differences among groups of educators across different sites or schools or programs. And then measurement can also help a leadership team. It can help an organization figure out where to ask more questions. Where to direct improvement efforts, how to prioritize, and then importantly how to evaluate the things that we try to do to make things better.

So when we were thinking about measurement in the chapter in the book, we really thought of five big questions. Let's see if this will advance. Here we go. Oh, no. It's not there. Five big questions. You'll just have to listen to me. One is, if to measure, when to measure, who to measure, what to measure, and how to measure.

So just briefly, if to measure. So as you heard earlier, this project was really born out of those early days of COVID and we all remember the chaos, the sense of urgency, all the uncertainty. That's an important time to be attentive to situational awareness, clear transparency, responsive to educator needs, looking for what works. Measurement has a better role, arguably, when the situation has become a little more stabilized, even if it's still complex or challenging in many respects. So this is a good time, I think, to circle back to what COVID and that whole disruption illuminated, some of the cracks and the stressors magnified them. So now is a good time to be thinking about measurement.

When. So just practically having led some measurement efforts, paying attention to timing is really important. The signal to noise ratio is real. We all feel that. And what are the competing asks of faculty or of educators? Being attentive to those things will help get a good engagement with the measurement. It's the worst feeling ever to put a bunch of effort into something and then get really low participation. Another thing to be mindful of is there are competing surveys. There may be ACGME surveys of faculty every spring that require certain response rates. Your organization may have an employee survey or a culture of safety survey or other things. So recognizing when those are happening maybe you can piggyback with it or at least be mindful so you're not competing and undermining response rates for multiple important things.

Three, who? Who to measure? And this really has two parts. One is who to lead the measurement efforts, and then also who will participate in the measurement? From the first perspective, who to lead, it's valuable to have someone who's visible, credible, respected, trusted within the organization, and has access to resources, not only to do the measurement, but also communicate it beforehand, communicate results afterward, and ideally support improvement efforts based on the results. Then, who to measure? And that, you'd say educators, but of course we all know that educators, faculty, those words can be defined in more expansive or less expansive ways. You may want to do a local measurement in one department or one program or something much bigger across an entire enterprise. So thinking carefully about scoping and who to measure is an important step at the beginning.

Four, what to measure. So this initially seemed really straightforward. We're talking about educator well-being. We want to measure well-being. But well-being can be measured in a lot of different ways, so even that's a conversation to have. We talk a lot about burnout. That was the first word that popped up today. There are good measures of burnout. We're seeing recently more interest in things on the positive end, like engagement or joy, things of that sort. And measuring well-being is valuable because it helps us see where our people are at. We can track that over time, get internal, external benchmarking. But just measuring well-being alone is not necessarily super actionable or give us like insights into what are the real factors that are most salient at a particular group. So it's worth thinking about how to link the measures of well-being to other information. Including measures of possible drivers of well-being in the work environment. We saw many of those in the stressor list, like workload leadership, behaviors, communication, fairness, values alignment, those sorts of things, and then seeing how that relates to well-being. Or taking the well-being data and linking it to external measures like FTE, maybe time for a role, or the type of role it is, or things of that sort, where you can get a line of sight to what might some opportunities be for to intervene for improvement.

Alright, then finally, how to measure. There are a lot of Ways to measure well-being, we mentioned that before. Being lends itself to self-report, which is why in some conceptions of well-being you have to measure with, you're a psychologist, right? You have to measure with self-report. So that's why I've been talking about surveys, but I want to acknowledge there are other indicators, existing data, that you may be able to tap into to get a line of sight to educator well-being, even if it's indirect measures. So examples could be turnover, recruitment, retention, soft attrition—so backing out of roles, dropping FTE—use of support resources, promotion, pay, time for roles, things of that sort.

How to measure is also where you bump into all that practical stuff, the burden of measurement, the cost, the validity, the reliability, the actionability, the sensitive sensitivity to change, attention to equity, or is this measure worded in a way that is applicable to all of our educators? Are we capturing the things that are relevant to all those groups? And we dive into all of that in more detail in the book, and there'll be some time for questions, so we won't go into all that detail now, but if you're interested, there's be an opportunity to ask and definitely check out the book as a place to read more. I can hand it back to you, Dave.

Henderson: Andrea, thank you very much. Given all of the discussion that's occurred thus far Maggie, when we think about trying to be a change agent at our institution where do we start?

Rea: Okay, I don't know if I have the solution completely. But it's interesting because when I'm thinking about it, and I certainly saw it here, my grandiose answer to that would be, how do we elevate the voice and the value, voice of our educators and the value of education? And I'm going to be cheesy for a moment and steal from the plenary this morning by Angela where the first step would be first looking at, what is working as well as what might be broken. And I think you all have some suggestions already about what might be broken. Starting by there, but I think, one place to start is the idea of how are we, for lack of a better word, compensating are educators, right? And what are the metrics that we're using? I've heard so much at this conference that has been amazing around innovation and education, but I would love to hear, and you don't have to raise your hand right now, but where does that play in a promotion package? So pondering for a moment about that and where does that land? So thinking about that, and I know one of the recommendations that we offer is, should institutions, schools be incorporating the AAMC's ideas about what is involved in education, what are the core elements of an educator, whether it be, developing curriculum, advising, mentoring, teaching, learner assessment? Does that have a place in, in, in a promotion package, if you will? And with that comes, wanting to advance both in terms of status but also financially as well. So pondering all of you, thinking about that, reflecting on that a good place to start.

Another one which in, which I, heard so much about in your Mentimeter is are we, are you, are we, providing the infrastructure needed, especially for our early educators to develop? To develop themselves professionally. We will, oh, we want you to develop a curriculum for that area. What's the infrastructure that exists to help that, especially younger or new educator do that? What about, we have, we mentioned... There were some unkind, perhaps, words about student feedback, but what if you are in the preclinical years and are being asked to pivot how you're teaching because the students are wanting you to teach to the test, right? What does that mean and what exists in the institution for that educator to, to modify their curriculum if needed, right? And today we talked about AI. What, how is AI and who's going to be, giving all of us that professional help and support around where AI, if and where and how is it going to fit in our worlds as educators?

And then we saw certainly with during COVID was a stark reminder of where's the support around educational technology. All of you were asked to, as well as we all were asked to transform how we taught and how we interface it with our students and our colleagues. But was there an infrastructure that existed to help us get us the support?

Those are, a couple of things, and one last one I wanted to mention because I've heard a lot of conversation today and yesterday about the conflicting roles. And boy, I saw a lot of that in what you all mentioned. And I really want, and that's why I asked that question about boundaries, like what is my role? Am I, I am an educator, but I'm also a clinician. What is the support I'm getting for each of those roles? So again, some place to start. Another—three. Sorry, Dave, I went into three areas that they could start with. So think about that. Because I, I love the words they use in the plenary. We want wonder and innovation. Well, that takes energy, time, and resources to have that innovation. So those are some areas I would love you to ponder around and think about starting.

Henderson: Maggie, thank you. No apologies for being thorough. We live in America where more is always better, so thank you.

Leep Hunderfund: Humans like that.

Henderson: Allison, actually Maggie just touched on the fact that we all play multiple roles. Some of us have two, three. plus roles. Some better acknowledged, others that aren't so acknowledged. And we all have often a number of identities that may be more or less prominent in different roles. And then there's the intergenerational piece, as well. So how can we take that mélange and use those perspectives in the work that we do?

Knight: I was thinking about this question, I wanted to start off by saying, I want you to take time and think about, when you get back to work, which will probably be, 7am on Monday morning, you're going to face this of when you're in sort of dual roles. And then I was like, I don't need to do that. All of you are in dual roles here, right now. How many of you are trying to juggle being an active participant learning and trying to figure out, where, how do I grow from this conference while still managing educational responsibilities or perhaps other responsibilities back at your institution? So we're all in that space all the time.

And so when we think about this idea of dual roles and let's be broader about more, multiple identities that we're carrying all the time and the cognitive load of that. Even if we just look at, clinician and educator, you are, asked to provide best possible patient care in the most expedient way while also providing physical and psychological safety for learners to have the best learning experience simultaneously, all at the same time, right? And the cognitive load of that, many, are doing it beautifully. But when does it cross over into being cognitive overload or burden, particularly if we're bringing other identities to our work that aren't as supported? I think we all know the strain of these lack of boundaries and trying to juggle all of these different identities at one time. But the research, and I know you all know this, the research is really clear about when we are doing that without… Educators often talk about, I don't have the training to do all the things I'm being asked to do. But even spilling over to, I have a sense of belonging and support at my institution for who I uniquely am. And so we're also talking about educators from historically excluded backgrounds, are we creating the space that their identities and our identities are being honored and celebrated? Because the research, and again, I know you all know this, the research is really clear, when we're not, that leads to disconnection, isolation that can underlie not only a decision to leave an institution or to a field as a whole—so it's a workforce issue—but obviously things we're very concerned about with burnout, poor mental/physical health, and even, unfortunately, suicidality in moments.

And thinking about these systemic interventions, and I had to laugh, because I was thinking about this talk yesterday, and I saw something online, it was a conversation between an employee and a manager, and the employee is saying we're all just really burnt out, and the manager's response was something like, I gotcha. And then there was a large picture underneath of a big, long table with what looked like 18 different types of pizza on the table. So like that, when we're thinking about supporting our diverse voices, we have to think about it with sophistication, right? And we all love free food, but that is not what we're talking about.

And I think a place to start is do we, have we identified, and hopefully, if not, how do we identify and bring them in, the formal and informal experts in this area? The people that can help us navigate how we're talking about educator well-being, but also with all the various identities that we bring to that role and providing support for everybody. And then also thinking about, and I think it came out very much in the Mentimeter, around leadership—and this is where advocacy and, thinking about how we're going to do this—leadership that has this physical, the physical, emotional, and mental space to think about bringing in those people and also supporting our educators. We talk about the differences between educators and our trainees—actually having leadership that's standing up and saying, I'm going to take the lead with navigating these changes with our learners and how do we help support them in not placing that burden on educators? So if there's some of you in the room who are in important roles of protecting and supporting educators, thinking about where you can stand up and take that burden off our educators for them.

And then obviously thinking about, again, just creating the space where we can… I think the talk this morning was, to me, very inspiring because when you're talking about change, it can be hard to think at a macro level, but there's so much that can be done in individual spaces and really looking at where the pockets of excellence that are already occurring in our institutions and what can we learn from those spaces that are supporting everybody? And how do we create the systems that that type of innovation is looked at and supported? I think it really starts with, having identified those folks that have this expertise and they can lead us in these changes.

Henderson: Thank you. You touched on sort of leadership leaning into this arena. And Andrea, you also gave us a nice rubric for assessment. But can you help us understand some of the pitfalls that may be encountered when we begin to move down this road?

Rea: Sure.

Leep Hunderfund: Sure, and pitfalls particularly around measurement. And this is all coming from my own journey is in terms of measuring and recognizing in hindsight. I wish I'd have thought of that at the beginning. So one: asking without acting, right? I love to measure things. I get really enthusiastic about that, but measuring something without having a plan, resources, leadership, support to do something based on the results can end up doing more harm than good and disenfranchise a community. Asking without acting.

A related pitfall is action without communication. And this is maybe more common perhaps. Yeah, where there are people here up here who work so hard on behalf of educators and learners and faculty for the education mission and are, may see results of an assessment and really really try to make improvements, but change doesn't happen overnight. It's hard to turn a whole yacht, and if the educators aren't seeing, feeling, hearing all of that work, it may not be recognized and appreciated. So acting and then communicating what we're trying to do to make improvements.

Three: Analysis Paralysis. I think the last time we measured something and I took results around, the most common response from every group was, let's measure some more. And that can continue going and going and you would need to like also realize when we got something to work with, let's try to make improvements.

To your point about leadership: predetermined solutions. That's another challenge. There may be a leader or a wellness champion that has like the thing, the mental model of what's going to help, but these are very contextual challenges. So rooting improvements, giving teams a voice to inform what the improvements are.

And then the last couple, deficit thinking, right? It's easy to focus on what's broken or the big challenges or to attribute group differences to assumptions or stereotypes that can be harmful, but moving away from that mindset to more of a strength-based approach and looking for where are the strengths that we can build on, how are differences an opportunity for strength to expand the way we think about things?

And then finally, disregarded distress. Sharing results can be pretty disheartening to people who are working hard on behalf of educators. And acknowledging if this doesn't look good, recognizing there can be some distress there. Leaders can feel pretty discouraged. They're not in easy spots either. Recognizing the emotional component of measurement and improvement is something I, I've under attended to in the past and recognize is important to pay attention to in the future.

Henderson: Thank you. We have been talking up here for a while and so we think it's time that perhaps we gave you all an opportunity to share questions, share experiences, comments whatever you feel appropriate. There are two mics, one in either…well, it's hard to call those aisles, but you all can probably see them a little bit better than we can, because you don't have light shining in your eyes. Does anyone have any comments?

Knight: And we'd really love to hear if you've navigated some of these problems for educators at your institution, even in small spaces and really found some success with it. Because I think that's the value of having a session like this, is let's learn from each other. And think about what we can take back to our institutions.

Henderson: I have an old dog-eared copy of the Yellow Pages up here that I could begin reading if that would help to fill in some time.

Abigail Ford Winkle: I'm uncomfortable with silence, so I'll throw this in. My name is Abigail Ford Winkle. I'm a Vice Chair for Education in OBGYN. And, I was just thinking, from a leadership perspective, we had an experiment happening in one of our practice groups where there was a lot of burnout and there was someone who was seen as a very effective leader from a, from the perspective of the members of that group who were dealing with all of the stressors trying to be in an academic practice. and at the same time, this leader wasn't seen as effective from above in terms of aligning what they were doing with the things that the institution wanted them to do. And so this was this big conflict of, I think that I guess the question for all of you experts is, as leaders, how do you wind up not…how do you manage that conflict between trying to respond to the things you're recognizing as the needs for action and change from the user end to the, just all of the reasons that this hasn't already happened from a overall academic center administration perspective? It just feels like there's a rock and a hard place there.

Rea: Scary when he calls an expert, but, and by the way, you're one of our authors, so thank you. I'll start. I'm sure you're not the only one who's experienced that. One of the things is, that I think is key, which is one of the, a word that came up on the Mentimeter, which is for that, so that's the middle person who's navigating above and below, trying very hard to, it sounds like, advocate for the people reporting to them would be a better way of putting it. So one thing I would say is transparency. Because I think one of the frustrations is if the people—and that person who is trying to make the change might not be able to if leadership above them is not listening and not wanting to make change, it'll be their crucial role will be to help the people that report to them to understand, even if it's not what they want. We want to understand, why is this decision being made? The transparency will be key, and the continuing online communication. Yes, we hope that, I haven't, I'm not going to... These guys tackle how will that person then go to the senior leadership, but I think for sure transparency and communication around changes that are being made or not being made and why.

Knight: Yeah, no, I, and I was thinking also about the talk this morning, I don't know that we can all innovate multiple times in a week. That was really impressive. But thinking about again, are the voices at the table, and to Maggie's point, are we understanding and are we being given transparency about why these decisions and what are these driving forces? And is this just because it's, this is the way it's always been, or is this because it's very real? And the value of having diversity, not only by just the educator voice there, but then diversity within the educator force, workforce in thinking about these problems as we come up with more creative solutions. And so I think one of the things that I hope medicine continues to evolve from is this very hierarchical system. While that is important in some elements and needed. I think about bringing all the voices to the table so that we can come up with creative solutions that that meet the needs, but still bring into this piece about well-being, because they're not mutually exclusive, but a lot of times we treat them as if they are, just because that's the way it's been done. I don't know, Andrea, if you have Oh, that's a

Leep Hunderfund: Oh, that's a great point. Yeah, I was pulling up an example on my phone of a group, and I can't quite see on the picture what the organization was, but they used the AMA Practice Transformation Appreciative Inquiry to Foster a Positive Organizational Culture. So this is one of the resources that the AMA has. But what I really liked about their output is they talked about the role of the leader in caring for their team but also communicating upward and it captures a lot of the themes of escalating information up the chain and then also approaching the next level of leadership with humble inquiry, right? Sometimes the way to advocate is to ask a really timely question and to make sure that you're understanding the rationale of the leadership team above you so that you can bring that back down to your folks. And I think if folks struggle where they're loved here but not trusted here, really thinking about that bridging role that we all have in our leadership positions I thought was a helpful framing.

Henderson: I'd just like to add that, Alison, you talked about the value of diversity. But very often the individuals who represent that diversity bear a disproportionate burden of the sort of weight when things aren't going well in an institution. And sometimes you have someone who has really good leadership skills, but not a lot of power. And having been in that position for most of my career I think that helping the folks that you report to understand the experience of others is actually really crucial. And finding ways to bring their voices. To those in power is really important so that it's clear that it's, that this isn't just you or an interest that you have but that this is a significant problem that does need attention and can't afford to be swept under the rug and to remind those in power of the sort of stated mission and values of the institution, and kindly suggesting that they make a concerted effort to visibly and measurably represent them. But, we have another question. Please.

Deb Weinstein: Oh, thank you very much. Deb Weinstein, University of Michigan. Thank you for the session, and, as you mentioned the obstacles are tough, and we should all work on promoting educators for educational contributions and getting more grant funding, and yes, to the AMA for getting that ball rolling. But at the same time, we have to work on things that aren't So hard and so long in coming and maybe just try to focus on maintaining the balance between the hard stuff that everybody encounters every day and those occasional moments that uplift people. And one thing that I've seen and the other thing that I've done both at Michigan and in Boston where I was before is education or educator awards. And those are really not expensive to start, and while they don't impact that many people, or not at least in a year, they really do impact more than the people who get awards because it shows the organizational appreciation for educators and learners and the whole process. And you can think of lots of different categories. And then everyone who takes the time to nominate someone else has that appreciative inquiry time of writing a letter and the people who are nominated who may not win know that at least someone out there appreciates them. So, I would suggest we do more of that because that's the easy stuff.

Henderson: Beautiful.

Leep Hunderfund: Love that idea. I'll riff off of that a little bit. One of the moments of joy for me during the academic year, we embedded a question in our evals that asked learners, was there a time on this rotation or in this course when you witnessed an exemplary demonstration of the Mayo Clinic values? Which is how we organize our thinking and talking about professionalism. The comments we get back from that are so beautiful, and just lifting those and feeding them back to our educators—it's not even an award, it's just a little note, like we heard this from the students, they said this beautiful thing about you and CC you supervisor, your department chair, or something like that. And it's a really simple, small, low-cost way to infuse recognition and celebrate the meaning and the joy that I think we all love about being educators. Great example.

Knight: And really to the point of—rather than expelling our students, although we all have days, right, we would love that—our learners, bringing them into these conversations. Because they want to be there, they want to recognize the people that are making a difference in their very challenging time in their medical education career and so finding those moments of synergy, I think it's a beautiful idea, you can think about multiple layers of nomination, but definitely include the learners.

Henderson: Thank you. We have one last question.

Amy Dewaters: Thank you so much. This is more of a comment. I'm Amy DeWaters. I'm from Penn State. One of the things I feel like I see very often is an attempt to try to flatten the hierarchy which is beautiful and well intentioned and then perhaps turns into a dehumanization almost of the educators where it's not a flattening of the hierarchy, it's that the educator doesn't even get to be on the team anymore. They're not even a human anymore. And those expectations of perfection at all times become very difficult for people to meet and I think lead to a lot of burnout. I find that students and learners in general are hungry to hear about the human side of their educators. And I frequently wonder if we allowed ourselves to be more vulnerable and speak to what our day to day looks like, if we could generate more empathy and understanding from our learners and a little bit more of a shared community about what we're all going through?

We've gotten to the point where I start saying things when I open meetings with students like, Dr Cooper, our trauma surgeon, just came off overnight call and hasn't slept in 48 hours. Let's try to keep this brief. I think that's really important to encourage empathy and understanding because I think if we're not willing to be vulnerable and help them understand that, we can't expect them to really show any empathy towards us. So I think some of this, not to be harsh on all of us, but some of this may be self-imposed because we're not willing to share what our day-to-day looks like. So I think more openness may help us.

Rea: And that's a, it's also, I love the, you're using the word community, right? There's something that we do at UC Davis which is we have what are called faculty student dialogues, right? What you're talking about is day-to-day, and I hear you, and absolutely. And I don't think our students really have any clue. I'm generalizing. But this is a very concrete sort of step we take. So we have, we have several faculty telling their stories and it doesn't have to be every intimate detail of the… but I say to them, just, take about five or six minutes, tell us a little bit about, your story and then a challenge you faced and how you got there, and are you got here, right? Because it's like wait, humanizing these faculty. And it's also, for me as a psychologist, I like when we talk about, conversations about well-being and mental health, of course, because that, that also de stigmatizes that conversation. But I think you're absolutely right in it's also, it builds community connection and remembering that there's also humans. Because sometimes I saw that in one of the things, student evals that are written, that sometimes they might forget that there's actually a human who's going to be reading that who's worked really hard on something and then they have to absorb that feedback. And then that does that evaluation go somewhere? Right. so thank you for that it's a really important comment.

Knight: You know we, actually we're having a session next week to train our first year students on giving feedback and how to do that productively and I actually had the idea of having one of our faculty members read some of the comments that have been received like the mean tweets on Jimmy Fallon. And I don't know how it's going to be received, but I think to realize there is a person behind this. And it's interesting though, the faculty member that we picked to do this, she said, I can handle the criticism about my course, I can always, that, there's no way that's ever going to be perfect. But she said, the things that cut me to the bone are when they say things like, you don't care about us as people, and we spend so much time thinking about them, and they're, and who we're trying to help develop. So, we'll see. I'll report back if the mean tweet approach works.

I think we have one other.

Henderson: Oh, yes.

Jean Klig: Oh, that's okay. Hi, Jean Klig from Harvard Medical School. I just first want to make a comment that I feel as though everyone in this room should win an award for what they do. [applause] Okay, and I think that It is so difficult, with kudos to you, to talk about educator well-being, because of course there are many layers, and we can often live at the meta layer where we look at systems and processes and so forth, that certainly give a lot of great definition as to what we're doing, yet also thinking about the individual level, which is so hard for us as educators too, to do that, is so important. And a piece that I feel is missing is that celebrating the small and large wins of educators, really getting it out there and appreciating, whether it's in divisions, departments, what have you, the level of work going into maybe that one student that succeeds or the ten students, or the one that fell down but didn't fall all the way down because of some educator that lifted them up, or maybe refined a curriculum or something. And I think the more we can think towards that, it will somewhere hopefully meet the meta level, too, and become a real win for everyone both individually as well as system wide.

Leep Hunderfund: Yeah, thank you. Find an educator next to you and find something to celebrate during the next break.

Henderson: We're at time, but as you depart we would like you to go back to Mentimeter and answer the question what is one area where this work can begin now at your institution?

Thank you all for your engagement during this session. The QR code for the Well-being Educator book is up and feel free to download it and read it. It's actually a very broad and engaging publication. So thank you all very much.

Knight: There are also some copies up at the AMA booth.

Henderson: Yes, there are.

Rea: Great. With me. Okay.

Henderson: Thank you all very much.

Rea: Thank you.

Knight: Thank you.

Leep Hunderfund: Thank you.

Video Information

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Enduring Material activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.


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