So, thank you so much for coming to our session. My name is Mark Horner. I have the great privilege of being with a really distinguished panel, and I'm super excited to talk to them and sort of iterate how we would make this useful for faculty. So, Dr. Gabriel Bosslet, Dr. Mark Leverkamp, and Dr. Kanta Vallamuri, so we're very excited to talk about this. There's a lot of things that we want to accomplish, so full disclosure here, there's a lot of things that we wanted to accomplish, and I think we'll have to pare it down a little bit, because each one of these things could be a separate talk, and so there's four things in the learning objectives that we talked about initially, which were compensation models and understanding really the idea was how do academic faculty get reimbursed and promoted and things like that. We'd like to distinguish characteristics in faculty development that help faculty members improve their efficacy, right, and then talk about ACGME faculty development requirements and use the clinical educator milestones, and then last, I'd like to make a few comments about a faculty competency committee. So, this is part of my disclosure. The first learning objective, we'll breeze through, we're going to spend most of the time in the middle two, and then we'll come back to the last one. This is our roadmap for today, so we're going to introduce the educator milestones, and then we're going to talk about teaching, scholarship, leadership, and then assessing faculty competency. So hopefully we can generate some great discussion here and have a framework to have this conversation moving forward. So I think the introduction for me is really the road of an academic faculty member is not at all linear. As you're starting off in an academic faculty, it's not always clear what the expectations are. It's not clear what the path forward to developing subspecialty interest and developing competencies in different domains, and how do you move forward in getting promoted, because ultimately you want to gain stature. You want to move forward into a place where you can design your career. And so vision casting is something that all of us need, but many of us don't do. So 10, 12 years down the line, I'm now thinking about the things that I should have been doing a decade ago, and so if we can help a few of you all get ahead, then that's our goal. There's a lot of challenges that faculty encounter in an academic setting, and so I'm specifically going to narrow my conversation towards the academic faculty working with the university and training programs and those things. And so we will skip a private or community practice in all those different forms. These you can read, I won't read all these to you, but really I'll reorganize this on the next slide and say these are the six that we're going to spend time on. Like I mentioned, lack of understanding and how you get compensated and promoted, we'll have a few slides towards that. Lack of faculty development and learned skills, and so there's going to be a lot of time spent, and my colleagues are going to do a great job of talking about learning skills, scholarship, leadership, self-reflection, and then I think the last one is big. Just like we've experienced with students and residents and fellows, the lack of regular, systematic, and I should have put the word meaningful feedback on progression as an academic faculty member is really something that can be a limitation early on, because you really need people that are five years ahead of you, 10 years ahead of you, 20 years ahead of you to talk to you about these are the things that you should be spending time on. And so what are the things we do spend time on? So I know that this is an international meeting, and so I'm not going to attempt to do what I initially wanted to do, which was sort of discuss the different things that are out there, because there's so many different variations, I don't think we'll get there. But suffice it to say, most academic faculty, the FTE, the full-time equivalent, is something we spend a lot of time talking about. And so that one full faculty salary really encompasses these different things. And so you can see, I didn't realize those bubbles don't show up very well, but the biggest bubble on the bottom that's the hardest to see, the pink one, clinical work is usually the driver. Now, throughout your career, the bubbles can change sizes, but educational activities are classically things that educators and folks that are sort of blue bloods that really want to shape and mold the future spend more time on. Leadership positions are things that folks attach and grow into. Research fundings are things that some folks have more than others, but really clinical work seems to be the driver in a lot of situations. And so what you get compensated for is clinical work, patient care, whether it's inpatient, outpatient procedures, things like that. As you get promoted, a lot of folks look at domains. And so then you need to see significant progression in domains. And so as far as I know internationally, there's only the three ranks. There's the assistant, the associate, and the full professor, right? And then tenure versus non-tenure is kind of a moving target depending on what country you're in and sort of what setting you're in. But the progression through these different domains are the things that help get you promoted. And so if you look at this and you go, gosh, I'm spending all of my time in only one domain, that may be some feedback that you need to solicit and say, wow, what do I need to do to grow and become better? And then how does that align with my vision for the future? So we wanted to use this as a conceptual framework. So as a panel was talking leading up to this discussion, we found this document and feel that we can anchor this discussion in some stuff that's pretty new. I don't think a lot of folks have looked at this yet, and it hasn't made it into guidelines and requirements and things yet. So I'm going to, I'll tell you what, I'll pop it forward so you can see the dinosaur real big. It's a long document, so I think this is a great link to look at. Because I'm a science nerd, I also printed out a paper copy up here if you want to look at it afterwards, because I like seeing stuff on paper. So really what it is, is we're really familiar with the ACGME's iterations of milestones. And so now there's a joint task force that's come up with what we think are meaningful milestones for the clinician educator. And so it's got these levels. So as you know, there's progressive levels all the way from novice to expert. But there's behavioral anchors for faculty, which is kind of a new concept, and I was really excited to see this coming forward. But as you start reading some of these things, you may start self-reflecting a little bit. And I'll ask Mark to help you with your self-reflection and growth on this, because you may go, uh-oh. So as we're thinking about the clinician educator milestones document, I wanted to put this in context for you. So there's four things that they call universal pillars here. There's reflective practice and commitment to growth. There's well-being. There's recognition of bias and mitigation of that bias. And then commitment to professional responsibilities. There's three additional levels of milestones where there's something about well-being of learners and colleagues, DEI, and then administration skills. And then when you talk about what we would consider hardcore education, there's 11 different milestones here on this right side. So to give you the roadmap forward here, this is what we're going to spend time on. We're going to cherry pick out some of these that we think are sort of the most meaningful in these domains. So first up, we're going to talk about this teaching and facilitating learning feedback and learner assessment. So our panelist for that is Dr. Gabe Bosslet from Indiana. As you can see, there's an empty chair here, and Gabe's not here, so I'll let him explain why. Hey, everybody. Mark, thanks a ton for having me. I'm stoked to be here with you and Mark and Comtef. We're not there. I'm not there. Clearly, I'm not there. And I'll talk about that in just a second. I'm Gabriel Bosslet. I am a former program director at IU, Indiana University. I've been active in chess for a long time, I love it here. And the reason that I'm not there is a recent occurrence, literally like two days ago. My oldest son, Eli, number four there, is a senior in high school and playing his last, his fourth year of varsity on the soccer team, and they're ranked number two in the state. And with their win on Saturday, they play this evening, so Wednesday evening, against their crosstown rival, Carmel, and Carmel's number one in the state, and so it's number one versus number two. So my other guess is Eli plays his last ever soccer game in high school or have a big win, so that would be awesome. So that's why I'm not there, I apologize. And Mark, I really appreciate your patience with me on this. So when we talked about this, we decided that we were going to talk about, focus on part, some of the F.E.A.R. milestones. And so I was asked to talk about teaching. So I'm going to talk about sort of simple things that you can do as a junior, middle schooler, senior faculty member, to just sort of continually develop skills as an educator. And rather than focus on a lot of theory, I'm not going to do that, I'm going to give you five simple things you can do today to become a better teaching physician, and one overarching concept that is sort of a swing thought to sort of guide these five things. So the overarching concept is this. A few years ago, I interviewed someone from Fellowship, and this resident was wise beyond a hundred years and said the following, a good doctor is just a good human with some medical knowledge. And man, this resonated with me so much, and I realized that being a good medical educator or a physician teacher is the same, it's just being a good human with some medical knowledge. And so if we keep this in mind, we will guide these five steps. But part of what this means is operationalizing this means that we have to acknowledge the fact that we are all just humans doing this thing together. And we have to be explicit about that, we have to talk about the fact that we're a teacher, I'm being a teacher, and you're being a learner, and we both have roles here, and talking about those roles together can be super helpful. So with this swing thought in mind, with this thought that we're being a good physician teacher, it's just being a good human, here are the five things I think you can do today, if you don't already, and you may, to make yourself a better teacher. Number one, regardless of how long the learning session you have with a learner, whether it be just a clinic, whether it be two weeks in the ICU, whether it be a consult service, take time at the beginning to get to know the learners that you're working with. And I like the rule of threes. It's a short session, just a clinic, ask three questions. I'm not going to tell you what questions those should be, they can be whatever you want them to be. For me it's often, where are you from? Do you know what you want to do? Do you have any pets? Do you have a significant other? These are all just things designed to sort of get them talking about themselves so I can get to know them as a human being. If it's a longer stint, especially like a two-week stint in the intensive care unit, we do something called three-minute autobiographies on the first day. This takes about a half an hour, so you have to sort of, I send everybody the day before an email with all my expectations as a faculty member so we don't have to review that, and then we spend the time doing three-minute autobiographies where I set my alarm on my iPhone for three minutes, and everyone has to talk about themselves for that entire time. Which means you can talk fast, you can talk slow. Some people will have a difficult time stopping at the end of three minutes, they can't talk enough about themselves. Some people will really struggle to get three minutes. Three minutes can seem like a long time, but this is a great way to get to know everybody on the team on day one. And then I do one minute after every three-minute autobiography of follow-up questions for anybody on the team, just to be curious about them. I find these things, asking three questions or three-minute autobiographies, are a great way to get to know people as a human being before we start our work together as clinicians and teachers and learners. Getting to know them as a learner means I have to ask two simple questions, and so I would urge you, if you don't do this already, you should. The first is, what do you hope to learn in our time together? What are the things that you think about and you would like to know before, in this time that we are together? So I can titrate my learning to the things that you feel like you need. Because if I go in and just teach PFTs, but you've already had somebody teach you PFTs, and you feel like you know them, that's not very helpful. And the second is, what should I focus on or pay attention to from the standpoint of feedback? That way it gives them an opportunity to let me know areas that they feel like they need work, so I can pay attention to those areas. So if you do these two things, if you get to know them as a human being first by asking, by finding out about them, and second, by asking two questions about them as a learner, I think you can really set the stage and create a really good learning climate for your time together. Number three, titrate your role on rounds to the needs of your senior learner. For me, this is usually the fellow. And I like to use the example of the chest tube. So when I put in a chest tube, it's either on suction, on water seal, or clamped. And I think of my role, especially with you, as analogous to this. If I have the chest tube on suction, and I'm acting in that role, then I'm running rounds. I'm the person that they're talking to, the house staff are talking to. I'm answering questions. I'm driving the learning. I'm doing, I'm actively involved in the process of rounds. Water seal means I'm there. The fellow's running rounds, but I'm there. I'm usually taking notes, paying attention to people as learners. How are they doing in the presentations? What kind of feedback can I give them on how they're doing? I'm also paying attention to patient care stuff. I usually have a computer in front of me where I can do that as well. But I'm trying to be as quiet as humanly possible, and it's only at the very end of a presentation, when we're getting ready to go in the room, or we've come out of the room, that I'll say, hey, you know, we didn't talk about the sodium level, and just prompt people on the things that we haven't spoken about. And I talk about water seal rounds. Hey, Joe, we're going to do water seal rounds today, so I'll be in the back. I'll be quiet, and you run rounds. Or, hey, Joe, we're going to do clamp rounds today. Clamp rounds is totally different. You start down there in the ICU with the team, I'll start down there, and I'll round by myself, and we will just meet and pass in the middle, and we'll car flip before and after. This is usually with senior fellows, right, fellows who know the medicine, and now are just trying to get their sea legs in running a service. So I think titrating my role on rounds as an analogy to a chest tube. The Pareto Principle, you've probably heard about this. 20% of your time is spent on things that determine 80% of your outcome, and vice versa. This holds in medical education. 20% of your learners will require 80% of your time. A lot of faculty think this is an anomaly. This is not an anomaly. This is the way things are. A lot of faculty will come frustrated with this one student, and the thing that I tell them is, this is why you're a faculty member. The other students and the other house staff who are doing fine, all you need to do is give them reps. Give them a pat on the back when they do well. Maybe make tiny course corrections. But 20% of your learners will require a lot more of your time to get them to where they need to be. This is not an anomaly. This is normal. The more we can understand this, the more we can accept this as the norm, the better prepared we'll be when we have that student who's struggling, or that resident who's struggling, who just doesn't get enough time. And lastly, commit yourself to two sessions per year where you are a learner, or you want to be a better teacher. This doesn't count. Maybe it's at CHESS. Maybe it's at your local institution. Maybe it's specifically a course on how to be a good learner. But commit to at least two sessions per year where you are going to continually try to make yourself better at being a teacher, because we're constantly evolving things that we're doing wrong. So that's it. These five things. Get to know learners as humans, using the rule of threes. Three questions with a three-minute autobiography. Ask two questions of your learners to figure out where they are as learners. Titrate your role on rounds, and you can use the analogy of a chest tube as either being on suction, water seal, or clamped. The Pareto principle absolutely applies in med ed, and the more that we understand this, the better we'll be. And commit to remaining a lifelong learner by going to at least two sessions per year and being a good educator. This is easy. I would ask for questions, but I'm clearly not there to take them, so this would be really hard. But you're in really good hands with the two marks in Compton, and I really appreciate being able to be with this group. My son, go, Pike. And we'll see you in Boston at CHESS 2024. All right. Well, so I'm grateful for Gabe's comments, and for those of you that missed it, he had to leave early. And so what we were trying to do here is cover some faculty milestones here. And so Gabe started off on the right side talking about some of the education-specific milestones. Next up is medical education scholarship. So I'm very pleased to invite Dr. Bellemari. Good morning, everyone, and thanks for coming out bright and early. I think challenges for education faculty are unique in some ways, and so we're here to try and help you. Gabe gave a great overview of how to develop your skills as a teacher in terms of teaching, feedback, learner assessment. There's multiple courses you can attend on that part of it. I think another thing that comes up is scholarship. So like Mark showed us, scholarship is one of the pillars that promotion is based on, and it's something that everybody's supposed to do. But where do we find time from all the different things that we're doing? So we're clinicians, we're educating, we're doing leadership roles. So where do you find time to do this? If you look at the milestones from this combined document, the aim of this scholarship milestone is to encourage clinician educators to base their teaching in scholarship and to contribute to the literature. So there are some questions here, if you want to go ahead and give you a minute for that. So here are the milestones for medical education scholarship, and it goes from level one, which was novice, to level five. But also note at the bottom, there's one thing where you can say not yet completed level one. So let's just start with level one, which is define scholarship in medical education. How many of you here can do that? Or would you check has not yet reached level one? I saw one hand go up, a couple, okay. Well, I'm going to get you through step one, okay. So here's scholarship in medical education. This concept came about from education in general with Boyer in 1997, expanding the concept of scholarship in teaching. Prior to that, a lot of scholarship meant just research and pure research. But this expanded definition of scholarship broadens it a little more to four different aspects. There's scholarship of teaching, scholarship of integration, scholarship of application, and scholarship of discovery. That last scholarship of discovery is what was traditionally known as research publications or scholarship. But as you see, there's a lot more you can do that does count as scholarship, and more and more educational institutions are recognizing this as scholarship, and you can count it towards your promotion as well. So, what is scholarship of teaching? So, what is done here at CHESS? So, teaching, innovative teaching materials and strategies, developing curricula or courses. We saw a lot of examples of that in the case reports and presentations. Producing videos for instructions like some of the webinars that you find on the CHESS Webinar Hub. Any innovations in how to teach procedures, how to do procedures, where you're teaching things, people how to do it better, and then publication of textbook. All of that counts in scholarship of teaching. Scholarship of integration also is thinking of workshops. So, you're going to put together professional development workshops, something like we've done here or like our educator course, where you're giving workshops to others on either your clinical topics or on topics of education. Doing presentation at conferences, non-academic publications, all of those count in scholarship of integration. Scholarship of application is taking all this knowledge that you have and then applying it either to development of new activities, new relationships and partnerships, and application of that theory to real-world problems. So, you may, if putting it in the context of medical education, you may attend a workshop on feedback, but then how you apply that and modify it to your situation when you're giving feedback to your learners or what you set up for your faculty may be different. And then, lastly, scholarship of discovery, which it hasn't gone to, but that would be the traditional research. So, scholarship in medical education per se is important, and you want to take a scholarly approach because not only does it help advance the field, but it also helps advance your own career. So, some of the tips I'm going to talk about scholarship, I'm specifically talking about the field of medical education because if you're already teaching, if you're already involved in it, you can make that work, just turn it into scholarship. And these are the tips I'm going to give you about how to do whatever you're doing already and turn it into scholarship. The same thing can apply to the clinical work you're doing, and the same tips and steps would occur for that too. So, as a question, how much educational scholarship have you done in the past five years? If you think of workshop, presentations, grants, and I'm talking about medical education-related topics here, not your clinical topics. How much have you done? Okay. Oh, we have some experts here also who can give us advice as well. So, a lot of you are very involved and have turned it into scholarship, but a lot of you are still starting out with maybe not much or one or two things that you've done in the field of medical education. So, what are some of the barriers that hinder, even for the people who've done the 10 to 15 activities, there must be barriers that came across. What were some of the barriers? How to get started, time. Time comes up over and over, as it does for many things when we look at barriers. Lack of guidance, lack of sponsorship, mentorship, don't know how to do it, there's no opportunities, what would be worth publishing, not feeling that my work is unique and adds to the field, where to look, all of these, okay. Lack of formal training. And these are not unique, okay. As you see with all the responses from other people, you see that this is common. It's not you, yourself, who's facing this. These challenges are there for a lot of people. So, what, for us to, you got through level one, everybody now can check off level one on their competency. If you look at the next few levels, it's to participate in medical education scholarship and the dissemination of educational approaches. Level three would be expanding through regular dissemination of these approaches. Level four would be serving as a PI. And level five would be demonstrating expertise and providing guidance and consultation to others. So this is where I think maybe getting from level 1 to 2 to 3 may be doable for a lot of people, and then the next step to try and become a PI or actually do projects is harder. The barriers to medical education scholarship, the ones you mentioned, like you see in this study that came out in 2018, it's the same thing, same things that you've said. Lack of mentorship, lack of time being the highest one, lack of funding, and the one on top, lack of effort for rewards for your efforts. It seems like that is not an appreciated part of our role as clinician educators, but that it is your job to kind of advocate for yourself, and we were talking about this before the session started, in showing the importance of the medical education role as well. So here are some tips about steps for engaging in medical education scholarship. One of the barriers that came up was I don't know what to do or I don't know how to do it in your things. So you want to explore medical education research to find out more about what's out there. You want to find a mentor, again, a barrier that came up, and I'm going to talk about how to address that. Find a mentor or community of medical education scholars. Approach all your activities in a scholarly manner. Learn the skills to do medical education research, and then develop a systematic approach to writing. So these are some tips about how to become better at medical education scholarship published from this article in 2020. So exploring medical education research. There are a lot of journals that are dedicated to medical education, with Academic Medicine from WAMC being one of the premier ones, Clinical Teacher, Journal of GME from ACGME, ATS Scholar, and CHEST also now has an education section. So if you peruse these journals and if you want our discipline specific, looking at ATS Scholar and the CHEST education section will give you a lot of information of what people are doing and also how they're doing their work and translating it into publications. Another way to explore medical education research, and I strongly recommend everybody does this, is to sign up to be an abstract reviewer. So right now there's a call out for being a reviewer for the big medical education conferences that AAMC puts together called Learn, Serve, Lead and the GEA group for each regional group. If anybody's interested in doing that, I have the email and I can give you the survey link. You just say, I'm interested in being an abstract reviewer and put your name and email address and they contact you. And seeing what other abstracts are put in, not only in medical education, but in any research, clinical research, is a great way for you to see what's out there. What does medical education research and scholarship mean? You also want to explore the resources you have locally to help with learning more about medical education. A lot of places have pilot grants. There's not a lot of money in medical education research, but there's some. So you can explore what there is in your institution. CHEST also has some that supports medical education. So look at those pilot grants to get you some time or some administrative support to get started. Librarian, your institutional librarian is a very underutilized resource and you should become best friends with them. They can do your whole literature search. They can do your whole background search. And you just have to frame the question and give it to your librarian and they're there to help you. So use your resources that you have within your institution or reach out across your city to find other resources that may be there. So after exploring medical education research, you want to find a mentor or community of medical education scholar. It's really important to find a mentor because mentorship and medical education research is different. Somebody who's a mentor in basic science or in clinical research may not necessarily be the person to help you in your medical education research. However, there is a lack of mentors in this field. And I felt that when I was starting out, I felt like I'm forging the path myself. There was no mentorship in my section or who was interested in this or did anything with this. So what's important is to reach out. You don't have to be limited in where you are. There will be some mentors around you or maybe over time, you become the mentor yourself. But it doesn't have to be within your division and department. If you have that, great, but you can reach out to interdepartmental. For me, I found mentors in the Department of Pediatrics who were very much ahead of the game in our institution. And so those great mentors in the Department of Pediatrics really helped me on my path. There's a lot of PhD educators who are PhDs in education in your institution. Reach out to them and see how you can collaborate with them. The other good thing is there are mentors within national medical educator communities. Here at CHESS, we have the CHESS Education Committee and the Educator Development Committee for you to reach out for mentorship. All of the other committees, AAMC has a MedEd meeting, and then AMEE also has mentors. And the MedEd Portal, I don't know if you've heard about MedEd Portal, actually has a formal mentorship program. So you can reach out to them and they'll assign you a mentor to work with on your publications. The next one is to approach all your activities in a scholarly manner. And thinking about all the four definitions of scholarship that I showed you, I'm going to give you an example of how you can use scholarship of presentation and scholarship of publication to come together. And when you think about presentation of scholarship, presentation-based scholarship, it could be a didactic lecture. You could teach a topic within your expertise, and that still counts as scholarship of teaching. You can have presentation-based grand rounds, posters, or oral presentations, or workshops. So getting involved in any of these would be presentation-based scholarship. If you think about publication-based scholarship, it could be a letter to the editor, a commentary, a brief report, or a full research manuscript. But any of these also would be publication-based scholarship. And so getting out of the mindset of thinking that there's only one type of scholarship, which is the research manuscripts, really expands your mind and lets you think of what else you're doing and how to present that as scholarship. So an example of what I mean by approaching all activities in a scholarly manner is started with a project of one of the faculty thinking that faculty are taught how to teach didactics and all the teaching skills that, you know, workshops we go to, how to teach at the bedside, how to give didactics, how to give feedback, how to assess a learner. But there aren't really ways on how we teach faculty how to teach procedures, right? So the teaching of procedures to faculty. And so that thought led to a collaboration. So this was one of my colleagues who was talking with me about it, and we said, okay, let's collaborate. So she and I got together, and we collaborated on this and designed a faculty development workshop on this. We based our faculty development workshop on previous literature as well as educational theory on how we would approach it. So we were able to present our workshop on how to teach procedures at one of the MEDED meetings that's held in Texas, which is a consortium of all the medical schools within the Houston area. So this is called a Teach Us Conference, and in 2019, we were able to present that workshop. And then using that presentation, so this was our workshop at the Teach Us Conference. Using that, we were able to put in abstracts for the GME Innovations Virtual Summit that was held later that year. So that was taking one of the ideas, we just started an idea and a discussion, took it into a scholarship of presentation workshop, and then scholarship of an abstract at the next meeting. The next level of taking it to scholarship of publication is where we're at, and we're hoping to do that soon now that the pandemic has passed. So here's an example. How many of you were involved in fellowship interviews in the past two years? If you go to PubMed and search fellowship interviews, you will get 243 results. So this is something that you're all doing, and there's many different ways if there's something you're doing different or something you introduce to write it up and present it. So something you're doing anyways, approach it in a scholarly manner and say, what can I do with this? What is a question I can answer? So the next time you're doing interviews, you may do things a little differently. You may have a survey in there. You may have some other form that you use when you do your interviews, something that will help turn what you're doing anyways into scholarship. And next step would be learning to do the skills to do medical education research. So if you just want to start out with reading, this is a great guide from academic medicine, conducting research in health profession educations from idea to publication. So this is a great resource for you to just put your toe in the water, see where we're at. There are AMEE guides and many guides about many, many different topics. So you can narrow it to as much as you want. So for example, just an introduction to research or how do you develop questionnaires. So if you're going to do a survey-based research and how do I write my survey questions and how do I develop those questions, how do I do my focus interviews with my learners? There's guides and teaching tools for those as well. There's books. You can go on to books. This is a great book called Researching Medical Education by Stephen Durning and an international handbook of research in medical education. So a lot of books out there specifically for medical education that you can peruse. And if you want to get one step further, there's actual courses you can take. So there's medical education research certificate program called the MARC program where there's nine modules that go through each of the steps of medical education research and their half-day sessions, modules. Sometimes the national meetings have them, but you could even bring all of these modules to your institution if you have the institutional support in faculty development. There's also the AIME Essential Skills in Medical Education research course. And then if you want to take it to the next step, you can enroll in a master's program in health profession education. There's over 150 when this was published in 2013, and there's many more now. And it's worldwide. It's not limited to the US. There's these offerings across the world. And if you look at these medical education or master's in health education programs, you find that there's certain domains that most of these cover, similar to the competencies that are there in their ACGME competencies. So teaching, learning, curriculum development, evaluation assessment, research methods, and leadership and management. This is a good framework. When we do our educational development course, we use this framework also to kind of see what topics to teach our learners at CHEST here. And then lastly, just develop a systematic approach to writing. I think that biggest barrier of time is what is hampers most of us. So trying to get some sort of systematic approach helps. First of all, making writing groups. So at my institution, they started these writing groups, faculty writing groups. Unfortunately, this writing group was 9 to 10 a.m. on a Tuesday morning. So not very conducive to, you know, us, me. But then we went on to making a different working group that was at a time that worked better, and it was Wednesday afternoons from 4 to 5. And if you have a meeting that's set up, people are going to show up. Even if you don't do anything beforehand, everybody gets together, takes that one hour, and you make some progress during that one hour. So ideally, one hour a week, but even 15 minutes works. And for most people, it's that first step, getting that first start going. And once you do that, then it kind of rolls through. Having a writing group can also help in dividing it up among many people. There's guides on what they look for in the manuscript. So looking at that guide helps you get started on writing. And where to publish. This was another barrier that came up. These are some of the journals you can look at. If it's just a curriculum, you can publish it in MedEd Portal. If you want to, for example, with my workshop, if I took that workshop curriculum, I would send it to MedEd Portal. But if I reported on the outcomes of the workshop, I would send it to one of the other journals. So that's it. Your next steps to success should be network. While you're here, reflect, explore, learn, and then start doing. Thank you. Thank you so much. That was a wonderful discussion about medical education research. So we're going to switch gears over here and talk about leadership and administration. So pleased to have Dr. Lavercombe. Thank you. And thank you all for being here. It's great to see so many faces at a medical education session. Thanks for being here. So my name is Mark Lavercombe. I'm a physician in Melbourne in Australia. I'm also currently Chair of the Education Development Subcommittee and incoming Vice Chair of the Education Committee. I'm employed part-time as the Deputy Director of Medical Student Education in one of our medical schools in Melbourne. So I do a lot of undergraduate teaching, but I also do, obviously, as we all do in our clinical work, supervision and assessment of fellows. I have no disclosures. So the first milestone that I was asked to discuss was about reflective practice and commitment to personal growth. And the way that it's described in this document is demonstrating a commitment to lifelong learning and enhancing one's own behaviours as a clinician educator. And I think, basically, you've all met that now by being here this morning at 7.15. So this is how they've outlined the milestone in the document. So the first level is accepting responsibility for one's own professional development by establishing goals and being able to identify gaps between what we expect our practice to be and what our actual performance of a skill or our actual knowledge is, as well as seeking opportunities to improve. Level two is being open to receive feedback, as well as being able to identify, analyse and identify where the gaps might be or what the factors are that lead to the gaps between our expected and our actual performance. Level three, being willing and open to seeking feedback data that's going to help us improve, as well as trying to identify ways to change our behaviours that will close the gap or narrow the gap between our expected and actual performance. Level four, doing that consistently and iteratively over time to continue improving. And level five, being a role model and being able to coach others. So just as a quick question, and this is non-identifiable, but I wonder where the people in this audience think they sit with regards to the Reflective Practice Milestone? Okay. Well, I mean, that's really good. I think that's a healthy level of reflective practice in this group, so that's great. So why is this important? I think reflection and reflection in learning is established as part of our learners' learning, our adult learners' learning. And these authors from Australia suggested that if we accept that that's the truth, that self-reflection can lead to learning and development for students, then it is intuitive that it should also be possible for reflection to lead to our own professional growth as well. Reflective practice is defined in one of these AIMI guides that Kanta was referring to as a metacognitive process that allows us to generate greater understanding of ourself that will then inform future action. So it's not a one-and-done kind of thing. It's not a stop. It helps us guide what's going to do next, what we're going to do next, and how we're going to behave, how we're going to learn, and how we're going to teach. Jen Cleland, who was one of the authors of the book that Kanta referred to, talks about this as a skill and something that can be learned. So it's not like you're either someone who is reflective or you're not. It is something that can be developed over time with practice and with guidance. So how might we think about our performance and how might we get data or seek data on which to reflect? Brookfield talks about various lenses that you can think about. So there's the theoretic lens. What is the best practice for teaching at a session in a scientific meeting? What are the kind of active learning principles that you might embed in your presentation? And then, okay, well, what did I do? Comparing your own practice against a theoretical norm or standard or range of standards in order to sort of help you identify gaps. Our learners give us data. We're all familiar with student evaluation surveys. CHEST asks us, and we will ask you to evaluate this session at the end of the session. And that data is information that you can use to try to figure out where your performance lies against where you want it to lie and where the standard might lie. Our colleagues can give us data. So you can seek it actively. You can ask people to watch you teach or give you a review on your teaching. And CHEST has this program now, peer coaching, available to faculty at the CHEST meeting where if you do a presentation, you can opt in to have someone come along anonymously and review your presentation and give you feedback on things that you did really well and things that perhaps might need to be worked on for the next time. And there's autobiographics. So what are the stories that we tell ourselves about our performance, our capabilities, how we learn, you know, I'm good at this but I really don't think I'll ever be good at that. You know, those kinds of stories inform both how we reflect but also how we develop. And being able to acknowledge but also perhaps challenge some of those internal stories can be a critical part of reflective practice and then developing as a lifelong learner. This is a really busy slide. I'm going to break it down. But this is a model of adult learning that I really like. And it talks about... So when you come into this room today, you have knowledge that you bring, okay? You've already lived your professionals. You've got all sorts of experiences that you've had. That's your existing knowledge base. And then maybe you hear something, maybe you teach a course, maybe you supervise some trainees on the ward or in the ICU and something challenges your knowledge base. There's something that doesn't go very well or a learner asks you a question and you think actually I've never thought of it that way like Gabe described before. And that creates cognitive dissonance, okay? So that will generate a process or start off a process where you think about that. Why is that different to what I thought before? Some of that will be conscious and some of it might be unconscious. But reflection on what the dissonance is, what the difference is, is going to help you to eventually end up with a new set of existing knowledge. As that reflection process occurs, you will elaborate on the knowledge. So you come in with a set piece of knowledge. Something about it isn't quite right or it didn't fit that situation. And so you think about it in a slightly different way that allows you to refine your concept of this scenario for the next time around. And then you will probably then experiment. The next time you do it, you might do it slightly different. The next time you do your round in the ICU, maybe you're going to do a, what was it, water seal round. And you're going to try that out, right? You're going to take that home. You're going to say, Gabe Bosslet, he's amazing. I'm going to do a water seal round. And then you see how that goes, right? And maybe it goes well and maybe it doesn't go well, but you reflect on that information that you've learned. And then that leads with feedback that you get, which is consistent throughout this whole process. You get that from your learners. You get it from maybe the nursing staff in the ICU who say, what the hell was that? You know, why did you do it that way? And then you end up with a new set of skills or a new level of knowledge, right? And then the next time around, you're going to try something different. You're going to tweak something slightly differently or you're going to go and seek some literature information and that's going to inform your knowledge. And this continues for your whole life, right? You're always adding, subtracting, modifying, linking pieces of information to make a whole set of knowledge in your head. Okay, so you can learn reflective practice. So this is from JGME where they've looked at multiple publications about reflective practice and looked at things that have worked and not worked. Monthly coaching sessions with written reflections, you can see if you look at the data produced in those sessions that people can become more deeply reflective about their own practice over time. We can undertake writing exercises that also are shown to deepen our reflective practice over time and narrative reflections. So there are ways that this can be developed and as I said at the start, this is not that you come into this as someone who is reflective or not. You probably do come with a level of self-reflection but that can still be increased with practice and with repetition, like almost anything. So I'm going to move on in a moment to leadership. I guess I wonder after what I've just said, has where you rated yourself changed? So I'll give you just a moment to think about where you were and where you might be now. And then once you've voted and in keeping with the theme, okay, well we've actually moved up to C, so that's good. What's it going to take to get you to level four? Just spend 15 seconds, what are you going to do next when you go back to your institution today or tomorrow or whatever it is, what are you going to do next that's going to shift this needle? How are you going to be more reflective? All right, so that wasn't very long, sorry about that. Maybe after the session, take another 15 seconds, that should be all it takes. All right, so leadership skills. So I was asked to talk about this, and reflection and leadership I think go absolutely hand in hand, so it makes sense that I'm talking about both. So this is part of the administration set of milestones, so being able to develop in your professional role such that you can manage programs, lead environments, lead teams that change and improve outcomes within your institution, your environment, wherever you're leading. So again, starts out with level one and zips through up to level five, sorry I say zip because I'm going to zip through because we're going to run short on time. So what are the skills of leadership, what are our own leadership styles, what are the things that we think we're good at and not so good at, being able to assess what kind of skills are required in a specific situation, because not every situation requires the same skill set, being able to lead teams to achieve the goal or the outcome that you wanted to lead them to. And then the higher level one is leading diverse teams, program level or being dean of a faculty or something, that sort of thing, which some of us will get to and some of us probably won't. I'm going to skip over that poll about where you are, but you can all think about where you might be. I'm going to tick off, as Kanta did, I'm going to tick off milestone one by telling you what leadership is. So leadership is a dynamic combination of activities known as the leadership triad, and this makes sense to me intuitively because I think we all have all of these roles, every one of us, leadership, setting the vision, management, identifying problems and helping find solutions to achieve the vision, and followership, supporting but also challenging the leader when needed. So I have my head of department, who is both a leader and a manager, but when I'm on the ward, I'm the leader. There are times I let my trainee manage the activity, as Gabe was saying. There are times when I need to go to my head of department and say, look, I think we need to approach this slightly differently, or I just need to give her support in the things that she's doing, and so I have all of these roles in any one day, and I'm dynamically moving between them in a way that, I guess, provides leadership but also provides support to people above me. And I suspect that's true for all of you as well. You can think of health professions education leadership through various lenses, educators like lenses. We've already had Brookfield, and now we're going to have these lenses. So intrapersonal, which is sort of the EQ type stuff, right? Being able to sense how we are feeling about a certain situation, being able to regulate our own emotions and our emotional responses to a specific situation such that we provide appropriate leadership and guidance and feedback to the people who report to us, as well as being able to manage our relationships with others. Interpersonal being credible, so that's really important if you're leading a team and you don't know what you're talking about, it's going to be pretty clear your team is going to figure that out, and it's not going to be authentic, right? So you have to actually have some knowledge in the area to build credibility, you have to develop psychological safety so that people can talk and speak up and raise questions, raise concerns with you, and that there's no fear of reprisal or some kind of punishment for doing that, and being collaborative, right? So the days of, I'm the leader and this is what I say and that's how we're going to do it, is gone. It's about getting the most out of the members of your team, that's what a good leader is, rather than it being a top-down, I tell you, go and do it kind of approach. And then there are organisational and global levels or lenses that you can consider leadership through and for the sake of time I'm just going to skip through those. This is all from an Amy Guide 148 if anyone's interested. So how do we assess ourselves? So this was milestone two, right? Being able to figure out where we are and what our skills are and what our deficiencies are. So there are lots of these, the Myers-Briggs Type Indicator is a very well-known one. I went through a leadership course at my institution where Professor Rob Moody from Australia talked about one he's used extensively and you can go through all of these domains and give yourself a score on how you think you are in that specific situation, so that might be communicating with people, giving an oral presentation, it might be reflective practice, which is in emotional intelligence in this one, and so on. So you can formally kind of approach yourself as a research subject, right? You can figure out where is the skill, where is the deficiency, where is the really strong skill, where is the really big hole that I need to start to fill with new information. The NHS has a leadership framework in the UK and this is a picture from it, it's quite an extensive document, but this is sort of the overall picture of how all of the different things, lenses or spheres of leadership fit into leadership development and leadership assessment. It's actually a really good document, so if anyone's interested, feel free to check that out. And then formal training, so like reflective practice, leadership can be learned, okay? It's not something that you necessarily come to as an expert, I suspect that's much less common than the other way, I don't think people are born leaders, I think you learn it. And so you can read about it, you can attend leadership training, you can do leadership courses, I have a higher degree in leadership now because I specifically sought that out. One of the things you can do is go to, in the United States, you could do the leadership development program through AAMC, as I said, I did one in my country, but there are lots of resources, most countries are going to have something like this. Okay, sorry, I thought I had one more slide. The last thing I will say before I hand back to Mark is that one of the most profound impacts for me on my personal leadership development has been trying to develop leadership opportunities at CHEST. So every year in about March or April, I can't remember, but it's sort of a second quarter, CHEST has a call for leadership nominations to participate in committees, work groups and whatever, and I can't recommend that enough, okay? So please consider thinking about that. Thank you, Mark. Thank you. Thank you very much. So I know that we're over time, I wanted to simply show one slide here. This is how the different domains where we assess faculty competency, a pilot project at our place over the last year and a half has been a faculty education development committee, and this is why. There's a lot of goals that we had here and different processes that I'll skip through, but this is really the meat of it, is a performance plan. So if you've never seen one of these before and you don't have this in residency or fellowship training, then there's an escalation plan where it's a little bit more overt. The issue was when faculty come to a competency type evaluation, you're a level three, right? Something's been going on for a long time and you're about ready to get fired by your department and they want to remediate you. And so as an educator, that's a really untoward situation. So if we can back up and get to a prospective model in which we're talking to you on day one about resources and getting involved in trajectory and vision and all these things that we spent the last hour talking about, then we don't ever get to level three, right? So I'm going to skip through these things. We had a lot of objectives here. Our key points are these. Know how you're compensated, know what your model is, understand your local environment. I think the second point that I would put up here is be intentional, and I think my colleagues would agree that there's a lot of intentionality that you can do and it doesn't take a lot of time, but that can really help years to decades of your career in terms of trajectory. And then seek help early and often.

faculty development

compensation models

faculty efficacy

ACGME faculty development requirements

faculty competency committee

compensation and promotion

continuous professional development

feedback

reflective practice

leadership in academic settings