Good afternoon, everyone. Welcome to the second half of our daily program for Monday, October 9th. My name is Dave Schulman. I hail from Emory University School of Medicine, but I am here in my role as past president to honor someone who is very deserving of one of the, in my opinion, most seminal awards for chess, one of the most important awards that chess can offer. In session 2004, the endowed Edward C. Rosenau III MD Master FCCP Master Teacher Honor Lecture gives special recognition to Dr. Rosenau, who promoted the development and training of hundreds, if not maybe even close to a thousand chess physicians during his three decades at Mayo. It acknowledges the role of mentoring pulmonary critical care docs into leadership roles within chess as well. During Dr. Rosenau's distinguished service on behalf of chess, he selflessly donated his time and expertise to foster the development of many physicians in training and to improve patient care. The award here reflects Dr. Rosenau's outstanding career and leadership. This year, it is my privilege and pleasure to present the award to Dr. Septimio Mergu. Dr. Mergu is a professor of medicine and the co-director of the bronchoscopy at the University of Chicago School of Medicine in the USA, where he's also the program director for the interventional pulmonary fellowship training program. Dr. Mergu practices pulmonary critical care medicine and his interests include interventional pulmonary, thoracic oncology and procedural related training. At the University of Chicago, he's an active member of several multidisciplinary teams managing patients with thoracic malignancies and benign airway disorders. Dr. Mergu has authored a number of books, including a bestselling textbook on bronchoscopy and has participated in a number of chest and multi-society consensus statements and guidelines related to procedural training, procedural performance and thoracic oncology. Dr. Mergu is the immediate past chair of the education committee, past chair of the live learning subcommittee and bronchoscopy domain task forces, past member of the COVID-19 task force and scientific program committee, and currently is president of the American Association of Bronchology and Interventional Pulmonary. In addition to his leadership roles, he's worked and participated on writing panel for the chest AABIP and AIPPD consensus statement on tracheostomy during the COVID-19 pandemic. He also served on the relevant guideline panel for chest. As an international educator, he's passionate about bronchoscopy simulation education. His current work with chest is focused on designing and implementing engaging in-person and virtual education programs and assisting with redesigning the curriculum pathways. Dr. Mergu has received the distinguished chest educator designation since its inception and is the 2017 recipient of the Early Career Clinician Educator Award. I can put the script down now and say a couple of great things about Tim. So I have had the pleasure of being involved with chest for about 15 years now. I've had the pleasure of knowing Tim for probably the better part of the last decade. Tim is an indefatigable innovator. He constantly wants to make the way we teach better. And even outside of it, clearly he's an expert in procedural training, is an expert clinical, expert in interventional bronchology, but he really aspires to make chest and pulmonary critical care education a better place. He is a resource without which chest would not be where it is today. He's been an extraordinary participant in many of our programs over a number of years and served the education committee incredibly well in his role as its leader over the last couple of years. It is my privilege, once again, to announce the winner, and I ask that you all please join me in welcoming Dr. Septimio Mergu to present the Edward C. Rosenau Master Teacher Honor Lecture. I am humbled and honored. It's the best introduction I have ever had, and I have no regrets for bringing my family in this room today. May I tell you a story? In 2007, my mentor at the time, Harry Colt, took me to a conference in India. It was in New Delhi, and the other faculty was Erika Dell of Mayo Clinic. I go on stage, like today, I give a talk. It was 20 minutes, so modular. That's great at that time. And I get, I finish, I go to my seat, and I feel pretty good about myself. Despite my accent, I thought I did a good job. Clearly unskilled and unaware of it. Harry comes, and he gives me the first lesson of public speaking and physics in the same sentence. He goes, Tim, light travels about a million times faster than sound. Don't ever read a slide again. By the time you finish two words, they already read your slide. I smiled. I didn't know how to react. Then Harry comes in, and he gives me a lesson on humility. With his undefinable style, he says, that was great. Don't ever say, in my opinion, before the age of 50. So fortunate are those of us who have mentors and who give us unconditional feedback. And I think that's Dr. Rosenau's legacy. I learned about that from the prior awardee of this Memorial Lecture, Dr. Alex Niven. If you had the chance to attend the session about a year ago, Dr. Niven really gave an absolutely amazing lesson on mentorship and leadership. And it was about Dr. Rosenau's legacy. One of the cool things I found on the web as I was preparing this talk was this quote from him that I always taught with fun in mind. And ultimately, when it comes to education, we do have to keep that in mind. And I believe everything we've done at CHEST for the last decade was done with that philosophy. So I'm going to follow the advice of Henry not to read my learning objectives today. But I will give you my three-sentence pitch. And I will make the claims in this talk that true teaching involves effort with everything else that's consequential from that. I will also make the claim that learning to teach is an acquired skill, which fortunately, we can do that here at CHEST, because I genuinely believe we are the home of clinician educators and definitely pulmonary simulationists. I stole that term from Kevin Dorshug, the chair of simulation. I have never heard of a simulationist before until that, but I identify with that term. And ultimately, in a learning culture, we will have to innovate and take some risks in order to make progress and overcome the current challenges. Back in 2013, when I started actively being involved with the simulation courses at CHEST, the leadership at that time came to the realization that we need to implement more active learning strategies, because the typical lecture-based program was clearly ineffective. I mean, we know that we forget about 70% of the things you hear or read just in the hours that follow that. So a lot of what I say today, you won't recall in tomorrow. So active learning strategies became a priority. In fact, one of my favorite quotes in regards to engagement and education is from Benjamin Franklin. It's right there on the slide. And that's actually supported by neuroscience these days, that it takes attention coupled with engagement in order to make those structural changes in the brain that lead to memory. So this is my formula, if you want, to a faster and deeper learning. I learned in my professional activities and in my recreational activities that learning starts with some frustration, and sometimes even you feel quite miserable when you have no skills. And that's not only related to procedures, that's also related to teaching. But that doesn't always have to be the case. Learning can be made fun, because fun leads to attention, attention that leads to engagement, and that's responsible for deeper learning. We also learned that we have to bring structure to our courses, because structure is the backbone of education that creates the predictability and the safe environment for learners. And learning has to be effortful, otherwise it's like writing on the sand. It's here today and completely gone tomorrow. We also decided to give feedback to our learners, not only through a pre- and a post-test, but on-site at the time of the simulation to give them feedback on their procedural skills by implementing assessment tools and checklists. To me, those are all proofs that we care for our learners, that we respect our learners. So that's my mnemonic to a faster, deeper learning. So we started questioning the content that we're teaching, the delivery methods, and then the connection between content and the way we teach. And that's when Eric introduced us to David Kolb. David Kolb was an educational philosopher who, when he was a medical student at Harvard in the 1970s, proposed a learning theory known as experiential learning theory. Now there are about 70, 7-0 learning styles out there, and when you read about them, everybody claims that you should teach according to the learner's learning style. Well Kolb says that there are mainly four categories of the way people learn, and that has to do with the way people perceive an event and the way they convert that, transform that into knowledge. So if you look at this somewhat complicated graph, what you see on the vertical axis is the grasping or perceiving either of a concrete event or interaction or of an abstract idea or concept. And then some of us, what we do with that, we transform it into knowledge by reflecting on it, and some really like to play with it, experiment with the newly acquired information. And that defines four learning categories or learning styles. When people were surveyed in medical education what style they prefer, the majority actually like to play with the newly acquired information. And I'll come back to that in a second, but not everybody. So ideally, when we design a curriculum, we should incorporate all of these learning styles. Stir it up. We mix them up. We surveyed people coming at the bronchoscopy courses, and 90% were on the left of that axis. They like to experiment with the newly acquired information, preferred more active learning strategies. So let me illustrate how we implemented that with our programs. At the same time, to give you a little more context, at the same time, the flipped classroom became very popular. Now the flipped classroom has been used in undergrad education for a while, but it really became more popular once web-based technologies became easy to implement. Because what we do with a flip is people study at home at their own pace, and then when they come to a class, that allows for more one-on-one interaction with the faculty, either for a problem-based learning or inquiry. And also, we should always ask the question, if we start doing this, what's the background? Where is the data? This is a meta-analysis that was just published now in 2023, including 11 randomized control trials with more than 8,000 students from medicine, pharmacy, and nursing. And they basically showed, this author showed, that flipped is the preferred learning style of the students, again, undergrad, and improves knowledge acquisition and satisfaction. But it seems like it applies to other generations as well, not only undergrad students. In GME, there was a systematic review published in 2019 showing similar results, improved satisfaction and learning gain as assessed by pre- and post-tests. And then since then, during the pandemic, and even after the pandemic, there are original articles showing similar outcomes. So it's becoming more popular even in graduate medical education, not only undergrad. All right, so let me walk you through these four quadrants of COLB learning style and how we apply them in our courses. So quadrant one, or the diverging style, if you want, when you have a concrete experience and then people reflect on it. We implemented that by having case-based interactive sessions. A case is presented, and every few slides, we throw a question. And people reflect on what they see. They articulate what they know by pushing a button. And they get themselves ready to receive feedback from the faculty. We know that interactive lectures are much more efficient than formal didactic lectures in regards to knowledge gain. This can be done in a smaller group format, where there is an instructor with just a few people in the room in a breakout session, if you want, like amid a professor, a small case discussion. It's probably not the best way of using the time. If we are in this kind of format, more active engagement is necessary. But we have done this, I suggest, from time to time. Now if you're dealing with more abstract concepts, like flow dynamics, for instance, or ideal or guess equation, or I don't know, mechanisms of resistance to TKIs, those can also be done in an interactive fashion. And that's addressing the other learning style, the assimilating learning style, where you take more abstract concepts and have people reflect on them. So by the way, most lecture-based programs stop right here. I think where we innovated a chest is by application of knowledge exercises. And that's where we introduced truly learner-centric simulation, problem-based learning, and gaze-based learning, which I know you learned more during this conference from Dr. Kelly. So let me start with simulation. There are different ways of introducing simulation, with low fidelity, like cheaper models, if you want, high fidelity, like virtual reality. In bronchoscopy, there was a meta-analysis done by a Mayo group that showed that for certain procedures, low fidelity actually may be preferred because you use real instruments and because of the tactile feedback. But learners, many times, prefer high fidelity, and those are also preferable for more deliberate practice, unsupervised practice, and getting objective feedback. And that brings me to the first quiz of the day. I did not bring an ARS for efficiency reasons, but I want you to look at the statement and raise one finger for one and two fingers for two. And you got a vote. This is November 4th. You have to have an opinion. I'm seeing twos. All right. So that was easy. This is Adele in action, showing heads-on, hands-off approach. You see the learners there. They are all engaged. Why? We have a role assignment for everybody. There is no demonstration. People didn't come to the course. They didn't pay to see an expert doing the procedure. They came to the course to learn, to stay engaged. In fact, if you ask me today, like, how would I evaluate a successful education, I would say A, people implementing their practice, what I taught them today, and B, they did not check their phone during my session. So don't turn on your phones, please. So we've done this with a longitudinal program. This lasted almost five years in several iterations. It was an interdisciplinary, cross-disciplinary lung cancer education program. We've done it in the United States and in Europe. And please take a look how we blended several educational modalities. Interactive case-based discussion, simulation, problem-based learning in six hours. We've done this at the headquarters, of course, and this is just an example of an agenda from a bronchoscopy course for intensive care unit. And by the way, from the very beginning, we're very transparent to the learners, setting the expectations for the day, including the need for assessment. Call it testing if you want. I think assessment is a better term. And we do that for two reasons. A, get feedback on how good we are as educators, because if the entire class fails, it's not the class's fault. It's our fault. B, it actually helps us become better teachers, because if Carla Lam has done bronchoscopies for many years, she has very complex mental models of the technique. And even though the procedure is not totally subconscious, you don't necessarily, Carla doesn't necessarily think of every single step of that intervention, and that makes teaching relatively difficult. When you have an assessment or when you have a checklist deconstructing the procedure into basic fundamental steps, it makes it actually easier for us to teach. That in education is called avoiding the curse of knowledge or that chunking kind of behavior. And then, of course, it's good for giving feedback to the learners. A lot has been written and talked about feedback. I only have one slide. And there is an entire book written about dishonest feedback. Carol Dweck, a psychologist at Stanford, wrote a book called Mindset. She makes strong arguments that praise, self-esteem, and performance go up and down together. So at some point, too much praise leads to poor performance. By having an assessment tool, by having a checklist, that feedback, at least for procedures, can be objective and not personal. Okay. Question for you. Again, light travels faster than sound. You read it, and then raise a finger. All right. I'm seeing twos. A couple of twos. Some people who don't vote, two. All right. That was easy for this audience, right? I mean, I suspect many of you have an interest in education, and that's why you're here. People struggle with this, and we struggle with this at CHEST as well. What do we actually show as part of pre-course material to maintain engagement? And this is just an example from a paper with medical students learning anatomy. They were dividing in three groups, augmented reality, videos, and notes with images, PDF notes, PowerPoints, et cetera. And then you can look at the scores there, but there were statistically significant difference. AR won. AR was better than video, and video was better than notes, clearly. I mean, it's kind of intuitive, but it's nice to have the evidence for that. We surveyed our members on, hey, do you check the pre-course material when you come to a CHEST course? And the majority says yes. You can see that here. And when we ask what they actually access, it's really the videos and the e-learning modules. These are PowerPoint presentations in the form of the video with a narrative, 15, 20 minutes. So we have that. We are not at the VR, AR yet in terms of remote learning. But I want to take a pause here from educational science and educational modalities and just give you a brief history of simulation at CHEST in the last decade. So I want to show how we started with flipping the classroom in 2013, first with the Camp Bronco Dibas course. There were two independent courses until then, Fundamental Bronchoscopy and Endobronchial Ultrasound. For marketing reasons, different strategies, we rebranded it, put them together, and we flipped the classroom at the same time. Then John Mullen of Mayo Clinic proposed and CHEST agreed to implement the first cadaver course at the Professional Society. And that was done on pleural procedures in 2015. We applied that model a year later when we introduced bronchoscopy and CHEST tubes in the ICU, also a cadaver-based course. In 2019, with Eric, we introduced Therapeutic Bronchoscopy for Airway Obstruction, also a cadaver-based program, because we believe for certain procedures, cadaveric models are the most authentic models. In 2022, Otis Rigman here in the room proposed the first course on advanced bronchoscopy for lung lesions that was technology agnostic. There are many corporate America programs. This was one program that taught every single technology available on the market in an, what we think, unbiased way with a very diverse faculty. And then we took EBUS to the next level, and now under the leadership of Zach Depew and Laura Fry, we have introduced this year successfully the next phase of EBUS courses, EBUS Masterclass. This type of teaching we've done around the world. We've done it at CHEST courses. And I know we need to continue to improve. And I know Rich Hsu, our chief learning officer here in the room, keeps thinking about it. He definitely looks like he's meditating on this in this picture and even now as I talk. It's important to reflect on what we do and what the data is. So let's look at this for a second. Is simulation actually effective when we teach procedures? For bronchoscopy, I think I referred to this math analysis already, it was shown to improve skills and also allows for objective feedback and allows for deliberate practice. Great. For airway, interestingly, this is from the same group from Mayo, by the way. The authors show that simulation also improves skills, but not necessarily when they look at the knowledge gain. So these are somewhat older meta-analyses. What about more recent data? So we have a couple of meta-analyses, not from bronchoscopy, but from other fields. This one looked at high-fidelity simulation in advanced life support and compared that with low-fidelity training and with no training, no formalized training, just standard traditional training. And they showed no definite benefit from high-fidelity when it comes to advanced life support. In surgery, for gyne-onc and for robotic-assisted surgery, there was a benefit in terms of improving procedure performance in the operating room and the procedure time. What about in fields that are a little closer to us, like endoscopy? So VR in GI, yes, intuitively, was better than no training when it came to independent procedure completion. But when compared with conventional training, interestingly, virtual reality resulted in fewer independent procedure completions, which makes you wonder if people get comfortable in a VR environment, and when they go to the patient arena, they lost that confidence and independence. Probably food for thought. And I was not aware of this, but there are two meta-analyses looking at VR in GI. For bronchoscopy, I think that is still emerging. I came across this prospective randomized study from Ping Li from Singapore, where she took two groups of fellows, one randomized to traditional teaching, the other one to VR-based teaching. And at three months, which is nice to look at the retention and attrition at three months, the learners were tested using a validated assessment tool, and multiple choice test. And what she showed is that the intervention group had a much faster learning curve. The other ways of implementing active learning strategies when it comes with playing with that newly acquired information, it's not just through simulation, but through problem-based learning and game-based learning. So I want to now talk a little bit about PBLs. First of all, there is a lot of science around PBL. It's commonly used in industry. Companies are using them for their team-based exercises. And it's becoming popular in medical education as well. It's a fundamental component of a flipped classroom methodology where people study at home, and they come to the class to really apply that knowledge through a trial and error approach. The instructor, like you see this instructor here in Greece at one of the game programs we had with CHEST, is really there just to facilitate the dialogue, not to teach. So how do we do it? We give the learners a case that's unresolved with a CT scan, a PET scan, some basic clinical information. And then we define the objectives. You need to stage this person, strategize the procedure, what are your expected results, and what are you going to do with those results? And in order to facilitate the thinking, we give them a template, the so-called four box practical approach. And then they just fill in blanks. That process of filling in the blanks, a trial and error, that attempt to actually offer a solution and not just memorize a solution was shown to improve knowledge retention and decrease attrition compared with traditional lectures. We, in fact, because nobody is really an expert on how to, we didn't think there are experts on how to coach a session like that. We went through the literature, and we actually created a checklist for the faculty on what the roles and expectations are during a session like that. And then once people resolve the case, they come and present the case to the rest of the group, like you see here. Faculty is in front of the class. The team assigns a presenter, and they present the solution to the case in front of everybody. And then direct, immediate feedback is being provided. Now, you can argue the feedback doesn't always have to be immediate, and it doesn't have to be direct. It can be grouped, and it can be delayed. But that's the way we've done it in this particular program. What's the science for PBL? I'm only summarizing in one slide, and that's the meta-analysis that was published this year that showed that PBLs compare with traditional lectures, improves knowledge and satisfaction. What about games? What about games? You're going to learn a lot about this from Bill Kelly. I learned about how to apply games in an educational program from Bill Kelly, with an educator development program. I think it was the first one we had back in 2015, Alex? 2015, 2016? It's been almost a decade. If you want to learn more about that, please join Dr. Kelly for his honor lecture tomorrow morning. But in brief, what I want to point out today are just a few things. I learned this from Amy Morris, also from a slide from the educator development program from many years ago. There are various ways of implementing adult games in education, and I would only illustrate two, that matching game and the peer pressure. Peer pressure. So what Bill did, and we took that model, he split the floor in four quadrants, A, B, C, D. He showed the multiple choice question with four choices, asked everybody to get up and go to the letter that they thought was the correct answer. To my surprise, after applying this at CHEST headquarters and around the world, there is always one winner. At some point, somebody will detach from the group to the correct answer. I'm always nervous about doing this, because how many prizes can you give? But we didn't have that surprise yet. The other way of doing this, in addition to the peer pressure game, the way we implemented this in bronchoscopy courses for dry information, like anatomy, is a matching game. So it's fascinating to see how people can get engaged with very dry content if it's done in an interactive way. We started with this, with flashcards, showing CT scans and the corresponding endobronchial ultrasound image. And half the group will have an image of the CT scan, and the other group with EBUS, and you just have to find your mate. So you will have 4L CT, and the other person 4L on EBUS, and you're going to go and find it. And then you come to the instructor and see if you did the right thing. Games are good. They are engaging if you set the rules right. So the rules of engagement have to be very clear. There should be some kind of reward. I mean, you can have candies. We had candies at chess, socks, t-shirts. But sometimes, motivation is just intrinsic, right? If you know the anatomy well, you can provide a better staging. And then, obviously, has to be feedback. At the end of that matching, learners get together around the instructor and get feedback. If you want to learn more, if you're an educator or interested in becoming a clinician educator, and you want to learn more about how to do this, this has been taught at the faculty development programs, educator development program, since we started almost eight years ago. And what I would like to see more when it comes to our courses is publishing on the outcomes of our programs. We had a few publications. The Ultrasound Group has published. We have published our chess experience with the game project. But there is some work in progress. I know the Brocascopy DTF is working on one manuscript, looking at the e-bus courses. But there is need for more. All right, now assume for a second you taught a course. The course is over. You do a post-test. You get the evaluations with a Likert scale or whatever. And what would you do next in order to further increase knowledge uptake and retention? One, two, or three fingers. Two. I see two. Invite people again. I see a three. In the back, it's twos. Invite people again. And some people are not voting. I see another three, another three. This is why clickers are better, right? Everybody votes with clicker. OK, so we think the answer is three. You know, people have written about forgetting curves, plotting the forgetting curve since 1885. I read the paper on this. People question, like, how fast do we forget? And again, a lot of what I say today will be forgotten instantly. But if I really want to delay that, if I want to improve that knowledge that you potentially gain after this lecture, I will do it in two ways. I will send you a quiz every four to six weeks for the next few months. So that spacing effect, that you can So that spacing effect appeals to retrieval of information rather than just rereading the material. That's the spacing. And apparently, rather than just rereading, it's better to quiz people so they actually put some effort in retrieving that information. This is called spaced learning. It was shown compared with formal teaching to decrease the attrition and even improve the knowledge gain after an event. In fact, there are companies that develop platforms on how to do this. And this can be done now quite easily if you believe in e-content and e-learning and you have the software to do it. And I want to say three words, a few words about e-learning. The pandemic has changed the way we teach, we believe. CHESS has responded to this appropriately. In fact, if you check the library, the e-learning library at CHESS, the number of products has gone up exponentially. In fact, there are programs at CHESS that are just e-learning based completely, 100%. And there are a multitude of programs where e-learning is incorporated as part of flipped classroom, like those hybrid events. I would invite you to just eyeball this list of what e-learning should be about. If we can check a box next to each of these criteria, then we'll truly have a meaningful e-learning content. I think CHESS is doing great when it comes to credibility in terms of faculty, comprehensive, modular, integrated. But we can do better when it comes to measuring the outcomes of our products, when it comes to accessibility, and maybe even leverageability, if you want. Content that's created for one platform to be used for others. And that obviously comes with cost and time and effort. So is it worth it? So what do you think about these statements? Which of the following is true regarding e-learning? Fingers. No votes. All right. Based on the evidence I reviewed, the correct answer right now is one. So for surgery, there is meta-analysis showing that e-learning is at least as effective as other methods for surgical residents. For all health care providers pooled together, there was actually no evidence that it's any better than traditional teaching methods. So that's important, right? Because we can invest a lot of time and effort in creating more and more products. But ultimately, it comes down to how impactful they are. So for the next slides of my talk, which are also the last section of my lecture, I like to reflect on a few things that maybe we should be doing differently, or things that we should be reflecting on moving forward when it comes to education in general and education at chest in particular. First, targeting the audience properly and teaching that specific audience. We cannot make assumptions about our audience, but we know who they are when they come in. Chest does an amazing job learning about the audience. We know their demographics. We know how much they know because they take a pre-test. And we also know the generational mix because they fill out surveys. So if we know who they are, then we should teach based on their needs because generation X and baby boomers learn differently than digitalites. We cannot make assumptions on what people want. First of all, I think chest does an absolutely amazing job with marketing these days. It used to be one of my biggest frustrations in the past thinking, you know that Alex, that thinking that chest maybe doesn't promote the programs that we work so hard on. And that's a challenge for us to make them visible to our audience. I don't think that's the case anymore. Every time we ask the question at chest, how have you heard about this program? Universally, they click on chest website, email from chest, look at those bars. They learn from chest. When it comes to course design, I thought that after the pandemic, people want brief sessions, very specific to one technique, come in, drop in simulation, six hours, go home versus a three-hour program. I'm so sorry, three days program. The formal programs that we had were three days or two days. When we asked them like, what would you do? And this is just a survey of 24 people. So it may not be representative. These are people who showed up at the course that we had in 2023. 60% want a three-day program, 40% a two-day program. So go figure. Maybe it's because if they take time off from work, family and friends, they wanna maximize the time off to learn and get their CME credits. I don't know, but that's what this sample has shown. Accessibility and reaching out to learners. Maybe local regional programs are a way to do it. Meanwhile, we can reach out to them even for procedures in a digital format. And I'm really looking forward to see this being launched. I know CHEST is working on it. We had very high quality videos recording during the pandemic. We have lots of tutorials and short lectures. And now what the team is doing is categorizing them by topics so people can access one particular module where they get the mini lecture and they get the procedure-related video and maybe a couple of articles. And then I don't know what brings people to the class. We can think about their lifelong learning, lifelong learners. Maybe that's the intrinsic motivation to get better. Maybe it's because they need internal validation of what they know. Maybe it's external motivation. Maybe their institution asked them to participate in a program prior to doing an intervention. And I do think that's where we need to reflect a little more on certifications and certificates. So assessment-based certificate program is fundamentally different than a certification program. And we use those terms interchangeably, but they are not the same. If you check the credentialingexcellence.org website, there is a clear difference between the two. So at a glance, an assessment-based certificate is when you educate and you test. A certification program is when you just test and you don't care where people got their training. So let's see what our sister societies are doing around the world. ERS. ERS has implemented a assessment-based certificate more than almost 10 years ago. They've been doing this for endobronchial ultrasound, in four centers in Europe, Heidelberg, Copenhagen, Ancona, and Amsterdam, I believe. They are using high-fidelity simulators, by the way, for assessment. They are reviewing videos. And to my knowledge, even during the pandemic, their slots for this program were actually filled. With AABIP, you heard, I hold a leadership position for another year as the president of AABIP. We, a few years ago, when Dr. Mousani was the president, we introduced a certification program. So this was just an assessment on advanced bronchoscopy. It was a slow uptake, but now we have about 20 people taking the test every year. What about GI? Take a look at this, guys. In GI, fundamentals of laparoscopic surgery introduced in 2004. And in fact, now, that's a requirement. It's a requirement by the American Board of Surgery, prior to sitting for the boards for laparoscopic surgery. In endoscopic surgery, the program was introduced in 2014, and also, starting in 2017, has been mandated by the ABS. And these are all certification-based programs. So maybe that's a motivation that other colleagues from other societies have identified when it comes to training and certification. The other thing I learned, and I suggest we reflect on, something that we learned during the pandemic, is that we increasingly need to get modular and bi-sized with our educational products. I mean, take a look at this registration for webinars that we had during the pandemic. When you see how many people registered and how many actually attended, you're learning two things. Well, I learned two things. About 30% of people who register actually participate in the live event. And also, after about 20 minutes, the interest is lost and people disengage. So we gotta keep them short and make them accessible because they come back and watch that recording down the road. So accessibility and bi-size seems to be, seems to be the way to go when it comes to webinars, web-based lectures. And then feedback. I mentioned that in my first slide. We get better if we get feedback. So when it comes to our programs, our outcomes group, initially with Dr. Madison, then Dr. Taro Minami and the staff, Greg Lasko and Rob Ramilosa, they do an absolutely amazing job in giving course directors and course faculty feedback on their programs. The outcomes report from a program is about 30 page long, but we also have snapshots on how we performed. You see the metrics by how much people improved in terms of knowledge and skills, how many people participated, if they would promote the program or not. That scorecard, I found it extremely useful. And then feedback from faculty. And I give credit to David Bell, prior chair of Life Learning Committee, who initiated that. If we are more diligent in filling out that form, I do think we can continue to improve our courses. Because it is time to reflect on what we do. And I thank Alida for sharing some of this data, which with the help of my fellows, we put it in a graph form. You look at the ultrasound course attendance for the last decade. That's the brown line at the top. All the other lines are bronchoscopy programs and their trend. Some are doing okay and stable, but some clearly show a decline, which is a signal that we need to pay attention to details. And the question is, what has happened? I don't know. But I do know that this was the defining time in my professional life. And maybe it was the defining time in the way we educate. Hallways were empty when we're showing up to work in March. The sky was blue in Chicago for the first time ever. And we look like astronauts as we were doing procedures. But I don't think we had an idea on how much this is going to affect the way we educate. CHEST has the ability to respond. And we've done that. Under the leadership of Stephanie Levine, Steve Simpson, and Ryan Maves, the COVID-19 task force met on a weekly basis, guys, for a year or so. And then we spaced them out and met like every two weeks. So that frequent meeting and awesome leadership led to generating a variety of products from webinars, interviews with experts, consensus statements, graphics, you name it. We were trying to bring some order in that chaos of information. This was also the time when we had the opportunity to experiment with longitudinal learning and spaced education. Yes, Alex, just for you, longitudinal, Alex's favorite word. And it will be intriguing for me to see the success of what CHEST is doing right now where we're trying to incorporate and leverage all this content that was created over the years in a longitudinal pathway. We have done that with asthma under the leadership of Sandy Andens and others, and for lung cancer, which was just launched recently. I invite you to check the websites and you'll see different educational deliveries on a variety of topics. So if you have ideas, bring them on. We should be open to suggestions on what we can change. We will take some risks. I think we need to take some risks. And I know it won't be easy, but we're gonna have to try new ideas. I want to finish with a few words of thank you. It's the time of the year when we need to reflect on who we're grateful for. And here are mine. First, I read some great books. And honestly, I'm grateful to the authors of these books for putting their work and thoughts together in writing some of the most amazing books I read when it comes to education and professional development. In fact, one of them inspired the title of my talk that make it stick. I'm grateful to my mentors. Some are on the slide. Some are not. Some of you are in the room. I do believe in functional mentorship where we learn something from everybody. But what kept me engaged over the years in working with CHEST, it's the CHEST family, the CHEST faculty. Always fun, always professional, and always welcoming. It's not just about products and results. It's about people as well. And I do believe that strong communities grow. Small communities and weak communities vanish. And we are growing. I'm also grateful to my dad, declining health and aging. He taught me work ethics. I'm grateful to my nuclear family for always understanding and unlimited resource of understanding for me not being home. I'm gonna finish with another brief story. So 1806, Lieutenant Montgomery Pikes, Pikes, I'm sorry. Lieutenant Montgomery Pikes was sent by Thomas Jefferson to explore the newly acquired territory in Southeast Colorado. So Pikes and 22 men settled by Colorado Springs, Monito Springs. And they saw a mountain above the clouds. And he and three of his men tried to hike it for five days. And they did not succeed. And they did not succeed. The mountain keeps his name. It's called Pikes Peak. And apparently rumor has it that he said, there is no human that will step foot on that mountain. Not only people have a marathon right now to the top of Pikes Peak, they have a tram that takes you up and down. So you cannot, we cannot predict the future. I discovered a new passion in midlife, hiking at high altitude. As I was hiking, this took me eight hours. I was reflecting on that peak, the book Peak I just mentioned, Secrets from the Science of Expertise, same title. And I don't know if you know Anders Erikson who wrote the book. He's the guy responsible for the 10,000 hours that lead to expertise. It's really 10,000 hours or 10 years, which is the reason I also reflect on what we've done at CHEST for 10 years of simulation. So thank you CHEST for allowing me to be part of a meaningful education for the last decade. So let's stir it up and make it stick. Thank you so much. Thank you.

innovative teaching methods

engaging teaching methods

medical education

active learning strategies

simulation

problem-based learning

game-based learning

assessment-based certificate programs

spaced learning