Thank you all. Second day, second official day of CHEST. We're going to go ahead and get going. I'm assuming everyone here has a lot of interest and some experience in education. So we really, you know, thought we'd get together and talk about, boy, you know, COVID came, everything got all messed up. Everything got turned into Zoom, which maybe was a good thing to some extent. But then, you know, now that COVID's gone, should we just go back to the same old lectures with or without Zoom that we've always had? Well, maybe not. So going to have a few conversations here today. And please, we really, really want to hear from you all. And so we certainly have preserved time at the end. But I think even going through, if there's something that you want to talk about, let us know. Start talking. We do not want this to be a simple, I'm going to profess to you all, because that's certainly not my style and I don't think that's the style of Amy or Alex. I'm going to go through just some sort of overview of some integrating educational innovation into your practice. Turn that over to Amy Morris, who's going to talk about some high-impact educational videos and how to make them more impactful. And then I think an important thing, Alex Niven is going to be talking about, boy, in a publish or perish world, how does all this stuff fit in so that we can keep getting credit for the work that we do? I have nothing to disclose related to this talk or anything else for that matter. I'm going to talk really briefly about adult learning theory and discuss some educational needs of various learners and explore a few new or at least new-ish ideas. And if you need more information, you can scan this QR code. I'm actually not familiar with how this one works, but has anyone else used that yet in other talks? No. All right. I saw a few nods. It's all good. I did not put this slide in my talk. All right. Just, and I think with many education-type people in the audience, you may know more about Cole's theories of experiential learning than perhaps I do, but the concept is that you have an experience, a concrete experience, then you can reflect upon that experience and decide what sort of action you might want to do, and then based upon that action, active experimentation, decide if that was a good thing to have done or perhaps not such a good thing to have done, and then learn from that going forward. The other thing I wanted to talk about really briefly is Bloom's taxonomy related to the cognitive domain in learning, you know, published over half a century ago, with the concept of the first step of learning, right, is to recall facts. Can you remember what you were told during that lecture? But then there's a hierarchical pyramid of learning. Can you then recall facts and can you understand what those mean? Can you apply those, that information in new situations and draw connections amongst other ideas and ultimately get to the point where perhaps you can create new product to further your learning as well as learning of others as well, and this is meant to be hierarchical, that the higher levels suggest a higher level of learning compared to the lower levels, but it's also a pyramid because, you know, the reality is that it has to start with the facts, right, and if you don't learn the initial facts up front, then you can't build upon those things, and so the majority of our education may be related to this, but to get our learners to a higher level, we want to make sure we move up the taxonomy pyramid. So, and again, I think everyone here has some idea of when you're getting ready to prepare a teaching product of some sort, it starts with a needs analysis, a gap analysis, anyone that's submitted a session to CHESS should be familiar with those if you weren't already, but I think we also need to be thinking about this educational product that I'm making, is it scalable, is it for my 12 fellows, is it for a department-wide conference, is it regional, national, and can that same product be made scalable to address those other audiences and move back and forth. I think lots of people are struggling with asynchronous education, right, how do we deal with that, which certainly is a challenge. My hot word for the day, situativity. Wow. I didn't make it up. Is that a word? I did not make it up. You can, there's many peer-reviewed papers related to situativity, and I think it's self-explanatory, right, is yes, you have a knowledge fact, but when you're in a situation, can you apply that knowledge to the situation, and really that's sort of case-based learning type things, is applying that knowledge in a situation, which also sort of ties in with experiential, but also, you know, in this day and age, especially when we're talking about ICU education, but I think any education, you know, physicians, practitioners are just not sole people, really depend upon a team, and so it doesn't really help to talk about airway management to just the intubator if everyone else in the room doesn't have a clue what's going on, so interprofessional education, very, very important. Again, you know, I think the majority of our education probably still needs to be sort of lecture-type based, because there's just a large number of facts that we need to be able to deliver, but the reality is, is that it's hard to deliver that in a way that doesn't make people fall asleep on their computers if they're doing it over Zoom, even in person, I frequently see people nodding off, not in this room, thank you, but, you know, and Zoom just adds a whole other layer of, am I really accountable for what I'm trying to learn? Again, of more reason why we need to do better than that. One concept I wanted to share with you all is the idea of, if you do have to do a lecture-based thing, even whether it's live or over Zoom, a social media wall, a Twitter wall, if we call it an X wall, whatever, is a technique that some people have done, where you ask people while a lecture is being delivered to live tweet, and then somewhere there's a monitor with those tweets loading on the monitor, so that you have a wall here that has 20 different tweets going on, and so that way your learners are interpreting the information that you gave, put it into their own words, processing that information, and then sharing it with others as well, and then the wall, by being there, will encourage people to keep doing it, because not many people are going to pull out a phone and just tweet in the middle of a lecture, there's a few of you out there, but the more you see the wall going, it does encourage more active participation, and this can be a really effective technique, because once it's out there, in this particular instance, this was a regional conference we had in Iowa City, this person replied to the tweet, hey, here's our experience in the United Kingdom. Okay. This tweet had 3,000 impressions, over 3,000 people viewed that one tweet related to our educational offering, and this also provides an opportunity for people to ask questions during your talk or following up from the talk, and the wall can actually be used then two months later, too, for that space learning, you know, go back and review those topics again, and the wall sort of just makes it more exciting than just rote facts being reminded to people, so that's something that you can think about, there are free versions available, you can get better versions for somewhat more, and available for lots of different platforms, and many of the walls are actually platform independent, that they can take feeds from X, from Facebook, from Instagram, so that's something that some people can do, and I think it's an effective thing to do. Tweetorials and twirls, I think everyone knows tweetorial, twirls is a pearl of information, somewhat shorter than a tweetorial, you know, I think this is one from someone that's very active here at CHEST, and I just love this, because this was a night on call that he did a whiteboard drawing of something related to pulmonary embolism, and not so much that I love the information on it, because I haven't reviewed it that carefully, but I love the fact that he made this product, and said, you know what, I'm going to share this with lots of people, and it has been shared with many, many people. You know, I think the problem with any social media education is the lack of peer review, as Chris Carroll said a couple of years ago, it's just some dude in the basement with a computer. But I think there actually can be some peer review, because unfortunately, people are going to let you know what you think about it, and if there are opposing views, they're going to post that, and so there is some need to make sure that you're putting something out that's a defendable statement, and if not, you'll get called out on it. That's the advantage of things like social media, and Alex will talk more about this as well, but it is quantifiable, in that when you're ready to go up for promotion, you can say this tweet had 7,000 views. Clearly impactful, whether it is quality or not, it's impactful, which is probably as important as anything else. Simulation. I think the three of us up here all do a fair amount of simulation, a huge simulation component. It's great for situativity, I love that word, and again, that experiential learning, the opportunity to make a mistake, the gift of that, being able to make a mistake and learn, get that learning scar in a safe environment, and also encourages interprofessional education. Of course, as much as I love simulation, I recognize that it is expensive, the equipment can be very, very expensive, it's time intensive, especially for the educators, it takes a lot of time to set up simulation and make it work well, and then you have to find a sim lab, which is often not where our learners tend to be, because they tend to be in clinical practice. So there's a lot of challenges with simulation, it certainly cannot be our main way to develop educational product. Again, I love simulation. But I think there are other options out there, too, that are a lot simpler, nearly free. There's more and more screen-based simulators out there. Two brands here, and again, I have no disclosures, I'm not endorsing either one of these, but TrueVent comes from TrueCore. You get two mobile devices, one of which is what the learners see, and one of which is you, and you can control the patient physiology while they're looking at the ventilator waveforms, and you can modify the ventilator settings to match what's needed for the learner. Simple is just a simple telemetry product that you can control, even if you have a task trainer, a low-budget task trainer, you can then create human physiology to go to inspire new interactions. And there's, you know, I love the name, Awesome Ultrasound Simulator, free app, same thing where you as the instructor can control what images they see on the ultrasound, you can change it on the fly as the patient changes, develops their tension pneumothorax, things then change. So that's some low-budget things that we can do that don't require a sim lab, don't require a lot of money, these are actually all free apps that can be very, very useful for education. Choose your own adventure, sort of video-based education here. I'm actually going to play a 46-second video here, and I'm going to ask you a question at the end of this video, and I don't know that we have audio response going, and that's okay. Okay, let's take a look. I think I'm going through the cords. Okay, yeah. Can you plate that cuff, please? I'll listen for breath sounds. Do you see end-tidal? I see end-tidal. All right, I've got the tube, take a listen. I hear them on the right, but not really anything on the left. Do you think maybe it's named stuff? Possibly. Okay, what would you do now? Continue ventilation until SATs increase, retract the endotracheal tube 2 to 4 centimeters, listen to the stomach, remove the endotracheal tube, or reinsert the video laryngoscope to assess the ET tube position. Again, I don't know that we have audience response. It should be working on the QR. A different question. It's all right. How about a show of hands? Everyone willing to be vulnerable here? We can just do this. Do 1, A, B, C, D. But then you want me to capture that? If you can. Show of hands. How about who's going to choose A? Who's going to choose B? I'll be brave. Okay. Nobody else? Okay. Thanks, Meredith. Okay. Thank you. Who's going to choose C? Who's going to choose D? And then who's going to choose E? All right, all right. Now I have a different question. Preparing to intubate an ICU patient, BVM results in good saturations and a normal end of life. They have a grade 2 view with video laryngoscopy and see the tube past the cords. Saturations fall to 78%. And title CO2 is 40 initially but is absent after 8 breaths. Breath sounds are present on the right but not the left. What would you do now? Who wants to choose A? Who wants to choose B? I'm making it good. Who wants to choose C? How about D? Lots of people are not voting. How about E? Interesting, interesting. So these were the same questions. What I just wrote here is what was described, what was shown in that video a few minutes ago. But even just looking around here, some people change their votes, right? And I think the concept here is that this question in front of us is really sort of that knowledge base, maybe gets a little bit into applying that knowledge. But really I think it's perhaps easier for folks to understand what the question really relates to here as opposed to the video where there's so much more complexity that really relates to the real condition that we're going to see in an ICU setting where maybe it's not so clear what one's going to do. And now the whole thing comes up. All right. The correct answer is remove the endotracheal tube. I'm not going to justify the answer right now. But this would be followed up with a long discussion. And there are some references if you want to have that, look that up later on why removing the endotracheal tube is the correct answer. Again, I don't want to delay on that topic. But the concept of a choose-your-own-adventure video was a 45-second video. We recorded it three times to get it right, so five minutes. So pretty easy to do. And then that can be then asynchronous education. And then, of course, that would be followed up with a good discussion of what the correct answer is. And this can be scalable, interprofessional, lots of opportunities there. And finally, the last thing I want to just touch base with is the idea of escape rooms. I think lots of people have talked about escape rooms. I recall Amy Morris here and others did publish in Chess a couple years ago about building an escape room at the Chess National Conference. And that escape room was quite elaborate. Who did it? Did anybody do it? Raise your hand. Nobody went through the escape room? That's a dirty question. Oh. Yeah, any year. Any time in the last couple years. We'll count it. Anybody go through it? It was very, very cool. I'm not that cool. It may not be a surprise to those up here that know me. But one can build an escape room that fulfills an educational goal on a fairly decent budget here. A fake hand sanitizer with some supplies inside it, a lock that has words emphasizing that if you're doing airway management, you need to develop a plan. So plan is the code to the lock. An old textbook that's two versions old, hollowed out to put a key in there. A shark's container and a black light. You can go a long ways to make an escape room on a fairly low budget. And really focusing upon the education that one is trying to deliver. There's fun, but you're also trying to deliver education. And so you can do pre and post knowledge assessments related to the escape room. And when we ran this a while ago, we did see interval improvement in several different domains related to airway management. So again, escape room can help with sort of the new situations and drawing connections between concepts. So another concept that don't get intimidated by the fancy escape rooms that exist there. Start with something small and build from there. With that, I want to hand over to Amy and talk about how to make the video that I made even better. Because it was low-ish quality. That's okay. That's okay. So let's get to the next talk here. So raise your hand if you have made a medical education video. Raise your hand if you haven't, but you're interested in learning how to do it. Or you want to do it. What? You can come up. It's okay. It's like imposter syndrome. I don't know if I can. Oh, yeah. You're welcome. So anybody can make an educational video. I want royalties. It's just all about getting, you know, knowing how to use the lasso tool and resizing. So I was asked to talk about making high-impact educational videos as one example of a way to use a more innovative or slightly different educational technique that's very approachable. Because they're all different levels of doing this, right? A way of augmenting your medical education practice. And depending on where you practice, you may have different applications. So who here works with trainees? Everybody. Okay. Great. Perfect. But I would argue that there's a lot. There's role for educational videos even outside of the academic arena where you're working with trainees. Because there are hospital staff and non-MD healthcare providers who need to be educated about a lot of things. And some of the videos I'll show you here actually have applicability outside of the MD and APP arena. That's me. No conflict of interest. Nobody pays me for the videos I make. I will say, who went to opening ceremony last night? Very cool. Dr. Rutledge makes amazing videos. Got a little bit of imposter syndrome watching those last night. Let me tell you, mine are not that good. But I also don't partner with industry. So you got to work with what you got, right? So goal here is in 15 minutes I want to give you some key tips and techniques for making good on your promise to yourself to make an educational video. Normally when I talk about this, I first have to spend a few minutes convincing some folks in the audience that using additional techniques for teaching is somehow better than just this, standing in front of a room and lecturing. But even for those of us who have already bought into the idea that this can be a useful tool, I think it's helpful to understand some of the cognitive biology behind that. So just bear with me a moment. So Mayer's theory of multimedia learning, there's a rich literature out there about cognitive function as it relates to learning. And the multimedia approach to this is acknowledging essentially that when you take in different methods of sensory input or different types of sensory input, so video and audio here, that then feeds into your working memory. That's where the magic happens, where the cognitive processes are happening. You're integrating knowledge. You're putting it together with what you already know. And if there are two different streams of that happening, there's good data to suggest that that is more effective at then creating long-term memory and folks actually retaining what they learn over time. So not just speaking and hearing, but repetition, we'll talk about that in a minute, can help solidify, cement these processes. So not just looking at a picture of sarcoidosis in a book, but looking at a picture, better yet, a video, and hearing the word sarcoidosis at the same time feeds into two channels of this cognitive processing. And there is data to suggest that using educational videos as part of your strategy improves comprehension as documented by outcomes in terms of memory, both short-term and long-term. Skill acquisition, a lot of this literature comes from the surgical world, and it's impactful. It's successful completion of procedures. It's efficiency of procedures and engagement as well, and I think this is one of the main reasons a lot of us look to videos is students seem to like this or learners seem to like this. Heck, adults like this. And there's good data for this. There's a fantastic study where they took 200 medical students somewhere, I believe it was the Netherlands, and it was over 150 hours of lecture that they made part of it into videos, and then every day they would take a chunk of the med student group out, show them the videos, and then they did analysis at the end of the session. This was months long, and evaluated what did you like best, and what they found. There's a range. People learned better in different ways, but a lot of folks really do like the video method. However, not everybody. There is a role for both here. It doesn't replace the more traditional learning methods. It is a tool, not an end in itself to the goal of teaching your learners, and they found that they didn't necessarily, the folks in the learner, the content that was video was not necessarily better retained than the lecture. So it is not an end in itself to make an educational video. It is an additional tool. So what's it good for? Lots of stuff. You can teach cognitive concepts in a way that is a little bit more creative, right, with moving videos as well as audio, and it allows you to really dig in deep with cartoonized concepts, not just words, to get across complex things like how ultrasound works with the converse piezoelectric effect here. Procedural videos, all quite familiar with this, and those can be fairly simple, right, how to place a central line. This is the video that we made recently at our own institution for certification for our incoming trainees to complex. So taking a very complex skill like running a code, this was one we made a couple of years ago in circumstances we're all unfortunately familiar with, to try to break down a very complex process into digestible pieces that folks could then watch repeatedly if needed to try to get those concepts down. And then, of course, a key role for just-in-time training for procedures or events, both of which, well, especially the coded central lines aren't necessarily rare, but other high-risk, low-frequency procedures. This is a fantastic video. Many of you may have seen this. It's been viewed tens of thousands of times by an EM doc who performed an emergency cricothyroidomy in the ED on an awake patient whose permission he got to film him getting it done. So go to YouTube, Google it. It is amazing. I chose a still before the incision. Don't need anybody passing out this time in the morning. So all sorts of applications. When you have decided what it is you want to talk about, what it is the – we heard about gap analysis, figuring out what's missing from your educational content and where you feel a video would be helpful to augment your learning or your teaching for your learners, take a moment to really firmly decide – this is where we get into the practical steps of making a video, y'all. To very clearly decide what exactly is your topic and what is your scope of this particular video. You're not just going to talk about bronchoscopy, right? That is a long video. You're going to talk about the mechanics of how to perform a transbronchial biopsy. That is something that you can do in a small enough bite that it makes an effective video. There's a lot of data coming largely from the didactic world, lecturing, that retention starts to diminish after about 10 minutes in a didactic session. So a good educational video generally isn't much longer than 10 minutes. Now, lots of you will be familiar with the phenomenon of learners speeding up the rate at which they watch their videos, right? So a 12-minute video can become an 8-minute video and you sound like a chipmunk. But I would aim for roughly 10 minutes speaking at a normal rate of speed. That will feed into the data that we have best supporting that duration. Now, I'm going to pause for just a moment and say at this point we're going to get into these practical tips here. I want to make sure that we've got time at the end, but I also would love to get comments, input from the audience. A lot of you raised your hand saying you've made videos before. So if you've got additional comments to make about any of these things I'm about to say or questions, please raise your hand or just jump in. This is a small group. We're all friends here now, right? Yeah? So just jump in. Let's share best ideas with each other. I think this is a great format for that. Anybody disagree with the 10 minutes? Anybody have a different technique? If you're posting on Twitter, it's definitely shorter than 10 minutes. I have a question. How long does it take you to make 10 minutes? Oh, man, that is a great question. So it depends on your perfectionist tendencies. Hours. I spend a long time futzing. We're going to talk about some of the details of optimizing your shot and your audio if you're doing a moving video. And then I spend a lot of time putting it together myself, actually, with video editing software. I will say this transbronchial biopsy video was not one of mine, specifically the central line video that I showed earlier. This was from our institution, but one of my colleagues was really making that one. We've got a whole series on our WISH website, the Washington Institute for Simulation in Healthcare. You can go check them all out. But the CDC video all told was, it's eight and a half minutes long, I think. Is that right, Hugo? Eight and a half minutes? That probably took me 20s of hours. Is that a word, 20s of hours? Sure. It took a long time. But it does not have to. We're going to talk about a few different methods that you can use to make that go much more quickly, and you do not have to do fancy video editing software to get a pretty good product. We will talk about how you can do that more efficiently. Does that answer your question? Thank you. Thank you. Were you going to ask something else? You answer. My question is, does it have to be perfect? Yes, exactly. I mean, everybody and their brother liked video to whiteboard during the pandemic, right? So is there actual evidence to suggest that there's a difference between the quality that you deliver? So great point. I do not believe there is. Now, it could be that because I've not actually, I've not gone to PubMed with that very question, but my guess is no, there is not good data that a better video teaches any better than a chalk talk that's been filmed, right? In an effective way. So let's talk about effective ways to shoot whatever level of video you're going for. First of all, you've decided your topic, your scope. It's sufficiently narrow that you're going to be able to get across the ideas you want to get across in a bite-sized digestible piece of time. Writing your learning objectives using smart language, you'll notice I did that at the beginning of my talk, in the next 15 minutes, you will be able to do this thing. So smart learning objectives, I think we're all, many of us are familiar with this from Bloom's Taxonomy, we heard about that already. They're specific, they're measurable, they're things you can accomplish within this period of time that you have. They're relevant. The time-based one never really made a lot of sense to me, but that's all right. So consider using this language at the top of your planning document for your video. At the end of this video, the learner will be able to, and then use words that are measurable. They'll be able to list this, describe this, explain this, perform this. That's your goal. Make it something that you could actually measure your success with. Then determine your format. Okay. So you mentioned the Chalk Talk. So this is a setup that I used during the pandemic for teaching in real time, but also recorded a couple of videos this way that involves one camera staring at my face on my laptop there, and then another camera, which is my phone, sitting on top of this box, aimed down at a piece of paper. I did not invent this technique, and I really should put up here the name of the person on Twitter I got the idea from. Sorry about that. My apologies to him. Let me know if you want it, and I will try to find it for you. But essentially, you can record the video from your phone of you drawing in this little box, and it is simply a recorded Chalk Talk. It can be very effective. Some of the best videos, anybody use Khan Academy for their kids, if not yourself? Yeah. So a lot of it is just cartoon and drawing ideas out, right? So this is a very effective way to drill down to the essential content without getting distracted by extraneous special effects. So highly recommend it, and definitely much faster to put together than more of a video where we're actually recording live action stuff. This you could do with good planning. You can get this done, one and done, within a couple of hours. Defining the format that you're going to use. So one option is the sort of a Chalk Talk style. You could do the Zoom talking head over PowerPoint. I didn't show a picture of that, because we've all seen a lot of that. And then you could move into more of a live action video style recording with more of a moving camera, what we think of as a moving video. And that can be a big picture shot where you're watching people move around, like in the airwave video, or this is part of our CVC video here. It can include close-up shots, which are then layered with a little bit of illustration. Again, doesn't have to be fancy. A little picture of a fake lung with an arrow does a lot to get the idea across that you would want to make sure your needle is high enough up on the neck, right? So decide what your tools are, what you have the bandwidth for and the time for, and then you're going to plan your project. So I recommend, even for a very simple project, if you're just going to be recording a Chalk Talk and getting it up there online for your students who maybe couldn't make it to whatever lecture you're doing that day, make a script. This is the script style that I use. There's lots of variations out there. But what I do is on the left-hand column, I have it organized by what it is I'm trying to get across. I section it out in terms of the content I'm getting across. And then in the middle, I've got a list of my visuals. But I describe it, as you can see, just in my shorthand. And then I have a script on the right-hand side. And I link up the visuals with the script. So in my mind, as I'm planning this out, I'm seeing what I'm going to see on the screen and I'm hearing what it is I'm going to say on the right-hand side of the screen on the voiceover. And linking those up then makes it very easy to just plug and play as you move forward. Collecting your visuals is your next step. This QR code will take you to a very nice website that's not designed for medical education necessarily, but it's got a great list of resources for free pictures that are copyright-free. So for this, I've used stuff that, this is just educational, we're not making a profit off of this, it's not broadcasting live. But if you're going to do something that you're going to then be posting, I would recommend using images that are either yours or are copyright-free. Make sure that the images that you're obtaining are big enough, right? You're going to be able to see them well enough. You are focusing them well enough. So you have zoomed in on what you really want to show. The lighting allows you to see what it is you really want to see. And this is true whether it's a live shot or a still image. Make sure that it's clear, right? So your graphs cannot be fuzzy. You can't cut and paste a fuzzy graph onto a video. Here you can see the bronchoscope very clearly going through the ET tube here because we've zoomed in really nicely and adjusted the lighting so you can really see what we're looking at. Make sure that you plan to spend adequate time on the screen. And that they emphasize your content. Here this is James Town, one of our faculty, talking about the concept of compliance in the lung and the stiffness of the lung for the medical students here. You can emphasize that point with a fairly straightforward kind of fun image, but you don't want to distract, right? You don't need this. So keep it simple. Content which you want to highlight without showing too much and getting distracted. Then, again, background, the cognitive load theory. So there's a lot of language around this. There are different types of cognitive processing. The essential cognitive process is what we want. We want to take the important info, mull it around in our heads, fit it in with what we already know, turn it into long-term memory that leads to understanding. The generative germane part of the process is that organizing, integrating process. But extraneous processing is what's not helpful, and that's all the extra visuals all around. It was just a short clip that we saw from the airway video, but there was a lot happening there. There was a lot of extraneous processing happening that didn't help us think through the scenario. Note on audio. Make sure that your volume is adequate. Get yourself a decent microphone. It doesn't have to be super expensive, but something decent where it's going to come across very clearly. There are de-essing programs. If you tend to be a close talker like this, you can very quickly eliminate all of those siblings. Enunciate. No mumbling. If anybody remembers this scene from Ferris Bueller. And then keep your tone conversational. So when you write the script, read it out loud. Does it sound like you? Does it sound like a 1950s overview to a video? Or does it sound like you? Your learners are going to want to learn from a human being. Make it conversational. This is the point where you do your initial peer review. Get somebody to look at your script, the visuals that you've collected, before these guys take a look at it. Before you do all the work to put it together into a complete product and get a thumbs up or thumbs down from the critics. I hope everybody in the room still knows who this is. I'm dating myself a little bit. Yeah, please. Can I see some hands, some nods? Thank you. Thank you. Okay. I feel better. Siskel and Ebert, for those of you under 40. So before you finish it, before you put a lot of work into putting it together, make sure that you've looked it over and somebody said, I don't know what you're trying to make with it, what you're trying to say with this point. This visual is fuzzy. This is misspelled. So this is where you do the initial peer review. Then you do your recording. So it can be very simple. This is a Zoom recording. I'm recording Varen here for a little video that we're making. And it's just his face. In a moment, his face will go up to the side of the screen. There'll be a slide. Talk over it. So that can be very simple. Zoom makes it very easy to record a very simple face or head over slide image. Or you can get a little fancier. And I just wanted, I show this video to show, a green screen is not hard to do. You really do just need a green sheet. And a cell phone camera can do a lot for a video. So if there's anything that you want to demonstrate and you really want to get rid of background images, extraneous cognitive processing, this is a great technique. And it's not as hard as you would think. And then you're going to edit, put your video together with editing software. Now at the top of the screen here, Alana Crum was one of our residents at the University of Washington. She has written a fantastic article that was published in CHESS last year on creating a video. There are folks, additional folks in the audience here who are quite familiar with this work. And in that, a lot of the steps that I've gone over today are outlined here. That's no surprise. We work together at the UW. But one thing that I find really helpful is a list of various editing software options that are out there. So there's a lot of good stuff in this article. I definitely would check it out. This is Camtasia. This is the one that I like to use. It's not designed, I find Photoshop a little more challenging. This is much more user friendly if you don't have a lot of editing experience. It looks super complex up there, doesn't it? Raise your hand if you're intimidated. It's okay. It looks really complex, but it is very amenable for playing around. And they have a very nice help. So you want to do XYZ series of videos on their website. So I recommend this one. They're not giving me any money. But medical educator to medical educator, I think this is the easiest one to work with. So I like this one. All right. Putting it all together. So the list of steps to go through if you are going to create your own video. Now, folks may do things a little bit differently. If those of you who are experienced video creators or editors here, I would, we've got a minute and a half still in my time. I would love to hear if there are additional pointers you have that you'd like to share with the audience that I completely missed. that you've done that you think are fantastic tips that you've just got to share. Anybody disagree with the things that I said and does it differently? Yeah, jump in. Yeah. Yes. Oh, screen. Thank you. Yes. Screen capture. So I showed the really low budget set up. I'm going to show you the high budget set up. I meant to mention that. The low budget setup of aiming your phone at a piece of paper, literally drawing what it is you want to do. But you can actually, so do you want to just talk about that just for a second? How does that work? If you have a iPad that has a pen capability. And you can mess it up and redo something, and then when you go back to edit your video you can chunk it up into pieces. So yeah, you can do it more high-tech. I wanted to show the easiest access way, but you can absolutely do it. Procreate? Any app that you can get, and then what I did instead of doing it as the whole thing, because I'm playing pre-planned to edit it, so I would do it as a whole. So you've got a series of videos that you then pull into whatever your chosen software is. If you're on a fruit-based computing system, I understand that Mac has a very easy editing software too, but I'm not on that software system. But you can just pull in a little video here, link it, video, link it, yeah. Yes, I think the shorter ones, then you're less likely to get stuck. Yeah, true. And when you're doing a live action, if you're going to do more of a live action video like our CVC video, obviously we're recording little pieces that then you pull in those individual pieces put together. Okay, I'm going to pause there. I would love afterwards, we should have, I'm 40 seconds over my 20 minutes, I apologize. So we're going to have time after we're all hanging around, I'd love to hear more ideas. Please come share with us and each other. I just have to share that I learned the screen catcher function on my iPad for my 15-year-old. Oh, if you have teenagers, yes. My 13-year-old actually was very helpful as I was learning to use Camtasia. I am not afraid to admit that. All right, so my job is to talk to you about getting credit for your innovative work. My name is Alex Niven. I am the Director of the Academy of Educational Excellence at Mayo. I'm an Education Chair in my division and I have nothing to disclose. So that's my objective. And I think, I'm just going to jump to this in the interest of time. So I think in a time of disruption and urgency, frequently those sorts of situations drive significant change. And certainly I have learned a ton over the course of the last three years in terms of how to deliver virtual education, vary the ways that we do things, and we've experimented in a lot of different directions really, really quickly. But I'm talking to a room of clinician educators who most likely work in environments where there's a whole lot of clinician. And so I know what you're thinking. You're listening to the YFM channel, which is what's in it for me, right? Where if I'm going to spend all this time being creative and all that stuff, how am I going to get incentivized and rewarded for that time and effort? Well, I suspect many of us in this room either work for or are affiliated with some sort of academic institution, right? And so I'm going to remind you of the painful fact that when it comes to appointments and promotion, academic institutions focus on clinical care, research, and education. But in terms of quantifiable accomplishments that are typically considered meritorious scholarly work, really the biggest commodity is publications. And how do people weigh the importance of that publications to ensure that they are of sufficient merit for promotion? Well, they look at the number of citations of your papers. They can look at age factors, impact factors, and the like. Certainly grant funding, especially because there's a chunk of that that goes to the institution, gets weighed in a little bit as well. And then numbers matter a little bit as well, for better or for worse. Now I know what you're thinking. I have the sinking feeling in the pit of my stomach too as a clinician educator when we talk about these things. The reality is that the digital revolution that we have enjoyed in medical education over the course of the last couple of years has completely blown up this paradigm, right? Because all of a sudden we can generate lots of content very quickly that gets disseminated to a huge audience in a very short period of time. And the challenge really is the impact in the peer review in terms of what we think about for scholarly spread of knowledge. Let's face it. The other thing that we have to deal with as clinician educators is although many promotion committees say that they weigh clinical activities, research, and education equally, the reality is in many settings there is an invisible glass ceiling when it comes to education accomplishments. And that is largely because the perception is that these efforts are not quite as rigorous and the methods used for innovation and dissemination are not the same as traditional research. So what does the available evidence say in terms of things that are out there to help support clinician educators who want to do all of these cool things that my co-presenters have just talked about, that they can do those things and potentially get credit for it? Well, there's lots of places in the United States that have designed clinician educator promotion tracks, and those things are really, really great. The challenge is that at least based on this paper published in 2022, less than half medical schools have a clinician educator track, and you have to be able to understand the track in the language to be able to translate what you are doing into something that's potentially quantifiable for promotion. Certainly there are lots of folks out there who have published really interesting information in terms of how to quantify things with an educator portfolio, and there's lots and lots of information there about potential quantifiable accomplishments in each of these different domains. But again, they are relatively institution specific, so in case you perhaps change jobs and change institutions, oh my, maybe that's a little bit of an issue. And the other challenge is the level of support that you have to gather up all of these super cool things that you're doing and put it in a format that makes sense to a committee. And then last, the third sort of domain that's been described in the literature is faculty support. So these are mentorship programs, leadership courses, perhaps providing more flexible schedules so that you have a little bit of protected time to do these things provided they align with teaching programs and the needs of the institution, or for institutions that have a more set expectation in terms of time in rank before you are promoted, the ability to stop the clock. And I don't know about that last one, but to me that starts feeling a little bit more glass ceiling-y. So this was a really nice article that was published last year talking about some of the problems in promotion equity for clinician educators, and then some of the solutions that kind of go along with that. So, you know, in terms of the primary problems that we face, well, we've already talked about publications being the primary commodity for impact, limited sort of clearly defined clinician educator roles and their value to an institution as part of the promotion process. The, quote, soft science outcomes, well, you know, learner satisfaction scores being used as a primary marker for accomplishments and promotion. And then also the limited opportunities for external peer review and dissemination along with a less than adequate voice on promotion committees. And I think perhaps in the interest of time, I'm just going to highlight the fact that the solutions to these is to be a little bit more systematic as a clinician educator in terms of how we engage in our educational activities using the lens of scholarship, focusing our efforts to have a specific area of expertise, broadening the definition of educational excellence, and that's something that you can't do individually but needs to be done in a division or an institutional level, and then highlighting the importance of our engagement in admission and promotion committees across the board. So how do you increase the scholarly value of digital content, social media, and other educational products that we do? How do you quantify that? Well, you know, the reality is that there's not a lot of people out there doing a lot in this area. So this was a paper that was just published a couple of years ago highlighting the fact that less than 8% of medical schools in 2018 in the United States had some sort of policy that addressed the use of digital media in promotion decisions. This is an article published by a friend of mine, Dan Cabrera, in JGME back in 2017, that for me is probably the clearest set of guidelines that I've seen out there, both for institutions and for individuals, to help quantify education scholarship. So we recognize, as we rapidly disseminate content on social media, that there is a little bit of risk associated with that, especially when you are associating yourself with your institution. And so from an institutional side, having clear guidelines in terms of acceptable scope of social media activities that align with the values and priorities of the institution, and having a systematic approach both to quantify the degree of accomplishment, which is significant, how many impressions is really enough if you're writing something for a huge medical school that has hundreds of people? It seems like you're going to have a competitive edge over somebody who's working for a much smaller audience, right? And then developing an objective grid to look at what's important and what the impact of it is, is key here. And again, this is a bit of a similar theme in terms of the scholars. Obviously we want to abide by our institutional guidelines and not get in trouble, either ourselves or our schools. But really being thoughtful about how we approach academic scholarship. What is our niche? What's the community that we're targeting? What are the objectives and clearly defined innovations that we're trying to drive? And then clearly describe that as we go through with our activities. So GLASSIC's framework is kind of the classic framework that we think about for scholarly production and rigor. We identify a goal. We do a literature review. We design appropriate methods. We execute our study and collect those results. We present them clearly and effectively. And then we reflect on their strengths and weaknesses, right? That's the classic thing that we've all been taught to do with a paper. We can certainly do that with education. Now I will show you one way that as a clinician educator who is otherwise unfunded, sort of leverages my surroundings to do that. So I do a lot of work with Agi Gajic, who is an R-funded researcher, critical care scientist. And ironically, the virus registry came out of a tweet that he put out saying, gosh, it would be really great for us to collect some outcomes data for folks with COVID-19. This was really early in the pandemic, right? So you can Google it. The virus registry now has 83,000 separate patients that has been gathered from across the world. And in their preliminary analysis of the virus registry, they found that the greatest variation in terms of outcomes that was modifiable was process variation. Not surprising, right? Because everybody and their brother were tweeting out what they thought the right thing to do was for COVID early on. So he got a little bit of money through the SCCM and the CDC to design an education program to disseminate best practices in the care of patients with COVID. Now when you talk about dissemination, huh, Agi's not an educator, but I am. So I can help him in terms of instructional design to design a needs assessment that we'd actually already developed for our certain program previously, think about a variety of different delivery methods using both synchronous and asynchronous interventions, and then designing some really basic outcomes using Kirkpatrick's levels, looking at reaction and learning, and the follow-on stuff that we're still working on is the long-term sustainment in terms of behavior and outcomes in the different institutions with which we've partnered. And so when you leverage scientists to help you with the rigor, guess what? They've also got a research lab with them and a variety of different trainees that can help you in the midst of your day-to-day activities in terms of writing up the work. So we've been able to publish all of the things that we've done and adapt that same model for a variety of different settings. So we learned how to do this through the Stop Virus Collaborative, which I'm sorry I forgot to highlight on the other slide. One of the most important things about education scholarship is to make sure that it's discoverable in some way, shape, or form, and not just in a publication. So if you type in Stop Virus Collaborative right now into your Google, you will be able to find all of the information that we've gathered and synthesized over the course of the last several years on the SCCM website. And even better, if you're able to track the number of people who go to that site and use that information, that's another important quantifiable thing in terms of dissemination. So we were able to adapt that for another collaborative very similar that was supported by the World Health Organization. And when the conflict broke out in Ukraine, that just-in-time tool was also something that we were able to pivot and partner with the Critical Care Anesthesia Society in Ukraine to provide just-in-time trauma critical care. I'm a retired Army doc, so I know a little bit about that. And because one of the tools that we used was virtual simulation, it actually sparked interest and a little bit of funding in terms of strengthening our virtual simulation platform for a simple screen-based opportunity to provide applications with that. So I'll just run through two other things real quickly because we're also out of time. So I mentioned at the beginning that we were-that I'm the director of the Academy of Educational Excellence. I think many institutions have something similar to this, but it's really a structure to help partner with the admissions and-or the AAPC, the Appointment and Promotions Committee in your institution to help quantify educational activities. So our academy basically requires an academic appointment as a place to start. And for our educators who are looking for appointment and promotion along a clinician-educator pathway, it requires meaningful demonstration of education skills development and then application of those skills in a specific avenue. This is an example of just one of our four tracks. So this is excellence in teaching. You can see that the expectations in terms of skills development is significant, but it also demonstrates a meaningful commitment to developing expertise in an area. And then these are just examples of anchored descriptors that demonstrate excellence in teaching largely through progressive awards or dissemination of teaching skills at progressive external levels. I'll just scroll through this in the interest of time. So what we've tried to do is design a wide variety of educator modules. So we've got 190 overall now that are available online and asynchronously for people to use. And we've also designed an annual meeting where people can come, basically consume that content and meet the requirements in terms of educator skill development and use that as a place to meet and network with other educators, again, to build those critical masses that we need to be productive. And we've been designing a speaker's bureau really to provide, again, opportunities for external dissemination because that's how you get those bullets that build notoriety and reputation, especially for the associate and the professor promotion level. We've been working with senior leaders to help align our pathways for teaching, curriculum design and development, administrative leadership and education research to help simplify what otherwise always feels like a reinventing the wheel experience for many of us trying to find our ways in these different pathways. And I wanted to just highlight a little bit the distinguished educator program that we've designed here at CHEST, which is another added benefit of engaging in educational activities with this organization and another way to sort of add another notch to your belt. You'd get a letter that goes along with your DCE, your DCE certificate that basically highlights that you're in the top 5% of CHEST educators in this international organization, right? And those are important things to quantify for promotion committees. So with that, it is a really, really exciting time, I think, right now in medical education. We have broken the glass and done a lot of things really, really quickly. But I think for us to solidify our gains and systematize them in terms of understanding what really works, because I really don't know if the person on YouTube on the whiteboard is effective or not, and there's been an awful lot of them over the course of the pandemic. I think it's going to be really important for us to be deliberate as we apply these skills going forward to make sure that we understand the right approaches for our communities. And what I've tried to do is at least offer some examples in terms of structured frameworks, either leveraging with other funding sources or looking for opportunities to partner with other individuals, either at CHEST or in your institution, to help make sure that your efforts translate into meaningful promotion and scholarship for yourself. And with that, I'll thank you for coming and open it up for any questions. Thank you.

COVID-19

medical education

innovative teaching methods

educational videos

academic promotion

active participation

Bloom's taxonomy

interprofessional education

institutional support

challenges in education