Medical education is new center’s focus

Accomplished faculty at medical schools across the United States often receive little formal training in pedagogy, and academic medicine is known for rewarding research accomplishments while not always incentivizing excellence in teaching. At the School of Medicine, however, the teaching of medicine is not only benefiting from a new, central home on campus; it is also quietly attracting national attention.

In 2012, the medical school introduced a new means of supporting medical education: the Teaching and Learning Center (TLC). As the TLC enhances faculty teaching, measures students’ learning, assesses the curriculum, and delivers digital educational tools, it is supporting the teaching of medicine at Yale with an array of new resources.

The TLC is part of the Strategic Plan for Medical Education, a vision for YSM’s future advanced in 2010 by a group of stakeholders under the leadership of Deputy Dean for Education Richard Belitsky, M.D., the Harold W. Jockers Associate Professor of Medical Education and associate professor of psychiatry. The Strategic Plan called for the school to rebuild its curriculum “from the ground up” and to elevate the status of teaching.

Education has been center-stage at the School of Medicine since its founding in 1810, and was the subject of intense focus when the “Yale System” of medical education, which prizes students’ independence and their original research, was established in the 1920s. However, the instructor support the TLC provides is unprecedented.

Led by Janet Hafler, Ed.D., associate dean for educational scholarship and professor of pediatrics, the TLC has a team of experts who work together to develop innovative assessment strategies, incorporate technology into the learning process, and support educators by drawing upon and conducting educational scholarship. “Faculty are very interested in effective teaching strategies to promote learning,” says Hafler.

The new curriculum—set to launch in 2015—will emphasize small-group student-centered learning. The TLC offers resources to support this format: educators can ask the TLC’s experts for confidential feedback on their teaching styles or request help with course objectives, curriculum, slides, or written materials. TLC experts offer many workshops on teaching strategies, including, for example, a workshop on how best to teach clinical reasoning skills; some 100 faculty have taken it. The Center has also offered a faculty fellowship for the past four years that covers subjects like offering feedback, making talks interesting, and keeping learners engaged.

“The Teaching and Learning Center has been a godsend for clinician-educators like me,” says Dana W. Dunne, M.D., assistant professor of medicine, who worked with Hafler to implement a curriculum in humanistic bedside teaching. “Some of us hadn’t been immersed in adult learning theory, or had any access to education experts. If you have an interest in educating faculty, students, or residents, the Center can help with a framework and the tools to get going.”

Some of those tools are digital. Gary B. Leydon, the TLC’s associate director for technology services, works with faculty to create tailor-made educational apps and websites, some of which are used during class time. Leydon developed an interactive pharmacology website that lets students plug in different values to explore how the body processes a drug. He has also built websites for posting faculty-generated curricular videos supporting a variety of courses and clerkships, and to facilitate faculty development in areas like the teaching of clinical reasoning.

In the fall of 2011, the School of Medicine drew national attention by doing away with paper copies of course materials and instead, providing medical students with iPads that allow easy access to specially developed digital tools. Using the iPads, “we’re actually integrating these tools into the curriculum,” says Michael L. Schwartz, Ph.D., associate dean for curriculum and associate professor of neurobiology, who spearheaded the initiative.

One of the TLC’s biggest challenges may be assessment of faculty, students, and the curriculum itself. To meet this challenge, two experts in the TLC are devoted to assessment. Assistant Professor of Psychiatry John A. Encandela, Ph.D., associate director for curriculum and educator assessment in the TLC, develops methods of weighing faculty members’ teaching skills and educational scholarship that can count toward reappointments and promotions. Professor of Medicine Michael L. Green, M.D., M.Sc., as associate director for student assessment, faces a particular challenge. Schwartz says, “it’s a very complicated task: how to create assessments that are useful to the learner, but still allow us to validate our programs and graduate physicians that are appropriately trained. We don’t want to integrate things that are the antithesis of the Yale System.”

Green’s role is to examine ways assessment can aid the School of Medicine’s educational mission while preserving—and contributing to—the school’s unique spirit of independence and collegiality.

One of the TLC’s functions is to draw on pedagogical research. With Hafler’s expert help in accessing and interpreting such scholarship, faculty can make more informed decisions about how to approach education-related tasks. The TLC also guides faculty in conducting their own educational research for publication in peer-reviewed journals.

The popularity of the TLC’s activities attests to a widespread interest at Yale in medical pedagogy. The Center’s Medical Education Discussion Group draws crowds, as did its first annual Medical Education Day last year. A new medical education elective offers students the chance to work with simulators and Web-based tools to gain advanced educational experience.

When a Medical Education Interest Group launched last year, it drew in some 300 students and faculty. “[The TLC] is seen as a great asset,” says Ray Chen ’14, a fourth-year medical student and former president of the interest group, who adds that students directly seek out TLC resources for their own research.

The School of Medicine is not alone in prioritizing formal pedagogical support: other top-tier medical schools have taken similar steps in recent years. For example, the Stanford Faculty Development Center for Medical Teachers offers workshops and consultations to faculty, while the Institute for Excellence in Education at the Johns Hopkins School of Medicine provides faculty with educational research support and training seminars. Similarly, the University of Pennsylvania’s Center for Teaching and Learning offers resources to instructors across the university.

But Yale School of Medicine’s successes with original educational scholarship and its creative use of technology are nudging the school into the spotlight. In April, the school will host the Association of American Medical Colleges’ Northeast Group on Educational Affairs; and Schwartz is frequently approached by medical schools curious about Yale’s use of iPads and video technology in the curriculum.

Outside attention aside, the TLC’s innovations are designed to fit Yale’s strengths. Belitsky has told students that these changes in medical education are intended to strike a balance between the School of Medicine’s collegial, collaborative values and the need to innovate responsibly, keeping apace with the times. And in all the interactions with faculty and students, Hafler says, the TLC harmonizes with the Yale System by emphasizing a supportive approach.

“We want the Teaching and Learning Center to be a safe place to explore teaching, make mistakes, learn how to teach from uncertainty, and not be judged,” says Hafler. “And we want the same learning environment for the students.”