News and Commentary Macy Faculty Scholar Douglas Larsen on Transforming the Educational Ecosystem

Douglas Larsen, MD, MEd, of the Washington University School of Medicine, discusses his new self-regulated learning program aimed at building a collaborative educational setting.

What are you working on as a Macy Faculty Scholar and why is it important?
When we think about where learning, especially clinical learning, takes place, it is in the act of practicing medicine and taking care of patients. However, much of our educational system distracts from that. We spend a lot of time pulling students into conferences and lectures or having them prepare for multiple choice examinations. In the end, much of how the system is built distracts from actual patient care for medical students.

My Macy project will aim to get medical students to pay attention to and take responsibility for their own learning, and focus on developing their practice in caring for patients.

How will you do this?
We started piloting this project in the fall of 2014 with approximately 120 third-year students from five departments. On a weekly basis, each student thinks about two specific tasks or goals to focus on in in caring for patients, and comes up with a specific plan for how he or she will achieve these goals. The student also comes up with a plan for how to track this, because we know from the research on self-regulated learning that having a strategic plan for implementation is critical to success.

For instance, one student’s goal was to become more of a point person for keeping his patients informed about their care, and to make sure he was checking in with patients and their families after rounds to ensure that all of their questions were answered. Other goals are more technical, like coming up with the right care plan for a patient.

The students share their goals within their clinical teams and get feedback and guidance to help them refine their approach. Then, most importantly, the clinical team helps the student accomplish the goals during the week.

How is this unique?
This approach transforms the training environment into a collaborative educational setting rather than a hierarchical and judgmental setting where students are focused on getting their grades and doing what they think is going to make the attending and resident happy. Now they are focused on how they can take better care of their patients in a very self-motivated way.

It also teaches medical students that they need to work with others to improve—in other words, the self-improvement process is not an isolated event for which they alone are responsible. They have to work with others to improve their practice and they have to seek out the feedback to know how to improve.

Looking ahead, what are your ultimate goals for this project?
This is ultimately all about improving patient care. If we are teaching students to listen to each other and attendings to listen to students, then the natural extension of that is how well we are listening to our patients and understanding their goals. This is really about developing a culture of listening and changing culture overall. If an educational intervention is just something that’s administrative or a once-in-a-while type of event, that doesn’t change culture. It just becomes an add-on and that’s frustrating for people. But if you have something that changes your daily practice, then you’ll start to change culture and inevitably improve care.

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