Creating Inclusive and Effective Learning Environments Across Educational Settings

There we go. Thanks, Renee. Well, welcome everyone. We're so glad that you're here. I I kind of did a brief survey of those that were in uh on the the call today and um it looks like we have a very wide variety of folks that uh coming from a coming from uh you know basic science, clinical science and and and other areas. So, we're excited to kind of lay out for you a little bit of, you know, our understanding of um what an inclusive effective learning environment might look like as it pertains to classroom education, clinical education, um virtual settings, which this may be a week for that. Um uh so, um I I think we'll start by just maybe briefly introducing ourselves. I I I don't know as I looked at the group that we need that much introduction, but um we can do that nonetheless. So um I'm Aubrey Knight. I am um I've been involved in medical education at the graduate or undergraduate level for [clears throat] nearly 40 years. um uh and so I've seen an evolution in um the the the way in which the learning environment is uh is treated and and the way in which learners are are expected to um to function and educators are expected to function and it's it truly has been been an an evolution. Um clinically I'm a family medicine a family doc and a geriatrician. Um and currently um I'm section chief for for geriatric medicine um at Krillian clinic and for the next oh what is it two weeks I'm I'm still the phase 2 director um at VTC. I've been um uh had an a couple of different roles at at VTC and but the the longest tenure was as the uh student affairs dean um for for you know the chunk of my VTC uh career. So Renee, take it away. Hi everyone. Like Aubrey, everybody on the call knows who I am, but this may be a little bit of a different introduction. I am an educator. I'm in basic science education and a biochemist by training. Um I'm also an avid runner, which this this weather I will be out in shortly, even [laughter] though it is not ideal, but it's it's I'm always up for the challenge. Um I am team- based learning and problem based learning is usually is very much my wheelhouse which requires this uh very safe environment for and um I am a constant renovator so improvement is is well within my nature. So there we go. These are we're just want to set the stage with our presentation assumptions for everybody in the group. um our audience is mostly physicians and educators and everyone has a varying background or experience in what they consider to be you know their educational educational setting. So I think that's um that's goes without saying our challenge here is always rethinking what learning looks like in each and every one of these contextual settings whether that be shifts uh situational shifts or generational shifts as we all heard about last week. Um and and those can all present with varying levels of challenge and then resources, right? We're all very busy busy individuals. Our time is is limited, but we're very conscientious and I think everybody is continually open to learning about how best uh to adapt uh to the learning environment and how how best to put that foot forward. So these are our objectives and these are very uh very broad but to identify key elements of our inclusive learning environment. Again, defining that learning environment, however that is for your mental lexicon, how you interface with students the most, and then looking at applying evidence-based instructional strategies to enhance participation and accessibility for our learners so that they they can um be the best they can in all of our settings here. So, we're just just want to start the the conversation with getting everyone on a level playing field about what is included in the learning environment. And you can pop uh comments in the chat. You're welcome to just unmute um and share your thoughts here. But really thinking of what are all the things and spaces uh when we say the word learning environment to consider. While we're waiting for others, I I will I will tell you a little story from the the our first LCME um uh prep visit. So So we had the consultants come in um at the very beginning of the school and they asked um a group of us and I can't recall exactly who. I remember a few of the people that were in the in the room, but so tell us about your learning environment and and um and and we piped up and were proud to talk about our library and our classrooms and our um uh spaces that we had for students. Um and uh we're quickly reminded that the learning environment is a lot more than that. And I'm seeing some of the chats that that you guys are getting it. You you know what the learning environment is. I see essentially everything. Um, you know, that's ex exactly right. If it impacts learning, it's a part of the learning environment. Yes, the library and the classrooms are part of it, but it's it's much more than that. Yeah. Even even what people bring from outside the classroom, that's that's also a great comment there. Um, psychological safety. Yeah, I think I think we've got it here. So, yeah, absolutely. So when we think of the learning environment, we've got to think of these these major categories here. It's not just about the physical and virtual space and adequacy for learning. So do we have that the space you know does everyone have a seat that is that is one real um minor in my mind it is it is not a major component when we think of this learning environment although it's important and often for the the social and scaffolding relationships and interactions as well as the personal identity formation and personal growth make up um so many key aspects of the learning environment. And then we have the organization itself. So who what how does VTCS SOOM uh their accreditation and organizational culture as well as our curricular uh resources and structure um which is now our identities curriculum. How does that impact um this learning environment? So everyone seems to we're all on the same page here as we start to think about the learning environment involving many more things than just our new coffee shop and library. although very important. So when we think about how a VTC um strives towards a positive learning environment um we can think about our our shared understanding and I'm going to turn it over to Aubrey for for all of these. Yeah. So this this um came straight from the VTC page on the website. If you if you click on the learning environment um when you go to the website, this is what first comes up and and then you can click onto each of these areas and and learn a little bit about what it is and and um uh the um the the gist of why this [snorts] page exists and why these things are important really comes down to our accreditation. And um I'm just going to read what the LCME says we as a medical school are responsible for when it as it as pertains to the learning environment. They say a medical school ensures that the learning environment of its medical education program is conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, faculty and staff at all locations and is one in which all individuals are treated with respect. The medical school and its clinical affiliates share the responsibility for periodic evaluation of the learning environment in order to identify positive and negative influences on the maintenance of professional standards. Develop and conduct develop and conduct appropriate strategies to enhance positive and mitigate negative influence and identify and promply correct violations of professional standards. Um, and I say all that and I we we wanted to remind you of that because and we've got a slide later on about the learning environment advocacy committee because I know that um sometimes seems punitive and sometimes seems like this is this this committee that's that's looking at at finding fault in in the way and allowing students this anonymous ability to um uh to identify things that that they are um concerned about with regard to the learning environment or a particular educator. And while yes, it's a yes and um uh we do we are responsible um to create a learning environment that does support the students that is respectful of of students um where they are but also remember that it's also the the learning environment is not just about the students it's about the faculty and staff as well. Um so so the faculty need to be supported, the staff need to be supported um as so it's a it's an all-encompassing um uh uh environment that we that we live. So So on this website and and we don't have it pulled up, so we're not going I'm not going to click onto these things just to show you, but um there are examples of um things that could be considered um mistreatment um standards for the treatment of our learners and each other. Um uh there also are examples of exemplars of of learning environment and and and what how um particular faculty members, students and staff are identified as being um being just that. So um uh I would encourage you um while you're snowed in to to kind of take a look at this and and and and remind yourself of of what is the expectation for our learning environment and for us as faculty. So that segus us beautifully into the teacher learner compact which really does sort of drill down what those expectations are. And I'm um really glad that Aubrey just mentioned there are exemplars. So oftent times we think of this or it's thought of as this punitive always punitive in reporting but there are key exemplars that we like to draw out to say these are these are instances where people um are shining in this area and creating some really um wonderful safe spaces for learning. And so just as we sort of think about the teacher learner compact is this defined relationship where um we have key aspects where as a as an educator I take responsibility and as a learner um I have expectations of uh for them in that space. And so one very small aspect of this which I want to draw out for everybody is this to maintain uh and acquire currency in my professional knowledge and skills. And so sort of historically when we thought of ourselves as educators providing knowledge in the form of information that information transfer was so uh sentinel to to us as educators and it still is although you'll note it's a small piece of our overall defined uh compact with our learners. All of these other things play uh extremely important roles when we think about the learning environment. So modeling the profession and and that again is on many levels whether that be in the clinical environment or in the educational setting. Um model those interactions with learners, patients, colleagues and staff. So uh really allowing the students to see that and reflect that and embody that faculty accepting the duties. So accepting that responsibility um and and sort of sharing in that mutual respect as you create a community of practice. um across VTCS soom you want to nurture that learner commitment uh to achieve personal family and professional balance and I think at least in my career here at VTC we've seen uh some really great strides towards that balance of you know what are we doing both while we're here and what are we doing externally which has again helps create this safe learning environment where we can communicate across this communication uh chasm which my perception is is is getting much less and less where we have these open and fluid communication channels between the students and the staff and the and the learners. And then again, there's this mutual level of respect across learners and patients and colleagues that really is essential in making sure the safe the space is safe um and we can have these open constructive dialogues to help elevate the entire community. So with that, one of the places where um uh where students struggle a little bit with with the learning environment um and and this I I I stuck this in here um in my in my current role, I see this I see this uh all the time. It it especially at the very beginning of of the clerkship experience for for particular students. And there's this 2017 paper um that that that looked at what are student perceptions around that transition from phase one to phase two. Um uh we as educators, you know, we we know what the I mean we created the curriculum. We know what the what the expectations are and how things are different. But just for for those of you who are strictly in phase two, um phase one is very structured. Um the number of hours per week that the students spend in class or ex expected to to do outside of classes is is very defined. Um uh they're this the schedule is pretty set. They know it from from the beginning of a semester or a or a block. Um uh and they know what to expect every day. Um uh for those of you in phase one, that is nothing like what phase two is. Um phase two is is much less structured, much more chaotic, much less um with with expectations that are going to vary not from semester to semester and and and block to block, but from day to day and clerkship to clerkship. So in this study um not surprisingly students reported significant difficulties in that trans transition and those difficulties were relative to the new environment going from a a classroom and lab environment to a clinical environment. um they experienced difficulties relative to the expectations and they they rightly um recognized that the expectations were less clear. Um uh e either the daily expectations of what they were to do or um the the uh the the objectives from a from a a clerkship itself and then um uh very very difficult transition relative to the workload. Um the hours are less defined. Um uh there there is not builtin time for study usually or at least the the the time for study is is when you're not when you're not in your clinical setting. Um uh the students reported that their perceptions of the learning environment that the the global perception of the learning environment in phase 2 was less positive than it had been in phase one. um uh and uh this is a quote um from the from the authors. The stress of the clinical learning environment may affect student professional identity formation, maintenance of well-being and academic performance. Now, this study did not do a lot to say how do we mitigate that? How do we how do we um uh uh prevent this from from occurring other than to say it's really all about communication um and and and setting those expectations. um reminding students of of the the the difference um in the in the uh environment between between what phase one and phase phase 2 was going to be. But a but a um uh a real um uh difference in this this particular um surveyed study which leads me to um an area that that uh actually one of you mentioned when when when when we when you were asked what the learning environment is. Um uh and then and then another of you on the call has been um given a talk with me um around psych psychological safety. Again, Chad, you'll notice that I I completely um in included some of the slides from that talk. So um uh so with uh with uh u due um respect for and and and acknowledgement of of Chad Deont's assistance with me in that previous talk on psychological safety. I'm I'm going to spend a few minutes just defining it and and helping you hopefully understand why I believe this is a this is a a way in which um we as clinical educators in the clinical learning environment can at least help our students through that challenging transition and um through the difficulties of the the clinical learning environment. So, so the concept of psychological safety is is not a a a a clinical um concept in and of itself. It's a it it's was I was uh coined by Dr. Amy Edmonson from the Harvard Business School and and she said it's a belief that one can share one's thoughts, feelings, ideas, questions, concerns or mistakes without fear of punishment or humiliation. It's basically a team climate characterized by interpersonal trust and mutual respect and and enables team members to take risks, be creative and learn from each other. um in in in the business world, this is not necessarily learners and educators. Um but I think it it very clearly can uh fit into the into the learning environment into the clinical learning environment. Um so it's it it involves setting the stage, it involves inviting participation and it it involves responding proactively. So, so setting the stage whether that's daily um or at the beginning of of whether it's it's more global at the beginning like of phase two um reminding students of what the purpose and education purpose and uh expectations are for phase two at the beginning of a clerkship reminding students what the the goals of that particular clerkship are and and and what the expectations are going to be. um uh or at the beginning of one day, one one set of rounds, what are what what are we going to do today? What are we here to accomplish today? What how how are we going to incorporate learning into our taking care of our patients? Um uh psychological safety includes inviting participation and and and acknowledging that all voices are credible. Um and that as a team we can do things differently and better um uh based on the the the uh the voices that that are responding. And then um when there are needs for for responding that we do that um productively that we express appreciation that we we um acknowledge um those voices that that are are um uh involved in that learning environment. And I see it. We can move to the next slide, Renee. um as um uh and oh yeah before we get to what I was about to say this is a this is a great little four quadrant thing that I think um illustrates this well and and I used to show it to student or I have shown it to students um to help them understand that that while up in that upper right hand um quadrant might feel good um it's it's both safe and comfortable but you're probably not going to grow um in that quadrant um it's really in the lower right hand quadrant where we grow where there yes yes there's safety we do want to um um take care of each other and and make the learning environment safe but um in order to grow there sometimes must be discomfort and and as as hard as that might be um uh and as difficult in the moment as that might be that is where we grow. So, so this is a this is one of those four quadrant things that I think can be can be uh illuminating to students um as as they struggle with um you know the the discomfort of the especially the clinical learning environment. So um in the clinical learning environment, if if we talk about psychological safety in the context of the clinical learning environment, I think one thing we've got to do is recognize that that there are there's a third set of stakeholders here. Um not just the teacher and the learner. That's, you know, that's clear. We're we're here to teach and we're here to learn. Um but there's there's another stakeholder and that is the patient and and that has to be acknowledged as we as we uh um progress through with in the clinical learning environment. And then there's some stages of safety that I didn't I didn't uh invent these but we we'll talk a little bit about the stages of safety as well and and what what uh how we can how we as educators can maintain the safety of our students while also challenging them and um including them but also challenging them. So, so from from the learner standpoint, um we can move on, Renee. Um it we need to we as educators need to um maybe communicate explicitly to our learners that it is safe for you to seek to discover new knowledge. It is safe for you to ask questions. It is safe for you to say I don't know. Um it is safe for you to experiment with the the ways in which you you know create a differential diagnosis um uh uh um uh u do a presentation um to to your team. Um uh and the only way it can be safe is if if we make it safe and we allow for those I don't know moments to be well let's explore that as opposed to what do you mean you don't know? You should have learned that. Um uh and then and then it it is safe it should be safe for as students discover ask questions say I don't know and experiment that they can learn from their mistakes. That's that's the way that's the way I learn best is is looking back at where I screwed up and and and and uh uh trying my best not to let that happen again. But also it learners need to recognize that it's it's it's a safe learning environment. When a teacher asks questions, a teacher needs to be safe to ask questions, to share their experience. Um, and sometimes that's sharing experience that maybe we're not proud of. Um, uh, and uh, and what we've learned about either clinical medicine or our own professional identity or whatever it is. um that that that we whatever bit of experience we want to share that that we need to feel safe in doing that. Um teachers need to be need to feel safe in challenging their learners um they need to feel safe in in in setting expectations um and setting expectations that are not only achievable but but maybe that are are are challenging um to our students. And we as teachers need to feel safe in being able to give constructive feedback to be able to to to tell a student um no that's not exactly what we're looking for here. Um let's explore where where you came to that conclusion and um and then um you know what what we where where we might have where you might have learned um to uh to you know to draw another conclusion or or whatever. And then and then remember also the third um uh stakeholder in these in these uh um uh experiences in the clinical learning environment. Um uh remember that our patients are vulnerable. Um uh that uh and as we communicate in front of them recognize their health literacy. um uh they're they're hearing us and they want to understand what we're saying and and and and if we're if we're talking to them in in either talking to or talking at them in in in clinical speak as opposed to um uh recognizing that that we need to to speak to them in in from where they're coming from. um we need to recognize their background and the potential um u misperceptions that that they may have and we need to give them the opportunity to to clarify and and ask ask for ask questions. So the the clinical learning environment is complex um and again doesn't just involve the teacher and the learner but involves involves everything else. Um and then those the three types of safety I just wanted to to to briefly um um talk about is is um inclusion safety. Um and that means everyone on the team is is is a part of the team. Everyone is valued. Everyone is treated fairly able to contribute um and and and have have a sense that their opinions matter. This is the moral imperative of of clinical education is in is the safety of those that are that are on rounds with us that are or that are that are in the in the O with us or or wherever it is that that teaching and clinical care are being merged. There also is collaborator safety. Um we should all feel feel safe as faculty to faculty, as faculty to learner and and as learner to teacher to engage and interact to to demonstrate mutual respect um to be accessible um uh to foster constructive dialogue. um this results in openness and trust and and and and I think if we set that expectation um and and if we um uh make our learners aware that this is what the expectation is we'll be given I think we'll be given a little bit more grace um if we if we are to um uh misstep or or misspeak or or whatever um that might otherwise have and a LEAK report. And then finally, um uh there's challenger safety and and and and I think we as teachers need to be to recognize that it's okay for us to be challenged. Um uh it, you know, when a when a when a learner challenges a teacher, it may seem embarrassing and but it's okay, it's just like it's okay for the for the for the learner to say, "I don't know." It's okay for the for the faculty member to say, "I don't know. Let's look that up." um uh or or you know that is a great question and and I I don't know when the last time I thought about that that was but but let's let's investigate that further. Um uh it's okay to challenge the status quo to identify problems in in the learning environment as well as within the clinical setting. this that that challenger safety allows us to be creative, innovative, and um and and to to I think um learn ourselves even as we're as we're trying to teach, which brings us um to the um uh learning environment advocacy committee, LIAK. you know, I I understand and I've I've heard it I've heard it actually used by several people that that leak has become a verb. Um uh that that uh a faculty member can say that, you know, they've been leaked. Um uh so, you know, I it's it's it was not intended to be a verb, but it has has become a verb. But I just wanted to to remind you I I think recognizing that it it is a responsibility of the school to provide an opportunity for learners um to identify um uh concerns relative to the learning environment. Um uh the the leak has been in existence for almost the entire history of the school or some some prior iteration of the leak from the entire history of the school. Um currently it's an interdisciplinary committee that meets monthly. It there are there are um students, residents, faculty members, clinical and and uh pre-clinical faculty members. There are nurses um on the committee um uh and um uh all reports I think you know this but all reports both the reporter and the subject are deidentified. So whenever whenever a particular report is shared with the committee um there there is no identifying no identifying um information to to try and and uh you know maybe even bias the uh the uh the committee. Generally, we know that it's a student who made the report or a um yeah, we know whether it's a faculty member or resident just by the way the report is is is uh uh uh created. But um other than that, the reports are are deidentified. The the committee hears the report. there's actually a triage process that occurs before it comes to the committee to determine whether or not it's actually a learning environment report or is a professionalism or some other non-learning environment kind of a a concern. Um but once it comes to the committee um the committee determines whether or not there is in fact a learning environment issue and if so what the severity is and then determining how to best proceed um what what kind of um report education um needs needs to occur. the committee has had there are there are concerns students bring up on themselves bring student to student um student to faculty student to resident student to nurse um other other staff um so it's it's been you know a a a across the board kind of a thing um but it is um uh a necessary and I think for those of you who are on the committee I'd love to hear your perspectives if we have time at the end about um how the committee has evolved and and I do believe it's it is um we are they are they are learning their um way around the the best way to address these kinds of things because the bottom line is we do want a healthy respectful learning environment here at VTC. Um, and we have to give students the ability to um, uh, identify concerns relative to their learning environment. A little bit of a nonsequittor, but I think is an important thing to bring up um, uh, relative to the learning environment is is humor. Um we've had teach has had several um speakers on humor and gallows humor and and and these kinds of things over the years. Um uh but you know I think um I think we have to recognize that um what's funny to one person is not funny to everyone. Um number one um humor humor in and of itself can be a coping mechanism. It's a coping mechanism for me. Um uh and and it it can be for for many people. Um um it can be used when used well it can be used to to to make connections with with patients and with learners quite frankly. It can break down barriers between folks that that are coming at uh issues and and problems and concerns from two different areas. Um but it also can be perceived as insensitive um uh and and and many times is in fact when it's not contextualized or maybe even um maybe even whether it was contextualized or not um would have been perceived as as as insensitive. Um my encouragement to you is if you use humor, let your team know um that's what you're doing. Um and be willing to accept feedback about how it might have been perceived differently than you intended it. um uh to to uh to be perceived. And then, you know, try and aim your humor at common human annoyances rather than aiming it at specific people. Um uh that's, you know, that's just again a couple of little um things that I try to do as I um as I use humor. Sorry everyone, my learning environment here is involving students look is students looking for their mittens to go out sliding in the coldness. But we [laughter] uh we want to take the last few uh the last bit of our talk to look at some common or not so common scenarios when we think about impacts to the learning environment. And so these have been adapted uh from a medad portal publication and just we're going to kind of go through them constructively together and really want your feedback and thinking about what is the impact of the learning environment on these scenarios and what approaches could we use could we crowdsource in this conversation to modify the interaction and just really asking are are these concerns that you've encountered or you've had um and and thinking thinking about um the impact in that space. So, we'll kick this off with this this first scenario here. And this scenario surrounds formative feedback. And so, I'm actually just going to give just going to pause and let you read read these for yourself. And I'm going to give you a few few seconds, a few few minutes to do that. All right. Hopefully, this is something I know we are are doing a lot of in phase one is giving lots of formative feedback, meeting with students. Um, and I know that this is also happening in the clinical environment as well, giving specific formative feedback. I also know we are also often very very busy individuals. So, anybody have any any immediate reflections on this or or thoughts as to to what what this does before we sort of unpack the learning environment here? You can pop them in the chat or just be brave and unmute in our in our learning space. Okay. Then I will go forward with this silence and thinking of when Aubrey and I looked at at these scenarios, we really like to think about what is the impact on all of the four aspects of the learning environment, the personal, the social, the space and organizational and um what what sort of micro changes. So how how would we think about about changing this? So I'm going to flip. There we are. So, when we think about unpacking the scenario itself, um I'm going to I'm going to turn this over to Aubrey to think about what this formative feedback may look like as it's sort of framed in the clinical space. Yeah. So, I think Dr. Permishwar um just chatted to us. This was brief and and didn't take didn't uh I I I know it said brief and then something else, but but uh uh brief and did not respond to the student did not respond to students interest. Yeah. So, so we have a busy person giving um giving uh almost no feedback. Um uh frankly, um and uh so I I I think the the first bullet point up here at the at the top of this slide says this was not developmental. This was very transactional. This was this this person just basically said, you know, uh I don't have time for this right now. um uh and um uh and and and kind of moved on. Um it became somewhat faculty centered rather than learner centered. It was based on this faculty member's um busyness. Um Krie said the dismissiveness um uh and and absolutely very dismissiveness. Um uh it it uh it did feel like the student was burdensome. Um and and and and at least the way the the scenario was written, this was a this was a scheduled formative feedback. This was supposed to be this was supposed to be feedback. This wasn't just a student coming up um uh uh randomly to a faculty member and asking for for feedback. Um so so this was this was you know I would suggest you know not a very good formative feedback session. Um uh I think you know it's um uh we we can be distracted. We are busy. We have good days and bad days. Um uh and sometimes we are not prepared even though we've got a scheduled you know our our schedules get get out of whack. um and uh we've got a student coming in um uh you know they they are expecting something from us and and we don't have it to give. I think it it this could have been handled a lot differently. If in fact that the the faculty member was so busy that they didn't um in fact have the time at that moment they could have acknowledged that and and and made some other made some other arrangements. Yeah, exactly. The only Oh, sorry. The only other thing I want to point out here is on each slide we have these hidden curriculums which I think are things for all of us to think about how our actions sort of impact that bigger organizational culture at times even when we we don't mean any malice. There's no intent. There's no negative intent here, but the actions often will think about how does this then sort of frame the students future of other formative feedback sessions. Um, and does it does it normalize this disengagement or minimal investing in in teaching roles? Yeah, I think that's a great point, Renee, is is normalizing this not only not only for them for their expectation moving forward, but but you know, for their um their practice moving way forward um uh that that you know it's you know this is the this is this is the way of medicine. So, so this is how how that's what the expectation is going to be for me. I think the second bullet on the on the hidden curriculum when preparation for feedback is optional um is uh is you know that's the message that was that likely would would have been gi would have been uh taken by this by this particular student. Um whereas the you know again we are busy our schedules get upside down sometimes. Um it it it would have been a better I think en encounter had this teacher said you know I do not like to have formative feedback sessions without having had time to prepare. I thought I was going to have time to prepare for this one. Um but I didn't. Um I apologize for that. Um I know your schedule's busy too but can we find another time um for for for me to really give you some meaningful feedback? Um uh again it it acknowledges that we do want to be prepared. It acknowledges that we respect their time. It's not just about us. It's about them too. They're students are busy. Um uh and and it it sets the expectation that feedback is important and preparation for feedback is also important. Yeah. And just a plug for our current phase one learners and our harmonized milestones. they are really embracing the feedback. We have had so many opportunities where learners have come up to me as a phase one faculty member and other phase faculty phase one faculty members on the on the call here to say can we schedule a meeting for formative feedback on an assessment on an opportunity on an engagement and so that they are are primed at wanting some real uh meaningful constructive feedback. So, and and following up on that plug, um, is that that the first class that has had the the new, uh, phase one enters the clinical learning environment on March 2nd. So, so you're going to you're going to have students on your clerkships that that have been uh socialized to this formative feedback to a much greater degree than than prior students. um uh if I had a crystal ball and could could um point out what I expect might occur in the clinical learning environment from from the uh the the the um new curriculum compared to the old. That will be one of them is that they they really are anxious for for for feedback and and for learning. Um uh another thing is that and I don't know whether this is going how this is going to play out but just to let you know um uh their time has been um much more strictly um monitored and and and uh you know while we get concerns from clinical students now about not enough time to study um we may get more you all may get more of those in the future. I don't know. We'll we'll see. But um uh we're we're trying with the uh the preparation for the clerkships to bring students along about, you know, what the clinical how the clinical learning environment is different from the phase one learning environment, but that's that may be something we hear more of. All right, thanks everyone. That was good discussion. And the second scenario really focuses on off uh campus impact uh interactions that we we have we have no no real oversight over and and just take a minute to read through this one and then we'll go through it. All right. Any immediate thoughts or um reflections on having maybe experienced this or seen what this looks like in in your space? I think this one is harder to to to do in the learning environment. So, I'm gonna turn it over to Aubrey. Yeah. So, so this one is harder and and I'm I'm I'm I was trying to think back to to examples um in the clinical learning environment about this kind of thing. And I I I don't really have any, but when I was in student affairs, I had plenty of things that were not dissimilar from this. um uh and and I think the faculty being respon the the faculty member um that is identified in this you know being um uh open and and and uh willing to acknowledge um and and that there maybe was some harm um in this and and uh being willing to kind of sit down and and and walk through it with a student is is the right first step to take um uh where you go from there though is very challenging when you know once once you're once you're that faculty member and they do open up that that um that uh that Facebook or whatever whatever site um you're now a part you're now kind of a part of it um and uh you know you got responsibilities and and um uh if it's if for instance since it's any kind of a title N kind of a a potential comment that puts you as a mandatory reporter um as pertains to title N. Um and so yeah, you it it it needs to be fraught with some some degree of trepidation um and um recognizing what your role is going to be once you once that is shared with you. Yeah, we've got a comment. it. I'm not sure if it matters if the negative comment came from another student, a fellow student. That was the intent was that it was coming from another student. So, this may be something that then was going to then play out in the classroom potentially if they're, you know, in our scenario, if they're on the same clerkship group or in the same PBL group, for example, how these sort of external interactions then sort of frame how they're participating in that space. Um, yeah, that's a great comment. Thanks Vidia. It is it is also really important that the student felt comfortable enough there is there are positive aspects of this. So thank you for drawing that out that the student felt uh safe enough to meet with a faculty member and to tell them that this this was happening um and that they they felt but there is a lot of things as Aubrey mentioned that are just things that are outside of our control. And so focusing on helping this individual learner navigate through through that their response and their interactions is is best. And I think more and more this digital professionalism uh is is not an optional is not optional, right? We're seeing this more and more in the context of AI use and generation. Um and setting that example is really important. Anything else? All right, we'll move to the last scenario quickly and then we want to make sure we get time for questions. So, this one's a little more straightforward. All right. Thoughts? I think we've all at some level encountered showing up to class to do something and then um having a a group of learners that may or may not have prepared to the level or depth that we've anticipated them to. And I think this is something that is potentially a shared experience. But um this one posing a little bit more challenge because it relates to um the instructional design and potentially the the learning management system. So any thoughts there? So kind of desperate than the other two scenarios. This is a really more of a structural or organizational uh issue or concern um both with the faculty response and thinking about how do we present our learning materials for best outcomes for our students. So this is really more of an instructional design where um we can think about how do we organizationally challenge manage this? How do we set these boundaries? And in the curricular restructure, the team has done a great job of really looking um you know, are are the resources manageable? Would the students have to spend four and a half weeks preparing for one week of learning because we've all been really excited about posting volumes and volumes of preparation material um and making sure they're they're um presented and available. So thinking of that um in that that level of consistency. And so this again plays out in the clerkships and clerkship calendars and resources for students. Making sure that those resources are available and timely and there's a clear communication stream really helps the learning the learning management. And we've seen this um and we've seen this now in in our new um identities curriculum and and the way that we've been able to roll out materials more consistently see consistently across not just a single what used to be a block but really across an entire phase. So, three semesters of learning. Um and and also in addition that students feel safe when when there is in this case a broken link or or a missing um resource that students feel safe to acknowledge that and and and seek help from whoever the the right person for the help is as opposed to um feeling like they don't have the safety to bring that issue up until the end of the block or the clerkship or the whatever. and when they when they uh uh express that as a concern um because I've seen it both ways. Yeah. No, absolutely. Um we get great communication from our learners and in ways that are, you know, very productive to say this would be helpful or these are things we can't find and and faculty responsiveness has equally been really productive in that. Making sure that it's an equitable learning space as well. So this is again something to think about when we're thinking of restructuring. You know what in in your case many cases inter sessions look like and how these materials roll out is thinking about what is the usability and the accessibility for the learner. So with that I just want to finish up. This is our the educational mission statement that was uh crafted uh several years ago now. um really reflects on the goal of generating this learning environment again that is intended to cultivate lifelong learners and health systems uh positioned to improve health care equity and hum humility there and then along along with our charge they're really to promote a sense of inclusion within the health care team. So being able to to really reflect this positive engaging learning environment as students transition through the health care space. So our final slide is really just a summary here and really this is just an honest reflection to say we we h we will all fail at this at some point in time. It's it's it will happen and it's important that we try we be positive, conscientious and directive. Um, it will likely be uncomfortable at times. I think we've all experienced those moments within the classroom or clinical setting that that is just we have to be in that quadrant as Audrey Aubrey mentioned that is both uncomfortable but supportive of growth. Um, and encourage those conversations. Um, be open in having in having the conversations with your teams and with students and get involved. Um, and so that involvement may look like a variety of different things, but if you see something, it's important to say something and be curious about it in that space and and be honest. Um, I think that I I stole this from a book called Steal Like an Artist and I encourage everybody to pick it up. It's great to have by your desk. And um these are it sort of hallmarks there reminding us we all need to be curious, kind, we all need to have stamina because oftent times these are these are a really long frame shift and the willingness to look stupid are their words not mine but really using that I don't know phrase uh repeatedly if there are encounters that we we don't have we don't have the right words for. So with that um Aubrey any final remarks and we will take questions and I want to thank everyone for being here our students learners and colleagues uh as well as staff in this space and and thank you for sharing this time with us. Yes, absolutely. Thanks and I appreciate the comments that that were made in the chat. Um I think they were very helpful to us and we do have like four minutes. So, anybody have any specific questions or feel free to unmute or post something in the chat and we can pass it along or read it aloud. Uh, I'm going to try and ask a question. I'm not putting on my um uh camera. It's a snow day. Um um you know there's a lot of issues that come up in the learning environment especially in the first few uh rotations. They're so eager to learn. They're so eager to be there so excited but there are times when there is just this massive disconnect in how the students um give feedback. It is so non constructive at times. And I I sit there and I and I read everything and I wonder if they re if they truly recognize the implications of their actions that they are huge implications because we do tend to focus on protecting the students. I mean that is first and foremost always protect the students, make sure that they're in a safe work um environment. But sometimes it becomes a a really difficult environment for the faculty. That's a great comment, Vidian. And and and one of the reasons why I think that the LEAK has the reputation it has is that that that's the committee that has to adjudicate at some level some of these comments. Um, you know, I think I I it is a a tight rope that we have to walk between um uh giving students the permission and and an ability to to um share their feedback either either anonymously through some kind of a portal or directly to us, which doesn't happen all that often. um uh with helping to educate them on on what effective feedback really looks like. And I I think we've engaged the student members of the LEAK and and and tried to get them to be um ambassadors for the process and and help their colleagues to to learn how to give better feedback and and and I think at some level that's helped. But it it's but you're right. We still get we still get comments that really provide no um real uh uh important actionable um information uh or or ability to to to uh to to address it. And and I I'm not sure what the solution to that is. Someone smarter than me is going to have to figure that solution out. We are I will go ahead. It really I I would love to circle back to this conversation again. As Aubrey mentioned, our new phase one learners are moving into phase two and they had a a very different feedback system with curriculum reps. And so a lot more of the feedback was actually face-toface. Not that we didn't we still collected end of course and weekly evaluations which were again anonymous and subseted uh subset. But the con I will say my perception is the level of constructive feedback and collaborative feedback that we've engaged uh between with the students has been has been really a lot more productive than I have seen seen previously. So I hope that they take that with them. Thank you both for a very informative and practical session. Lots of thank yous in the chat. Um we are out of time for today. Uh, so if folks need to sign off um for other meetings or responsibilities, of course, feel free to do so. But if there is, you know, another question, I'm sure we could stay on for a minute or so, unless our presenters have somewhere they need to be, in which case we can wrap it up as well. I have a few minutes, but thank you everybody.