[21] Unpacking Medical Expertise: Illness Scripts, Clinical Reasoning, and the Future of CanMEDS

On this episode of KeyLIME+, Adam speaks with Drs. Saleem Razack and Stuart Lubarsky about the concept of medical expertise. They dig into definitions and interpretations of medical expertise, ideas around cognitive load, and the role of illness scripts in clinical reasoning. They also address the recent public discussion about the centrality of medical expertise within the CanMEDS framework and what we might expect in the next iteration of CanMEDS.   Length of episode: 50:25  Resources to check out:     Lubarsky S, Dory V, Audétat M-C, Custers E, Charlin B. Using script theory to cultivate illness script formation and clinical reasoning in health professions education. Can. Med. Ed. J [Internet]. 2015 Dec. https://journalhosting.ucalgary.ca/index.php/cmej/article/view/36631  Kahneman D, Klein G. Conditions for intuitive expertise: a failure to disagree. Am Psychol. 2009 Sep;64(6):515-26. https://pubmed.ncbi.nlm.nih.gov/19739881/   Contact us: [email protected]   Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski     

Description:   In this episode of KeyLIME+, Adam speaks with educational psychologist Anique de Bruin, exploring the concept of desirable difficulty in medical education. They discuss how well-designed challenging learning conditions can enhance long-term learning and knowledge transfer, despite the initial struggles that learners might face. The conversation delves into practical techniques such as retrieval practice and interleaved practice, the importance of self-regulated learning, and the new S2D2 framework. They also touch on the paradox of procrastination and its potential benefits, as well as the unique challenges of learning in clinical settings.   Length of episode: 37:00 minutes  Resources:  Make it stick: The science of successful learning by Peter C Brown, Henry L Roediger III, Mark A McDaniel 1st edition. Cambridge, Massachusetts : The Belknap Press of Harvard University Press, 2014.  Worth the Effort: the Start and Stick to Desirable Difficulties (S2D2) Framework | Educational Psychology Review  Resources to check out:    https://link.springer.com/content/pdf/10.1007/s10648-024-09852-7.pdf  Study Smart - Study Smart  https://www.sciencedirect.com/science/article/pii/S2211368120300279  https://www.sciencedirect.com/science/article/pii/S2211368120300590  https://link.springer.com/article/10.1007/s10459-022-10149-z    Contact us: [email protected]      Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski       

Dans cet épisode, le Dr André Tricot, psychologue spécialisé en formation et chercheur, se joint à Adam pour explorer en profondeur la théorie de la charge cognitive. Ils discutent des répercussions de cette théorie sur l’enseignement et l’apprentissage de différents groupes d’âge dans des contextes variés, dont celui de la formation médicale en particulier. Ils se penchent aussi sur des stratégies pour optimiser l’apprentissage, sur le rôle essentiel de l’attention ainsi que sur l’incidence de la surcharge et de la « sous-charge » cognitives sur le rendement – et les erreurs – d’experts et d’expertes.  Durée de l’épisode : 56:04  Ressources à consulter   Read, D. W., Manrique, H. M. et Walker, M. J. (2022). « On the working memory of humans and great apes: Strikingly similar or remarkably different? » Neuroscience & Biobehavioral Reviews, 134, 104496.   Kristin Fraser sur la théorie de la charge cognitive et la simulation en formation médicale    Fraser, K., Ma, I., Teteris, E., Baxter, H., Wright, B. et McLaughlin, K. (2012). « Emotion, cognitive load and learning outcomes during simulation training ». Medical education, 46(11), 1055-1062.   Sweller, J., Van Merrienboer, J. J. et Paas, F. G. (1998). « Cognitive architecture and instructional design ». Educational Psychology Review, 10, 251-296.  Fraser, K., Huffman, J., Ma, I., Sobczak, M., McIlwrick, J., Wright, B. et McLaughlin, K. (2014). « The emotional and cognitive impact of unexpected simulated patient death: a randomized controlled trial ». Chest, 145(5), 958-963.  Coordonnées : [email protected]    Suivre le Dr Adam Szulewski : https://x.com/Adam_Szulewski 

Description  Adam and guest co-host Charlotte Alexander speak with physician and applied anthropologist, Dr. Eve Purdy about the nuances of team stress management in simulation training. The conversation highlights the importance of getting stress management training right during high-pressure simulations. Adam, Charlotte and Eve explore how teams can better manage stress through well-designed authentic scenarios that avoid trickery as well as the importance of recognizing and naming stress in both professional and personal contexts so that we can perform at our best.  Length of Episode: 38:04 Paper discussed:  Brazil V, Orr R, Canetti EFD, Isaacson W, Stevenson N, Purdy E. Exploring participant experience to optimize the design and delivery of stress exposure simulations in emergency medicine. AEM Educ Train. 2023 Mar 30;7(2):e10852 https://pubmed.ncbi.nlm.nih.gov/37008650/   @char.alexander93  @purdy_eve     Contact us: [email protected]    Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski     

In this episode of KeyLIME+, Adam (along with co-host Dr. Victor Do) delve into the critical role of feedback and coaching in medical education with guest Dr. Adelle Atkinson. They explore the distinctions between feedback and coaching, the significance of low-stakes assessment, and the impact of the learning environment on learner outcomes. The conversation emphasizes the need for strong relationships between supervisors and learners, the idea of psychological safety, and the importance of providing actionable feedback to foster growth and competence in medical training.   Length of Episode: 43:03  Resources to check out:    Atkinson A, Watling CJ, Brand PLP. Feedback and coaching. Eur J Pediatr. https://pubmed.ncbi.nlm.nih.gov/34021400/    Contact us: [email protected]     Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski      

In this episode of KeyLIME+, Adam and resident guest co-host Dr. Kim Vella, chat with Dr. Sarah Blissett about her recent paper on cognitive load theory in medical education. The conversation explores the development of the Workplace Cognitive Load Tool, which measures how various workplace characteristics impact cognitive load and learning for medical trainees. The discussion highlights the importance of understanding cognitive load in the chaotic environment of medical training, the factors that enhance or impede learning, and practical strategies for educators to optimize the learning experience in complex clinical settings.  Length of episode: 41:13  Article discussed:  Blissett S, Rodriguez S, Qasim A, O'Sullivan P. Beyond the Task: Developing a Tool to Measure Workplace Characteristics That Affect Cognitive Load and Learning. Acad Med. 2024 May 9. https://pubmed.ncbi.nlm.nih.gov/38722251/   Contact us: [email protected]    Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski   

In this episode of KeyLIME+, Adam and resident guest co-host Adom Bondzi-Simpson engage in a thoughtful discussion with Dr. Chris Watling about the nuances of public advocacy in the fields of medicine and law. They explore the differences in how physicians and lawyers approach advocacy, the challenges faced by physicians in public advocacy, and the importance of interdisciplinary collaboration. The conversation highlights the evolving role of advocacy in medical education and the professional identity of physicians, emphasizing the need for a collective professional responsibility in addressing some of these issues. They also talk about the idea of courage and the risks associated with advocacy work, including professional and public backlash, and emphasize the importance of mentorship and advocacy skill development.  Length of Episode: 46:26  Resources to check out:   Watling C, Sandomierski D, Poinar S, Shaw J, LaDonna K. The courage to advocate: How two professions approach public advocacy work. Med Educ. 2024 Nov;58(11):1361-1368. doi: 10.1111/medu.15430. Epub 2024 May 15. PMID: 38749669.  https://pubmed.ncbi.nlm.nih.gov/38749669/   Dobson article - https://pubmed.ncbi.nlm.nih.gov/22836842/ Resistance article - https://pubmed.ncbi.nlm.nih.gov/34232150/#full-view-affiliation-1  Contact us: [email protected]     Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski      

In this episode, Adam discusses the complexities of growth mindset in medical education with guests Milad Memari and Katie Gavinski. They explore the differences between growth and fixed mindsets, the dangers of misapplying mindset theory, and the trap of false growth mindset. The conversation emphasizes practical strategies for educators to promote a growth mindset among learners, the challenges of assessment in medical training, and the need for systemic changes informed by mindset theory to support learner development.    Length of Episode:   45:09 Resources to check out :    Memari M, Gavinski K, Norman MK. Beware False Growth Mindset: Building Growth Mindset in Medical Education Is Essential but Complicated. Acad Med. 2024 Mar 1;99(3):261-265.  https://pubmed.ncbi.nlm.nih.gov/37643577/   PISA 2018 Results (Volume I): https://www.oecd.org/en/publications/pisa-2018-results-volume-i_5f07c754-en/full-report.html   A national experiment reveals where a growth mindset improves achievement: https://pubmed.ncbi.nlm.nih.gov/31391586/   Yeager DS, Dweck CS. What can be learned from growth mindset controversies? Am Psychol. 2020 Dec;75(9):1269-1284. doi: 10.1037/amp0000794. PMID: 33382294; PMCID: PMC8299535. https://pmc.ncbi.nlm.nih.gov/articles/PMC8299535/  @MemariMD   @katiegavinski          Contact us: [email protected]         Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski     

In this episode of KeyLIME+, host Adam Szulewski and guest resident co-host Brij Karmur speak with Dr. Mary Ott to explore the complexities around both the theory and the implementation of Competency-Based Medical Education (CBME) in Canada. They discuss the disconnects between the intended and enacted curriculum, the assessment burden on residents, and the need for adaptive responses to improve learner development. The conversation highlights the challenges and opportunities for CBME 2.0. Mary also shares some of the struggles she’s experienced getting work published that challenges the status quo. Length of Episode: 45:30  Resources to check out:  https://pubmed.ncbi.nlm.nih.gov/39105665/  Ott MC, Dengler L, Hibbert K, Ott M. Fixing disconnects: Exploring the emergence of principled adaptations in a competency-based curriculum. Med Educ. 2024 Aug 6. doi: 10.1111/medu.15475. Epub ahead of print. PMID: 39105665.   https://pubmed.ncbi.nlm.nih.gov/36274774/   Ott MC, Pack R, Cristancho S, Chin M, Van Koughnett JA, Ott M. "The Most Crushing Thing": Understanding Resident Assessment Burden in a Competency-Based Curriculum. J Grad Med Educ. 2022 Oct;14(5):583-592. doi: 10.4300/JGME-D-22-00050.1. PMID: 36274774; PMCID: PMC9580312.  Contact us: [email protected]    Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski            

In this episode, Dr. Tom Hurst, Medical Director of London HEMS and consultant in critical care at King’s College Hospital, joins Adam to discuss the unique challenges and operations of London HEMS—a leading helicopter EMS service known for its rapid, high-acuity trauma response in London, England. Their conversation highlights the real-world application of medical education principles in a high-pressure clinical environment, exploring how lessons from this setting can inform more traditional medical education contexts.  Tom emphasizes the pivotal role of teamwork, particularly the integration of paramedics and physicians in delivering emergency interventions right at the scene. They also delve into the complexities of continuous training for a diverse group of practitioners, including paramedics, fellows, and senior physicians, all working together to enhance the speed and quality of trauma care at one of the world’s busiest air ambulance services.  Length of Episode: 35:10 minutes  Resources to check out:  https://www.londonsairambulance.org.uk/  Contact us: [email protected]      Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski