[26] The Lasting Impact of Clinical Learning Environments: Why Where You Train Matters in Medicine

On this episode of KeyLIME+, Adam speaks with Charlotte van Sassen about the subtle ways that knowledge of patient outcomes can influence how supervisors assess clinical reasoning. Their conversation uncovers the impact of outcome bias on feedback and evaluation in medical education, exploring the challenges this presents for fairness and learning. They also discuss strategies to recognize and address these biases, aiming to improve how we support trainee development in complex clinical environments.   Length of episode :  30:52     Resources to check out:    https://pubmed.ncbi.nlm.nih.gov/40479526/  van Sassen C, Mamede S, van den Broek W, Bindels P, Zwaan L. Does Knowledge of Clinical Case Outcome Influence Supervisor Evaluation of Resident Clinical Reasoning? Acad Med. 2025 Jun 6  Zwaan L, Monteiro S, Sherbino J, et al Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workupsBMJ Quality & Safety 2017;26:104-110. https://qualitysafety.bmj.com/content/26/2/104.abstract  Caplan RA, Posner KL, Cheney FW. Effect of Outcome on Physician Judgments of Appropriateness of Care. JAMA. 1991;265(15):1957–1960. doi:10.1001/jama https://jamanetwork.com/journals/jama/article-abstract/385633  Contact us: [email protected]      Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski    

This episode of KeyLIME+ delves into the complexities of clinical learning environments in medical education. Adam and guest co-host Danielle Chang speak with Jena Hall about the dynamic nature of these environments, their impact on patient outcomes, and the importance of adapting to external societal influences. They discuss the challenges of physician burnout, the role of social media, and the integration of AI in medical training. The conversation emphasizes the need for intentional adaptability in educational practices to foster a supportive and effective learning atmosphere for the doctors of tomorrow.    Length of episode : 39:45    Resources to check out:   Nordquist J, Silva S, Caverzagie K, Hall J. Clinical learning environments: Updates. Med Teach. 2025 Jun;47(6):911-917. https://pubmed.ncbi.nlm.nih.gov/39901697/      Asch DA, Nicholson S, Srinivas S, et al. Evaluating obstetrical residency programs using patient outcomes. JAMA. 2009;302(12):1277–1283. doi: 10.1001/jama.2009.1356    Thoma B, Karwowska A, Samson L, Labine N, Waters H, Giuliani M, Chan TM, Atkinson A, Constantin E, Hall AK, Gomez-Garibello C, Fowler N, Tourian L, Frank J, Anderson R, Snell L, Van Melle E. Emerging concepts in the CanMEDS physician competency framework. Can Med Educ J. 2023 Mar 21;14(1):4-12. https://pubmed.ncbi.nlm.nih.gov/36998506/     Contact us: [email protected]      Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski    

In today's show, Adam chats with Gustavo Patino to discuss the implications of artificial intelligence in medical education publishing. They explore the need for transparency in AI model reporting, issues related to predictive accuracy, and the potential biases that can arise in AI applications. The conversation emphasizes the growing need for clear reporting guidelines in the use of AI in health professions education research and reviews some practical strategies to achieve this goal.  Length of Episode: 31:04  Contact us: [email protected]     Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski    

On this episode of KeyLIME+, Adam speaks with Maria Mylopoulos to explore the concept of adaptive expertise in medical education. They discuss theories of expertise development, the importance of fostering adaptive expertise, and the need for a shift in educational practices to better prepare physicians for the complexities and uncertainties of modern healthcare. They review the differences between routine and adaptive expertise, as well as strategies for promoting productive struggle and variation in learning environments. The conversation emphasizes the necessity of embracing uncertainty as a fundamental aspect of expert practice and the importance of integrating innovative ideas from physicians on the ground into educational theory.   Length of episode : 33:11  Resources to check out   Mylopoulos M, Kulasegaram K, Woods NN. Developing the experts we need: Fostering adaptive expertise through education. J Eval Clin Pract. 2018 Jun;24(3):674-677.   https://pubmed.ncbi.nlm.nih.gov/29516651/   Contact   Contact us: [email protected]     Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski    

On this episode, Adam and guest resident co-host Amit Chopra speak with emergency physician and trauma team leader Andrew Petrosoniak about the evolution of M&M rounds in healthcare and his vision for M&M rounds 2.0. They talk about the importance of shifting away from individual blame to a systems-oriented approach in case analysis. The conversation explores the exciting potential of integrating video review into M&M rounds and the potential to start capitalizing on this technology for performance coaching, just like athletes have done for decades.    Length of episode :  51:41   Resources to check out:    M&M rounds 2.0: the future of performance improvement | Canadian Journal of Emergency Medicine  Contact us: [email protected]      Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski            

[12] Avoid the trap of false growth mindset This episode was first released on February 18, 2025. Description: - 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   

[2] Listening to podcasts while you exercise is an exercise in futility: fact or fiction? This episode was first released on October 1, 2024. Description : - Adam and guest resident co-host, Dr. Victoria Turnbull, interview Dr. Michael Gottlieb about a recent paper of his that should be relevant to anyone who listens to podcasts for learning. The paper looked at immediate and delayed recall of podcast content of residents listening to podcasts during aerobic exercise and at rest. We also discuss multitasking, cognitive load, and the way our brains make decisions.   Length of Episode: 38 minutes   Resources to check out :  Gottlieb M, Cooney R, Haas MRC, King A, Fung CC, Riddell J. A Randomized Trial Assessing the Effect of Exercise on Residents' Podcast Knowledge Acquisition and Retention. Acad Med. 2024 May 1;99(5):575-581. doi: 10.1097/ACM.0000000000005592. Epub 2023 Dec 18. PMID: 38109353. https://pubmed.ncbi.nlm.nih.gov/38109353/  Perham, N., & Currie, H. (2014). Does listening to preferred music improve reading comprehension performance? Applied Cognitive Psychology, 28(2), 279–284. https://doi.org/10.1002/acp.2994 https://psycnet.apa.org/record/2014-08687-016  Contact us: [email protected]   Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski 

[9] Debunking myths in education with Dr. Paul Kirschner This episode was first released on January 7, 2025. Description: - In this episode, Adam and Dr. Paul Kirschner discuss some of the biggest myths in education—like multitasking, learning styles, and the belief that Googling can replace knowledge. They dive into what sets experts apart from novices and explore how certain 'desirable difficulties'—those useful challenges in learning —actually improve long-term retention, even if they're tough to stomach.    Length of Episode: 52:41  Resources to check out:  The Ten Deadly Sins of Education by Dr. Paul Kirschner  Bjork, R. A., & Bjork, E. L. (2020). Desirable difficulties in theory and practice.  Journal of Applied research in Memory and Cognition, 9 (4), 475-479.     Bjork, E. L., & Bjork, R. A. (2011). Making things hard on yourself, but in a good way: Creating desirable difficulties to enhance learning.  Brown, Peter C. (2014). Make it stick : the science of successful learning. Cambridge, Massachusetts :The Belknap Press of Harvard University Press  Paul's 3 recent books:  How Learning Happens: Seminal Works in Educational Psychology and What They Mean in Practice  How Teaching Happens: Seminal Works in Teaching and Teacher Effectiveness and What They Mean in Practice  Ten Steps to Complex Learning   Contact us: [email protected]      Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski   

[1] Does the pursuit of excellence in medicine conflict with the pursuit of well-being? This is Episode #1 which was first released on 17, 2024. Description: -  Adam invites Dr. Lisa Rosenbaum to discuss her recent publication in the NEJM titled Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training.   This thought-provoking paper is the 3rd in a series of 4 essays in the NEJM by Dr. Rosenbaum.  It's a social commentary on recent cultural and societal changes and their impact on medical education. We discuss Lisa's critical perspectives on the important notions of wellness and professional identity in our field.   Length of Episode: 40 minutes   Article discussed: Rosenbaum L. Being Well while Doing Well - Distinguishing Necessary from Unnecessary Discomfort in Training. N Engl J Med. 2024 Feb 8;390(6):568-572. doi: 10.1056/NEJMms2308228. Epub 2024 Jan 17. PMID: 38231543. https://pubmed.ncbi.nlm.nih.gov/38231543/  Resources to check out :  Dr. Rosenbaum's recent related publications    https://www.nejm.org/doi/10.1056/NEJMms2308228 Being Well while Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training   https://pubmed.ncbi.nlm.nih.gov/38265727/ Beyond Moral Injury - Can We Reclaim Agency, Belief, and Joy in Medicine?   https://pubmed.ncbi.nlm.nih.gov/38197811/ On Calling - From Privileged Professionals to Cogs of Capitalism?   https://pubmed.ncbi.nlm.nih.gov/38170694/ What Do Trainees Want? The Rise of House Staff Unions   Podcast 'Not Otherwise Specified' https://not-otherwise-specified-podcast.nejm.org/e/tough-love/     Contact us: [email protected]   Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski    

In the Season 1 finale of KeyLIME+, Adam shares reflections on a memorable first year, highlighting listener feedback and key insights from across the season. We revisit important conversations about balancing wellness with excellence in medical education, rethinking med school admissions, applying cognitive load theory to clinical teaching, and leading change with humility. Thanks to all our listeners and contributors for being part of Season 1 — KeyLIME+ will be back in September with an exciting Season 2!    Length of episode: 36:50  Resources to check out   Episodes mentioned: -   Episode 8 Is applying to med school like playing the lottery?  https://keylimepodcast.libsyn.com/7-is-applying-to-med-school-like-playing-the-lottery   Episode 11 Challenging the status quo of CBME in Canada  https://keylimepodcast.libsyn.com/11-challenging-the-status-quo-of-cbme-in-canada  Episode 14 Exploring cognitive load in the workplace: A new tool for medical educators  https://keylimepodcast.libsyn.com/14-exploring-cognitive-load-in-the-workplace-a-new-tool-for-medical-educators     Contact us: [email protected]     Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski