[3] Performance under pressure

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      

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   

In this episode we discuss the new admissions policy at the school of medicine at Queen’s University, which now features a lottery system as part of its process. Adam speaks to the assistant dean of admissions, Dr. Peggy DeJong, about this change, which represents a first for Canadian medical schools.    Length of Episode 28:33   Resources to check out :  https://meds.queensu.ca/academics/mdprogram/admissions/methods-selection  Contact us: [email protected]   Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski  

Adam’s guest today is Dr. Akshay Rajaram, a community emergency physician and AI expert. Our conversation about the impact of AI on medical education is inspired by a recent paper that Akshay wrote in the Canadian Medical Education Journal titled “Large Language models in medical education: new tools for experimentation and discovery”. We are also joined by a resident co-host, Dr. Henry Li, who is a PGY4 pediatric emergency medicine resident from the University of Alberta who also has a special interest in the field. We cover some AI and LLM model basics as well as some of the implications of AI for both medical learners and educators.    Length of Episode: 44:01  Article discussed:   Rajaram A. Large language models in medical education: new tools for experimentation and discovery. Can Med Educ J. 2024 Jul. For more information, check out these resources that we mentioned during our conversation with Akshay:    1. Rajaram – LLMs in Medical Education: new tools for experimentation and discovery: https://journalhosting.ucalgary.ca/index.php/cmej/article/view/78879   2. Different versions of ChatGPT: https://www.cnet.com/tech/services-and-software/the-free-version-of-chatgpt-just-got-a-big-upgrade/  3. IBM Research Retrieval Augmented Generation: https://youtu.be/T-D1OfcDW1M?si=OznZlMpG_Rb-nifS  4. Retrieval Augmented Generation: https://bea.stollnitz.com/blog/rag/  5. Gao et al: Comparing scientific abstracts generated by ChatGPT to real abstracts with detectors and blinded human reviewers: https://www.nature.com/articles/s41746-023-00819-6  6. https://openai-openai-detector.hf.space  7. NEJM Grand Rounds – Google’s Exploration of LLMs in Medicine https://open.spotify.com/episode/5hweI4jXl64vfNJ7Wnn6pr?si=a5d5fa751ca94860    

This episode is Part 2 of a live recording with Dr. Shiphra Ginsburg and Dr. David Taylor as they discuss their perspectives on CBME. In part 2, we touch on the assessment burden in CBME as well as the tone of the discourse around CBME in the literature.  Adam moderates the discussion and provides his take on the topics covered at the end.  Length of Episode: 38 minutes   Resources to check out :  Ott, M. C., Pack, R., Cristancho, S., Chin, M., Van Koughnett, J. A., & Ott, M. (2022). “The most crushing thing”: understanding resident assessment burden in a competency-based curriculum. Journal of Graduate Medical Education, 14(5), 583-592.  Boyd VA, Whitehead CR, Thille P, Ginsburg S, Brydges R, Kuper A. Competency-based medical education: the discourse of infallibility. Med Educ. 2018 Jan;52(1):45-57. doi: 10.1111/medu.13467. Epub 2017 Oct 27. PMID: 29076231. https://pubmed.ncbi.nlm.nih.gov/29076231/  Contact us: [email protected]   Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski  

In this episode, Adam is joined by two med ed heavyweights, Dr. Shiphra Ginsburg and Dr. David Taylor, who discuss their views on CBME in Canada in front of a live audience of medical educators. In Part 1 of this lively discussion, our guests discuss whether using EPAs as the unit of measurement in CBME makes sense as well as the challenge of differentiating signal from noise in an assessment environment with so much data.   Length of Episode: 40 minutes   Resources to check out :  Szulewski, A., Braund, H., Dagnone, D. J., McEwen, L., Dalgarno, N., Schultz, K. W., & Hall, A. K. (2023). The assessment burden in competency-based medical education: how programs are adapting. Academic Medicine, 98(11), 1261-1267.  Schumacher DJ, Cate OT, Damodaran A, Richardson D, Hamstra SJ, Ross S, Hodgson J, Touchie C, Molgaard L, Gofton W, Carraccio C; ICBME Collaborators. Clarifying essential terminology in entrustment. Med Teach. 2021 Jul;43(7):737-744. doi: 10.1080/0142159X.2021.1924365. Epub 2021 May 14. PMID: 33989100.  Contact us: [email protected]   Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski  

Adam invites Dr. Jane Philpott (the Dean of the Faculty of Health Sciences at Queen’s University and former federal Minister of Health) to discuss the changes she’s seen in medical education over her career thus far. Jane also talks about where she sees the field of medical education (as well as Canadian healthcare in general) moving forward in the coming years.     Length of Episode: 35 minutes    Resources to check out :   Dr. Philpott’s book    Health for All : A Doctor's Prescription for a Healthier Canada, Publisher McClelland & Stewart, 2024. https://healthsci.queensu.ca/stories/blog/introducing-health-all    Contact us: [email protected]    Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski    

Dr. Dan Dworkis joins us to discuss his perspective on performance under pressure and how it applies to teaching residents in clinical practice settings that are sometimes unpredictable and messy. We’re also joined by a guest co-host, Dr. Julie La, who is a PGY5 general surgery resident and PhD student, who provides her perspective on the topic.    Length of Episode: 47:50   Resources to check out :   Dr. Dworkis’ book:   Title  The Emergency Mind: Wiring Your Brain for Performance Under Pressure  Author  Dan Dworkis  Publisher  Amazon Digital Services LLC - KDP Print US, 2021  ISBN  9798746482327  Length  228 pages  https://www.amazon.ca/Emergency-Mind-Wiring-Performance-Pressure/dp/B094GY88RK   Contact us: [email protected]    Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski  

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