6

Closing Reflections

HIGHLIGHTS

• Informal and incidental mentorship, especially of diverse learners, can help set learners on a path toward faculty careers. (Williams)
• Formal faculty development should include opportunities for self-reflection and consideration of learning objectives and priorities. (Williams)
• Faculty can leverage the learning potential of any situation by actively seeking out different people and perspectives. (Williams)
• The process of engaging with diverse people, settings, and experiences can expand and shift faculty’s knowledge, skills, and aptitudes; this increases competence. (Williams)
• Double-loop learning can be a way to reconsider the traditional approach to faculty development. (Williams)

The last session of the workshop served to bring together threads from the other sessions and explicitly highlight diversity, equity, and inclusion in the steps of faculty development (see Figure 6-1). Norma Poll-Hunter, Association of American Medical Colleges (AAMC), introduced the session saying, “We’ve worked through each of the steps, and now what we want to do is underscore how diversity, equity, and inclusion are important threads in our work.” Poll-Hunter further described the concepts of diversity and inclusion mentioned throughout all the presentations. The speakers encouraged everyone to explore their own responsibilities for preparing individuals to be culturally responsive and environmentally sensitive to

the unique abilities of each learner. Participants were encouraged to think very broadly about diversity, inclusion, and equity as they listened to Valerie Williams reflect on the messages she heard through the lens of her experiences.

REFLECTIONS ON SPEAKERS’ REMARKS

Valerie N. Williams, University of Oklahoma Health Sciences Center

Valerie Williams, vice provost for academic affairs and faculty development at the University of Oklahoma Health Sciences Center, summarized the “pearls” of wisdom from each session, offered her own perspective, and asked participants to share their insights in the chat box.

Attracting Talent

Attracting talented future health professions educators means starting early and broadening recruitment, said Williams. Sánchez had noted that the faculty of health professions education is not as diverse as it should be, and she said that there was a need for more intentional engagement with prospective faculty. Williams reflected on her own career, and said that both intentional and incidental mentors set her on the path into academic medicine. She encouraged participants to think more broadly about the idea of mentorship, and emphasized that “little m” mentoring can be as influential as “big M” mentoring. For example, faculty can reach out to pre-faculty learners through actions as small as an encouraging conversation or an invitation to an event. These types of informal interactions may be particularly

important, said Williams, to learners who are underrepresented in the environment. She encouraged participants to consider ways to invest in various forms of mentoring, and to select mentees who may not traditionally have health professions opportunities or mentors.

In reflecting on the other presentations, Williams described what she heard as four components in the ways connections are made and pathways are laid into health professions education (see Figure 6-2). Everything, she said, from engaging with student interest groups to understanding and talking about the benefits of being a health educator with learners, can potentially seed an opportunity. Opportunities also come from working with staff who are based in the community or in settings outside of the formal education setting, where there are other kinds of connections. Helping learners, whoever they are, pre-faculty or early-career educator-clinicians, to build an identity as an educator and then ultimately as a practitioner can open the way for mentoring someone who is underrepresented in the profession and on the faculty.

Developing Faculty

Developing future health professions educators means offering current and new faculty formal opportunities for learning how to become more effective as an educator. Williams appreciated that Cohen Konrad, Hall, and Pardue used the term aspirations when presenting on the conscious instruction framework, because what learners aspire to may be very different, depending on their individual background, community, and culture. In formal faculty development, she said, learners are often told what they are expected to learn, rather than engaging in self-reflection about their own expectations and objectives. Faculty development should instead be an invitation to direct attention to different areas and to critically reflect on priorities and goals.

Williams developed Figure 6-3 in order to demonstrate the areas to which attention can be directed, and where shifts can be made to think and learn differently. For example, focusing on “place” by taking learning out of the typical classroom environment and into the community can give new insight into what patients are experiencing. An important area for reflection, said Williams, is to consider how educational institutions or workplaces can help faculty pay attention to issues such as engagement,

teamwork, impact, diversity, and transparency and accountability to the community.

Facilitating Continued Learning

Facilitating continued learning includes attending to informal and incidental learning opportunities for future health professions educators to enhance their knowledge, skills, and aptitudes. Williams said that Sherman’s point about looking for “learnable moments” really resonated with her, and that “we can learn from not only the surroundings, but how we attend to the surroundings.” That is, faculty can leverage the learning potential of any situation by actively seeking out different people and perspectives. Engaging with diverse people, settings, and experiences can expand and shift faculty’s knowledge, skills, and aptitudes, she said, giving four examples:

1. Interprofessional teaching and learning allows us to hear from a broader array of individuals and professions;
2. Working with diverse or underrepresented community partners allows us to tap into new perspectives and collaborate on shared goals;
3. Community-based participatory research can be an avenue for building affinity-based relationships outside of the formal educational environment; and
4. Co-teaching with former patients can bring new insight about what a patient would want learners to understand about an acute or chronic illness.

Williams discussed her experience of working with community partners as a way to illuminate the potential for incidental learning opportunities. Williams is the director of a university center for excellence in developmental disabilities. One of the center’s goals is to build a bridge between the university and people with developmental disabilities, families, providers, and other supports in the community. As part of this work, there is a community advisory group. When this group came together, Williams said, it was “not a symphony of voices but somewhat of a cacophony.” There were widely different expectations of what the group would do, and different expectations of the partners within the group. Out of this cacophony came a list of 148 things that people wanted out of the partnership. The group engaged in long discussions about their values, expectations, and reasons for partnering, and ended up whittling the list down to seven values to guide their work:

1. Recognize the need to partner.
2. Value and respect each other.
3. Accept each other.
4. Set clear expectations.
5. Provide feedback.
6. Expect impact, product, or outcome.
7. Trust each other.

As important as the list of seven values is, said Williams, just as significant was the process work of engagement that went into it. The process, she said, is “what enables us to build the knowledge that lets us leverage the skills and the aptitudes within any group … trying to achieve a common endpoint.”

Evaluating Outcomes

Evaluating outcomes based on thoughtful program designs means beginning with a clear idea of the desired outcome, summarized Williams. The knowledge-to-action framework that Thomas and Artino presented was helpful because “nothing will happen if we are not enabled to act on good ideas.” Using such a framework gives an opportunity to “test the waters” and to build a foundation for a “bigger and healthier house for the future.” Being thoughtful about building this foundation is enormously important, because “we need many people to be able to walk that path and build and live in that house.” The future health professions faculty hold the promise for all of us of a healthier society and healthier outcomes for people who are struggling with illness. Building this future is a “remarkable task” but one that is doable, Williams said.

Several presenters, said Williams, had touched on the importance of reflection at all stages of faculty development. Faculty development sometimes feels like a “vicious cycle” in which people are trying to change something but without any clear direction or forethought. She compared it to a group of people “rowing in every possible direction” and creating chaos and confusion by not asking where are we trying to go? In contrast, a “virtuous cycle” leads in the direction of positive change and alignment of a shared set of values. It requires reflective and active conversation, reflection about the actions taken and whether they will lead to the desired outcome, and listening to diverse voices. The idea of a “virtuous cycle” is similar to the concept of “double-loop learning,” first described by Chris Argyris in 1991 (see Figure 6-4). Double-loop learning, said Williams, asks people to take a step back and consider the assumptions that underlie a plan of action, rather than simply adjusting the plan itself. There are certain things that are known about faculty development, including various approaches, how

it works, and for whom it works. “As we try to think about how to engage diverse audiences” in faculty development, said Williams, we should take the opportunity to step back and consider changing the way things have traditionally been done in order to do it better.

Finding the North Star in a Time of COVID

Chappell revisited her opening remarks by asking Williams what is her “north star.” In other words, “What would be an actionable step that each of us could take within our own environment to move forward with thinking about what that north star might look like?” Williams responded by describing what she asks of her leaders and of herself—to have at least one conversation a week with someone you do not know, to ask them for perspective. She also acknowledged how personal networks have changed during the pandemic but that everyone at the university remains united behind fighting a common enemy, the coronavirus. However, she added, the thing about being in it together is we are still faced with a wide power and financial differential between, for example, the academic scholars and the cleaning staff. So to be in it together educators have to think about that full continuum of people and ask whether everybody is afforded similar access to information they can use, because that is part of those building blocks.

Closing Thoughts

In her concluding remarks, Williams said that health professions educators are like a symphony; each person must play his or her individual instruments, but together they can create beautiful music. Every individual is responsible for developing his or her own skills and bringing his or her personal, intellectual, and experiential capital to the table. Collectively, they can harmonize the work, collaborate, and advance the principles of

diversity, equity, and inclusion as a powerful asset for achieving a shared aim. She invited workshop participants to consider what they would do differently after today’s workshop, both as individual “musicians” as well as members of the broader group of faculty, community, and interprofessional teams.

Williams further emphasized the importance of giving faculty unstructured opportunities to engage with one another—“when everything is not structured down to the last hair on the nit, they share some remarkable insights.” She noted that some faculty may find this easier than others, and suggested that various methods, such as virtual meetings or chat boxes, could be used to facilitate the broadest conversation. Williams said these kinds of open conversations can give faculty a chance to step back from their usual role as experts and allow them to see other perspectives and gain other insights. Williams added that faculty and learners all can benefit from talking to people “they don’t usually talk to.” Leaders in particular should seek out conversations with those outside of usual networks, communities, and circles, and invite people to speak “who have not spoken before.”

PULLING IT ALL TOGETHER: REFLECTIONS ON THE STEPS

Reamer Bushardt, The George Washington University, and Kathy Chappell, American Nurses Credentialing Center

Bushardt and Chappell then closed the workshop with a look to the future. They expressed sentiments of hope that as the forum and today’s participants have identified the kinds of skills and capabilities that our future workforce needs, the health professional educational and practice communities can work together across disciplines, learn from each other, and build momentum toward greater diversity, inclusiveness, and equity. Bushardt emphasized a point made by Williams that coming together around shared values for this work will ensure we are not all rowing in different directions but all heading together toward that “north star.”

REFERENCE