The Educator as Designer 2011 AAP Annual Conference September 21 – 23 Scottsdale, Arizona Thomas E. Ungar, MD, M.Ed, CCFP, FCFP, FRCPC, DABPN Chief of Psychiatry & Medical Director, Mental Health Program North York General Hospital Associate Professor, University of Toronto Jennifer Riel MBA Associate Director, Desautels Centre for Integrative Thinking Rotman School of Management University of Toronto

Disclosure Slide Consultant/Speaker Astra Zeneca, Lundbeck, Astra Zeneca, Lundbeck, Eli Lilly, Pfizer Founder/Director Mental Health Minute®

How I got interested  “  “ What’s your five year plan?”   Scholarly education studies (contextual learning, transformative learning, hidden curriculum, participant observation, knowledge translation and exchange)   Airport Bookstores– Reading   SARS   Work with family physicians – interdisciplinary collaborative care, deep knowledge of end user   HBR, Globe and Mail national newspaper, Rotman School speakers, series, books, Jennifer Riel

Learning Objectives Gain knowledge about the basic principles of Design Thinking and relate them to their educational activities Gain awareness and knowledge of their educational design activities and products, and how to document these for academic promotion and professional rewards Reflect on their attitudes and values as to whether educational design constitutes valid scholarly academic activity, and potentially transform their career and educational identities and direction.

Design in Business

Design activity - Project based Designers care impact Designers care about impact Design is humanistic, observational, iterative

Definitions Design thinking can be described as a discipline that uses the designer’s sensibility and methods to match people’s needs with what is technologically feasible and what a viable business strategy can convert into customer value and market opportunity. ~Tim Brown Design thinking is the “balance (of) analytical mastery and intuitive originality.” ~Roger Martin

The IDEO Approach

The Rotman Model

Observation In terms of the application of observation to the design of medical education, it is a question of looking beyond what students tell us to understand their deeper-order needs and the needs of the patients they will one day treat. Observation is this case includes attempting to understand the full student experience of engaging with the material, from cracking open to the book, to attending the lecture, to attempting a procedure for the first time.

Imagination Imagination can be the most difficult skill to acquire. So much of our education, from grade school on, is designed to drive creativity and originality out of us. We kill new or unusual ideas swiftly, before we have a chance to learn anything from them. We dismiss all that we cannot prove in advance. Designers, on the other, use their abductive reasoning to explore what might be possible. They ask what is interesting or exciting about a wild idea, not what is wrong with it. They build and refine quick prototypes to test out ideas and learn all they can from them. Here, educators can learn from the discipline of prototyping – testing new pedagogies in rough form and iterating to improve them, rather than attempting to create a perfect final design before rolling it out. Testing and failing early, then learning from that failure, is at the root of innovation.

Configuration Configuration is the process of fitting the new idea or innovation into a larger system of activities. It is at this point that weaker designers struggle. They foist their brilliant new prototypes on the world without attempting to understand to what extent the new idea fits with existing activities. It is important to ask, to what extent does a new design fit with current culture and existing protocols? How can it be made to work with them? Can the new design be scaled? Can it be delivered at a cost that fits within our financial constraints? If it cannot, how can we adapt it to do so. The configuration stage is not about compromising the innovation, it is about integrating it into the existing system such that it can be sustained.

The Predilection Gap

Cognitive Errors in Academic Medical Education   “OR” –all or none thinking-analytic or intuitive thinking   ‘AND”- analytic and intuitive thinking –i.e. Design thinking

Analytical Thinking Intuitive Thinking Design Thinking Purpose To prove through induction and deduction To know without reasoning To balance analysis and intuition Approach  Exploit existing knowledge  Focus on the past  Venerate data, dismiss judgement and bias  Refine what is  Explore new knowledge  Focus on the future  Venerate insight, dismiss analysis  Invent what might be  Explore and exploit  Integrate the past and future  Combine data and insight  Design what should be Goal Reliability: An outcome that is consistent Validity: An outcome that meets the objective Reliability and Validity: A productive balance Key Differences

The Knowledge Funnel

Deductive Logic: The logic of what must be (reasoning from the general to the particular) Declarative Reasoning What is true or false? Modal Reasoning Abductive Logic: The logic of what might be (inference to the best explanation) What could possibly be true? Inductive Logic: The logic of what is operative (reasoning from the detailed facts to general principles) Expanding the Toolset

Abductive Logic How does that happen? By : seeking the best explanation when faced with new or interesting data that does not fit with existing models, understanding that the “best” explanation may well not be the simplest, the most obvious or the most accepted, and instead of dismissing data that seems to disconfirm one’s model, embracing it as a cue to think about a new explanation. Novel, surprising or anomalous data New theory, “a leap of the mind”

The Exercise The challenge: Think of the worst idea ever Propose ideas for the worst psychiatric residency training you can imagine

Rules for Brainstorming 1) Defer judgment 2) Encourage wild ideas 3) Build on the ideas of others 4) Stay focused on the topic 5) One conversation at a time 6) Be visual 7) Go for quantity

Educational Applications UG PG CE IPE Public Ed Admin Clinical UG PG CE IPE Public Ed Admin Clinical Design

Where Does Design live in crusty old academia?

University of Toronto Faculty of Medicine Promotions Manual: Planks for promotion 2011   Research   Education   Creative Professional Activity

Hollenberg Report on Creative Professional Activity 1983   It is not assumed that CPA and traditional academic excellence are mutually exclusive or that they can not manifest themselves in the same individual   Professional innovation/creative excellence is expressed in performance, film, and exhibition or staging of a work of art, original architectural or engineering design, original clinical or therapeutic techniques, introduction of an original concept in approaching a professional problem, etc.

2011 U of T Promotions Manual Professional Innovation and Creative Excellence Development, introduction and dissemination of an invention, a new technique, a conceptual innovation or an educational program. Creative excellence, in such forms such as biomedical art, communications media, and video presentations, may be targeted at various audiences from the lay public to health care professionals.

Presenting/Showcasing Design Activity for Academic Promotion   Education-Teaching Dossier Curriculum Design Instructional Design   Creative Professional Activity Dossier/Portfolio- Educational Design Portfolio Projects/conceptual innovations/designs/products Outcomes Impact Statements Utilization Dissemination Figures/Examples/Testimonials

Tom’s CPA Dossier

“The Creative Professional Activity in this dossier demonstrates a model of education that recognizes the need for contextualization of information along the knowledge cascade between research, specialist clinician, primary care physician and public. Each new context, practice culture and practitioner therefore requires an attempt at creative redesign of the style, placement, methods and language if effectiveness is to be expected. Ultimately the educational scholarship requires design activity, which for me is primarily an innovative and creative process complementing the foundation of scientific medicine.” Educator’s Statement

Educator’s Statement cont; “Each creative professional activity and Innovation in Primary Care Mental Health Education is approached as a knowledge translation problem requiring an instructional design solution that takes in to account the differing contest of primary care mental health delivery. This leads to creative and innovative curriculum materials, designs, products, and practice and learning enablers. To the specialist psychiatrist these may appear to be unconventional dilutions of specialty knowledge.”

Educator’s Statement cont; “Contributions in Instructional Design and Innovation demonstrate the scholarship of synthesis of knowledge as well as the scholarship of knowledge translation or implementation science.”

Rewards/Protections Educational Designs - “Products” Intellectual Property Copyright Trademarks Patents

How to Create a Design Friendly Environment   Organizational   Personal

Thank You

Primary Care/Family Doctor Education Example Reality GP video

Clinical Design Example – Pandemic Plan

CMAJ Publication on Pandemic Plan

Public Education Design

 Why Design thinking for medical education? relevance?  Link to educator skill sets, natural affinity for teachers, who understand learners, student or end users and deep understanding of context – empathic design etc  Examples of medical education instructional design-curriculum design, educational tools, acronyms, mnemonic device creation, video creation, case writing, simulation design, games, knowledge translation materials, interventions, social media public health campaign strategy and products etc.  Educational Design to assist identity formation for medical educators – faculty development and career validation  Challenges for design thinking in reliability oriented world of medicine and science, where educators and clinical teaching is second or third fiddle to research  How to document and present educational design activities-the educational design portfolio-creative professional activity dossier  Challenges for academic institutions to recognize and evaluate meaningful impactful non traditional academic educational design activity  It’s in our interest to embrace design thinking to enhance the field of medical education and innovation.

AAP Workshop Outline  Introduction10 minutes  Disclosure Slide  Learning Objectives  How I got Interested  Design Thinking Primer – PowerPoint20 minutes  Abductive Reasoning Exercise20 minutes  Psychiatric30 minutes Educator Applications Educator Applications Promotion & Documentation Promotion & Documentation CPA Dossier/Design Portfolio CPA Dossier/Design Portfolio Design Products - Example Design Products - Example  Educational Identity Formation  How to Create a Design Friendly Environment10 minutes Organizational Organizational Personal Personal  Evaluation

Intellectual Property

Clinical Care Design (Practice Enabler)