1. Newer Competencies for Medical Teachers Zubair Amin Batch K 42; Dhaka Medical College Associate Professor; Dept of Pediatrics School of Medicine National University of Singapore Senior Consultant and Head; Dept of Neonatology National University of Singapore 1

2. Newer Competencies
Developing content knowledge as an integral part of competencies as teacher
Importance of understanding the context of medical practice and applying those into teaching
Integrating education with the healthcare
I am starting with an end in mind. These are key themes that will reverberate throughout the presentation.

3. Timeline to Become a Specialist
Basic Medical Degree + Internship
Transition to PG Trainee
Fellowship
Learning in Practice
2023
2026
2030
2035
Becoming a practitioner has a very long gestational period. Students who are entering today in medical school will be an independent specialist in the year between That’s a very long period. We have develop our students as future ready students.

4. What Do We Know will be Different in Future?
Changes in healthcare delivery
Aging population
Explosion of biomedical knowledge
Emergence of new technologies
Rising healthcare cost
Emerging new diseases
Increasing public and student expectation
New learning technologies
Challenges to ethics and professionalism
New generation of learners
MERS, Zica virus,

5. Demographic Changes in Developing World
Global Impact of Demographic Changes. IMF Working Paper WP 06/9

6. Planning an Evidence-Based Education

7. Changes in Disease Patterns
Ten projected leading cause of Disability Adjusted Life Years (DALYs) in Developing World by Murray and Lopez. Lancet :
Murray Article on DALY; Disability adjusted life year.

8. Traditional Model
Upcoming Model
Medicine
Surgery
Pathology
Radiology
Et cetra
Health and well-being
Acute care
Chronic disease management
Elective procedures
Palliative care

9. Future of Health Care
Complex; non-linear; interprofessional; and integrated

10. Addressing the National Needs
Health and well being
Elderly and adolescent population
Mental health
Ethics and professionalism

11. Learning Among Millennial Generation
Doing is more important than knowing
Knowledge is no longer perceived to be the ultimate goal (the half-life of information is so short). Results and actions are considered more important than accumulation of facts
Learning more closely resembles Nintendo that logic
Nintendo symbolizes a trial-and-error approach to solving problems; loosing is the fastest way to mastering a game because loosing represents learning.
Millennials: Our Newest Generation in Higher Education. Northern Illinois University, Faculty Development and Instructional Design Center;

12. Learning Among Millennial Generation
There is a zero tolerance for delays
Millennials were raised in just-in-time, service-oriented culture. They expect and demand quick turn around in today’s 24X7 culture and do not easily accept delays.
Consumers and creators are blurring
In a file-sharing, cut-and-paste world, distinctions between creator, owner, and consumer of information are fading. The operative assumption is often that if something is digital, it is everyone property.
Computers are not technology: Computers, the Internet, and the WWW are much a part of Millennials' as telephones and televisions are to previous generations
Millennials: Our Newest Generation in Higher Education. Northern Illinois University, Faculty Development and Instructional Design Center;

13. Stress Among Medical Students
This is about recognizing our learners. The college is the KSU, the premier medical school in the Middle East. 35% students reported moderate to severe stress. The stress seems to be universal across all the years.
Hamza Abdulghani. Stress and depression among medical students: A Cross Sectional Study at a medical college is Saudi Arabia. Pakistan J of Medical Sciences. 2008: 24(1).

14. The same study looking into the relationship between academic grade and stress level. Both good and poorly performing students are equally likely to report stress.
Hamza Abdulghani. Stress and depression among medical students: A Cross Sectional Study at a medical college is Saudi Arabia. Pakistan J of Medical Sciences. 2008: 24(1).

15. Higher Education in Digital Age
Massive development in e-learning. Mooc, Coursera, Khan Academy are some of the few ones.
Economist. The Future of Universities: Digital Degree. June 28th. 2004

16. Higher Education in Digital Age
What can we offer to the students that online e-learning platform can not deliver?
How can we harness the power of technology?
Who would drive the education in the era of rapid development of technology?
We can not take a back-seat when changes are happening around us, impacting us.

17. Newer Competencies Adding values to existing practice
Broadening the range of competencies

18. Scottish Doctor Learning Outcomes

19. A Framework for Newer Competencies
What medical teachers are able to do
How medical teachers approach their teaching
Medical teachers as professionals

20. A Framework for Newer Competencies
What medical teachers are able to do
Knowledge competencies
Skills competencies
How medical teachers approach their teaching
Scientific underpinning of teaching and learning
Understanding the context of practice
Medical teachers as professionals
Scholarship

21. What a Medical Teacher Should be Able to Do
Knowledge competencies
Skills competencies
Knowledge refers to content knowledge; a often ignored part of faculty development. Skill competencies I refer to delivery of teaching, creating assessment etc.

22. Knowledge Competencies: Emerging Opportunities
Health
Aging
Mental health
Patient safety
Preventive medicine
Emerging infectious diseases
Genetics, epigenetics, and genomics
These are some of the global themes that most, if not every medical teacher, should be able to deliver. The word epigenetics did not exit in our textbooks when we graduated years ago. Concepts such as personalized treatment did not exist in our vocabulary. We grew up learning 4 Interleukins!

23. Examples: Aging Biochemistry Pathophysiology Anatomy Why do we age?
What are the biomolecular changes during aging?
Pathophysiology
What are the changes that take place in organ function during the aging?
Anatomy
What are the changes that take place in musculoskeletal systems during the aging?
What are the modifiable factors in aging?

24. Examples: Aging Pharmacology Preventive Medicine: Paediatrics
How do drug-drug, drug-disease interactions affect elderly patients?
How does aging affect metabolism of drugs?
Preventive Medicine:
Why do people age differently?
How can be compress the period of morbidity?
Paediatrics
What are the similarities between approach to problems in paediatrics and elderly population?
What is the impact of death and disability of grandparents on a tri-generational family?

25. Prerequisites High level of integration
Continuous faculty development and updating of knowledge
Radical change in the educational planning and delivery
Expanding the horizon of content knowledge is critical for delivery of good teaching
Content knowledge should not be separated from process of teaching
Most faculty development program focus on process

26. Harden RM. Integration Ladder.

27. Inter-professional collaboration
Medical, nursing, allied health, pharmacy, medical students
Interdisciplinary collaboration
Science, engineering, public health, epidemiology
Harden RM. Integration Ladder.

28. Technical Competencies: Existing Paradigm
Delivering an effective lecture
Teaching at the bedside
Using simulator/simulation to teach
Providing effective feedback
Facilitating a PBL
Creating a contextual MCQ
Conducting an OSCE
Developing a module

29. Rationale for Simulation Use
Safe environment, mistake forgiving
Trainee focused versus patient focused
Controlled, structured, and proactive patient exposure
Reproducible, standardized objectives
Opportunity for immediate feedback
Increase public trust in the profession
Scalese, Issenberg 2005; McGaghie 2007

30. Ethical Reason for Use of Simulation
“The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.”
Ziv A et al; Academic Medicine. 2003;78:783–788.

31. Putting the Patient First: Repeated Practice

32. Putting the Patient First: Infrequent Clinical Situations

33. Putting the Patient First: : Emergency Team Drills

34. Putting the Patient First: Privacy and Comfort

35. Putting the Patient First: Sharpening the Clinical Skills

36. Curriculum Integration & Progressive Exposure
Learning Outcomes
Intubation
Suture
Heart sounds
Pelvic examination
Available Options
Video >> Simulator >> Real Patient (RP)
Plastic model >> Animal tissue >> RP
Audio, video >> self-learning modules >> Harvey >> RP
Anatomical model >> Standardized patients >> Anesthetized RP >> RP

37. Technical Competencies are Insufficient
Technical competencies alone are not enough to meet the need for the future
Knowledge and skills in pedagogy are closely linked together
We should not repeat what others’ can do better

38. manpower cost complexity Volume Value Creation Low volume
High complexity
manpower
cost
complexity
Moderate volume
Moderate complexity
High volume
Low complexity
Volume

39. manpower cost complexity Volume Value Creation Value Creation
Integrated Seminar
Expert Lectures
Value Creation
manpower
cost
complexity
TBL, PBL,
Simulation, Tutorial
Internet resources
Study Guides
Let me elaborate on the concept with examples. In a resource constraint situation, idea is to reserve your best teachers, best resources for value-added components. Much of the materials can be taught better with low cost, low complexity, and high volume educational methods.
In assessment, high volume/low cost: CBT, MCQs, quizzes; whereas volume and high cost: judgment based decision making such as observation
Volume

40. manpower cost complexity Volume Value Creation Low volume
Critical thinking
Clinical judgement
Application of knowledge
Value Creation
Low volume
High complexity
manpower
cost
complexity
Problem-based learning
Simulation
Task based learning
Moderate volume
Moderate complexity
Facts
Basic concepts
High volume
Low complexity
Instead of spending our time in high volume and low complexity teaching and assessment activities, we should focus on value addition. We should deliver what we are GREAT in doing, what can not be done by other means. Our focus should be on quality; not on quantity. This will need re-orientation to how do we appraise teachers.
Volume

41. "We must acknowledge again that the most important, indeed, the only, thing we have to offer our students is ourselves. Everything else they can read in a book or discover independently, usually with a better understanding than our efforts can convey.”
Daniel Tosteson. Dean, Harvard Medical School
Learning in Medicine. NEJM. 1979: 301 (13):
<<Beyond the bubble>>

42. How Medical Teachers Approach Their Teaching
Understanding the Context of Practice

43. “The knowledge of the world is only to be acquired in the world, not in a closet.”
Lord Chesterfield, Letters to his son

44. Green et all. The Ecology of Medical Care Revisited: NEJM

45. Number of deaths resulting (millions per year)
Leading causes of preventable death worldwide
Cause
Number of deaths resulting (millions per year)
Hypertension
7.8
Smoking tobacco
5.0
High cholesterol
3.9
Malnutrition
3.8
Sexually transmitted diseases
3.0
Poor diet
2.8
Overweight and obesity
2.5
Physical inactivity
2.0
Alcohol
1.9
Indoor air pollution from solid fuels
1.8
Unsafe water and poor sanitation
1.6
The question that should ask Does our curriculum or teaching reflect the reality of the health? How much time do we spend in teaching smoking prevention or poor diet or overweight and obesity? My daughter once told me, she does not trust nutritional advice from doctors because medical students typically have 2 hours worth of teaching on good nutrition.
WHO Global Burdon of Diseases

46. Understanding the Context of Practice
Medical education needs to be firmly linked to the practice of healthcare
Integrating the teaching with the larger context of healthcare is paramount for value creation
The risk of ignoring the environment is akin to burying the your head in the sand during a sandstorm

47. Medial Teachers as Professionals
Scholarship in Education
Faculty Development
This is about value of what we do; this is about people first ahead of curriculum, materials, and any others physical assets.

48. “Comprehensive faculty development, which is more important today than ever before, empowers faculty members to excel as educators and to create vibrant academic communities that value teaching and learning.”
Wilkerson and Irby, Acad Med 73:

49. First Who; Then What
Getting the right people on the team before vision, strategy, and tactics
Getting the right people on the bus, and getting the wrong people off the bus
Put your best people for the greatest opportunities, not for the biggest problem
James C Collins. Good to Great. 2001

50. Good Program Good Teacher Bad Teacher Bad Program
Pragmatism, collaboration, and support

51. Good Program Good Teacher Bad Teacher Bad Program
Evidence suggests that students and parents will choose good teachers over good program. Single most important determinant of students’ career choice is passionate mentor.

52. Good to Great Transformation
A good medical teacher of the present is someone with the requisite knowledge and skills to serve the students.

53. Good to Great Transformation
A great medical teacher of the future will incorporate the context of healthcare into her teaching, add values to her teaching, and be passionate about the advancing the educational scholarship.

54. If you are planning for a year, sow rice;
If you are planning for a decade, plant trees;
If you are planning for a lifetime, educate people.
Chinese Proverb
If you are teaching for a year, teach the students;
If you are teaching for a decade, hire teachers;
If you are teaching for a lifetime, educate the teachers.

55. “I touch the future, I teach.”
Christa McAullife; A Teacher in Space