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Academy Insights
Vol. 5, No. 10
The Division of Developmental Medicine at Boston
Children's Hospital: Bringing Modern Pedagogy to
the Tried & True "Grand Rounds" Experience
Submitted by Jason Fogler, Ph.D.
The Division of Developmental Medicine at Boston
Children's Hospital provides multidisciplinary care as well as
clinical, basic science, and translational research for children
and adolescents with Autism Spectrum Disorder, ADHD,
Intellectual Disability, genetic disorders, substance abuse
problems, and associated common learning and psychiatric
comorbidities. In addition to its clinical and research roles,
the Division has an educational mission providing primary
training to both Developmental Behavioral Pediatric Fellows
and Postdoctoral Fellows in Clinical Psychology, as well organizing seminars and lectures for faculty, staff,
and colleagues. Since the Division represents a collaboration among specialties, opportunities for crossdisciplinary teaching and collaboration are incredibly rich. For example, a Developmental Behavioral
Pediatric (DBP) Fellow might give team assessment feedback with an attending pediatric psychologist and
vice versa for a Psychology Postdoctoral Fellow with an attending pediatrician. Our faculty is comprised of
developmental-behavioral pediatricians, psychologists, nurse practitioners, social workers, and psychiatrists,
and members from either discipline are equally likely to lead seminars and experiential learning
exercises. We additionally provide interdisciplinary learning experiences with our colleagues in Neurology,
Psychiatry, Audiology and Augmentative Communication, and Genetics.
At the beginning of 2014, a new Educational Strategy Committee (ESC) was formed, with the conscious
decision to have it jointly led by a psychologist (Dr. Mauras) and pediatrician (Dr. Schonwald). This new
interdisciplinary leadership was focused on streamlining, and where possible, unifying the educational
experiences of new fellows in DBP and psychology. The Committee aims to refresh and reinvigorate our
educational program through the incorporation of research-based best practices in teaching and learning, as
well as modern leadership and coaching theory.1
Educational opportunities in our Division come from three main sources: real-time skill-building during
clinic, didactic seminars), and -- the central topic of this article -- our monthly Division Center
Meeting. Until this year, the Center Meeting followed the format of the traditional all-department meeting,
and included a Morbidity & Mortality Rounds, an invited speaker or "job talk" of a potential hire,
announcements and updates on new research initiatives and pertinent administrative changes, and a
meeting to discuss staff business. A major initiative of the ESC was to reduce redundancy among these
educational sources. Fellows now start the training year with a "Boot Camp" package of skills critical to
commencing work on multidisciplinary teams and following our patients in continuity clinic. Subsequent
seminars now focus on more specialized, clinically pertinent material in neurology, psychiatry, and
developmental medicine. With these structures in place, Center Meeting is now able to focus on developing
our division as a whole - fellows and faculty -- and on offering truly novel content, which we put into action
in the following ways:
1. Constructivist Learning: We have begun to implement pedagogical strategies that are often overlooked at
the post-secondary level but that promote strong engagement, intrinsic motivation, and deep learning
among students of all ages. At our Division meetings and seminars -- most recently in a discussion of a
complex behavioral genetics article about autism spectrum disorder -- we have created student-centered
learning expectations in which the instructors act as facilitators and coaches, and in which the learners
explore information, interact with peers and construct their own understanding and meaning of
material. Instructors use a variety of educational tools such as role plays, case studies, exploration of testing
materials, and structured debates to enable students to engage deeply with material and to create their own
knowledge. Based on the model of the "flipped classroom," students acquire primary background knowledge
at home through print and technology, and then explore and expand this basic knowledge in the classroom
with peers.
2. Panel discussion with colleagues and consumers: We had the privilege last May of a panel discussion on
the topic of differential diagnosis of psychotic disorder from neurodevelopmental disorder by senior
members of our psychiatry staff. This spring we will be joined by a facilitated discussion panel of adults
living and thriving with neurodevelopmental disabilities. This panel format provides learners with a broad
range of knowledge and opinions, and invites critical thinking and debate. Through exposure to multiple
perspectives of the same topic, learners are prodded to critically evaluate information and beliefs, and they
are able to develop rich and multi-faceted conceptions of essential topics. We routinely invite colleagues
from Radiology, our Emergency Department, Child Protection, and other departments when we identify
blind spots in our service delivery and/or when new learnings about how to work better with our
interdepartmental colleagues are likely to improve our clinic operations.
3. Real-Time Multimedia Teaching and Evaluation: Following the principles of such writers as Huang
2
(2002) we have used real-time survey technology to increase awareness and engagement of new quality
improvement initiatives and opportunities for professional development. We recently used electronic
polling to introduce a prospective evaluation method for our fellows, and we anticipate using it as the
3
backbone of our overall program evaluation and quality improvement plan.
On a practical level, the Center Meeting fulfills an important role by providing all practitioners in the
Division with a streamlined range of educational opportunities and important administrative
announcements. However, by the end of last year it was clear that the agenda was often too full to allow for
meaningful learning experiences. Hence, this new initiative stresses an appreciation for optimal pacing for
maximal attention, effective learning, and information processing. We look forward to updating the
Academy in due course about these evolving efforts.
References
Lencioni, P. M. (2012). The Advantage: Why organizational health trumps everything else in business. San Francisco:
Jossey-Bass.
2
Huang, Hsiu-Mei. (2002). Toward constructivism for adult learners in online learning environments. British Journal of
Educational Technology 33.1: 27-37.
3
"Poll Everywhere." Poll Everywhere. N.p., n.d. Web. 1 Mar. 2015.
Candy, Philip C. (1989). Constructivism and the study of self-direction in adult learning. Studies in the Education of
Adults 21.2: 95-116.
1
Acknowledgements: We are grateful to Laura Weissman, MD for her service to the Center Meeting Planning Committee,
Rosetta Mojahed-Dacey for her current oversight of the Center Meeting's agenda and infrastructure, and to all past and
current faculty, fellows, and invited speakers who have shaped the Center Meeting's development through the present.
*Jason Fogler, M.A., Ph.D., Catherine Ullman-Shade, Ph.D., Carrie Mauras, Ph.D., Ronald Becker, M.D., & Alison
Schonwald, M.D.
Jason Fogler, M.A., Ph.D is a graduate of Williams College, Teachers
College of Columbia University, and Boston University. He completed a
predoctoral internship and postdoctoral clinical research fellowship in a joint
appointment at the National Center for Posttraumatic Stress Disorder, VA Boston
Healthcare System, and the Department of Psychiatry at Boston University
Medical Center. He is a Staff Psychologist in the Division of Developmental
Medicine at Boston Children's Hospital and an Instructor in Psychiatry at
Harvard Medical School. He has taught regionally, nationally, and
internationally on the topics of trauma-focused assessment and treatment and
executive functioning. A regular presenter at seminars for psychology and
developmental-behavioral pediatric fellows, Dr. Fogler also co-organizes his
Division's monthly Center Meeting with an eye toward complementing the overall training experience with
novel speaker topics and opportunities for experiential learning.
Randy King Honored for Teaching Excellence
HMS professor recognized with AAMC award
By: Mary Commisso
Image: American Association of Medical Colleges
Randy King, the Harry C. McKenzie Professor of Cell Biology at Harvard Medical School, has been awarded
the American Association of Medical Colleges Excellence in Teaching award for his involvement and
innovation in the laboratory, in the classroom and across the curriculum at HMS.
"He views teaching as a profound privilege rather than an obligation and looks forward to developing
innovations in both the classroom and the laboratory," said Jeffrey S. Flier, dean of HMS.
King was integral to a major curriculum redesign of the four-year MD program at HMS. His theory is that
students learn better when the material is developmentally appropriate.
King is leading the design and implementation of an interdisciplinary first-year introductory course called
"Foundations," which integrates fundamentals of cell biology, biochemistry, pharmacology, anatomy,
genetics, immunology, pathology and microbiology.
"He is the gold standard against which we compare all other course directors," said one of his students.
"He is an accomplished researcher, and I'm amazed by how he is able to direct this course as though it is his
only task," said another.
In recognition of his contributions, students have nominated him six times for the HMS Faculty Prize for
Excellence in Teaching. King was awarded the prize in 2005.
50 Studies You Can Use in Your Teaching
Submitted by Julia Whelan
Countway Library of Medicine
Has a medical student or resident ever asked you, "What are
the key studies on this topic?" A new resource available from
the Countway Library of Medicine, 50 studies every doctor
should know: the key studies that form the foundation of
evidence based medicine, offers concise advice and is touted as
"a quick way to get up to speed with the classic studies that
shape clinical practice."[S1] Dr. Michael Hochman, editor
and HMS alumnus, arranges studies by specialties: preventive
medicine, internal medicine, surgery, obstetrics, pediatrics,
radiology, neurology and psychiatry, and systems based practice. The well-known acronyms are here,
ranging from ALLHAT, ACORD and CAST through COURAGE, and IDEAL to SYNTAX and many more.
Most notable are Hochman's easy-to-read synopses of the studies which provide useful teaching tools that
facilitate integrating discussion of the evidence into course content. For each trial, the authors outline the
research question, funding source, dates, location, population, inclusion criteria, sample size, intervention,
follow-up time, endpoints, and results. These are followed by study criticisms and limitations and a brief
bibliography. A related clinical case presents a patient and then a discussion of how this study will shape the
patient's care. In addition, a bank of multiple choice study questions (answer key provided) could be useful
for both independent study and exam creation.
50 studies every doctor should know: The Key Studies that Form the Foundation of Evidence
Based Medicine / edited by Michael E. Hochman. Oxford ;New York : Oxford University Press, [2014]
http://id.lib.harvard.edu/aleph/014118679/catalog
In print - Countway Medicine | ZW 20.5 F469 2014
An online version of this book is on order
Who's Who in the Harvard Medical School
Academy
John B. Livingstone, M.D.
John B. Livingstone, MD, FRSH (UK) is an adult, child and adolescent
psychiatrist and a broadly trained psychotherapist. He is a former director of
Outpatient Services at McLean Hospital and a Chaired Assistant Clinical
Professorship at Harvard Medical School. In addition to a private practice, he
currently conducts research on the efficacy of healthcare professionals to
facilitate health-related behavior change and medical decision-making. He
teaches contemporary aspects of medical interviewing to medical students at
Warren Alpert, (Brown University) and to advanced medical residents at BIDeaconess (HMS). Collaborating with his wife, Joanne Gaffney, RN, LICSW,
IFSC, he conducted pilot studies to test the effectiveness of a new
interviewing process for use by nurses and physicians informed by the new
science of mind as a multiplicity of personality parts. His past medical
research experience includes infectious pulmonary disease in polio patients at Massachusetts General
Hospital, and, in Italy, prevention of psychotic-like development in children born blind. He designed a new
care delivery model at BI-Deaconess and McLean Hospitals for delivery of integrated health care to children
and their parents. He was a Frances Wayland Scholar at Brown and is an Honorary Fellow of the Royal
Society of Health (UK) for being the first to discover that hospital environments were the major source of
staphylococcus infection in vulnerable patients. He received a first prize from Simmons School of Social
Work for his integration of pediatrics and child psychiatry in a clinic design and first prize as a medical
information officer for his 5 years of editorship of Dialogue, a quarterly public health publication for screen
writers, producers and directors to portray adaptive social behaviors in their scripts and programming. He
has been a consultant on series publications, in print and in the media, including Hotline Series for Children
and script consultant for Nova at PBS and Hanna Barbara. Dr. Livingstone was trained fully in EMDR, Voice
Dialogue/Psychology of the Selves (a multiplicity model anti-dating IFS), and in the Internal Family Systems
Model. A partner at Gaffney and Livingstone Consultants, he makes his home on Cape Cod.
John and Joanne Gaffney are the authors of IFS and Health Coaching: A New Model of Behavior Change and
Medical Decision Making, (2013) in Internal Family Systems Therapy: New Dimensions. Sweezy, M.
and Ziskind, E., Eds., London: Routledge Publications.
Their approach to health coaching is embedded in the research reported by Wennberg, et al. New England
Journal of Medicine, Volume 363, No.13, (and the Supplementary
Appendix, 22 pages) September 2010.
Christopher G. AhnAllen, Ph.D.
Dr. AhnAllen is a Staff Psychologist with the Inpatient Mental Health Service
on the Brockton Campus of the VA Boston Healthcare System. He is an
Instructor of Psychology within the Department of Psychiatry at Harvard
Medical School. Dr. AhnAllen has served for three years as the Brockton &
West Roxbury VA Medical Center Site Training Director for the VA Boston
Healthcare System Psychology Pre-doctoral Internship Program where he
also serves as a clinical supervisor within the Inpatient Mental
Health/Therapeutic Recovery rotation. As part of this role, Dr. AhnAllen also directs a monthly faculty
development seminar on clinical supervision for staff psychologists within the VA Boston Healthcare
System, an area which he has published an educational toolkit on MedEdPORTAL Publications. He was
awarded the 2013-2014 Outstanding Peer Reviewer Award by MedEdPORTAL Publications. Dr. AhnAllen
has served for three years as the Chair of the Psychology Diversity and Inclusion Committee within the VA
Boston Healthcare System and he has received funding from the American Psychological Association to
conduct educational research on the development of cultural competency in VA providers. Dr. AhnAllen has
been recognized for his educational work by the Harvard Medical School Office for Diversity Inclusion and
Community Partnership with the 2012-2013 Harold Amos Faculty Diversity Award. He is also a Co-course
Director of the Cognitive Behavioral Therapy course and Clinical Supervisor for PGYIII psychiatry residents
within the Harvard South Shore Psychiatry Residency Program. His primary research interests include the
relationships amongst cigarette smoking, nicotine, cognition and schizophrenia. He is presently an Associate
Editor of the scientific journal Schizophrenia Research. Dr. AhnAllen completed his doctoral education in
clinical psychology at the University of Massachusetts Boston, clinical pre-doctoral internship at the Boston
Consortium in Clinical Psychology and postdoctoral research training as a T32 NIDA research postdoctoral
fellow within the Center for Alcohol and Addictions Studies at the Alpert Medical School of Brown
University. He completed additional postdoctoral clinical training at the Brookline Community Mental
Health Center.
Symposium on the Science of learning
Dealing with Failure: Getting Our Learners to Ask
the Right Questions- RSVP
Friday, April 10, 2015- 2:00 PM to 5:00 PM
Students and residents can be obsessed with "getting the right answer," and often find it difficult to wrestle
with a problem for more than a few moments. Lack of certainty about an answer can evoke a sense of unease
and stress, and getting the wrong answer can be devastating. This session will address the great learning
value associated with the "unknown" and with making mistakes, and will explore strategies to motivate
students to address learning as more than an enterprise designed to acquire facts.
Teaching Failure
Stuart Firestein, Ph.D., Professor Department of Biological
Sciences Columbia University
Science succeeds by failing, a lot. However we too often omit this perspective in our
teaching by leaving out the crucial failures and only telling a heroic narrative - or
worse no narrative at all - just the facts. Failing to teach failure gives students a
distorted view of the process and does not create critical thinking that will help them
to understand the failures they will inevitably experience. The question then is how do we teach failure
successfully?
The Art and Science of Learning to Ask Better Questions
Dan Rothstein, Ed.D., Co-Director The Right Question
Institute Cambridge, MA
What's wrong with the right answers? If you've asked the wrong question, the
answer won't be of much help. Students arrive at medical school after years of
excelling at giving the right answers to questions posed to them. When and how will
they learn to ask their own questions? The skill must be deliberately taught, for
students will frequently face cognitively perplexing and emotionally fraught
challenges for which there is not one readily apparent, simple and correct answer.
They need to learn how to wield the skill of question formulation as a flashlight. It won't guarantee an
answer, but it will make for a much more efficient search than groping in the darkness.
Upcoming Academy Events:
Annual Symposium on the Science of Learning- Dealing with Failure: Getting Our Learners
to Ask the Right Questions RSVP
Stuart Firestein, PhD. Professor Department of Biological sciences Columbia University
Dan Rothstein, EdD, Co-Director of Right Question Institute Cambridge, MA
Friday, April 10 2015 2:00-5:00PM TMEC 2nd Fl. Amphitheatre and Atrium
For more information click here
Inter-Hospital Collaborative
Holly Gooding, MD, MSc, Instructor in Pediatrics, Boston Children's Hospital - Lessons learned from a
medical education project to increase preventive services provided in resident primary care practices
Zev Schuman-Olivier, MD Clinical Instructor of Psychiatry at Harvard Medical School, Cambridge Health
Alliance; Adjunct Assistant Professor of Psychiatry at Dartmouth Medical School - The MINDFUL-PC
project: Integrating Mindfulness into Primary Care
Wednesday, April 15, 2015 - 4:15-5:30 pm TMEC 250
Medical Education Grand Rounds: Fostering Leadershipin Undergraduate Medical
Education-RSVP
Diana Wohler, BS and Arjun Suri, BS, both candidates for the MD from Harvard Medical School
Wednesday, April 22 2015 4-5:30 PM
Medical Education Grand Rounds: Designing a Post-Clerkship Curriculum for Pathways:
Creative Ideas and Best Practices- RSVP
Edward M. Hundert, M.D, Dean for Medical Education, Harvard Medical School
Bonnie M. Miller, M.D., Senior Associate Dean for Health Sciences Education and Associate ViceChancellor for Health Affairs, Vanderbilt School of Medicine
Friday, May 1, 2015- 7:30-9:00AM TMEC 227
Inter-Hospital Collaborative: Advancing consultative medicine through teachingRSVP
Eli Miloslavsky MD, Instructor in Medicine, Massachusetts General Hospital
Jakob McSparron MD, Instructor in Medicine, Beth Israel Deaconess Medical Center
Wednesday, May 13, 2015 - 4:15-5:30 pm TMEC 250
Academy Symposium: The Many Flavors of Scholarly Writing: Possibilities and
Practicalities-RSVP
The Doctor as Writer
Atul Gawande, MD, MPH, Professor of Surgery, HMS, Professor of Health Policy and Management, HSPH
Thursday, May 14, 2015 1:00-3:30PM
Medical Education Grand Rounds: For Modern Pedagogy, Do We Lecture or "Flip"? And
How? An Exercise and Analysis of Animating the Classroom- RSVP
David Hirsh, MD, Associate Professor of Medicine, Associate Director of the HMS Academy
Friday, June 5, 2015- 7:30-9:00AM TMEC 227
New Medical Education Pubmed Citations
from Academy Members
Please note that we use an automated search system to identify new pubmed-cited medical education
literature. If we have missed a medical education paper you have published, please let us know. Also,
please let us know if you have published medical education materials on MedEdPortal or other sites.
Bae GH, Lee AW, Park DJ, Maniwa K, Zurakowski D; ASSH Diversity Committee, Day CS; ASSH Diversity
Committee. J Hand Surg Am. Ethnic and Gender Diversity in Hand Surgery Trainees. 2015 Jan 29. pii:
S0363-5023(14)01600-1. doi: 10.1016/j.jhsa.2014.10.065. [Epub ahead of print] PMID: 25639841
[PubMed - as supplied by publisher]
Boland RJ, Becker M, Levenson JL, Servis M, Crone CC, Edgar L, Thomas CR. Psychosomatics. The
Milestones for Psychosomatic Medicine Subspecialty Training. 2014 Nov 13. pii: S0033-3182(14)00184-4.
doi: 10.1016/j.psym.2014.11.003. PMID: 25660433 [PubMed - as supplied by publisher]
Chen XP, Williams RG, Sanfey HA, Smink DS. Am J Surg. A taxonomy of surgeons' guiding behaviors in
the operating room. 2015 Jan;209(1):15-20. doi: 10.1016/j.amjsurg.2014.07.018. Epub 2014 Nov 7. PMID:
25454960 [PubMed - indexed for MEDLINE]
Olasky J, Chellali A, Sankaranarayanan G, Zhang L, Miller A, De S, Jones DB, Schwaitzberg SD, Schneider
BE, Cao CG. Surg Endosc. Effects of sleep hours and fatigue on performance in laparoscopic surgery
simulators. 2014 Sep;28(9):2564-8. doi: 10.1007/s00464-014-3503-0. Epub 2014 Mar 27. PMID:
24671352 [PubMed - indexed for MEDLINE]
Yule S. J Am Coll Surg. Invited Commentary on Influence of Surgeon Behavior on Trainee Willingness to
Speak Up: A Randomized Controlled Trial 2014 Nov;219(5):1007-9. doi:
10.1016/j.jamcollsurg.2014.08.004. Epub 2014 Oct 17. No abstract available. PMID: 25440028 [PubMed indexed for MEDLINE]