● 의사를 더 나은 교육자(educator), 변화의 주체(change agent)가 되게 하기 위한 Harvard Macy Institute

Harvard Macy Institute Helps Physicians Become Better Educators and Change Agents

M. J. Friedrich

Boston—In spring as the weather warms up and the semester winds down on college campuses, students' thoughts often stray beyond the classroom. But for the physicians who returned in May to the Harvard Macy Institute's program for medical educators, getting back to course work was a number one priority.

미국과 그 외 국가에서 온 67명의 physician-scholar

Eager to pick up where they left off at the end of the January session, 67 physician-scholars from the United States and other countries returned to Cambridge to build on knowledge and skills imparted a few months earlier, refine specific educational projects they had been working on, and consolidate their connection with a community of people who share their commitment to medical education.

더 나은 선생님이 되고자 하는, 그리고 자신의 기관 발전을 효과적으로 이루고자 하는 사람들이 매력을 느낄 것임.

The program attracts medical educators who not only desire to become better teachers but who want to learn how to effectively bring about improvements in education at their institutions, said Elizabeth Armstrong, PhD, codirector of the program, director of education programs at Harvard Medical International (JAMA. 2001;286:659-661), and associate professor of pediatrics (medical education) at Harvard Medical School.

1994년 설립되었음 : Josiah Macy Jr Foundation, 하버드의과대학, 하버드 교육대학원, 하버드 Business School의 협동.

Established in 1994 through a grant from the Josiah Macy Jr Foundation, the Harvard Macy Institute is a collaborative effort of Harvard Medical School, Harvard Graduate School of Education, and Harvard Business School. The medical school works with the graduate school of education to develop the program for physician educators. It also collaborates with the business school to produce a second program—not highlighted in this article—for leaders in medical education, such as deans and chairs of curriculum committees, that focuses on institutional change.

프로그램의 목적 : 

(1)최고의 교육에 숨겨진 원칙을 가르침으로서 의학교육을 향상시키는 것, 프로젝트의 설계와 도입을 통한 변화를 이끄는 것.

(2) Organizational learning을 달성하는 것.

The main purpose of the physician educator program, said Armstrong, is to improve medical education by helping individuals learn about the principles that are embodied in the best educational practices and to bring about change in educational activities through special projects they design and implement. Another goal is to have those projects influence the institution to bring about "organizational learning."

"교수개발 프로그램이 개개인에게 새로운 지식/기술을 가르쳐 주지만, 그 개인이 일하는 조직의 변화를 가져오는데는 한계를 보이고 있다. 더 나은 교사, 더 나은 교육자가 되기 위해서는 어떻게 변화를 주도하고, 어떻게 그 변화를 측정하고, 어떻게 변화를 설계하는지 알아야 하며, 그 변화를 주도할 수 있어야 한다."

"Too often faculty development programs have been good at helping an individual learn a new skill, but they don't have a significant impact in actually changing the organization within which the person works," Armstrong said. "My feeling is that if you are going to become a better teacher and a better educator you need to think about how to lead that change, how to measure that change, how to create or design the change, and to have it driven by the core values we represent."

PROGRAM FEATURES

다섯 개의 주제

The classes and exercises offered in the physician educator program revolve around five main themes: 

• teaching and learning, 
• assessment, 
• curriculum development, 
• leadership, and 
• information technology. 

상호작용을 강조한 수업

An interactive class in strategic performance, for example, combines theater skills with leadership development training to help scholars improve their ability to communicate, negotiate, and make presentations.

비디오테이프 녹화 등과 같은 다양한 simulated teaching situation이 제공되었음.

The program offers numerous simulated teaching situations that help scholars practice new strategies and methods of teaching. 

Participants are videotaped so that they can evaluate their teaching styles. One such exercise involving a patient simulator—a computer-driven mannequin that mimics physiological changes and can be programmed to replicate various clinical scenarios—provides physicians the opportunity to practice teaching with this new tool that is gaining popularity in many medical schools.

특징적 요소 : 하버드 교육대학원의 참여

A number of unique features set the Macy program apart from other continuing education programs for medical educators, said Robert Kegan, PhD, codirector of the physician educator program and professor of adult learning and professional development at Harvard Graduate School of Education.

Two-session structure의 특징 : 한 번 보고 끝나는 것이 아니다. 

One novel aspect is the program's two-session structure. Most education improvement efforts are one-time events that present a lot of stimulating information, said Kegan, "but then they say good-bye and never see you again." In contrast, the design of the Macy program offers participants the opportunity to acquire a basis in educational theory in January, which they can begin to apply to teaching and administrative work when they return to their home institutions.

5월에 있는 두 번째 미팅에서는 자신의 기관에서 추진하고 있는 프로젝트에 대한 논의를 함. 

During the second meeting in May, with sessions designed specifically to help participants consider ways in which they can effectively influence organizational change, the participating educator-scholars can reflect on the impact their new ideas in education have had on their institutions. They meet again with colleagues to discuss the approaches that worked and those that did not—to explore their experiences and revisit their assumptions. Many scholars have noted in evaluations that this is one of the most important program features.

PROJECT PROPOSALS

프로그램에 지원하기 위해서는 프로젝트 제안서를 제출해야 함. 또한 그 프로젝트는 지원자의 기관에서는 다음의 것들을 인정해줘야 하는데 (1)acceptable해야하며, (2)그 대학의 철학에 맞아야 하고, (3)지원자가 그것을 할 수 있는 위치에 있어야 함.

Another innovative feature is the project component, said Kegan. To apply to the program, scholars submit a proposal for a project that is designed to reform a component of medical education in their institution. For an application to be considered, the scholar's institution must acknowledge that this project is acceptable and fits into the school's philosophy and that the scholar is in a position to make the proposed change. The Macy program provides a laboratory of sorts in which the project can be developed, honed, and tested. Having come to the Macy program with support from their dean or a similar figure in their institution, physicians can return to implement this educational project.

여러 사람을 보낸 대학도 있다.

Armstrong said that some institutions that have sent a number of people to the Macy program, such as the Mayo Clinic in Rochester, Minn, help physicians who are interested in applying to the program define and shape projects that are consistent with changes the institution would like to carry out the following year.

프로젝트는 의학교육의 여러 분야를 포괄하고 있다.

• Case Western Reserve School of Medicine에서 온 Terry Wolpaw의 프로젝트 소개 : 

Projects focus on a wide range of issues in medical education. Terry Wolpaw, MD, associate professor of medicine at Case Western Reserve School of Medicine, Cleveland, Ohio, who attended the program this year, developed a project that sought to change the way students and residents are taught in an office setting. Traditionally, once a patient has assented to being examined by a student or resident, the student examines the patient, takes a history, and then goes into the hall to report to the instructor. The instructor takes over at this point, interpreting the student's observations. Wolpaw's idea is to engage students more fully in the learning process so they do more than just report details. Instead, they become actively engaged in presenting their thoughts about the patient to the preceptor while the preceptor becomes a facilitator who guides the student's thinking.

• 이러한 새로운 접근법을 교육하기 위해서 Wolpaw는 Macy group의 도움을 받아서 새로운 모델을 개발하였음.
  

To teach this new approach to students and faculty, Wolpaw developed a model, which her Macy group helped her refine, that allows learners and teachers to act out their roles in traditional and novel learning scenarios while being videotaped for later comparison.

하버드 의과대학의 Kitt Shaffer가 개발한 프로그램

• A project developed by Kitt Shaffer, MD, PhD, associate professor of radiology at Harvard Medical School, focused on changes occurring in radiology—namely, the conversion from film-based to digital imaging with its attendant work flow and clinical implications. As a Macy scholar in 1999, Shaffer sought to find a means educators could use to revise teaching methods in radiology to reflect this shift. She developed surveys to gather information about "filmless" education methods in use around the country.
• As a result of this work, Shaffer has incorporated digital teaching methods into her clerkship and has designed computerized digital examinations for her students. In addition, instructors at Harvard are now completely revising the teaching of radiology in classes on anatomy this year, converting to a "filmless" teaching program that uses images on the Web to replace prior tutorials using films.

커뮤니티 구축

BUILDING COMMUNITY

프로그램의 중요한 강조점 중 하나는 전 세계 의학교육자들의 커뮤니티를 만드는 것이다.

An important emphasis of the Macy program, Armstrong said, is building a community of medical educators around the world. Educators often feel lonely in their home institutions, she said. "The medical schools have been great at getting communities of researchers and communities of clinicians together, but where do physicians go when they want to talk about how to build a course in medical education?"

이를 위해서 여러 노력을 했음.

To address this need, Armstrong and other Macy faculty have worked to foster an ongoing community that provides advice, support, and encouragement to physician-educators who are committed to bringing about improvements. The idea is that once someone has taken this course—and there are now more than 700 alumni—they will have many ways to remain in contact with program colleagues, from on-line mechanisms and newsletters to a standing invitation to return to the Macy program as a leader of a small group to work with and mentor a new group of physician educators.

젖은 강아지 효과("wet dog" effect)를 노리는데, 이는 젖은 강아지처럼 신나서 온 열정을 다해 몸을 터는 것을 말한다. 자신의 기관에 있는 사람들에게 영향을 주는 것을 노리는 것이다. 또한 이 프로그램은 기존에 참가자를 보낸 기관에 우선권을 준다.

Kegan said the Macy program, like many other continuing professional educational programs, can create a "wet dog" effect, in which one person from an institution attends a program and comes back "like a wet dog, excited and shaking with enthusiasm," an exuberance that can be off-putting to stay-at-home colleagues. This effect is mitigated by inviting several people from an institution instead of one individual at a time, he said. The program also gives priority to applicants from institutions that have already sent participants, to encourage building a team over time.

어떤 alumni는 Macy program에서 교육을 하고 있다.

Some alumni scholars, such as Paul O'Neill, MD, professor of medical education at the University of Manchester, England, now teach in the Macy program. O'Neill said he comes back every year not just to instruct but also to sit in on the courses. "Each year is different, each year a new group of scholars attends and new sessions are introduced," he said. O'Neill has also attended the Macy program for leaders in medical education, and he is running a leadership course in medical education—a sort of "spin-off for British educators"—this summer in the United Kingdom.

성찰, 연결

REFLECTION, RECONNECTION

Alumni scholar Lindsey Henson, MD, PhD, senior associate dean for medical education at University of Rochester Medical Center, NY, who plans to teach at the United Kingdom meeting, also teaches in the Macy program. She said she values the opportunity to return each year to Boston because it offers time for reflection as well as a place to reconnect with friends and interact with experts who can help her learn to resolve issues and move things forward at her institution.

"Almost anyone who's been through the program," said Henson, "will say that it gets your brain moving in ways it didn't move before." She noted that the wide range of material presented can initially be a bit overwhelming, but as time goes by physician-educators find it a ready reference for new situations they may face in the years ahead.

Such enthusiasm and dedication to the goals of the program are gratifying to the codirectors. Armstrong said, "I'm pleased with the fact that we've not only offered new information to these people, but also have engendered this spirit that one can accomplish more as a team." And Kegan noted the privilege he feels to be working with "some of the best people in medicine, people with big hearts who are still trying to stay connected with the original ideals that brought them into medicine in the first place and to preserve those ideals in their students."

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JAMA. 2002 Jun 26;287(24):3197-9.

Harvard Macy Institute helps physicians become better educators and change agents.

Friedrich MJ.

PMID:

 

12076200

 

[PubMed - indexed for MEDLINE]