Chief Learning Officer - April 2008 - (Page 23) S he can feel her heartbeat quicken and her hands grow clammy as the attending physician turns to her for an explanation of the patient’s symptoms. Only her second day of residency and already she is expected to understand the patient’s ailments, provide possible causes and offer an effective solution to the problem, all while maintaining her composure in front of the bed-ridden patient. All eyes are on her as she describes Mrs. Johnson’s shortness of breath and smoking habits. She grows less nervous with each word, beginning to feel a bit proud of presenting to her peers and superiors during her firstever “rounds” experience. However, her comfort is short-lived: Upon completing her presentation, Lia is unexpectedly peppered with questions from her colleagues about Mrs. Johnson’s family history, diet and demeanor. Caught off guard, Lia promises she will remember to ask next time. Together, the medical team surveys Mrs. Johnson’s array of symptoms, discussing potential diagnoses of lung cancer, emphysema and anxiety. As the junior residents offer possible treatments, medical students, social workers and pharmacists take feverish notes. The attending physician assures Mrs. Johnson the team is working together to understand and treat her condition. As the team moves from the patient room into the sterile hospital hallway, Lia comforts herself with the knowledge that rounds are designed for learning and not as an opportunity to shine before her peers. Like Lia, interns and junior residents across the United States are confronted daily with the daunting task of presenting a patient’s symptoms, diagnosis and treatment plan to a medical team during morning “rounds,” often in front of the patient. Although often nerve-racking for novice doctors, rounds provide an unparalleled opportunity for learning, all while the routine work of patient care is accomplished. In the summer of 2005, Judy Rosenblum, then president of Duke Corporate Education (Duke CE), a unit of Duke University specializing in custom executive education, began to consider the learning environment in teaching hospitals and its transferability to the modern corporation. Parallels between hospitals and corporations — fast-paced technological advances, the rapid and constant influx of new information and regulation, long hours, persistent stress and a strong pressure on employees to perform, compounded by economic pressure and high risk — spurred Rosenblum to gather a task force to dig deeper into the hospital environment. She hypothesized that the learning-at-work model employed by teaching hospitals could provide insight and help in accelerating learning in a corporate setting. In an effort to learn more about the teaching hospital learning model and test its transferability, a team at Duke CE undertook a two-year study of the culture and practices of the country’s best teaching hospitals as recognized by U.S. News & World Report in 2005. Subjects included Mount Sinai Hospital in Manhattan, the Cleveland Clinic, Washington Hospital Center in Washington, D.C., and Johns Hopkins Hospital. Visits to every hospital, combined with the comments of an advisory board comprised of doctors from each of the institutions, yielded an abundance of information on how students and doctors learn, as well as many ideas about how these routines and practices could be transferred to the corporate realm. The Value of Values In each hospital Duke visited, it discovered a robust set of core values guiding teaching and learning. These values form the foundation of each hospital’s learning environment and manifest themselves through unique educational processes and learning methods. First, and perhaps most importantly, teaching and learning are cornerstone values AT A GLANCE of these organizations and are espoused and A Duke Corporate modeled by leaders at every level of the orgaEducation team nizational hierarchy. According to Dr. Charles undertook a two-year Wiener, director of the Osler Medical Training study of the culture Program at Johns Hopkins Hospital, everyone and practices of in the hospital is expected to teach, and all are the country’s best required to learn. In other words, he reflected, teaching hospitals as “The learners are the teachers.” Similarly, recognized by U.S. as one attending physician at Mount Sinai News & World Report. Hospital noted, “The most important thing a Subjects included medical or science student can learn is how to Mount Sinai Hospital continue learning.” in Manhattan, the In America’s best teaching hospitals, good Cleveland Clinic, teaching also is rewarded and established as Washington Hospital an organizational and individual priority. Center in Washington, Often, physician teachers benefit financially D.C., and Johns for their dedication to teaching. However, as Hopkins Hospital. one hospital leader noted, financial compensation for instruction could undermine the value placed on teaching and learning in that environment and so is often considered beside the point. More often, teachers are recognized in the hospital community for their commitment to develop future leaders and lauded by hospital leadership for their efforts. Because teaching and learning are highly valued and expected in top teaching hospitals, assessment and feedback are ubiquitous and continuously employed through various means such as formal testing for medical certification, 30 seconds of real-time feedback after a medical procedure and in-depth portfolios created by medical students to show evidence of skills and knowledge. Even the quality of teaching is assessed and carefully monitored. As a result, top doctors can expect to receive feedback from outside observers on their teaching and facilitation skills, as well as formal training to help improve these skills. As a doctor at the Cleveland Clinic put it, “Feedback is the heart of the system.” Chief Learning Officer • April 2008 • www.clomedia.com 23 http://www.clomedia.com
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