Doing it better

How can we do this better? It’s a question that Dr. Mark Goldszmidt has been asking about medical education and the delivery of patient care for the past 20 years.

It’s also the question central to his program of research. Focused on the interface between clinical work and clinical teaching in team practice settings, Dr. Goldszmidt’s work, and that of his colleagues in the Centre for Education Research & Innovation (CERI), is now on the precipice of being translated into clinical practice. It’s been a long journey that has brought answers, rewards, and, even better for an inquiring mind, more questions.

Dr. Goldszmidt first got involved in medical education during his residency in the late 1990’s. Since that time, he has had the great fortune to interact with some amazing mentors, colleagues and friends. He met his first medical education mentor, Dr. Wayne Weston, following a workshop where he sat down with Dr. Weston to share ideas about how to improve the workshop. 

Little did he know at the time that this would set him on a path that, supported by many others along the way, would lead to the creation of CERI and the identification of a second mentor, Lorelei Lingard, PhD, who would guide him through his PhD into the researcher he has become today.

“I’m now able to ask questions and discover answers about how the health care team functions in the clinical teaching setting with its constant flow of transient learners,” he said.

Specifically, Dr. Goldszmidt is looking at how clinical teams’ oral and written communication practices serve to shape what they reason about and how they share their ideas and plans with all members of the interdisciplinary team they work with and the patients they care for.  

He is also asking questions about how reasoning shifts and changes as members of the team change, and how team membership changes influence learning and disrupt communication patterns. He’s hoping to identify how to bridge the gaps that arise from these constant movements within and across the teams.  

Dr. Goldszmidt’s most recent paper focused on clinical reasoning tasks during admission case review on the inpatient Internal Medicine clinical teaching units at Schulich Medicine & Dentistry. The study looked at what physicians and learners are reasoning about, and when that reasoning actually takes place during the encounter.

Using history taking as an example, Dr. Goldszmidt explained that we often teach our students to collect key components of the history like the medication list and past medical history as though they were just a backdrop to the patient’s current problem. What he is finding however is that each of these components require far more active reasoning than has previously been recognized or taught. 

Dr. Goldszmidt also found that, contrary to popular teaching, the “chief complaint” does not drive the agenda of an encounter for patients with complex problems. Rather, discovering what problems a patient has and how to best support them is an iterative process that takes place throughout the entire encounter with the patient. He further suggests that his study findings have numerous implications for how we teach and assess students on their history taking skills. 

This paper was recently presented by Dr. Goldszmidt at the International Association for Medical Education (AMEE) Conference and was recognized as one of the top research presentations at the conference with an AMEE 2016 research award.  

“It was quite humbling to be recognized at the conference,” said Dr. Goldszmidt. “There was a lot of great research presented, and to be selected is quite validating.”

While the recognition won’t change or shape Dr. Goldszmidt’s research, it did help to create visibility for his work. “My paper, which had literally just come out online ahead of print the week before the conference, went from zero views to about 300 during the week of the Conference,” he said. “And that’s just thanks to the recognition and the follow-up activity in the ‘twitterverse’.”

This research, along with his past work, has also recently led to the creation of an innovation based team whose mandate is to do the knowledge translation necessary for improving interdisciplinary, team based care in the clinical teaching team setting. He’s grateful to Dr. James Calvin, Chair/Chief, Medicine, as well as from his fellow attending physician colleagues on the clinical teaching unit of team 1 at the University Hospital for their support of this work.

His research also has a tie into competency-based medical education (CBME), as it will set the stage for more effective team competence and help to broaden understanding of how individuals contribute to team competence. 

Dr. Goldszmidt feels blessed being at a School and part of a Centre that is so supportive of medical education research that allows researchers like him to thrive and do their part to improve education and clinical practice. 

And, he is indeed not alone. His colleagues Lingard and Dr. Chris Watling have just received one of two 2016 Dean’s Research Initiative Grant awards for their CBME based project that is poised to address the local need for innovation to meet the assessment burden associated with CBME and to also position the School as a national and international leader in the science of CBME assessment.

So as Dr. Goldszmidt and the entire team at CERI continue to ask the question ‘how can we do this better?’, they will do so as the School embarks on the journey to implementing CBME in postgraduate education training and, in the near future, in the undergraduate and continuing professional development education programs.