“It’s not hard to make decisions when you know what your values are” -Roy Disney
You are a #meded leader charged with integrating health professions education into a health system. The new system includes the alignment of nurse practitioner and physician assistant training. How do you construct an education program for maximal resilience?
Health professionals are burning out, learners are burning out, and educational systems are burning out. Key symptoms of burnout include emotional exhaustion, detachment, and a low sense of accomplishment.
There is a debate about what portion of burnout is related to the capacity of the individual to handle stress, a.k.a. the gene code (see Daniel Cabrera’s excellent posts here and here), and what portion is related to the capacity of the system to handle stress, a.k.a. the zip code.
The next four posts in the #meded leadership series will focus on four elements of resilient educational programs that are able to handle system stress. They include:
- Identifying clear values (discussed in this post)
- Maximizing the density of connections
- Maximizing the ability to bend
- Incorporating systematic reflective practice
Explicit Values: The Cornerstone of Resilient Educational Systems
A key to a resilient #meded program is the establishment of clearly defined values explicitly communicated to #meded system stakeholders. This clarity grounds culture, facilitates connections, allows bending to internal and external stimuli, and stimulates systematic reflective practice. In the absence of clearly defined #meded values, external support functions, such as measurement and finance, sometimes fill the void and become the de facto values. They increase system stress and may inadvertently crowd out key de-stressing values such as civility and transparency.
There are several ways to approach the identification and clarification of system values, ideally values that are actionable:
- Sorting: Assemble a group of #meded system stakeholders. Distribute a list of values. Many can be found online. (See here.) Spend reflective time to pare the values down to 10 or so. Discuss. Spend reflective time to further pare the values to three or four.
- Creating: Assemble a group of #meded system stakeholders. Reflect on and discuss the most important values of the #meded system. Repeat two or three times to identify the most important.
- Modeling: Look at the larger context in which your educational system resides, such as your hospital, health system, or medical school. Model the #meded system values based on those that are important in this larger context.
Michelle Noltimier’s first-person case study, which follows, discusses how modeling the values of a larger health system can serve as the foundation for building a resilient educational system.
Case study: Modeling to Identify and Clarify #MedEd System Values
I come from a clinical and operations background working as a nurse, clinical educator, and manager in two Level 1 Trauma Center emergency departments. Both EDs have a rich #meded environment and a culture that appreciats education and training as a way to enrich the clinical environment and strengthen patient care.
Over the past year I began a journey of constructing a resilient educational system for Nurse Practitioners and Physician Assistants using the values of our health system. These values—Integrity, Excellence, Compassion, and Partnership—resonate with our stakeholders and with me personally.
Integrity. Creating trust and establishing relationships with leaders, educators, schools, and trainees throughout our system was a priority. My goal was to understand the needs of our system and the various stakeholders and establish a process to move the work forward. This required listening and honoring my commitments while staying connected through regular communication.
Excellence. Any successful work that is produced is usually the result of a team of many individuals. Creating a resilient educational system for PAs and NPs requires the input of many to deliver the best product. We use our relationships across the system to create and nurture a community of practice to produce excellent outcomes using the talents of all.
Compassion. I feel fortunate to work for a health system where compassion is one of four explicit values. I have been lucky that part of my role involves part-time clinical care to patients in the emergency department as a staff nurse. I am reminded how important is to place the patient and the learner at the center of any #meded design. Compassion for patients and for co-workers makes the work rewarding and provides for deeper connections with our educational and clinical teams.
Partnership. The best part of this work has been the relationships and connections I have made along the way. Partnership moves interactions beyond transactions into relationships built on trust. Partnership takes these relationships and connections to the next level because it requires commitment on both sides and a willingness to work together to achieve meaningful outcomes. I have been amazed at how committed and engaged the people I have met along the way are. I am energized by those around me and am excited for what we can create together.
Tips for Building Resilient #meded Programs
When building educational programs, consider the following:
- Identify three to four clear values for your educational program.
- Incorporate these values in explicit communications, describing the content and people of your #meded system.
- Use these values to bend, reflect, or co-create a revised #meded system to address competing pressures.