Advancing Our Medical Education Environments

Mar 24, 2021

Vice Dean Patrica HoustonVice Dean Patrica Houston Can we deliver a world-class education where learners face disrespect, mistreatment and feel unsupported? Can we prepare tomorrow’s health care professionals in environments where concepts like anti-oppression, social justice and advocacy are not integrated into our curriculum as well as our operational policies and practices? Can we improve the quality of our teaching and teachers without effective teaching evaluation tools?

In short, the answer is no.

Since I undertook my role as Vice Dean of Medical Education last July, I’ve been seeking ways to improve our learning environment across the continuum of medical training in the Temerty Faculty of Medicine. This work was identified as a priority in our Academic Strategic Plan and reinforced by a variety of evaluative tools, including program and teacher evaluations, the AAMC Medical School Graduation Questionnaire, the TFOM ‘Voices’ surveys, and our MD Program and Postgraduate Medical Education accreditation self-studies and external review findings. 

Overall, we provide a very high-quality education to our learners. But, there is much work that must be done to improve the quality of our learning environment. I want to take this opportunity to highlight some of the new steps and strategies we’re implementing to address these issues. 

Learner Experience

In May 2020, Professor Reena Pattani was named Director of Learner Experience. This is a role the spans undergraduate and postgraduate medical education, including oversight of pathways for learners to discuss, disclose and report mistreatment. We have already implemented a revised disclosure and reporting process in the MD Program and we are working to implement it within Postgraduate Medical Education (PGME).

Sadly, mistreatment is prevalent among MD and PGME learners. Twenty-five per cent of medical students and 39 per cent of residents reported being harassed. Forty per cent of medical students and residents reported being discriminated against, with a disproportionate burden reported by equity-deserving groups. The vast majority of these reports occur primarily in clinical sites. 

It’s clear that we need a new framework for addressing these issues across the continuum of medical education. A single one-size-fits-all policy isn’t possible, as our learning environments stretch over multiple institutions in which our learners interact with individuals in different roles, from faculty to peers and fellow learners to administration staff to patients and caregivers. However, a consistent framework will ensure an approach grounded in common guiding principles. It enables case- and context-specific application while supporting process transparency, procedural consistency and due process for all involved.

Evaluating Clinical Teaching

A tremendous amount of work — most notably, Competency by Design — has gone into reimagining how faculty evaluate and provide feedback to learners. It’s time that we put the same effort into reimaging how learners evaluate and provide feedback to faculty. To this end, we have created the Learner Assessment of Clinical Teachers (also known as LACT) tool. All MD and PGME learners will use this tool to evaluate teaching in clinical environments.

The LACT tool was developed with faculty, learner and education scientist input, and it addresses teacher/educator competencies. It will increase the amount and specificity of feedback that a given clinical teacher receives in an academic year. And, it supports the improvement of teacher assessment practices with respect to equity, diversity and inclusivity. We intend to implement this tool for all programs in the next academic year.

Investing in Wellness, Evaluation and Education

As mentioned, our current Academic Strategic Plan identified improving our learning environment as a major priority. That plan — and our Faculty — received groundbreaking support by James and Louise Temerty and the Temerty Foundation last fall. As a result of their generosity, we are now able to establish two new leadership roles devoted to learner wellness, as well as learner assessment and program evaluation. If we believe that the wellness of our learners and their input is important to our success — and we do — we must make investments in these areas.

I believe both of these roles will be transformative through their scholarship and by informing our practice. At the same time, our medical education programs are establishing a new theme lead in social justice, anti-oppression and advocacy. Working collaboratively with other curriculum leaders and learners, this role is responsible for designing, developing, implementing, and evaluating educational elements across all four years of the MD Program. The theme lead will also act as an advisor/consultant to PGME leadership and program directors on anti-oppression and advocacy content development and delivery. 

Change can be difficult and disruptive, but it is necessary. We cannot accept the status quo and we have a duty to our learners — and their future patients — to adapt and innovate to meet their collective needs. We will provide the unprecedented learning experience we all hope to deliver by closely listening to our learners, ensuring professionalism together with respect and civility amongst colleagues, evaluating teaching with greater precision, investing in the supports and resources required — and working collaboratively. 

Patricia Houston
Vice Dean, Medical Education
Temerty Faculty of Medicine
University of Toronto


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