Dr. Ryan Palmer is an assistant professor of Family Medicine as well as the Director of Curriculum Evaluation and Development for the Department of Family Medicine at Oregon Health & Science University. He is also currently piloting a program called the Transition to Clinical Medicine Community Mentorship Program at the American University of the Caribbean. To learn more about the pilot click here.
Can you describe your background and how you got interested in Medical Education?
My background is actually in theatre, believe it or not! I hold an MFA in Acting from the Theatre School at DePaul University. A long time ago when I was a starving artist in Chicago, a grad school friend told me about a gig she had playing a patient for medical students at the University of Chicago. I looked into it and started doing standardized patient work there and at other medical schools around Chicago. I really liked working with medical students, and when I decided to transition my career into education, I looked into ways to continue working in medical education. I was fortunate enough to come to Oregon Health Science University as a course administrator and then continued on as a faculty member after gaining my doctorate. So my path has been circuitous to say the least!
How important is this sense of community in the development of a medical school student?
I think it is inherent to medical education and any education, really. I subscribe to the learning theory that posits people learn best in social contexts. Children are the best example of this but then the traditional model of education tends to downplay the social aspect of learning and focus on the individual. But that desire to learn with and from others is always there. It also provides a support network that is so important, especially when going through rigorous, high stakes educational programs. My dissertation training was done in a cohort model, and I drew so much from my peers, both in the creation and sharing of knowledge in class and while working on projects, and then the support they provided me and I in turn provided them when things got tough. Medical education is intensely rigorous and challenging, so I think having a sense of community is crucial to success.
What excites you about this program that AUC has initiated?
It excites me that this is giving AUC students, who may have felt cut off from their peers during clinical training, an opportunity to meaningfully connect in ways that they didn’t have before. From my research work that informs the program, I feel confident that we’re giving students more than just a chance to video chat, we’re actually giving them a chance to connect robustly as professionals through authentic tasks that allow them to create and share knowledge. Many institutions in higher education have distance education programs, but I feel the community emphasis of this program is unique. Being a part of that is incredibly satisfying to me as a medical educator.
What are some major factors you looked into in the development of this program for AUC?
The biggest factor I looked into was the buy in of the AUC leadership, namely Dean Heidi Chumley. Her vision for bringing clinical students together with the assistance of the clinical fellows was there before I arrived, but there was still uncertainty around how it was going to happen. I had finished my dissertation that focused on virtual community formation not long before I started working with AUC, and I instantly saw some of that work as applicable to AUC. I knew it was going to take a lot of work and I would need a fair amount of flexibility in implementing the program. Knowing that I had the support of the Dean was really important to me. Dean Chumley gave me full support and directly helped develop the early concepts of the Transition to Clinical Medicine Community Mentorship Program. Senior Associate Dean Julie Taylor joined AUC not long after and has been equally supportive. The success of the TCM Community Mentorship Program is a testament to their leadership. The next biggest factor was the Clinical Fellows. This program literally could not function without them. I’m so impressed by these people. I knew we could make it work when I first met them, and it is their hard work, passion for improving the experience of AUC students, and trust in the TCM Community Mentorship Program vision that also helps make this program successful.
Can you describe the Palmer Method for Delivering Synchronous Online Education on a high-level?
At a high level, it is a specific approach to synchronous online learning that helps foster community formation and professional development among group participants. The ultimate goal is to create an environment where virtual communities of practice emerge.
What successes have you seen thus far?
I think the successful and sustainable implementation of the TCM Community Mentorship program itself is a success. I first met the fellows in early July of 2014, and Dean Chumley wanted the program launched by August 1st. We had to basically launch a brand new program with me based across the country in Portland, Oregon (AUC headquarters are in Coral Gables, Florida) and the fellows spread out all over the US and Canada just one month after we first met! None of the logistics regarding how we were going to operationalize a program that would serve every single AUC student starting their clinical rotations was figured out. But we made it work and launched the program on schedule. There were some bumps for sure, but we made it work again with the support of AUC leadership and staff and the incredible dedication of the Clinical Fellows. Another success is the feedback from students who have gone through the TCM Community Mentorship program who describe feeling supported and getting a lot out of the groups. It is good to know that this program serves many as it is intended and continues to do so more effectively as we use data to make iterative improvements. Finally, hearing the positive effect of the program on the Clinical Fellows themselves is incredibly satisfying. One of our first fellows went on to a residency and really emphasized how being a mentor in this program helped him grow professionally. He actually wanted to keep joining our weekly fellows meetings even after starting residency!
Going forward what would you like to do to improve on what is currently being done at AUC?
Continually tweak the approach of the program so it better achieves its goal of creating communities of practice among the groups. The tendency of the participating students and, to a certain extent the fellows, is to fall into the traditional teacher-student role. But these groups are not a class, they are a community meant to support members in their professional development. The fellows are leaders, but they are also community members. Finding ways to move the groups from the teacher-student model to a community of practice model where the group determines its learning goals and activities is where we want to go. We are getting better feedback data now and have really started to tweak the processes to help these communities grow.
Out of curiosity, if you could start a medical school today, what factors would you look at and how would you go about designing the school’s culture/curriculum? (This can also be viewed as what type of changes you would like to see in Medical Education?)
I would look first and foremost to meeting this mission: How can the medical school and curriculum reliably and accountably produce clinicians who meet the care needs of society? We have a true primary care crisis in the US. The society needs more primary care physicians (it needs all types of primary care clinicians, in fact, but the question specifies medical education so I’ll stick with physicians) and most medical schools need to be more accountable than they have been in the past towards helping to meet that need. I would double down on the mission by tying institutional metrics for success towards how well its graduates are meeting the actual physician workforce needs of society, not just by what residencies they go into but how and where they actually end up practicing. It’s only with this type of data tracking and accountability that medical schools can know if they are truly meeting the real physician workforce needs of society.