Teaching the Teachers

How NYU Grossman School of Medicine is Reimaging Teaching and Learning

Dr. Michael Poles '92, Res. 96, co-director of NYU Grossman School of Medicine's Educator Community within the IIME

As co-director of NYU Grossman School of Medicine’s Educator Community within the Institute for Innovations in Medical Education (IIME), Michael Poles ’92, Res. ’96, PhD, is uniquely positioned to support his fellow faculty and inspire them to embrace, and even help dream up, technology that enhances teaching and learning. He has been actively involved in curriculum reform and understands that the NYU Grossman School of Medicine’s curriculum and education methods must respond to and help shape changing times. Dr. Poles is also assistant dean for medical education in the preclinical sciences; associate professor of medicine and of pathology, specializing in gastroenterology; and a popular teacher. He has received medical school awards for both basic science and clinical teaching, including VA Teacher of the Year in 2010 and Gastroenterology Teacher of the Year five times. Grapevine’s Deborah Schupack recently met with him to learn more about how faculty are harnessing technology to innovate in education.

Q. When the newly formed IIME put out a call for faculty partners, you were one of the first to reply.  What was your interest?

We deliver the vast majority of our education in the classroom, yet there was a yearning to be able to deliver more content in novel and better ways. With the immensity of medical information to teach students, it is increasingly difficult to impart to them all of the facts that they need to know as physicians. In addition, medical knowledge evolves, which makes it more important to teach them to be flexible thinkers, able to adapt to the mercurial nature of science. I became particularly interested in finding an asynchronous way of delivering key information that could supplement classroom teaching, and I turned to IIME and its precursor, the Division of Educational Informatics, to find or develop e-learning modules for this purpose.

We could facilitate more active learning by “flipping the classroom”—having students access foundational content at home, then engage in group discussions at a higher level in class with an instructor. This change in format promotes a deeper understanding.

We believe it is important to get faculty comfortable and engaged in the process of pedagogical and curricular innovation. Most of our faculty themselves have experienced the traditional, didactic method of teaching. They sat in a classroom, people spoke to them about a medical topic, they took notes, and they studied from those notes. Now, we are asking faculty to consider other ways of delivering that content, potentially involving the use of home grown or outside resources. We are not looking to replace faculty—that’s very important to understand. Our faculty are experts in their field and can deliver content better than any outside resource. Obviously, the primary way our students will continue to learn is from our faculty. But we can also help them by delivering top-quality resources outside the classroom, so the students enter the room with a deeper level of understanding—and we can take our education to the next level.

Q. Are the faculty experiencing a culture shift?

The best teachers are typically the best learners, who understand that their own education should be a continuous process. As committed lifelong learners, they are well positioned to promote that drive within our students. The best teachers also want to help others improve their teaching ability.

We developed the NYU Grossman School of Medicine Educator Community to bring these inspirational faculty together to work collaboratively, push us to imagine new ways forward in education, and promote best practices. You learn about what’s being developed by others within the community to improve education and you think, “Wow, that’s amazing. I can definitely use that to teach my students or trainees.”

Our faculty have all these ambitious ideas for teaching and learning that they want to bring to life. If they tap into the Educator Community, we can help them bring an amazing idea to fruition.

Q. How are the IIME and the Educator Community using evidence-based innovations to continually improve teaching and learning?

We believe that providing individualized performance data is the key to enhancing learner performance in both undergraduate and graduate medical education [GME], in the same way that it is being used to improve the performance of practicing physicians. In GME, we are now increasing our focus on collation of clinical practice data and delivery of that data back to the trainee to identify, in real time, where gaps in knowledge or practice exist, so that we may react more rapidly in performance improvement. The same way that there’s a continuous quality improvement, or CQI, process for everything else in the institution, there’s a CQI process for students, young doctors, and even faculty educators to help them constantly improve.

I will provide an example from my specialty, gastroenterology. When we perform colorectal cancer screening using colonoscopy, it is vital that we identify and remove adenomatous colon polyps that have the potential to develop into a cancer. The data suggests that endoscopists should identify these polyps in approximately 25 to 35 percent of all screening exams. In this new world, we keep track of every fellow’s adenomatous polyp detection rate—meaning, in what percentage of patients does the fellow identify an adenomatous polyp that can potentially develop into a cancer? We’ve collected this data for 10 years now, so every fellow knows how many polyps they’re identifying—essentially, how many cancers they’re preventing—compared with the last 10 years’ worth of fellows. In real time, they can explore this, and other performance data, against expectations and against anonymized data from their peers. If they’re far lower than the norm, we can intervene immediately and identify specific steps to improve their performance and make sure they are meeting benchmarks.

Just as we are using just-in-time feedback for students and trainees to improve their performance, we’ve started just-in-time evaluation of lecturers in undergraduate medical education. Before this new initiative, faculty wouldn’t get performance feedback until months after their teaching was provided, when it might no longer be relevant. Now we can deliver that performance data in real time. We can provide lecturers feedback before their next lecture in a module, so they can already be thinking about how they can deliver content better and therefore do a better job at teaching the physicians of tomorrow.

The best teachers are typically the best learners, who understand that their own education should be a continuous process. As committed lifelong learners, they are well positioned to promote that drive within our students.

Dr. Michael Poles

Q. What are you hearing from faculty about the feedback?

We hear that for many, this is the first time they’ve gotten specific, actionable feedback, and they are incredibly happy about it. Some are a little daunted by the process, since they are not used to being evaluated immediately after they have completed a task. Still, the best teachers are always seeking to improve, and, just as we use feedback to improve our students’ and trainees’ performance, we have to be open to feedback as teachers—because we should all be involved in practice-based learning and improvement.

Q. Your son, Jordan, is a medical student here on the Accelerated Three-Year MD Pathway in internal medicine. How do innovation and technology play a role in his medical school experience?

Like most of his classmates, he has been steeped in technology for his entire life. Anything that we can envision, this generation of students can bring to life using technology. For example, during his preclinical medical education, Jordan felt that he and his classmates could use more opportunities to reason through difficult clinical cases and grow their clinical reasoning skills. So he developed an app that gives learners access to a communal library of clinical scenarios to help them advance their abilities in a low-stakes learning environment. He’s now working on a second app to help learners better understand arterial blood gas analysis and gain more confidence in their interpretation.

Today’s students are full of amazing ideas, and more importantly, they know how to harness technology to deliver those ideas. We get the best medical students in the world, and we must continue to advance how we educate them.

Q. You’ve been at NYU Langone for your whole career, except for a five-year stint at UCLA to obtain your PhD. What keeps you here?

It’s the NYU Langone vortex. You can only stay away for so long before you get drawn back. When I walked back into Bellevue after five years in LA, all the love that I had for this institution came flooding back. It’s not just a place where you come to work and care for patients. It really is home, where everyone feels like family.

Taking care of patients in the modern medical environment can be difficult. But it’s that much easier and more rewarding when you know you can count on everyone around you to be committed to excellence and committed to creating a comfortable, supportive environment that allows you to do your best work. That is what epitomizes this place, and I couldn’t imagine being anywhere else.

Written by Deborah Schupack