Empowering Educators: Exploring the Impact of the MEHPE Program

Podcast Transcript

Dr. James K. Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano:

Hello, welcome to today's episode of MedEd Thread, an Education Institute podcast exploring the Master of Education in Health Professions Education degree program. I'm your host, Dr. Tony Tizzano, Director of Student and Lerner Health here at Cleveland Clinic in Cleveland, Ohio. Today, I'm very pleased to have Dr. Wendy Green, Associate Professor at Cleveland State University, here to join us. Wendy, welcome to the podcast.

Dr. Wendy Green:

Thank you, Tony, happy to be here.

Dr. Tony Tizzano:

So, in today's segment, we will explore the Master of Education Health Professions degree program, a collaboration between Cleveland Clinic and the Cleveland State University Levin College of Public Affairs and Education, designed for health professionals who have current roles and responsibility in education. So, if you could get us started, Wendy, by just telling us a little bit about yourself, either what your interests are, what brought you to Cleveland, and your role here in this collaboration.

Dr. Wendy Green:

Sure, thank you, Tony, for the invitation, and I'm happy to be here, talking about our program as well. So, I had of variety of experiences prior to coming to Cleveland State and prior to entering my PhD program. I worked in social services and educational roles, including the program director for the adult education program for the Seminole tribe of Florida. I was also an educator and/ social worker for the Broward County Jail system for a while.

And then I decided I was going to complete my PhD. I went to the University of Pennsylvania, and my focus was on teaching, learning, and curriculum, specializing in adult context. I had my first opportunity to work in medical education as a graduate student at University of Pennsylvania, and I came to Cleveland State in 2014, in part to take on this role in our Masters of Education in Health Professions Education, which I will refer to as MEHPE here on in.

Dr. Tony Tizzano:

Excellent, because it's a mouthful. Well, so you bring really, a really broad experience. And I can't imagine that in many ways that hasn't helped you along the way. So, kind of try to help, for our audience, frame the mission of the Master of Education in Health Professions Education program, MEHPE.

Dr. Wendy Green:

Sure. So, we think a lot of people come into adult education in happenstance ways. So, people who are really good at their professional roles, for example, they're an excellent physician, they're an excellent nurse, they're an excellent salesperson or engineer, oftentimes get tapped to move into educational roles. And so, they may be good at their profession, but they're not well versed in education. And so I think a lot of times, when a person is in those roles, it becomes apparent that, you know, maybe you could use a little more formal training in education so you have a better sense of what you're doing and whether it was effective or not.

And so, our program is designed for people who are currently in educational roles in healthcare. It is a partnership with the Cleveland Clinic, but our students come from a variety of healthcare organizations. And what we're doing, what our mission of the program is, is to provide healthcare professionals who currently have educational roles with a background in ed theory and structural methods, theories of assessment, program evaluation and program planning, and to give them more of a formal background in education.

Dr. Tony Tizzano:

So, lots of parts and pieces, and, you know, you used to hear people say, "Well, you can always teach." But you know you can't always teach. And I think if there's an area that I feel like many of the areas in sciences, education has really begun to look and reflect on itself, "How can we be better? How to people learn?" People learn differently, and to explore all those various venues, I think, is making a big difference. So, when was the MEHPE program first conceived and, and what was the initial purpose?

Dr. Wendy Green:

So, I wasn't at Cleveland State at the time, so it's my understanding that the conception and development of the program took place over about a 10-year period. And my colleague Cathy Hansman, who has since retired, and Ellen Hull, who was a physician here at the clinic were sort of the co-creators or co-designers of this program. Our first cohort was in 2013, graduated in 2015. That was our pilot cohort, and I wasn't actually a part of that cohort. I came in, in 2014 and started with my first cohort in 2015. I was actually brought to CSU specifically to work in this program, in addition to the adult education program, and we also have a doctoral program that I work in. So, I work in three programs, but this is my main focus.

Dr. Tony Tizzano:

Yeah, I have the sense they looked at your broad background and thinking, "This is a great fit." So, one of the benchmarks I always feel of a successful organization is the extent to which it provides growth and pipeline development for its members in order to develop them and sustain them and propel the organization's success. How is this sort of educational mission served by the MEHPE program?

Dr. Wendy Green:

That's a very interesting question, and I think it's multifaceted, but I will say that we know that in order to facilitate organizational change that there has to be critical mass of people working towards that change. Our program develops learners as educators and provides foundational knowledge and frameworks to understand and to solve learning problems or learning questions. And so, our graduates return to workspaces with new ideas and tools and can work as change agents to shift how education is viewed and executed at places like the Cleveland Clinic.

However, we know that organizational culture and professional culture influences how we perceive education and the appropriate approaches, so what are some of the best ways of teaching, and that's influenced by our own socialization within our professional spheres. So, if you learn something new, innovative in MEHPE, and you go back to your department and you say, "Well, I'm gonna implement this," and you get pushback either from your leadership or your peers, it's going to be a heavy lift to do that. So, I think it's important to keep that in mind.

The other thing I was thinking about is when MEHPE graduates return to the workplace, I think it's important for leaders in their departments or leaders in education more broadly to check in with them and to say, "Okay, now that you've finished this two-year program, where do you see yourself going from here?" And try to map out a professional development role that moves them closer towards, you know, what they want to do. I think a lot of times, organizations ignore this aspect of it. "So, you've got your degree, good. You know, we're gonna celebrate you," but then there's no follow-up to say like, "What can you do moving forward with this role?" And I was thinking about this as I was preparing for this podcast that that's an important piece that I think a lot of organizations can overlook.

Dr. Tony Tizzano:

Yeah, I think that's a great point, and I know that, you know, we've been benefactors of your program, the clinic specifically. Our educations to communications director, Cleveland Clinic's Designated Officer Graduate Medical Education, Cleveland Clinic Lerner Colleges of Medicine Director of Student Affairs, all of these individuals have been through your program and to our benefit.

Dr. Wendy Green:

Our graduates are also contributing to the scholarship around education and health professions education specifically. And so, one of the things I try to do with graduates is encourage them to engage in scholarship and writing. I had two alums come to a conference with me last week and present work on MEHPE. When I have opportunities to write that are focused on health professions education, oftentimes, I'll invite current or former students to participate in the writing process. So, I haven't counted it up, but certainly, I have at least three, probably four publications that are co-written with graduates of the program. So not only are they learning how to be better educators, but they're also learning how to be better scholars and disseminators of knowledge and skills around HPE.

Dr. Tony Tizzano:

Wendy, that's great because not only are they looking at education, but they're also in the workforce. So, they kind of have their finger, I think, on the pulse of what's happening at that moment and how perhaps we can do better in educating those individuals in the organization, and as you know, it's one of the main pillars of the Cleveland Clinic is education of those who serve. What are some of the skills and areas that are addressed and developed over the course of the program?

Dr. Wendy Green:

Sure, so our program focuses on the development of skills necessary to be a successful educator, and our courses focus on, for example, instructional methods, program evaluation, program planning, assessment methods, using technology in education. However, I want to touch on the very first class that learners take with me is one that involves learning theories, and how do we apply learning theories to our practice? How do we design learning experiences grounded in particular practices? So, we learn the skills, or we engage in the development of skills, but we also engage in understanding and application of theory.

And I would say in addition to those goals, my own aim is to have learners re-envision how they understand education. So, in essence, I want learners in the program to expand how they would use instruction, to expand how they would evaluate learning, and to develop their own expansive view of the processes of education and understand that there are a myriad of ways to teach. And some of these approaches may seem foreign and not applicable, particularly for learners who have come through more didactic or passive learning environments, which frankly, is a lot of us who've come through higher education.

And then the other thing that I want them to do is to develop their own philosophy of education based on their understanding of adult education theory and adult education principles and how it informs or intersects with their profession because that's going to look different, depending on who's in the classroom. And so that's a bit of a challenge, but it's also what makes the program interesting is because the application of theoretical approaches to teaching and learning will look different for one person than it looks for another person.

So the challenge for the learner and also, I would argue the challenge for the instructor is to find ways and opportunities for learners to deconstruct these ideas and then figure out how they would apply to their own practice and to get feedback from others in the space who are either in similar roles or who are not in similar roles, but can also provide insight into, you know, the efficacy of some of these practices.

Dr. Tony Tizzano:

Yeah, this is great. This is the teasing apart of these concepts that, you know, if I ever knew about them, they went right over my head, but it's clear to me now. So, are there some evidence-based teaching methods that broaden the way we think about effective education?

Dr. Wendy Green:

Sure, so, you know, I had class last night, and I had a discussion with my current cohort of students about learning theories. And there are a number of learning theories that are applicable to educational practice. And then if we add adult learning theories on top of it, then we have a large selection to choose from. Some of the theories have more, let's say robust investigation into the efficacy of and appropriateness of the theory. And so, one of the things I've noticed in evaluation of health education programming is when people are trying to understand the efficacy of HPE, oftentimes, that's done by doing a pretest and doing a post-test.

And if the post-test is higher than the pretest, then it was successful. And what I'm interested in is the middle part. What's the process? So, if we do an educational intervention, how do we understand whether it's been effective or not? It could be effective, but if we don't know why it's effective, then how do we replicate it? How do we build on the successful aspects of it? And so, understanding learning theory can help us select teaching approaches that are more likely to facilitate the outcome that you're looking for.

To reflect on my discussion last night, we were talking about transformational learning theory, which is focused on the transformation of habits of mind, worldviews. And that requires different approaches to teaching and learning than if you're trying to teach somebody how to play tennis or teach somebody how to, you know, stitch a wound closed, for example. And so, if I'm trying to change values or perspectives, then the methods I use will look different.

And so having an understanding that if I want you to reconsider your core beliefs about something, then having a 45-minute lecture and an evaluation of that lecture is probably not the best way to try and facilitate that change. So, if we can have informed educators in spaces who understand that there are better ways of teaching something, then they may be more likely to get the outcomes that they were looking for.

Dr. Tony Tizzano:

Yeah, I like that. And I, I get the sense that taking it another step further that we, this may even impact the manner in which we provide care to our patients. So, you know, how can we help to educate ourselves as caregivers about the, you know, systemic factors that impact social determinants of health, healthcare access and outcomes for, you know, an increasingly diverse population?

Dr. Wendy Green:

That's a really interesting question, Tony, and in my experience with the MEHPE program, one of the questions I ask in the beginning, and I don't know if I was focused on this when I first started, but now I ask the question of how do you connect your practice to social justice? And oftentimes, people are not able to link specific ways that their practice does link to social justice. Adult education, our discipline, spans basically every area in which adults are taught, so that could be higher education. It could be adult basic education, GED, health professions education, community-based, education that goes on in libraries and whatnot, workplace education, vocational education.

And so not every aspect of adult education is tied to social justice, but social justice is a core value in much of adult education. And so, I started asking students like, "How do you relate your role to social justice? In addition to that, how do we understand in equity in healthcare and unequal health outcomes?" And so, one of the things I've been thinking about more specifically is how to incorporate the opportunity to learn more about these questions. And so, we have one course, which is program planning, and it's a skill-based course. In the fall of 2020, after we've, you know, become aware of unequal outcomes in relation to COVID, we've seen a lot of issues around race in this country.

We've seen people experience COVID differently as a result of racial identities, right? So, I started asking students to foreground, so the program planning has a semester-long group project, and originally, I let them pick a project in whatever area they wanted to as long as it was applicable to their work. And I changed it, and I said they had to pick a program that was embedded in an identified healthcare inequity. And along with that, they had to expand their analysis, so to look at unequal outcomes, for example, from an individual perspective, which I would argue is what we usually do when we're trying to understand social determinants of health.

We tend to assign responsibility to the individual, but also to look at what we do organizationally, like how does our organization inadvertently have barriers up for access? And how do structural issues impact social determinants of health? And an easy example in the United States is having healthcare tied to employment. So that is an economic factor that can impede somebody's access to healthcare. And so I grew up in Canada, and we don't have healthcare tied to employment. And arguably, I would say that we view healthcare more as a human right versus as something you can access as a result of employment or our other ways.

That would be an example of a structural issue that impacts a person's ability to access healthcare. And another example would be systemic racism and how that impacts, first of all, the health of a community, and then also how it impacts an individual's entrance into healthcare, knowing that most people enter into healthcare spaces with the experiences of their families, of their extended families, of their communities with them, right?

Dr. Tony Tizzano:

Yeah, these are just fabulous areas that we could talk about all day. So, I get the whole need for awareness around the topic of social justice and access and so forth. And I think that's an easy enough thing during a talk for someone to say, "Oh, yeah, that resonates with me." But how do you develop that critical lens or, or a sort of critical consciousness to analyze those problems that are embedded in these, you know, unequal societal structures?

Dr. Wendy Green:

That's a good question, Tony, and there's a physician at the University of Toronto that has done a lot of work on taking Paulo Freire's concept of critical consciousness and applying it to healthcare. And first of all, we need to have an awareness that these problems exist within our society, exist within our communities, and exist within our professional spaces. And a lot of the times, people have an unawareness or they can identify the problem pretty broadly, but they can't identify specifics.

Like, what are we doing in this example at the Cleveland Clinic? Or what are we doing at Cleveland State that promotes the development of critical consciousness? And so, a lot of it is developing critical lenses of analyses. So generally, there are meta narratives as to why things happen, and these narratives look different in different countries, right? But in the United States, I think there are some meta narratives in relation to, you know, why people have unequal outcomes, whether it's, you know, in relation to poverty, whether it's in relation to healthcare.

And I think the development of critical consciousness occurs by having a critical lens to analyze these problems. And as educators, both in healthcare but also in higher education, I think that we can be the facilitators of the development of this kind of critical analysis on issues.

Dr. Tony Tizzano:

Boy, that's outstanding. I mean, because that's where the rubber meets the road, I think, and so in consideration of all these efforts, are we seeing a measurable impact on the quality of patient care?

Dr. Wendy Green:

Well, that's a very interesting question. I thought about that and how we measure effectiveness. Now there are some program evaluation models out there that espouse the ability to measure training or educational programs and ROI, return on investment for organizations. And I argue that that is difficult to do and in some ways, unrealistic to do. So, if we look at the graduation of MEHPE students, and we'll look at the Cleveland Clinic specifically. Let's say we have 50 graduates over the course of five years. And these graduates are going back into their systems. So, there's so many variables in trying to understand an organizational impact based on 50 people within, what's the employee population of the Cleveland Clinic?

Dr. Tony Tizzano:

75,000 to 80,000.

Dr. Wendy Green:

Right. So, you're looking at 50 people who are coming into systems that may or may not be open to educational change. And I would argue that there's too much space between one to the other. So there's too much space between these 50 graduates, and is patient care improved at the Cleveland Clinic?

Dr. Tony Tizzano:

Yes.

Dr. Wendy Green:

So, we can think about that evaluation, but what I will add, Tony, is we have had a couple of departments at the Cleveland Clinic that have had students in our program almost every year. And there's one where we have their sixth student. Now, if you have six students that are coming out of a specific department and, you know, then we might ask ourselves, do we have critical mass in that department to make changes within the educational system? And then, does that affect how that department engages in patient care? Now, I think that's a more reasonable question, and I think that question can be answered. I'm using, like, quantitative and qualitative methods, but I think it's easier to answer a question versus trying to understand the impact on the entire organization.

Dr. Tony Tizzano:

Makes perfect sense, something more than a drop into a big bucket of water.

Dr. Wendy Green:

Right.

Dr. Tony Tizzano:

So, I get that. So, as we look at the MEHPE program, you know, what's the next step? Where does one go from there? They've done that. It's helped them in many ways. Is there another step beyond that?

Dr. Wendy Green:

Yes, so I have been enthusiastically promoting entrance into our doctoral programs for graduates who are, you know, very enthusiastic about developing themselves educationally. I think that there is an excellent opportunity for people who are, you know, trained as healthcare practitioners, to further their educational development through doctoral work, and yeah, enter the field of scholarship and research in a more formalized way because honestly, people with both skillsets, whether it's a physician and I mean, we see physicians with PhDs in epidemiology, let's say.

And I think that we're starting to see more physicians with PhDs in education or at least formal training in education, so maybe they have a master's degree. But yeah, I've been encouraging them, some of my learners and graduates to think about PhDs if they're interested in extending their learning as an opportunity to do that. I don't want to say Cleveland State is the only program.

There are other programs that are offered in different formats, which would be more, I guess, interesting or applicable to people that work full-time, and then there are the programs that require full-time study, which would mean, you know, quitting your job and actually working onsite. So, we have a program that is focused on urban education, and our section of that program is adult continuing and higher education. And currently, three of my advisees work in healthcare.

Dr. Tony Tizzano:

Well, we always look at it and think, "Oh, you know, get an MBA, and we'll be able to manage better. "But, you know, getting the master's of education or a PhD in education, perhaps that is a better way of instilling information at the foundation for all of our caregivers that instead of having management from top-down, you have educated the population better. There just seems to be something in all of that. Well, Wendy, are there other comments or questions that I didn't pursue that you feel are important for our listeners to know?

Dr. Wendy Green:

I do. So, there's a couple of things I was thinking about. My focus with learners is really on perspective transformation, so to get them to think about their role within their organizations and also their role within the learner populations that they work with. My practice is grounded in constructivism, which basically means that we co-construct knowledge as a learning group. And a lot of our activities are focused on making meaning. So, when we have new concepts or new theories that are introduced, that we as a group discuss, unpack, think about how we apply it to our own practice.

And part of the challenge is encouraging learners to be okay with ambiguity, right? So, we tend to do what we see, right? So, we grew up in higher education where we sat in lectures almost 100 percent of the time. And so, we tend to do that because that's what we have learned through social learning, right? This is what we've learned through observation. And so, if we are going to take different approaches to teaching and learning, I would argue we have to be okay with ambiguity, and we have to be okay with things failing, right? So, when I try a new approach sometimes, sometimes it, it doesn't work, or students don't understand what I was trying to do.

And that's a space for critical reflection. The other thing I wanted to say about didactics is when you come into a classroom and you lecture for 45 minutes, and maybe you have, like, five minutes of Q&A, you really control the space, right? So, there isn't a lot of opportunity for questioning. But if you have more of a discussion-based or a seminar-based class where people are asking and critically examining context, there is the opportunity for that person or those students to come back and say, you know, "We don't really see the relevance of this."

And so that opens up the opportunity to have a larger discussion about why or why not, or to have you as the educator think, "Okay, so they're not understanding the connection between this concept and their practice. Is it because they're just starting, or is it because I haven't addressed it in ways that have encouraged or provided the space for the connection?" And that's a very different form of teaching, so you have to be okay with ambiguity, with potentially failing, with students saying to you.

Dr. Tony Tizzano:

Questioning.

Dr. Wendy Green:

Yes, exactly.

Dr. Tony Tizzano:

Yeah, exactly.

Dr. Wendy Green:

Exactly. So, so that's, that's one thing that I try to remind myself and also remind others.

Dr. Tony Tizzano:

But as you say that it just sounds like there's an opportunity for impactfulness in education that might not have happened had you not had the opportunity along the way to ask those questions and then to address them.

Dr. Wendy Green:

Mm-hmm. I want to role model them. So, we also, want to role model what we want to see students because remember, if learners view in part through observation, then we want to make sure that we are role modeling approaches that we think we would like to see our learners implement.

Dr. Tony Tizzano:

Yeah. It's all great stuff. Well, Wendy, thank you so much. I think this has been a very fascinating and thought-provoking episode of MedEd Thread. To our listeners, thank you very much for joining, and we look forward to seeing you on our next podcast. Have a wonderful day.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.