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Interviewer: Two deans and two brand new medical curriculums. They're laughing, just to give you an idea of what this is going to be like. Conversations between colleagues is happening right now at thescoperadio.com at Learn Serve Lead.

We're exploring the innovative ideas shaping the landscape of academic medicine and talking about the experiences that your colleagues are going through facing the challenges and trying to give rise to a better future in academic medicine.

Today, we get the opportunity to listen to a conversation between Dr. Sara Lamb, the Vice Dean of Education at Spencer Fox Eccles School of Medicine at Ï㽶ÊÓƵ of Utah , and Dr. Jenny Christner, the Senior Dean of the School of Medicine and the School of Health Professions at Baylor College of Medicine.

So, as we said before this year, what are the odds we find two deans that had two brand new medical curriculums? Let's start with you, Dr. Christner. What was it like developing and launching this new curriculum?

Dr. Christner: Sure. So we actually started back in 2016, thinking that it would take us normally about three to five years to put on a new curriculum. And then we had little things like COVID come in to wreck things up.

Then we also decided to open up a regional campus, and so we made the intentional decision to wait to launch our new curriculum until our regional campus was ready to go and do both at the same time because that would be even easier and fun, right?

So I think one thing is just how long it takes to actually get something this comprehensive done if you want to do it really well.

Interviewer: Dr. Lamb, it seems like both of you still seem to have some semblance of sanity after doing this thing.

Dr. Lamb: Totally.

Interviewer: Is that your case, as well? And tell us about your experience launching the new curriculum.

Dr. Lamb: Yeah, I'll speak to the sanity part first. I think our movement and decision to change the program was in large part driven by faculty, students, leadership feeling like we could do better. And so it was fairly organic or grassroots that we started these conversations around, "What would we want to be? What would we want to do if we could change anything? And how big of those changes really be?"

And so similarly, I would say we started our conversations incrementally in 2016, as well, but very deliberately probably in 2019. We were gaining a lot of steam and enthusiasm and momentum toward wanting to change without a real, hard deadline where we were going to commit to making this type of change. It was more just figuring out what did we want.

And so when COVID, the pandemic started, it really blew everything up. Everyone felt disrupted. We realized that given the setting of all of this disruption, that's the time to just go for it.

We had just had an LCME site visit during the pandemic, and it had gone well, and decided, "Now is the time," given how long it takes to make change happen. And so really earnestly started to develop the plan from 2020 through 2023.

And I will just say we're always still planning, right? And still thinking about how to continue to make those plans better even though they've only just started.

But the sanity part is . . . I think because people are so excited about what we're doing, that has gotten us over the hump of the "change is hard." And that's still there. There's no question in my mind. The change and the effort and the newness of doing new work in new ways with new people is hard. And it's hard on people.

But seeing what we're working to achieve and the mission that we have reworked and truly said, "This is what we're doing," has energized people. People who've been in med ed for decades are like "I'm so excited," which has been inspirational to me.

So it's gone beyond keeping me sane, and it's giving me more energy and just feeling good about what we're doing.

Dr. Christner: Yep. So I think the similarities are pretty eerie, because we also started probably in earnest around then too. We also had an LCME site visit during the COVID pandemic. And you're totally right, realizing that we totally disrupted everything and we survived and it went okay really gave the impetus to push forward 100%.

And I agree, we did have, initially when we started, some resistance that . . . We knew that we wanted to go to an all active learning sort of curriculum, and so we did have certainly some folks that were like, "But my lectures are the best lectures . . ."

Dr. Lamb: "Are good." Yes.

Dr. Christner: ". . . that have ever been made ever."

Dr. Lamb: And the students love them.

Dr. Christner: One hundred percent. Yeah, you can't beat this. So we did have to do some change management strategies, and then COVID just helped because it's like, "There's change right there and you've got to deal with it."

So I agree with you that the faculty and the students were so excited, just so excited to continue that momentum. And that is definitely what keeps you sane. Especially seeing some of the people who were the most resistant to change and now they want to lead something is just amazing. It's so fun.

Interviewer: So it sounds to me that in this experience, if another school was doing this and they were getting a lot of pushback, just simply starting the process really creates a lot of energy for maybe those people that are pushing back. That sounds like it was both your experiences.

Dr. Lamb: Yeah. And I'll say how you start the process is really important. When it comes to who you're bringing to the table to talk about, "What's giving you pain about your experience right now?" it's students, staff, faculty, education leadership, department chairs, really bringing in the broad spectrum of people so everybody hears it.

They're not just hearing their group's perspective, which opens everyone's minds to seeing, "Well, I know that my work in this program feels this way to me, and I think I'm really good." But hearing from a broader perspective of students can really open your minds to why it should be different. They're telling you that they're not getting to the place that you want them to get to, and then they're like, "Oh, okay, I get it."

So I think that that broad audience is really critical in trying to bring in the what and why are we doing this.

Dr. Christner: We did the same thing. We had a very broad retreat with people, chairs, everybody was there to talk about things. The students are instrumental. At one point, I said, "Let's just turn it over to them." They're so smart, and they're so good, they know what they need, but we also obviously bring the perspective, too, of what they need. And so working together was just key. Our students actually got publication out of this. They were just amazing.

Dr. Lamb: Can I ask you, what sort of reception did bringing the students in to be at the table to . . . Co-production is one of our guiding principles, but we had a little work to do to get to that point. So I'm just curious what your experience was in partnering with those students so deliberately.

Dr. Christner: So I think that there were some faculty that were totally in favor of that, and then other faculty that were definitely skeptical. But I think that it was also picking some of the right students. And when they saw them at work, then they were totally on board.

Dr. Lamb: One of the things that we tried to bring into the discussion was our health system's transformation to really embracing patient-centeredness, patient satisfaction as being an important metric of our success as a health system. And we brought that into our discussion around education, saying, "Actually, being student-centered, not student-driven."

We had to make a really clear distinction between those two things because we had a lot of faculty who perceived us as being overly responsive to students when they felt like they had the expertise, and we were negating their excellence as educators in the equation of building our approach to a new program.

Ultimately, we're getting there. I wouldn't say we're totally there, but we're very staunchly committed to this, "It's a guiding principle that you have to partner with students because they're the ones who are experiencing the education, and we are a school because of our learners. We're not a school just because of us."

Dr. Christner: So we had entire faculty development sessions about student-centeredness and what that means. I mean, it's just pretty crazy. Yes, you have to do that because it doesn't . . . You're right. It doesn't mean the students are driving any . . . It's student-centered. So how are they going to learn best? How are you going to help them learn best?

Talking at them is not . . . We actually know their science to show that that's actually not effective and that there are better ways to learn. And so let's use our science like we use science in every place else in the whole school. Let's use our medical education science to do this right.

Dr. Lamb: What's changed about your program that maybe reflects that student-centered approach?

Dr. Christner: Yeah, that's a great question. I think one is a real focus on transitions. So we had some transition pieces in the curriculum already, but now it's extremely purposeful. So there's a month block transition to medical school, a month block transition to clerkships, a month block transition to residency that is much more intentional and driven by some of their needs.

This is a really kind of funny anecdote. So the first month is about professional identity building and all these transitions. And the students were talking to students at other medical schools and they told my boss, "Other schools, they're learning about the Krebs cycle, but we're not." And he was like, "Are they going to learn about the Krebs cycle?" I'm like, "Yes. Hang on. Yes, we're going to teach that." But they were just so excited to enter the profession in this way.

So that was a huge difference in the curriculum, going from lecture-based to . . . I think we have five lectures in the entire curriculum. So to being all active learning was the next step.

And then this idea, kind of the riff on personalized medicine to personalized education. So really focusing on "How are we going to personalize education for them?" was the other kind of big pillar of the curriculum.

Dr. Lamb: We've similarly incorporated a fifth pillar for our program of professional identity development, which includes a lot of those very similar concepts that you talked about.

Dr. Christner: How are you measuring outcomes for your new curriculum?

Dr. Lamb: Yeah, we have a wonderful education quality improvement and evaluation team, and they've been partnering with every phase, leaders, the courses that continue to exist as courses throughout our program to really define what are those measures of success at each step along the way, at the phase transition level, at the overall program level.

And so we've done a lot of work to define our key four goals for the program and align all of the outcome measures that will roll up to each of those four goal areas so that we can comprehensively, in a very purposeful way, lay out the results that will continue to drive our change to achieve the culture that we're trying to have as a school. Of course, sort of spelled out very explicitly in these four core goals.

One of them . . . I'll just go here. It's not really about the program, but I'm interested in this for you. One of our goals is graduating students with manageable debt.

Dr. Christner: I like that.

Dr. Lamb: And it's not typically something that a lot of the, I would say, curriculum . . . Our Student Affairs staff and faculty really think a lot about this in terms of financial aid counseling, but we don't really see ourselves as having a whole lot of weight in making those sort of decisions or change happen to have manageable debt.

But we've made this a key pillar for us in our program goals. And so that means partnering with lots of different types of individuals within our institution.

So I'm just curious, do you have any goals for your program that go outside of maybe what the traditional measures of success are?

Dr. Christner: So I'll be honest, we probably don't. We're probably more traditional. Although we do have a financial wellness curriculum that has specific goals in that, but it's not one of the major goals.

I think one of the things that we're looking at for outcomes that I'm excited about, and is a little bit different, is we're always looking at student outcomes, but we're going to be looking at faculty outcomes.

Again, capturing  that excitement, and why would you want to make this change, and why would you want to put in all this work? What are the differences in the attitude skills of our faculty? We've never looked at it from that lens. And so we're actually really excited to put a framework around that and look at that.

So that's something I think outside of the normal box.

Dr. Lamb: Traditional.

Dr. Christner: Right, that we're looking at.

Interviewer: After launching the new curriculum, what's it been like in this . . . I imagine you can just kick back and relax at this point, right? The work is done. What's the ongoing maintenance that has had to occur as a result of launching the curriculum? Like, evaluating as you go, or what does that look like? Let's start with you, Dr. Lamb.

Dr. Lamb: Oh, this is only the beginning. I would say that the work is . . . I think it's still an uphill climb, is how I would describe it. I mean, this is just the start of what will be just years and years of a journey of work, of new things and different things and continuous quality improvement. That's one of our guiding principles, is that we're just going to keep iterating and continue to improve.

And even getting our faculty and students bought into that mindset around the education experience has been an important part of our work. We have a lot of faculty who have taught for a long time who feel pretty comfortable of what they've always done and how they've approached education, and they feel pretty good at it.

And in reality, like you mentioned, the education science has to be applied to the education program in the exact same ways that scientific discoveries are applied to the application of clinical care.

And so we really pulled that together to say, "Wouldn't you want to continue to improve based on what we're learning about what's successful, what's not been successful? What do other people in the nation, in the world know about these different methodologies in their success?"

So it's only the beginning. There's no kicking back. I would say we're trying to kick back at times to celebrate. That's been an important part of our experience, is to really celebrate when we have a win, when people are feeling good about what the work has delivered, and to share that broadly and have a really good communications strategy with our partners to say, "Hey, man, this is good stuff," to really promote the positive.

Yeah, we've made some mistakes and things aren't perfect and we're committed to making them better. But this is something that we really have to sort of continue to energize people around to keep the work going, because it's a long road.

Dr. Christner: Yeah, I couldn't agree more. So celebrating small successes. The other thing that I really try to emphasize is that it's okay to fail.

Dr. Lamb: Yes.

Dr. Christner: We know that something in this curriculum is not going to work. And I actually will think the new curriculum is a failure if something doesn't fail, because if something doesn't fail, it means we weren't visionary enough. We weren't pushing the envelope enough. I almost want that to happen so that we can say, "Yep, we tried that. Well, now let's go back and see what we need to do to reinvigorate that or change or take it out," or whatever it is. It's constant surveillance.

Dr. Lamb: Have you had challenges with that? I mean, we've embraced the exact same principle, like, "We are a growing group of people and we expect to do things wrong. And we're not going to have shame over making mistakes. We'll just own them, and we'll learn from them, and we will make things better."

But I guess my question is we have students who think, "I'm coming to medical school. Don't you guys know what you're doing? What do you mean? What do you mean you're trying something new?"

And also, our faculty who are very perfectionistic, right? They hold themselves to an extraordinarily high standard, and making them feel okay, giving them that reassurance and confidence that, "You're not going to not get promoted because this innovation just fell flat."

So how have you done that operationally to make it real?

Dr. Christner: So I think having that be a central tenet from the very beginning, pounding that, "This is an expectation." And for me, it's probably more been about managing up a little bit. So saying at all the executive team meetings, "We're going to fail at something. That's great. Expect us to fail at something." So when something does fail, it's not like, "Oh my gosh, what is going to happen? Are our Step scores going to go . . .?" No. This is great. This means we are successful. So for me, I think managing up what this really means and what it looks like is key.

And you're right, managing some student expectations around that, too. Although I think probably we're trying to . . . When something goes wrong, it's really more, "It went right. These are the things that went well and these are the things that didn't go well. And when you're going to go out and practice, there are going to be things that you do that go well, that don't go well. So let's use our critical thinking and critical reasoning skills and figure this out."

Dr. Lamb: And let's have humility and comfort in saying, "I made a mistake."

Dr. Christner: Absolutely.

Dr. Lamb: We have to do that in healthcare, in patient care, and be comfortable with that language. And I think role modeling that . . . That's been the one thing I've tried to reassure the clinical faculty around, is, "We have to role model talking about our mistakes."

Interviewer: As we wrap this up, what are some initial successes that we can celebrate? What are some of these little glitters of things that you're seeing, like, "Wow, this is going to be fantastic"?

Dr. Christner: Sure. Fridays is dual assessment day where they take an exam, and then they can actually retake that exam in the afternoon. The students crazily love that, and we've seen the test scores go up across the board. They're so excited, our faculty are so excited, and it's just been an amazing win.

Dr. Lamb: That's awesome. Our first six-week course, and I think it's probably akin to your transition medical school four-week, it's our SCOPE course. And I knew the minute I said this someone's going to say, "What does SCOPE stand for?" And it's not Scope Radio, by the way.

Anyway, it has to do with professional exploration and communication and their professional identity and science. There's a fair amount of that in the first six weeks. But at the end of that six weeks, we got a handwritten note from our students. I mean, this is completely nothing in resemblance to what we've done in our program before. And it's uncomfortable for our faculty and staff and the students, to be honest.

But at the end of that six-week course, they gave us a handwritten note that I shared with our department leadership and senior leadership within the organization to read it to them. It thanked us for shaking up the medical school program and for having the faith and confidence and really building them as professionals, as individuals, seeing them as people who are part of this culture, and caring more about the bigger picture and showing them the way.

And that to me was . . . I cried when we saw it in our office. Completely unsolicited and signed by the class of 2027. And we just knew at that moment . . . We pushed it out from the mountaintops to say, "We are doing good work and it's hard, and we're grateful, and please, let's keep going."

Interviewer: Developing and launching a new curriculum. Would recommend, Dr. Lamb?

Dr. Lamb: Oh, totally, 100%.

Interviewer: Okay. Would you recommend, Dr. Christner?

Dr. Christner: 100%.

Interviewer: All right. Thank you very much for joining us today and sharing some of your stories. We sure appreciate it.

Dr. Lamb: Oh, thank you.

Dr. Christner: Thank you.