Thread by @RJmdphilly

1/#Tweetorial! The @Aaimonline Collab on Learning & Working Environment Optimization released a conceptual model to guide LWE improvement.

But how do you actually USE the model?

We suggest 3 simple applications for #meded at the front lines:

amjmed.com/article/S0002-…

2/One quick question before explaining our three proposed approaches. In your opinion, is there a difference between a “Definition” of a thing, and a “Model”? Poll below and feel free to explain your answer:

3/Merriam Webster defines “Definition” as “A statement of the meaning of a word” or “A statement expressing the essential nature of something.”

A definition is, by definition (ha), reductionist. The goal of a definition is clarity, sharp lines, exactitude, immutability.

4/A conceptual model is a representation of a system used to help people know, understand, or simulate a subject.

Models aim for understanding, esp in the face of complexity. They facilitate communication, create context & explain interactions, & provide a ref point for change.

5/You can see why we need a model, not a definition, of the LWE. In our model there are four domains: Personal, Relational, Curricular, Structural.

Here is the link to our first tweetorial, in case you need to brush up on the details of the model itself.

https://twitter.com/rjmdphilly/status/1120322819768844288?s=21

6/ The three proposed applications of the model are:
Reactive
Proactive
Holistic
The purpose and end product of each of these differ. Let’s take them one by one:

7/Reactive
Purpose: Understand/analyze a recent event or deficit in current state

Product: Identification of factors in the four domains leading to event, and possible mitigation strategies

Analogy: Root Cause Analysis using fishbone
@TheIHI tutorial:

8/Reactive Example
Intern doesn’t involve attending overnight when patient with cellulitis gets sicker. In AM it’s clear the team missed necrotizing fasciitis. The following factors are identified, and programmatic changes are made.

9/Proactive
Purpose: Design a new CLE component or process

Product: Program plan incorporating an understanding of base-state of one’s LWE domains, and the changes needed in the domains for successful implementation

Analogy: SWOT analysis (or maybe FMEA)

10/Proactive example
New DIO wants to improve the safety of bedside procedures by introducing more robust interprofessional involvement. Considering all four domains allows for selection of an optimal pilot unit, and request for specific resources necessary for success.

11/Holistic
Purpose: Align stakeholders and achieve a shared mental model

Product: Understanding and appreciation of competing priorities. Improved communication

Analogy: Therapy (kidding not kidding)

12/Holistic example
A clinic gets poor evals from clerkship students. The CD & Med Director at the site have competing priorities regarding staff productivity and the educational experience. Improved understanding of the relevant domain factors leads to better collaboration.

13/In our experience, the model provides an approach to problem solving stable across LWE challenge areas.
Key concepts:
4 domains: Personal, Relational, Curricular, Structural
Patient as axis
Influenced by sociocultural context
3 use cases: Reactive, proactive, holistic

14/In closing, we said a conceptual model should facilitate communication, create context & explain interactions, & provide a reference point for change. Does the @AAIMOnline LWE model achieve these goals? [comment w ?s below]

15/15 The @AAIMOnline collaborative will be presenting the model and use cases at @ICREConf 2019 and @acgme AEC 2020, so join us for more discussion! Are there learning environment challenges you'd like to see broken down in future #meded #medtwitter tweetorials?

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