3

Workshop

Zohray Talib, California University of Science and Medicine and forum cochair, opened the workshop and introduced Jeffries and Dunleavy as cochairs of the planning committee. Jeffries shared the framework for the workshop series (see Figure 1-1). She explained that the workshop would focus on two aspects of health professional education (HPE) Scholarship of Teaching and Learning (SOTL): one, its importance and value, and two, innovating and enhancing it. The objective, said Jeffries, is “to shed light on the critical value of SOTL for health professions’ workforce development and patient outcomes by exploring what is unique about SOTL in the health professions from education to practice.”

Dunleavy gave a brief overview of the history of SOTL that built on the description offered by Jensen in the preworkshop session (see Figure 3-1). In 1990, Boyer advocated for a broader meaning of scholarship, encompassing the scholarships of discovery, integration, application, and teaching and learning. In 1998, Glassick and colleagues highlighted the importance of standards across all types of scholarship, said Dunleavy. His proposed standards included clear goals, adequate preparation, appropriate methods, significant results, effective presentation, and reflective critique. Shortly after Glassick and colleagues’s contributions, Hutchings and Shulman (1999) argued that SOTL needs to drive systematic improvements. That is, explained Dunleavy, scholarship about teaching and learning would be publicly available, peer reviewed and critiqued, and reproduced and built on by other scholars.

Boyer’s model of scholarship has overlap and interdependence among each of the categories, said Dunleavy. Scholarship of discovery asks the

question, “What is yet to be known?” This area could include HPE research that addresses core problems, basic principles, or foundational questions. The scholarship of integration asks, “What do the findings mean?” This is where collaboration across fields provides context and bridges differences to synthesize knowledge. The scholarship of application looks to answer the question, “How can knowledge be applied to solve problems for individuals and institutions?” This area explores problems in their specific context and drives innovation that is grounded in theory and evidence. Finally, said Dunleavy, SOTL asks, “How can knowledge be accessed and applied? What teaching methods are the most effective for different levels of learners?” Scholars might study teaching, mentoring, development of learners, instructional methods and technology, implementation, and curriculum. While each type of scholarship is different, said Dunleavy, they are interrelated and can be seen as an integrated whole under the broad banner of scholarship.

FOCUS GROUP EFFORTS

Nunez shared details with workshop participants about the focus groups¹ that the planning committee conducted in August. The purpose, she

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¹ See meeting materials for a full description of the focus groups: https://www.nationalacademies.org/event/42801_10–2024_scholarship-of-teaching-and-learning-in-health-professions-education-a-workshop#sectionEventMaterials (accessed on February 16, 2025).

said, was to inform the planning with a better understanding of individual and institutional perceptions, beliefs, and attitudes about SOTL and how it is applied in HPE. The four groups had 25 participants from 11 different health professions. They held a variety of roles in HPE, including educators from different graduate-level HPE programs, clinical educators, academic leaders, administrators, and journal editors. Each group was composed of participants with different levels of experience in SOTL, said Nunez; 16 percent self-identified as participants (e.g., read literature, attend workshops), 36 percent as contributors (e.g., publish articles, offer faculty development), and 48 percent as subject-matter experts (e.g., publish extensively, serve as mentor or journal editor). Before the focus groups, the planning committee had identified specific areas of interest within SOTL; the interests of the participants collectively reflected all of these areas:

• Education within one’s health profession,
• Clinical care or clinical learning,
• Simulation,
• Interprofessional education or practice,
• Faculty development, and
• Promotion and tenure.

The focus group discussions centered on four topic areas, said Nunez: motivation for engaging in SOTL, institutional support for it, professional association support for it, and building value and innovation for it in HPE. Nunez gave an overview of the questions and responses in each area. Participants were asked what motivates them to engage in HPE SOTL; Nunez identified several themes. Participants explained that they were motivated by the ability of SOTL to demonstrate value and quality, the desire to develop high-quality faculty and support promotion and tenure, the potential for evidence-based education practices to improve outcomes, and the hopes of bridging academic education to clinical care outcomes, said Nunez. When asked whether and how their institutions support SOTL, answers fell into two camps. Those who reported support said that the institution’s mission and actions were aligned with SOTL; it was integrated and encouraged as part of merit, promotion, and awards; and faculty were given explicit support and development opportunities. Those who said that their institutions were not supportive reported a mismatch of espoused institutional values and SOTL support (e.g., only research was valued); no evaluation systems for SOTL or consideration of it in promotion and tenure; and limited support, funding, and development opportunities.

Next, participants discussed whether their professional associations facilitate the advancement of SOTL by, for example, offering professional development opportunities. Like academic institutions, said Nunez, support

varied. She noted that some associations were less likely to actively support SOTL due to their particular mission; for example, an association focused on developing researchers may not focus on it. According to Nunez, participants identified several approaches to support. These included providing resources, such as materials and support for academic and clinical educators (e.g., dissemination grants, accreditation standards); offering faculty and professional development opportunities (e.g., educational workshops, peer mentoring); and giving recognition (e.g., awards for SOTL achievements and excellence in teaching).

The fourth topic area for discussion focused on what could build value or innovation for HPE SOTL among different stakeholders. Nunez described the participants’ suggestions:

• Using Boyer’s scholarship model in academia;
• Offering an SOTL track in HPE programs;
• Developing common SOTL language/terminology;
• Enhancing the rigor, designs, and quality of SOTL research;
• Measuring the impact/outcomes of SOTL;
• Improving institutional and structural support, including funding, grants, promotion and tenure guidelines, and merit awards; and
• Developing communities of practice around SOTL, including interdisciplinary collaboration, mentorship, and networks.

During the focus group discussions, said Nunez, several participants mentioned initiatives that could be implemented collectively across HPE to advance SOTL. These are listed in Figure 3-2 and include joint advocacy for HPE SOTL, development of professional identities that combine education and research or education and clinical care, publication of SOTL-related

material in disciplinary journals, and training in SOTL at every level (e.g., doctoral education, residency training, professional development).

THE VALUE OF SOTL IN HPE

All HPE programs share the goal of preparing learners for professional practice, said Jensen. This shared foundation of education, training, and identity development is sometimes called “knowing, doing, and being” or the “habits of head and hand and heart.” SOTL can positively impact each aspect across professions, she said. Improving HPE through SOTL can have far-reaching consequences, starting with improved student learning and leading to improved patient outcomes and community health. Jensen introduced H. Carrie Chen, Kaiser Permanente Bernard J. Tyson School of Medicine, to talk about the value of HPE SOTL.

“Why is HPE SOTL important?” asked Chen. Ultimately, the aim is to improve the health of the public, she said, adding that SOTL supports the best practices in education to train learners to better care for patients by delivering safe, effective, and efficient care. Just as clinical care is ideally grounded in evidence-based practices, said Chen, teaching and educational practices should be too. There are studies that look at the impact of teaching and learning on patient outcomes, and some have identified “educationally sensitive patient outcomes.” However, said Chen, there are challenges involved in measuring the impact of teaching; education and health care are complex, so it can be difficult to demonstrate direct cause and effect. Paraphrasing Glenn Regher at the Center for Health Education Scholarship in Canada, Chen said, “HPE research is not rocket science—it is harder.” This is due to several factors, she added. Trainees have agency, and educational programs are not able to control their behaviors. For example, a program might inadvertently leave out a significant part of the curriculum but find that learners did just as well on the national exam because they taught themselves the material. In addition, patients also have agency and their own choices and behaviors. Furthermore, patient care is often provided in teams, and it can be difficult to tease out the contributions of individuals. Finally, said Chen, context matters; the impact of educational and patient care interventions may vary significantly based on their implementation contexts.

There are also challenges related to the standards of evidence in SOTL. The health professions are rooted in biomedical science, said Chen, which views evidence from randomized controlled trials (RCTs) as the gold standard. RCTs are generally not feasible in the educational setting and may not be necessary. Chen shared a “funny but real” review article that looked at the use of parachutes and major trauma due to gravity (Smith and Pell, 2003). The review concluded that parachutes should not be used, due to a

lack of evidence from RCTs; alternatively, it suggested that in certain circumstances, other types of evidence could be sufficient. By their nature, innovations do not have strong evidence of efficacy, said Chen. It is important for innovations to be theory informed and have efforts to generate evidence substantiating the value of an innovation. However, Chen said that if “we restrict ourselves to practices for which we already have evidence, then we would never innovate.” She suggested that due to these challenges, SOTL would most effectively be viewed through not the biomedical model but the models of implementation science and social science. These models value using observations to inform practice, sharing observations and lessons learned, replicating others’ work, and teaching others best practices. This process builds on discovery to increase understanding and touches on each of the categories of scholarship defined by Boyer (discovery, integration, application, and teaching and learning). Chen argued for value in shifting the perspective on what would make SOTL worth doing; instead of using strong evidence as the bar, set the bar at improving practice. That can be broadly defined to include improving educational practices, health professions training, and health care itself. Within this frame, she said, different types of SOTL and avenues for dissemination can be recognized and valued. For example, the best dissemination and impact of a practice or innovation may be seen through not a traditional article but an avenue such as a blog.

Given demonstrated value of SOTL, said Chen, how can this value be conveyed (see Figure 3-3)? The first step, she said, is to make SOTL visible and understandable for all of those involved. Chen said that chairs and promotion committees often do not feel capable of evaluating teaching

or SOTL excellence. There are ways to make their jobs easier, such as giving awards for teaching or demonstrating the reach of a teaching practice. These approaches provide validation of quality work from education experts. In addition, it is important to teach faculty how to make their own SOTL visible, said Chen. For example, they could track the number of times that a colleague has replicated their teaching practice or approach and include this information on promotions materials. “We need to help institutions embrace education as a science,” said Chen, and value the scholarly approach to education practices and the generation of scholarship. An institution that values SOTL would provide faculty development in SOTL, hold faculty accountable for using evidence-informed practices, and provide the resources that faculty would need to generate scholarship related to teaching.

Discussion

Jensen moderated a discussion session and invited workshop participants to ask questions. Jensen began by asking Chen about her personal journey with SOTL and what motivated her to start working to improve educational practices. Chen replied that she first became interested in education from the perspective of a learner. She wondered about ways to make learning more fun, interactive, engaging, and effective and if the policies that shape the learning environment could be modified to account for the fact that learners are human beings with individual desires and needs. Chen said that as she became a faculty member, she learned about a whole field of education with evidence to inform teaching practices. Role models and mentors helped Chen explore this evidence, develop innovations, and learn from mistakes. This process, she said, helped her realize the importance of sharing and helping other educators.

Noting that the participants represented leaders from across the health professions, Jensen asked Chen what she thought was the most urgent action item all leaders can embrace, regardless of their discipline. Chen responded that reflecting on the learning environment and examining how structures and resources within it can impact learning are things that all leaders can promote. Chen then added that faculty sometimes “point the finger at learners” when they are not doing what faculty expect; instead, faculty would need to consider how the environment is shaping learner behavior. Furthermore, institutional leaders can consider how faculty support and promotion and tenure processes can either facilitate or hinder faculty engagement in SOTL. Leaders who want faculty to engage in SOTL would have to provide faculty development opportunities, time and space for scholarship, and mentorship, said Chen. Some faculty who are involved in SOTL report feeling “very alone in their spaces.”

Generating Evidence on Outcomes

Tony Breitbach, who represents the National Academies of Practice (NAP) on the forum, recalled Chen’s comment about the challenge of measuring team-based outcomes. He mentioned that St. Louis University, where he is employed, hires students who are seeking a Ph.D. in industrial organizational psychology as research assistants. It brings a different frame to HPE; it examines the motivations of groups of people and the contextual factors that contribute to how teams work. This lens, said Breitbach, can help address the challenge of studying team-based activities in HPE. Chen agreed and said that this lens could also be used when looking at how faculty work together and support each other in SOTL. Chen noted that HPE has a view of teamwork that is not always beneficial. Scholars in HPE often follow the model of giving credit only to the first, second, and last author on a publication and also worry about diluting authorship credit by including too many authors. This perspective leads to practices that are not as inclusive as they should be, she said. It is important to think about how to value all the people involved and to do more team science in HPE.

Another participant noted that funders are often focused on patient outcomes and asked Chen for suggestions on how evidence could be generated to connect SOTL to these outcomes. Chen replied that evidence about the impact on patient outcomes is the “holy grail” but that it is very challenging to get these data. There are many intervening factors, and it can be difficult to connect all the dots between an educational practice and an eventual patient outcome. Chen said that it is important to look for evidence that impacts each “dot.” For example, researchers could look to demonstrate that a teaching strategy improves trainee learning and then that trainee learning is linked to certain patient care approaches or patient outcomes. It may be necessary to take evidence generation one step at a time rather than aiming for the “holy grail,” said Chen.

Chen added that education and training can have outcomes that are both intended and unintended and both positive and negative. It is important to look at all of these outcomes and recognize the complexity of these relationships. Furthermore, impacts may be related to the explicit and the “hidden” curriculum. Chen shared an example from her own work. A problem-based learning course put students into small groups for part of the curriculum. Chen looked at change in student behaviors and found significant variation among groups. She noted that this could have been due to the facilitators but also could have been due to level setting among the group participants. This demonstrates that the impact of a learning experience is based on not just the high-level curriculum but also how it is implemented, delivered, and experienced. Translated into the patient care

environment, this phenomenon means that outcomes can be influenced by both the individual team members providing care and the team dynamics.

Funding

Lyuba Konopasek, the forum representative of Intealth, asked Chen for her thoughts on the lack of funding for SOTL and how this situation might be improved. Chen responded that a lot of work in SOTL is being funded in certain places worldwide—specifically, the Netherlands and Canada. Looking at how these countries began to prioritize SOTL may help forge a path for better funding in the United States, she said. Chen noted that the largest funder of educational research is the Department of Defense; she asked the audience how health professional educators might begin to think differently about education and inspire society to value it in a different way. As a participant, Talib reflected on a global investment in HPE. The Medical Education Partnership Initiative was cofunded by various federal agencies, and it invested $150 million in HPE in sub-Saharan Africa. This money, she said, transformed the landscape of HPE in that area. Unfortunately, the grant expired after 5 years, but the systems investments in faculty lasted beyond that period. Talib noted that investments in the classroom tended to cycle out quickly, but those in faculty had more sustainable benefits. One of the universities involved wrote a paper that laid out a logic model for how HPE contributes to the health system (Mokone et al., 2014). Studying how educational systems contribute to health outcomes could support investing in HPE SOTL, said Talib. “If we can make the case, then maybe the funding will follow,” she said. Chen added that conversations are happening about how the Kaiser Permanente Bernard J. Tyson School of Medicine invests money and whether some approaches have a “bigger bang for the buck.” A data gap exists in this area, said Chen, but it is important to look at the impact and sustainability of investments at all levels.

Participants also commented briefly on a number of other topics for consideration:

• Lessons from SOTL in other fields, particularly those that work in teams;
• A desire to change the culture of HPE academia so faculty are valued who do nontraditional work, including SOTL and team-based education; and
• The importance of teaching learners to provide compassionate care, given evidence that patients’ outcomes are affected by their feeling that their health care providers care for them.

Chen concluded by noting that it can be “overwhelming” to think about how to change the culture in HPE to better understand and value

SOTL and said that it is critical to have these kinds of interdisciplinary crowdsourcing sessions to discuss how to move forward.

BREAKOUT ACTIVITY: THE VALUE OF HPE SOTL

Participants broke out into groups. In-person attendees remained in the room for table discussions; virtual attendees watched the evidence-based videos from SOTL subject-matter experts² and responded to questions in an online survey. Questions for discussion included the following:

• What are the elements related to HPE SOTL that are critical and make it unique?
• How do we connect HPE SOTL from classroom to clinic?
• What strategies would you use to bring HPE SOTL value back to your profession and/or across health professions?
• How do you advocate for implementation of SOTL innovation?
• How do we promote HPE SOTL as part of professional identities?
• How do you expand HPE SOTL training within and across health professions?

After the breakout groups concluded their work, participants reconvened for the second day of the workshop. Huang offered reflections on the first day, including takeaways from breakout group discussions. Huang said that participants mentioned a number of inherent tensions in the area of SOTL, such as seeking rigorous evidence while making research feasible, reconciling the desire to demonstrate a relationship between SOTL and patient outcomes and the reality that using process measures is more achievable. Furthermore, participants discussed holding a preference for a high burden of evidence while navigating the fast-moving pace of innovation. Huang noted that it may be advantageous to shift away from a biomedical model of evidence and toward methodologies such as implementation science.

To move SOTL forward in HPE, Huang said, participants discussed building bridges to stakeholders’ unique needs and roles. She added that faculty need education on the importance of SOTL; promotion and tenure committees need to understand its value; and educational leaders need to offer institutional support for it. To extend progress further, investments should be focused on the professional identity formation of HPE faculty as scholars, while continuing to emphasize the critical role of teaching in

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² See video resources at https://www.nationalacademies.org/event/42801_10-2024_scholarship-of-teaching-and-learning-in-health-professions-education-a-workshop#sl-three-columns-e5a903f9-5ee2-4a45-89d1-d9476c8c1783.

improving the health of communities. Rather than each discipline within HPE taking on this work individually, Huang said that bridge-building would best be accomplished through interprofessional collaboration. For example, professional societies could coordinate efforts, a national registry of learner outcomes could be developed, or a national institute for HPE SOTL could be established.

This workshop has been a “celebration of how wonderful and not in the box HPE SOTL is,” said Huang. SOTL is by its nature interdisciplinary and interprofessional, and it requires a team science approach. It involves both quantitative and qualitative methods and invites nonmedical disciplines to participate. SOTL illustrates the “messiness” of research in HPE, said Huang; it is not simple or straightforward to connect the dots between education and patient outcomes, but it is necessary and valuable work. Dunleavy added her thoughts on the workshop discussions thus far and said that SOTL draws attention to areas of health care practice that are critical but often overlooked. Skills like communication, empathy, and teamwork are incredibly valuable in health care, said Dunleavy, but how do health professional educators teach these skills, and how do we measure them? Moving forward, she added, educators and HPE SOTL researchers could identify the skills that make a difference in patient outcomes and determine how these are best taught to learners. SOTL is a way to connect best practices in HPE programs with the ultimate goal of improving patient outcomes, Dunleavy concluded.

INNOVATIONS IN HPE SOTL

Dunleavy introduced Patricia O’Sullivan, University of California, San Francisco, School of Medicine, to discuss innovations and new ideas in HPE SOTL. O’Sullivan shared some opening remarks, after which Dunleavy moderated a question-and-answer session. Innovation starts with how health professional educators approach the research, said O’Sullivan. HPE SOTL is a “team sport,” and it requires collaboration between experts in SOTL and faculty members with a passion for HPE. In addition to drawing on multiple disciplines, innovation in SOTL requires conscious and intentional inclusion of a broad range of voices. O’Sullivan noted that people often simply “turn to the people who are around” when embarking on a project rather than reaching out to find the voices that are missing. Innovation in HPE SOTL will not happen without “relentless” networking and moving out of silos, she said. Despite increasing scholarship in the area of HPE SOTL, it is made up of a small group of authors who often cite each other. Connecting to other disciplines, such as education, psychology, and sociology, would open the work to new perspectives, methodologies, and frameworks that could enrich the work. Furthermore, said O’Sullivan, so

would reaching out to scholars in other areas of the world who are often not part of the HPE literature. O’Sullivan noted that networking can and ideally would also happen in one’s own institution. Faculty who are engaged in SOTL can reach out to other faculty and leaders to educate, support, and motivate. O’Sullivan shared a story about a division chief who was hesitant to give financial support to an educational scholar. The department chair spoke up and said that it was an “issue of equity,” pointing out that there would be no question if it were a clinical researcher asking for funds. O’Sullivan encouraged people engaged in SOTL to work with leadership and help others in asking for the support and resources that they need.

Discussion

Dunleavy and workshop participants engaged in discussion with and asked questions of O’Sullivan that fell into four general areas: faculty development, alternative means of dissemination, challenges in SOTL, and measuring learning.

Faculty Development

In Europe, those who teach in higher education are required to have a basic teaching background. While this concept has not been embraced in North America, it is important to think about what health professional educators can learn from their system, said O’Sullivan. One approach for preparing faculty with the right skills, she said, is longitudinal faculty development programs. Evidence supports the effectiveness of these types of longer-term development programs; this is where the development of identity and change can occur. Another thing that is happening, said O’Sullivan, is the growth of masters’ and doctoral degrees in HPE. These programs develop valuable scholarship and deep thinking. It is important to have people in the HPE environment who can ask questions such as “What is the theory driving this curriculum?” or “How do we understand and adapt to our learners’ motivations in order to improve patient outcomes?” There has been significant progress in education in the workplace in HPE, said O’Sullivan, from simulation to skills practice. Quality faculty development programs can expand on this to prepare learners to provide the best patient care.

Alternative Means of Dissemination

Dunleavy noted that workshop speakers talked about alternative dissemination methods for SOTL, outside of the traditional journal system. She asked O’Sullivan about these and how to ensure appropriate review and rigor. O’Sullivan responded that many options within the journal

world are often overlooked. For example, she has a Korean colleague who publishes in a Korean journal to bring her ideas to a community that may have difficulty reading English journals. This would be important to explain to the members of a promotion and tenure committee, she said, because they may not understand the value of the contribution to that community. Other journals with targeted audiences (e.g., military medicine) could be useful for disseminating information about SOTL. There is great potential in alternatives to journals, such as blogs, online curricula, websites, and podcasts, said O’Sullivan, but it will be important to develop guidelines to ensure their quality. The criteria do not need to be the same as those used in journals, and different methodologies could be used to determine “quality.” O’Sullivan gave an example of an alternative method: one of her colleagues used a large language model to create a dialogue between two individuals about a journal article they had written. The core information was the same, she said, but it was presented more engagingly.

One major issue for faculty working in SOTL is how to convey their work understandably to a traditional promotion and tenure committee, said O’Sullivan. The standard format of the curriculum vitae is often merely a reflection of what has been done and does not show the impact or the quality of work. O’Sullivan encouraged faculty to explore different ways of describing their work and “seize the opportunity” to highlight the value of SOTL work.

Challenges in SOTL

Efforts have been put toward helping individuals in SOTL, said O’Sullivan, but the field will not move forward without work on the systems level. Students, postgraduates, and faculty engaged in SOTL are all struggling with the same issues, indicating that work within the system—the education to practice continuum—could help build a system that values SOTL. If educational and health care institutions value it, more resources and tools will be available, and people will be able to focus on quality work over quantity. Educators need the space to explore how to best prepare learners for the future rather than trying to produce more articles or make more quantitative impact. The challenges for individuals working in SOTL will not go away until the system itself values it.

Dunleavy said that the focus groups revealed a lack of support for SOTL at many institutions; she asked O’Sullivan for her thoughts on how to move it forward in these circumstances. O’Sullivan replied that one way to get started is to align SOTL with institutional values. Every institution has values and issues that they care about, she said, and showing how HPE SOTL fits into this framework can create a pathway forward.

Jensen asked O’Sullivan about the role that status plays in keeping SOTL from being more broadly adopted; she noted that calling it “education

science” can bring more visibility. O’Sullivan said that SOTL could benefit from using more design-based research. Some research on educational strategies is atheoretical and makes a lot of assumptions about why and how teaching interventions work. In contrast, design-based research requires understanding the theoretical principles underlying the intervention and enables rapid prototype testing. The researcher starts by hypothesizing the outcome, based on theoretical principles, and tests the hypothesis. If the outcome is not achieved, the researcher works with the learners to determine what happened and how the intervention could be redesigned. Design-based research, said O’Sullivan, has no need to wait years to see if the learning outcomes were achieved. Instead, there is constant testing and feedback about the process of learning.

Measuring Learning

A participant noted that research on educational innovation is episodic, whereas learning is a process that happens over time. He asked O’Sullivan how research in this area could better assess learning across contexts or over time. She responded by encouraging educators to think long term and strategically about how to gather data on learning outcomes. Some institutions have established longitudinal databases, and some schools in Europe use portfolio systems that enable examining how someone is learning over time. Longitudinal qualitative research has also emerged, said O’Sullivan, which takes a team commitment to slow down and aim for quality over quantity. O’Sullivan relayed a story from her colleague, who asks would-be researchers to describe not just their first proposed study but also followup studies that would build on its findings. “If the researcher can’t lay out three studies in a row,” she said, “they shouldn’t do the first.” While this might be a “stressful” way to think about research, O’Sullivan said that a coordinated and long-term study plan will contribute much more to the collective understanding of SOTL than a series of one-off research projects.

BREAKOUT ACTIVITY: FACILITATING CHANGE USING HPE SOTL

Participants divided into groups for an activity. Virtual attendees responded to the question “How would you develop a program of the future to facilitate change using HPE SOTL?” They were asked to name key elements in 300 characters or less. In-person attendees remained in the room for an activity led by forum members. The groups were asked to consider

1. the present state of HPE and workforce; and
2. the potential for new tools, technology, and methods to change

1. how students and health professionals learn and how clinical and classroom educators teach.

Each group was tasked with illustrating an innovative HPE SOTL design that would produce a meaningful result(s) for a target population and describing the relevant stakeholders. Groups created visuals to summarize their responses. Afterward, representatives from each group gave a report on their work, and Okuda moderated a discussion among participants.

Group 1

Nancy Moreno, Baylor College of Medicine, reported that Group 1 had a lively discussion about how to form a community of practice around SOTL in an organization. The figure they created (see Appendix B) uses the model of a house to illustrate their idea. Moreno noted that the house has three stories but emphasized that their model is not hierarchical. Rather, the base of the house is foundational knowledge, and the upper floors contain rooms with thematic areas related to SOTL, including inquiry, dissemination, and implementation, and a person who represents an expert in that area. Moreno explained that in community of practice theory, experts bring novices into the community through shared knowledge, understanding, and skills. The sun shining on the house represents institutional support, and outcomes emerge from the chimney and impact the greater community. Inhabitants of the house, said Moreno, include faculty, new faculty, existing faculty learners, experts who are specialists in SOTL, and other members of the community who share the goal of supporting excellent care for patients.

Group 2

Group 2 chose to focus on novice faculty, said Jeffries, on the clinical or academic side. With the goal of increasing knowledge and use of SOTL to improve scholarly teaching, their model (see Appendix B) illustrated a learning hub that included theories, literature, exemplars, and model applications. Learning is multidirectional, and learners are engaged in the process. Jeffries said that the group was creative in the tools for the learning hub and included innovations such as artificial intelligence (AI) and holograms. The content would not be solely focused on SOTL but would also include HPE topics. For example, a faculty member might give a cardiovascular lecture, after which another scholar could offer peer review and a debriefing dialogue. Other interventions could include mentorship and coaching, simulations, and paired novice–expert teaching. Learner feedback and reflection are essential parts of the model, said Jeffries; faculty would

not simply “assume that they did a good job.” A circle around the figure represents several foundational aspects of the model, including evidence-based practices, grounding in educational theories, and a sense of psychological safety. Jeffries explained that the latter is essential because it can be difficult for novice faculty members to be critiqued.

Group 3

Group 3 had members from many different professions, said Katie Eliot, forum representative from the Academy of Nutrition and Dietetics, and quickly identified the shared challenge of learner engagement. In their drawing (see Appendix B), the disengaged learner is sleeping, “shopping for shoes online,” and bored with the status quo of teaching. The group focused on how to use SOTL to transform that person into an engaged learner, such as by changing the learning environment. Jensen added that their model would be an interdependent process for which both faculty and learners would need to be prepared. It is critical, she said, to set the stage and help all stakeholders understand the expectations and the structure of co-participation and build trust and respect. Faculty would play a critical role by advising, mentoring, and coaching.

Group 4

Andrea Pfeifle, one of the forum representatives for NAP, said that Group 4 focused on learners in HPE working in underserved areas. The intended outcome was ensuring that they have the same resources and access to continuing professional development as other learners. Breitbach, also from NAP, explained the group’s figure (see Appendix B). It illustrates an academic–practice partnership that offers a continuing professional development program, working with accreditors and informed by accreditation standards. The program would use intervention tools such as AI, electronic health records, and IPE. With the goal of enhancing the skills of health care workers in underserved areas, he said, measured outcomes would include improved teamwork, quality of care, patient–provider experience, and equity across trainees in different areas. Scholars with expertise in each area would pull system data from accreditors to be fed back into the system for continuous quality improvement, sent to the accreditor, and perhaps used to update the standards. Hopefully, said Breitbach, the system would demonstrate success in improving quality, justifying the use of resources for the interventions, tools, and measurements.

Virtual Group

Huang aggregated the comments from hundreds of virtual attendees who participated in the breakout group activity through Slido, the question- and-answer platform. The group’s input focused on “out-of-the-box” thinking regarding the future of HPE (see Appendix B). Participants mentioned using innovations such as AI and other technologies to provide real-time feedback and continuous assessment. One commented that AI could be used for teaching basic knowledge and skills, while humans focus on human aspects of HPE that AI cannot teach. Participants also brought up creating linkages and resources among different disciplines within HPE, said Huang. For example, a white paper on SOTL for promotion and tenure committees could be created and shared with faculty and leaders across many different health professions programs. Finally, participants talked about new paradigms within HPE, such as using technology for more individualized learning journeys. Huang concluded that these innovations would undoubtedly cost money, so a dollar sign representing funding was drawn on their model.

Discussion

Okuda invited workshop participants to join him in a debrief of the group activity, sharing their thoughts and feelings about the process of collaborating. Peter Cahn, Massachusetts General Hospital Institute of Health Professions, replied that his group started by discussing the importance of innovation but fell back on the familiar tools they knew when building the model. At the end, they wanted to add innovation back in but could only think of technological innovations. Cahn wondered about other options and how HPE SOTL could use these rather than “defaulting to what’s shiny and beeping.” Eliot commented that although her group was made up of many different disciplines within HPE, they all had a common challenge: learner engagement. While no one had the “right” answer, a lot of energy and synergy were created by thinking together about that “thing that we all struggle with.” Finding these commonalities allows stakeholders from different areas to work together and build on each other’s ideas. Sue Forneris, from the University of Minnesota, added that stakeholders across disciplines could benefit from a shared mental model of HPE SOTL and being able to convey it to others. Awareness and articulation of a shared model allows people to work together across disciplines and create synergy, she said.

REFLECTIONS

In the final session, Dunleavy moderated a discussion among planning committee members and participants. She asked people to reflect on the

discussions and offer their thoughts and comments. Dunleavy said that one thing that stood out for her was the idea of a white paper for promotion and tenure committees. This is a “very tangible, very much-needed resource.” Integrating the knowledge and value of SOTL into these committees can take a long time and a lot of people; a shared white paper would streamline some of this. Cahn agreed, noting the work to do in this area and that systems that recognize faculty tend to hew to the metrics of the biomedical model, valuing quantitative work and randomized trials. Cahn encouraged the group to push back against this idea of “only one form of valuable knowledge” and consider creating space for the value of SOTL to flourish. Breitbach added that he supports the idea of the shared white paper and that having a resource on SOTL would be tremendously valuable for both the committees and the faculty submitting their work. These committees want to do the work and understand this area better, he said, and faculty could use the white paper as a “road map” to make their case for tenure. Another speaker noted an opportunity to create a curriculum blueprint for faculty development in SOTL that could be shared across professions. On this topic, a virtual participant commented through Slido that the University of Washington created an appointment, promotion, and tenure toolkit to help those who identify as team scientists succeed in a system that is based on evaluating individual work. Other participants noted that professional associations have done some work in the area of faculty development in SOTL and credentialing for educators. For example, Katie Sheats reported that the New Academy of Veterinary Educators proposed a model for a credential program that would include portfolio work, experiential-based training, and an examination. The National League for Nursing, said another attendee, has a competency-based certificate process for nurse educators. Dunleavy noted that the education and training time for some health professions has increased in recent years, and this time commitment may prevent some from pursuing additional education-specific certification. Jody Frost, who cochairs the forum, said that one approach for faculty development in SOTL is faculty residency programs; people interested in becoming educators can learn about what is involved with teaching and gain competencies in SOTL.

SOTL is an important topic, said Jeffries, as evidenced by the hundreds of people who signed up to attend the workshop virtually. There is a lot to do, but the ideas, strategies, and synergy at the workshop will be of great value going forward, she said. Frost agreed that SOTL is a topic that is “making a lot of noise,” and she suggested capturing the momentum of the meeting by creating a community of practice with all those who attended in person and virtually. Talib followed up with her observation that the energy at this workshop is in part due to the fact that many participants are “hustling in silos in our own institutions.” Many people are used to

working on SOTL on their own, and they find strength in the group when they all come together. She said that this is another reason why a global space, or community of practice, would be beneficial. Okuda added that it is also important to engage people outside of the SOTL world in order to move things forward. Peer-reviewed journals are one approach for disseminating information, but alternative means, such as blogs, can be incredibly powerful as well. Mark Merrick, forum representative for the Athletic Training Strategic Alliance, agreed that it is important to engage others in the conversation around SOTL. This workshop is “an opportunity to preach to the choir,” but structural barriers must be overcome, related to the culture, mission, and practices of institutions, so educational efforts can align SOTL with institutional values. Until institutions value SOTL as a critical piece of their work and put it into practice, “we’ll continue to be a choir rather than an entire group singing together.” Another participant agreed and said that when something is ingrained in an institutional mission statement, it becomes part of strategic planning and resource allocation. To make this shift, it would be necessary to make the case for why SOTL matters; those involved in SOTL could demonstrate how investments in it translate into meaningful outcomes. These outcomes might be related to community health, education, patient safety, or other areas, she said, but it is essential to connect the dots in order to drive change.

Dunleavy closed the workshop by thanking the planning committee, speakers, staff, and participants. She emphasized the importance of being a “visionary” for HPE and coming together with like-minded people to collaborate and think together about how to move ahead.

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