Jayzona Alberto EdD, MS began her continuing healthcare education career by working on curricula for dentists and other clinicians before transitioning to the Stanford University School of Medicine, where she currently serves as Assistant Director of Continuing Medical Education.
Jayzona and her team work with e-learning tools such as animations, and in this episode she walks us through the process of creating an animation from start to finish. We discuss the importance of building relationships with the faculty who inform education content, the resources for CME that an institution such as Stanford can provide, and the potential for changing clinical practice that well designed CME/CPD fosters.
Other topics we discussed include:
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Host: Alexandra Howson PhD, CHCP
Shownotes: Emma Kolakowski
Sound: SuZen Marie
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Alexandra Howson 00:01
Hello and welcome. I'm here today on Write Medicine with Jayzona Alberto, Assistant Director of Educational Programs and Services in continuing medical education at Stanford School of Medicine. Welcome Jayzona.
Hi, thanks for having me on this episode, Alex, I really appreciate it.
Alexandra Howson 00:43
Yeah, great to see you. So tell me who you are and how you find your way into continuing medical education?
Yeah, sure. So as you had introduced me, I'm Jayzona Alberto, and I am the Assistant Director at Stanford continuing medical education, which is under the Stanford School of Medicine, at Stanford University. I really fell into continuing education by chance like several of your other guests on your show. Prior to working at Stanford, I was employed with schools of medicine and dentistry in Southern California. And my goal really in those roles was to support future physicians and dentists. And so I worked very closely with the management of the curriculum at those schools. And while I love my role there and really appreciate it, appreciated interacting with the medical and dental students and have formed really strong friendships with them and colleagues, both staff and faculty, I started to look for something that was a little less prescriptive semester to semester. So I wanted a little bit of a change up. And when I was looking for jobs, I came across a posting at Stanford. And I didn't really know much about continuing medical education, I really just — the extent of my knowledge was my parents and uncles and aunts, they consumed continuing education to stay current in their respective nursing and medical fields. So that's really all I knew. They had to take these classes a few times a year, and they had to submit it. Sometimes I helped my dad submitting his online. No, that’s all I really knew about it. But the Stanford role really intrigued me because I had this opportunity, this really, really unique opportunity to partner as an education expert with some of the country or even the world's leading physicians, to design educational experiences for other clinicians. And it truly just has been a whirlwind ever since. So that's kind of how I got into the CME/CE world. And now I'm, I'm here and really enjoying it.
Alexandra Howson 02:57
And forgive me if I misheard, but did you say that your, your initial role was in education for dentists and other clinicians, but not necessarily continuing education? Can you talk a little bit about that, and what that involves and how you got there?
Yeah, yeah. So as many people after undergrad, I was a little unsure of where I wanted to go, I think I was interested in, in medical school, but I didn't exactly know if I wanted to commit the time and the money to actually go through with it. But I also really liked working in higher ed. I worked a little bit in higher ed in undergrad when I was working in student affairs, and had several different minor part-time student affairs roles in undergrad at the University of San Diego. And from there, I decided I would take a master's degree in health professions education, and that was at Western University of Health Sciences in Southern California. And this is where I learned a lot about adult learning theories, clinical teaching, and so, really interested me. And I found it very intriguing to see this: the teaching side, the instructional side of health professions education, and I was still working in the capacity of — like at an academic center. And so that was where I really started to love this field and really gotten interested in it. When I graduated from my master's program, I was actually offered a job at the dental school and that's where I started to work on just curricular affairs and helping manage the curriculum for the first year and third year students at the dental school. And that really involved helping develop some assessments whether that is, whether those were these objective structured clinical exams that the students were taking, or they were just regular multiple choice assessments. And then I really got into evaluation from there; helping develop course evaluations, working with our faculty to deploy those evaluations, and then also helping them kind of understand the measurement of outcomes afterwards and helping target the students who really needed help and find that, you know, these are their weaknesses, and this is how we can support them, so that they could be better clinicians when they graduate. And that's kind of where I was for the medical and the dental schools and what I did then.
Alexandra Howson 05:41
So you've been pretty immersed in education, designing and evaluating educational experiences for a while. Can we talk a little bit about, you know, I do want to talk about your work at Stanford, but you, you mentioned, assessments and evaluations. So what do you see as the kind of key components of assessment, as opposed to evaluation?
Yeah. So for assessments, I think the important thing is to assess the knowledge of the learner and really, really kind of gauge whether or not they are learning from the objectives that are set for that activity, or that course. And so for me, we oftentimes put in a post and a pretest assessment for our learners just to gauge their baseline knowledge. And then after the educational initiative is consumed by the learner, then we can see whether that knowledge has changed, or if they need additional, maybe additional learning, I think it's really interesting because we could do such unique things with like adaptive learning where it's customized to the learner. And through a series of assessments, you can gauge whether a learner will, whether a learner is strong in one area, and weak in another and then help them try to get to the level of passing, I guess. And then with evaluation that truly to me is after a course is complete, we typically give a post-course evaluation to kind of understand a little bit about the learner satisfaction with the course, whether they feel that they the learning objectives were achieved. Our university requires us to also do a net promoter score for some of our activities. And so just understanding if they would recommend our course to a friend or colleague and then seeing how that translates to success for, for our office for every activity or just, just longitudinally too.
Alexandra Howson 07:53
I want to come back to assessment because you foc-, you mentioned that a lot of your assessment focuses on, on knowledge. But let me ask first of all, what could you describe your work at Stanford and, and what makes the Stanford approach distinct in the CME field?
Yeah, so since June of last year, I actually have taken a more supervisory role at Stanford CME. So as the Assistant Director for office, I really manage the teams that execute online education, instructional design, and website and marketing. And I'm really fortunate, I work with a really talented team of individuals. And they design and develop online education like computer games, educational animations, online modules, as well as the creative staff behind the scenes of elevating our marketing and our website. But I also have a slew of different projects and programs that I still guide the educational strategy for. So as you know, I lead our offices CME live online conferences the past two years, and I also cohosted the CME live Onward Webinars series, which was a monthly series that I co-hosted with our Executive Director, Kurt Snyder. And those were really fun projects that I was on that I got to really immerse myself in the continuing education community and get to know people outside of our team and get to see what the rest of the CME world was doing in terms of delivering education to clinicians and how they're thinking outside of the box for education design, whether that is, you know, not doing slides or not just doing didactic lectures, but maybe involving a patient voice or maybe executing on an online module or developing an educational game for their clinicians. And so that allowed me to also want to take on a few other projects. And most recently, I was working on a two-day educational conference that focused on topics covering the intersection of artificial intelligence and health. And so that was one of the largest events that our office has put out to date. And so that was really, really interesting to me, because I was able to set up the curriculum, working with our planners to develop different types of tracks that would attract learners. And that would cover the, just run the gamut of all the AI and health topics. And it was, you know, it was a really incredible event. And it was really rewarding afterwards to have actually accomplished something to that magnitude. But yeah, it was, it was stressful, I have to admit, but it does give me a lot of joy. And it's really rewarding to work with our Stanford faculty and our team to deliver these learning experiences to clinicians and other learners across the world.
Alexandra Howson 11:09
So I'm curious what some of the topics were that you focused on in artificial intelligence and health? It's, it's obviously an expanding field. Although I imagine that people at Stanford probably have a little bit more exposure to AI than perhaps in some other contexts. Can you talk a little bit about in that conference where you're seeing some of the trends going in AI?
I don't think I can answer that question.
Alexandra Howson 11:43
What makes Stanford unique in your perspective? So let me just kind of reset that question. So what makes Stanford distinct in the CME field?
Yeah, so as I mentioned, Stanford Medicine employs so many clinical experts and healthcare thought leaders and innovators in the field of medicine. And I think our continuing education programs follow suit. I I've mentioned this so many times. So I feel like I am a broken record. But I really can't emphasize enough how lucky I am to partner with really great colleagues to produce the incredible education that we deliver. I think Stanford CME specifically has begun moving in the direction of designing and developing nontraditional continuing education and stepping out of the box when it comes to education design, as I had mentioned earlier, that just thinking in terms of not doing didactic lectures all the time, and really determining what the learners need to get out of that content of, of that core. So that conference, an example I wanted to kind of talk about is we're doing an online CE, we're developing this online CE activity, that is called Septris. And it's an online education game. And it's intended to teach clinicians about sepsis, but in a fun and unique way. And I think that's, that's a really interesting strategy to utilize educational games, to attract clinicians who need, who might need continuing education, but also might need to learn from something very specific to their, their, their specialty. I think especially now, as you know, the baby boomers are moving out of the workforce, and the generations are changing a little bit. We're gonna need to pivot to really address the learning needs of the new generations. That's the millennials, Gen Z. And so something like this might be something that they would be interested in. And when the pandemic hit, Alex, we were really faced with a challenge of educating our learners online, like everyone else in the world, obviously. But we took this as an opportunity to produce educational animations, which was really fun. I think for me, it definitely reduces the cost of needing to hire actors and the production of having a team, film it on site somewhere, maybe venue rental, things like that. And it allowed us to be really creative with the look and feel and overall outcome of an educational animation and what we want to get across to the learners and how we want them to interact or engage with that animation.
Alexandra Howson 15:26
So that's so intriguing, I don't think I've seen an example of animated CME. Could you talk a little bit about the process involved in creating an animated product?
Yeah, yeah, of course. So I really get excited when our course directors come to us saying that they would like our support in developing and producing an educational animation to help their colleagues or other clinicians learn about a specific topic. And so one of the examples I'm thinking of is we've worked with Stanford's bedside medicine team, to talk to, educate, using animation on bedside presence, and just being this the soft skill of really connecting with your patient while you are in either an e-visit, or if they come into the office, or if you are working at the bedside, and what kind of soft skills you need. And the implementation of the different strategies that this group has put together, in, in transforming that information into an animation. And so our process is that we begin asking them, what is their overall vision of this project? And so they usually tell us that, you know, they want it to be X minutes long, usually, usually around 15 minutes and micro learning is, is always a great approach to educational animations like that. And then, you know, how do they- what is the mood for the, what is the mood for this project? Do they want it to look professional? Do they want it to, to look a little bit more casual and informal? Do they want it to have bright colors? Do they want it to have more subtle, subdued colors? So just thinking through all of the different aspects. And then from there, we actually have them storyboard. And we work with them to put together a storyboard with different scenes, describing every single scene, whether the first scene is going to be in a hospital space, or is it going to be outside the hospital? Or is it going to be right in the patient's room? And then we have them develop the script, and we usually work with them to kind of fine tune it and make some suggestions along the way. Sometimes, if we know that this animation will be interactive, and that means that we're embedding some assessment questions or reflection questions, we have them insert some call outs, and we, we indicate that this section will either pause and then ask a reflection question for the learner to kind of consume and think about, then then they provide us with the question that they want to, want to include. And then once we have this script and storyboard finalized with our- with our faculty, we start the development process. And what that means is we use a tool, an animation tool that allows us to create all these scenes and then we develop the actual animation. And then from there, we collect some voiceover. So we might use a third party vendor to, to produce those voiceovers. And then we lay them on top, and then we put in captions. And then we usually show them to our faculty to see their reactions. And then after that, if you know, they approve of it, then we layer on top the assessment pieces. So those reflection questions or knowledge checks. And then once all of that is approved, then we go ahead and launch the educational animation.
Alexandra Howson 20:40
So faculty play a very central role in actually developing the, the minutiae of the content, the actual things that people are going to say, or that the animations are going to, to say.
Right? Yes, they absolutely do. That's why when I say that we partner with our faculty, we really, we truly do. So they're really important stakeholders in the process. They are subject matter experts, we turn to them for guidance on especially the clinical content. And then my team and I, we really just like to help guide the educational strategy, or like the educational design of it, to make sure that we're applying, like learning principles and learning theories that are sound to this particular course, or, or activity. And so that's how we involve, involve ourselves. And we try to, we try to ensure that there's active learning involved, and that the learner at the end of the day is really engaging with the content. And it's not just something that's passive, and they're just listening or watching this, and they're truly able to retain the information and apply it to practice in the future.
Alexandra Howson 22:01
So one of the things that you've talked about there, Jayzona, that I find really interesting is apart from the whole process, itself is you clearly, your department clearly has a very strong relationship, collaborative relationship with. With other stakeholders, we can talk about who those .stakeholders are in, in Stanford, Stanford University, or at least Stanford School of Medicine. And one of the things that we hear from a lot of people who work in hospital or sometimes even academic CME departments is that they kind of struggled to be visible, and struggled to make sure that they are seen and heard by other stakeholders in their organization who could use their services to deliver education. So could you talk a little bit about some of the work that you and your colleagues maybe have done in the past or have to do in order to make sure that those relationships with other stakeholders in the School of Medicine are vibrant? And what has led you to the place where you are this partner of educational delivery?
Yeah, yeah. That's a really great question, Alex, I'm glad you asked it. I think one of the one of the ways that our office has made ourselves more visible at the Stanford School of Medicine is that our Executive Director and our Associate Dean for Postgraduate Medical Education, Kurt Snyder, and Daryl Oakes, they did this incredible talking tour with all of the departments at the School of Medicine, I think almost all the departments and really highlighted and emphasized all of the services that we have, and the incredible team behind our office and all of the all the various things that we can do. And it did take a while to really get buy in from a lot of faculty. But I think one thing that has really, truly helped was the customer service that our team offers. Our faculty is really beyond anything I've ever experienced. I am not just saying that because this is a team that I am part of, but it is a team that I am immensely proud of. And I think that just the level of professionalism, expertise competence that this team brings every single day, day in and day out, is truly, is truly unique. It's a truly unique working environment. And I am really glad that we can deliver this and we can offer this to our faculty. And I think what happens from there is they have a good experience working with us and they noticed that you know, we're very attentive and our because our attention to detail is so high. We you know, like they, they appreciate, they appreciate that. And they appreciate working with people who, who believe in the mission and of the school and who also have a vision for our team, and are just really dedicated. So I know I'm talking up a storm about my colleagues. But I truly believe that they're just, just showing that you can produce some really incredible education, the word gets around and word of mouth is really important in, in promoting our services. And so I think, at least in my experience, every time I speak to a new faculty member, it's because they heard it from a colleague, and they heard that we do great work. And so that's what really excites me about that. And I think if it weren't for the groundwork that Dr. Oakes and Kurt had set up for us, when we all several of us had started the same year in 2018, it really set us up for success.
Alexandra Howson 25:59
So it sounds as though you, you at least initially had to do some, some deep work in, in making sure that the department, the unit, was visible to faculty at the School of Medicine, do you find that you have to do or that you're engaged in that kind of onward process- an ongoing process of promotion? To make sure that that word of mouth is current? And is that part of what you do in your department?
Yeah, yeah, absolutely. So I- before, I hadn't been doing a lot of the business development for our team. But when I moved into this role, Kurt has given me a few opportunities to build some relationships with people both inside and outside of Stanford. And then to try to do some, try to figure out some partnerships that way. And so I've been doing some of that, and I think it's been fruitful. I also feel like oftentimes, when some of my, my small team works outside with faculty or other departments, they just, people just keep coming back. And so then they have more ideas. And they, they email me or Kurt or Ruth, and they ask us to meet for- meet with either them or meet with a colleague. And so that continues to develop as well. I almost want to say to the point that we're overwhelmed. But yeah, they're just so interesting. And that, you know, we can help the overall advance the mission of our department.
Alexandra Howson 28:53
So you've been talking about business development and raising the visibility of CME within Stanford, can we talk a little bit about who your audiences are or who your learners are? So when faculty come to you with ideas, who are those, where are those faculty coming from and what kind of ideas are they pitching to you? And who are the ultimate learners? So that's three questions.
Yeah, I think I can answer those, let me tackle the first one. So who are our learners? Usually, when our faculty come to us, they do have a specific audience in mind. So oftentimes, I would say it varies between national and regional. So when I say regional, I mean, the Northern California or Bay Area population of clinicians. And typically, it is to kind of engage the community that's around Stanford, especially the academic community or the clinical or medicine community. And if it is outside of the Bay Area, nationally, it it's really, it's a really wide range. So it could be primary care, it could be specialists. And oftentimes, more recently, I think we've been having a very international reach. And so especially with online education, we tend to see more international learners than just those within the United States. So our faculty have- it seems to be that they've been more interested in having that international impact with our education.
Alexandra Howson 31:25
And so when faculty, when faculty come to you, where are they? Do you get a sense of where they are developing their sense of what the need is for education? I'll rephrase that question. So when faculty come to you, have they already kind of engaged in some kind of needs assessment? Or are you involved in that process with them to really kind of determine what the, the breadth and the depth of the educational need is?
Yeah, usually, the faculty have already developed a needs assessment and executed it. And then they come to us, they tell us that there is a need, that they see a need in education for X, Y, and Z, and that they would like to, they would like to develop some kind of continuing education activity around that need. Sometimes it's a grant focused. So perhaps they have obtained an educational grant. And that is supposed to address a specific topic in their specialty. And they would like to produce education that, that addresses that. And then, once in a while we do engage with them and help them develop a needs assessment. In our evaluations, in our, in our course evaluations, we also insert a couple questions that are asked that ask the learners who took a course, and what their needs are. And sometimes we do an analysis of those needs. And we, we provide that to our faculty to kind of show them these are the topics that people are interested in learning about for future activity, continued education activities. And these are mainly some things that we can incorporate in the next course that we partner with you on.
Alexandra Howson 33:24
We've been talking a lot about Stanford, and the resources and the approach to developing continuing medical education. I want to talk a little bit more about you. How does your background in psychology and education inform the way that you approach the design and delivery of continuing education?
Yeah, I think I'm going to have to go back a little bit, I know earlier in this episode, we talked a little bit about my current role. And so I wanted to just quickly go back and talk about my first role at Stanford CME actually. I started as an education development specialist. And with that, it really felt like I dabbled in all things CME. I helped with slide review, disclosure collection, conflict of interest mitigation, meeting planning, instructional design violations and outcomes managing, really, as I mentioned before, I was really, really immersed in continued education yet, I was still trying to learn the field. And then from there, that's when I started to move solely into a role that focused on education, design and evaluation, and outcomes measurement. And that's when I felt like I was really flexing the muscles I developed in school. I applied what I knew about adult learning theories from my undergraduate psychology degree and sound evaluation practices from my two grad degrees to the work that I was doing at Stanford CME and just having those two grad degrees, both the master's and the doctorate in education, it positioned me as the subject matter expert, who can really guide and deliberate with the faculty on designing continued- continuing education that invokes learners to both retain information, retain knowledge that they consumed in our activity or our course, and also implement changes in their practice. So really helping the faculty apply active learning principles, if that's flipped classroom, or if that's, you know, doing some small group reflections or things like that, and trying to deliberate and trying to have these discussions with them in a way where they're understanding why it's important to not- to kind of mix it up and not just be didactic. But I think our learners, I think all learners are very unique. Everyone has a different learning style. And it's just how we strategize as educators. As educators, it's how we strategize and how we deliver the education that can really engage our learners.
Alexandra Howson 36:11
So a couple of things there I just want to kind of explore your, your thoughts on one is about faculty, do you, you know, one of the things that I hear sometimes from people is that, you know, they spend a lot of time and energy, educating faculty on educational principles, particularly, you know, adult learning, is that something you've had to do in your role?
Yeah, yeah, I think one of the things I tried when I first started was, I felt like it wasn't being heard by our faculty, even though I knew I knew what I was talking about. And I didn't want to try to use technical terms with them, because it wasn't going to get us anywhere. So what I did when, when I, in the first year that I was at Stanford is I actually created like a menu of, a menu of active learning strategies that faculty can select from, and potentially incorporate into their, into their education, whether it be an online course, or a conference. And there were times when I would actually go to, go to conferences with my, with our meeting planners, and I would videotape like a polling session, so that I could bring that that recording back to faculty that I am meeting with, to show them how it could be beneficial in in their particular course. And I think that helped a lot. So kind of meeting them where they're at, and understanding that you need to talk, you need to show them how it could be used and how it could be benefit their learners so that they can buy into, into it.
Alexandra Howson 38:55
wonder if we can talk about some of the challenges that you face in developing and implementing CME in an academic setting, which, from my perspective, as an, as an outsider, seems distinct from many other settings, in that you've, you've talked, you know, you've implicitly refer to kind of resources that you have at your disposal in order to create, you know, kind of quality CME and obviously, a lot of CME departments don't have those kinds of resources. But what are the particular challenges that you do face in designing and implementing education in your setting?
Yeah, absolutely. So, although I've spoken several times, about how incredible partnering with our faculty is, there's also the flip side of that coin, where, you know, we get to work with these faculty, but they're also very busy individuals, they have clinical responsibilities, they might have academic appointments, they also are juggling, you know, work life integration, and we just some oftentimes are faced with roadblocks that are more like time management and, and actually getting deliverables from our faculty. And so sometimes that puts our projects either very lengthy, like gives them very lengthy timelines, which, to us, it's really difficult because we want to, we know that these, these projects will be really great, and we want to launch them, and we want to be able, especially for the online education, we want to be able to share it, you know, with our learners, but when we're constantly getting hit by non responsive faculty, or, you know, they're wanting to share and share it out and have several other rounds of iterations. That's kind of where we are, we struggle with. And so we think, like a lot of other continuing education departments out there who are developing online education. Yeah, it's definitely it's definitely a challenge to rein in your subject matter experts, and try to get them to stick to the project timeline that you discussed at the very beginning of the project. But I think with, you know, you learn to navigate those waters.
Alexandra Howson 43:25
How do you navigate them?
Sometimes it's talking about like, potentially re scoping the project or, or just even letting the faculty know that there's going to be a delay in launching this if we don't get all of the deliverables from them that we need, or if we don't even have content, and just having that very honest and open conversation with them. And yeah, I think that tends to wake them up a little bit. I think it's really important to have regular check ins with with the faculty. And so if that's, that means setting up a bi monthly cadence of you're checking in with them for 30 minutes to see how their script development is going or to see how the storyboard is is coming along. That usually helps move the project along and I think it holds them accountable. And it holds our office accountable to that if there are any action items that we needed to execute on within the the in the time that we last met with them, then we also are showing that to them at that check in meeting.
Alexandra Howson 44:35
Some CME providers rely more heavily on writers and other content developers to help move that content process along doesn't sound a zoo, that's a model that that Stanford uses. When you were talking earlier about soft skills, and it seems like, you know, I trained as a nurse in the 80s, we've been talking about soft skills for decades. And it and a lot of the work that I do, I'm a qualitative researcher as well, it one of the things I hear again and again and again, from clinicians, is they need more support, in communicating with patients, how to ask questions, which questions to ask what to see what not to see. Those kinds of things. So if I ask a question around that, will that allow you to talk about what you want to talk about? Yeah. Okay. All right. So 321. So earlier on, when we were talking, you mentioned a couple of projects, we're working on that focus on communication, skills, so called soft skills. And it's curious to me that, you know, really, we've been talking about the importance of learning how to communicate, or, or the importance of teaching clinicians how to communicate for decades. So I'm wondering what your take is on how, what some of the best ways are to teach clinicians about how to communicate with not only patients but with peers and other clinicians about important topics?
Yeah, I think one of the best ways to kind of train clinicians and give them the strategies they need and the tools they need to succeed in communicating both with their healthcare team and with patients and patients families is to provide them first with the an education initiative like an online module. We worked actually recently with the oncology department and we have a primary care focused course online course called Health after cancer. And this course is really interesting because it was developed by oncologist but has the framework of a primary care, primary care framework and so it was an oncologist to oncologists and a primary care physician who partnered together with our office to to create this, this module and they utilize really emotionally sensitive case studies and in scenarios that helped put a learner in the position of the physician or the clinician who was working with a patient. And it allowed them to do some knowledge checks to do some research reflection. And then at the end of it, it gave them tools and strategies and kind of like a template that they could use in their practice to implement. And we found that in the evaluation results that a lot of people were actually using those those support tools. So it was really nice to see that not only was the education that they consumed in this online module really helpful to them, and they were answering the reflection questions, and they were getting the knowledge checks done. And they were corrector. And they had a really good score, just generally, but also that, that they were actually implementing some of the strategies and the tools that they were provided. So that was really, really interesting to see. And something that probably could be replicated for other other departments or other specialties.
Alexandra Howson 51:17
And a rewarding example of the impact that continuing medical education can make in not only lifting knowledge, but also changing practice. Jayzona Alberto, thank you so much for spending time with me today and sharing your story with listeners of right medicine.
Great. Thank you, Alex. I really appreciated the time and the conversation.