Write Medicine

The Power of Multimodality Simulation in Continuing Healthcare Education

June 21, 2021 Alexandra Howson PhD Season 1 Episode 11
Write Medicine
The Power of Multimodality Simulation in Continuing Healthcare Education
Show Notes Transcript Chapter Markers

Martin Warters MA Ed. Tech, CHSE is Head of Education Development Management at Pfizer. Today he shares his expertise on how we can leverage simulation technology in clinical learning and continuing healthcare education. He talks about the power of narrative design to buttress the patient's story, and how to creatively craft pathways  for effective learning. 

Resources
High fidelity simulation
AR/VR
Lev Vygotsky and the zone of proximal development 
Narrative Medicine at Columbia
Narrative design
Conceptual frameworks in medical simulation
Simulation in adult learning
https://learninguncut.global/podcast/

Connect with Martin: LinkedIn
Connect with Alex: Thistleeditorial.com

Podcast Team
Host: Alexandra Howson PhD
Sound Engineer: Suzen Marie
Shownotes: Anna Codina

Alexandra Howson 19:28 

Hello, and welcome to Write Medicine. I'm your host, Alex Howson. And I'm here today talking with Martin Warters, a learning experience designer who's currently head of educational development management at Pfizer. Welcome, Martin. So happy to have you here on Write Medicine. 

Martin Warters 19:49 

Alex, thank you so much for having me. It's an absolute pleasure to be here too. 

Alexandra Howson 19:53 

Let's start with who you are, what your background is and how you find your way into education and clinical or medical education in particular? 

Martin Warters 20:05 

Well, it's it's one of those things I think, like for most people, I remember sitting on my my mom's knee as a five year old and declaring that I wanted to get into CME and, and simulation--no, it's obviously a joke but it's the same thing for kids growing up today the job didn't exist. So you know, it's incredible seeing what amazing professions will be available to children grown up in in 20 years or so. I think like most northern working class kids at the time, you know, even at a young age of four is going to be football as my professional choice or a train driver or a detective or some form of amalgamation of all three, I was looking at actually see to go to university to study a subject I was good at an enjoyed which was English. At the time, there was a lot of not overt pressure, but certainly you know, what, my friends were doing more vocational courses or IT courses as well for their studies. But, you know, I stuck with both humanities because it's something that I enjoyed or like something that I was, I was relatively good at and never ever, ever intended to, to become a teacher or get into education. It's just purely luck, studying something, something that I enjoyed. It did actually eventually open up the doorway to get into the into the classroom as a teacher 

Alexandra Howson 21:30 

Starting to realize you wanted to be a teacher? 

Martin Warters 21:32 

Yeah, so that was the first the first real job, as it were, quote, unquote, real. Yeah, so sort of the teacher moved on to teacher trainer, director, studies, materials designer. And it was at that time where technology was becoming more and more apparent in the classroom. So I find myself teaching a lot more online classes. And using some of the new approaches at a time I flipped classroom blended learning approaches. And it was becoming more and more apparent that this was something that I was enjoying, and something that's really having an effect on my teaching and my approaches. So I did a somewhat sideways career shift and started working for an organization who created online simulations in 3D virtual worlds. And that was for the aviation and the oil and gas industry. Of course, yeah, it is superb, Alex, it really was a real eye opener, just in terms of what was available, what the affordances were of the technology. And it was also an eye opener, in the sense that it was clear that my skill set was lacking somewhat. So I went back to university to do my master's degree in educational tech. And yeah, it just really, really exploded from there. That was the catalyst for joining a small startup in Durham, North Carolina at the time, who were creating virtual patient simulations. It was just past the coffee shop stage where I joined as the hired CE to do instructional design work for the virtual patient center and, and the rest is history. 

Alexandra Howson 23:23 

That is so interesting. I should point out for our listeners in the United States, then when Martin talks about football, he actually means soccer. 

Martin Warters 23:38 

Still somewhat painful to refer to that, but yeah, yes, it is. Yeah, absolutely. Spot on. 

Alexandra Howson 23:43 

Yeah, given Scotland success in 2020. In terms of ball, it's soccer. It's a big conversation in our household. And you mentioned a couple of things there, you know, flipped classroom and, and so on. It's interesting. No assumptions about age here, but how long some of those concepts have actually been around in the broader field of education. 

Martin Warters 24:10 

Oh, absolutely. Yeah. And that's the spirit still apparent today. Yeah, it is fascinating, isn't it? How some ideas take hold and some don't and some catch on and some don't. It's almost likened to a pendulum, isn't it, about some of the ideas and theories garnering more direction, and then going a little bit out of favor and swinging back to something else? So yeah, it's definitely an interesting time, both on the technology front and how the approaches were influenced by what was available in terms of the educational technology of the time. 

Alexandra howson 24:49 

That's shifted enormously when you talk about simulation. My first experience of simulation as a nurse in Scotland in the 1980s was Annie the mannequin. Annie’s the CPR mannequin, isn't she? 

Martin Warters 25:11 

Yeah. 

Alexandra Howson 25:13 

So what is simulation? How? Because when you're talking about advances in technology, you're not talking about a mannequin? 

Martin Warters 25:25 

Yeah, that's a really good point is that there's so many modalities of simulation alone. It's it's social emotive word right now as well what we're, you know, the current tech and how it's being portrayed in 

media, and, and film and television as well. It's anything really, you know, you've got your lo fi simulation, your high fidelity simulation. So things like the really, really, really expensive mannequins you don't just operate as a CPR training, but have the ability to portray human physiological responses to treatments or interventions that the practitioner provides on all the way down to something as basic as an orange peel being used as a suturing device. You know, it's got the broad spectrum between any of those, any of those several modalities. So I think, you know, is that a working definition? Certainly something that we use, it's just the idea of it being something that replicates some aspects of reality with the intention of training. I think that's probably a really nice working definition of simulacra. 

Alexandra Howson 26:35 

That's a great definition. Can you tell me a bit more about the orange peel because when you say, when you said orange peel, I immediately thought of oranges. And of course, we learned to actually give injections on oranges. 

Martin Warters 26:48 

They say this is you know, we should be sponsored by a fruit company or something. Absolutely. So the skin--the peel of an orange, I've seen it being used to practice suturing techniques for stitches and various things on those lines, apparently, it's got a very, very similar to a piece of human skin. So after you get an injection, you can perform a little bit of stitching on it as well. 

Alexandra Howson 27:12 

I will get my thread and needle out after this conversation. When I trained as an OR nurse, we actually had to spend a month in a sterilizing unit and have tours of, I think it was Ethicon. I don't think Ethicon is in business anymore. But they were a suturing company. And yeah, so we got to learn about it and there was a lot of Catgut, I don't think there's a lot of Catgut around. No, I think most suture material is synthetic. But we got to learn all about that. Anyway, that was a very long time ago. The other thing that you mentioned there that I thought was really interesting was mannequins that have physiological responses. Can you talk a little bit more about that? 

Martin Warters 28:00 

Yeah, it's incredible, isn't it? You know, the cutting edge technology that's available now. You know, a lot of the high, high end mannequins have the ability to perspire, they can replicate heart sounds, lung sounds, pupils dilate, pulses quickening, and just depending on what intervention the stimulation practitioners are performing at the time. So it's incredible to see, it really, really is. And then a lot of them also have the ability of speech. There's a small microphone placed into the mouth of the mannequin and an operator simulation operator can speak if need be to give an extra sense of portrayal of, of realism. So yeah, it's, it's incredible to see some of the high end tech and then you know, like saving between from that to to, I feel it's fascinating. It really is definitely an interesting area. That is amazing. 

Alexandra Howson 29:02 

So what kinds of simulation do you find work particularly well for clinical learners? Because I'm guessing that, you know, most listeners will think about simulation, you know, as we've been talking about, we're talking about physiology, we're talking about procedural stuff, we're talking about hands-on 

experience of clinical practice. Are there other ways to use simulation? So I guess there's two questions here. We know what kinds of simulation work particularly well in clinical education? And what's the most effective? 

Martin Warters 29:43 

Great question. And I think it comes back to the underlying question that we probably ask ourselves every day is an education lesson that's choosing the best modality for the best problem that we're trying to solve. So, like we said before, with the hi fi mannequins if you're looking for a cardiac situation or a trauma situation, you know, they're the top quality, most applicable appliable learning interventions and solutions for that one, simulation is great, though in the sense that you can go from that all the way through to a standardized patient. So an actor portraying a certain condition is a great way to practice taking a health history, maybe having some difficult conversations with a confederate as well. So for example, if you're learning how to break bad news to switch a partner to, to a parent or to a patient, obviously, a real life human being able to react to the words that you're saying is an incredible learning experience as well. And you know, the background I have really with virtual patient simulation, an amazing device in the sense that it portrays a virtual representation of a real life patient. So you can do all the things that you would do in a real life practice setting. So you can order tests, make diagnosis, administer treatments, prescribe follow up, and every step of the way you're getting targeted feedback on the appropriate or otherwise, of the decisions that you make. insights is a great tool for reinforcement of learning. But it also operates as a catalyst of change. So real safe environment, you can make mistakes, you can experiment, you can try things out, and you're getting the targeted feedback on whether it's a good thing or a bad thing and the data, the data behind the choices as well as to as to show why it is such a good thing or a bad thing. 

Alexandra Howson 31:45 

Can we talk a little bit about--you mentioned a couple of things there. One is actually you mentioned three, at least feedback? Why is feedback important? You mentioned mistakes? Why is it important to have that opportunity for making mistakes built into the kind of simulation that you're talking about? And then the third part that sticks out for me is you mentioned the catalyst for change. So let's just kind of break that out a little bit. What kind of feedback are possible in the kind of virtual patient simulation that you're talking about? And why is feedback important? 

Martin Warters 32:35 

I think the wonderful question and I think the the key component to to thinking this through is that, you know, full disclosure, I'm a I definitely person when it comes to anything of the clinical nature, but being in the in the close proximity to the field, and just realizing how how quickly things can change in terms of best practices, best treatments, new protocols, new algorithms for for treatment, or prescribing. Sorry for making a diagnosis. Having a medium, having a vehicle to provide this new information to practicing healthcare professionals in the field, its simulation is second to none. And you know, you could have a new conference proceeding that talks about a new protocol or algorithm delivered at the weekend, come Monday, Tuesday, you've got a simulation, whether the practitioner can apply that knowledge straight away. You know, and I think like with any industry, there's a lot of practitioners who are, we'd like to change just with the, this is what I've done for 20 plus years, it's always work, this is what I'm gonna continue to do, which you know, is a valid way of approaching the the treatment of a patient, what simulation can provide those that opportunity to say, okay, that is a decent selection when you've made, but evidence best evidence based medicine is suggesting that this might be a viable alternative option for this type of patient. So, you know, it's providing that, that fertile ground to, to consider behavior, and also to provide that opportunity for, for self reflection, which again, is something that that simulation is exceptional at doing and providing that opportunity to, okay, it's telling me that this is an option. Let's try it out. Let me be informed. Let me make a few decisions and then see how that can, how that can hopefully eventually be implemented into my own practice. 

Alexandra Howson 34:37 

Do you see a lot of--do you see many examples beyond the kind of simulation that you're talking about where feedback is really built into clinical education design? 

Martin Warters 35:01 

Outside the field of simulation per se? I think you know that the seven learning intervention sites do provide that same sort of feedback. I mean, even just a relatively simple e learning multiple choice type of endeavor will provide that level of feedback. I think, though, where restimulation excels is because it's so immersive. And it's so much investment in this, in this patient, their their story, all of the the baggage, all of the hopes and fears that this virtual representation of humans provides, then I think the, I think it's second to none in terms of refocusing and reconsidering the the options, but yeah, I think he's spot on in saying that it's not just feedback is not just obviously restricted to to the field of simulation, but certainly the way that it's applied and the way that it has their immediacy, based on decisions made, I think that's a real key strength of the design. 

Alexandra Howson 36:05 

And what about the other two things that you talked about a few moments ago in terms of building an opportunity for error and, and kind of designing simulation in ways that provide opportunities to create change to be the catalyst for change? And presumably, we're talking about behavioral change here? 

Martin Warters 36:29 

I think so. And it's a definite, again, I think this is an industry wide, maybe even quite grandiose to say, so maybe even a worldwide mindset, where for a lot of people error mistakes is, is seen as a bad thing. You know, so we definitely want to instill within the same that it's a safe space, you know, this is the old joke that we always do about, there's no virtual lawyers with virtual law suits with virtual malpractice. Yeah, I think it's just that, you know, getting your head around the fact that this is a safe space, there's no repercussions, nothing bad is gonna happen. It's in this sense, is not necessarily an assessment tool, it is a straight up training, teaching tool, where, you know, if you, you might make an error. And then if you are made aware of the fact that, you know, this, this test was unnecessary, it was invasive, it was uncomfortable, it was expensive, this is an alternative option, fantastic, you know, do the do the mistakes through the errors on this, on this virtual human rather than the person that you can be seen in a couple of hours time down there, down the hallway. And that's where the real benefit lies. I think it's just that, that change in mindset, especially with medicine, you know, and the mindset to become a doctor of being in top of the class got to be 100% all the time. It's, yeah, I've seen a little bit of a struggle with, with undergrads, just getting that that change of mindset to be able to, to experiment and play around and, you know, try, try things out, try it all out, you know, do it there and then and learn from it and treat that as a learning opportunity more than anything. 

Alexandra Howson 38:18 

Yeah, having that safe space and having the time actually to engage in the kind of practices that you're talking about. And I suppose that raises an important issue here. To what extent are the things that we've been talking about really applicable in relation to undergraduate clinical education, for physicians versus continuing education? In the health professions more generally? 

Martin Warters 38:49 

Again, super question, it's one that you know, we definitely struggle with in terms of the the two separate names of the cohorts you've described, I think with the just linking back to what I said before with the practicing healthcare professionals, with the the ever changing landscape of medicine is getting that information to them in the same way that any CME format would do, to keep the skills up to keep them practicing. Just to have that ability to apply new knowledge in a safe space, whereas with the undergrads, it'll be everything. And I've seen some really interesting programs, or various schools around the country where they're incorporating virtual patient simulation into a blended learning approach with the standardized patient, and then also the hi fi mannequin, so it's almost like the continuum of care. You might have a standardized patient come in complaining of chest pains, dizziness, sporadic, feeling faint and find those finds. The next step might be the virtual patient was a few drugs administered, a few tests or diagnosis made. So that's the next step. And it could culminate in a crash situation. Now, cardiac arrest isn't one of those, it's a really, really, really nice way just to show all of the skill set that the history takes in the differential diagnosis, the initial treatments, and then, you know, the worst case scenario. So different names, but I think there's a definite space for simulation to fulfill all of those needs between those two cohorts that you mentioned. 

Alexandra Howson 40:29 

And we're talking, or it sounds as though you're talking mainly in terms of individual skills, how applicable are the kinds of simulation that you're talking about, for teamwork, and, presumably, also, communication skills within teams? 

Martin Warters 40:53 

I think highly, yeah, that's another avenue where I think any modality of simulation can excel. You know, if you got a crash scene, especially, you got that highly functional team, or even with a virtual patient, I think there's opportunity for interprofessional education and allied health care professionals to, to treat the same patient, you might start with a PA doing the initial work history, and then handing it off to maybe something more of a specialty. And then, especially if they're handing off to a specialist. So again, just showing that continuum of care. And I think the real strength of that one is, you know, any Passover or change in terms of a misunderstanding, or a misdiagnosis or a misinterpretation of any piece of information, it's going to have that knock on effects down the continuum. So just I think it just highlights the importance of, of every step along the way. And again, just that, that teamwork, that communication and, and the referral process as well. And we're really, really strong, strong use of simulation for that type of training. 

Alexandra Howson 42:06 

Right. So really, the whole kind of continuum of care can be part of are addressed by simulation modalities. Can we talk a little bit then about how you assess all of that you're talking about feedback, and we're talking about making errors, presumably, there's a room there's room there for formative assessment versus summative assessment. 

Martin Warters 42:31 

I think that how we've done it, how sorry, how we've designed and seen it in the past has been that that immediate feedback in terms of this is good, this is bad. And then, you know, the summative assessment at the end, you should have done this, which I think could be, you know, relatively easily mapped out to standards of care and certain criteria to show competence of a certain skill set. So I think there's that opportunity there. I think the best way to think the differentiation between the two is rather than having that formative assessment, during the course of the simulation, having more of a summative, just end of sim debrief, these are the things that you didn't do, these are the things you did do this is good, this is bad type of type of debrief will be will be beneficial. Where we've, where we've struggled with that in the past is especially for CME, because it does need to be highly, highly structured in the sense that if you're gaining credit for this, the experience needs to be controlled to a certain degree. So we're providing feedback along the way for each of the choices that are made. Whereas if you're going to use it more of a, an undergrad teaching tool, then you probably just have no immediate feedback, none of the formative assessment and let them go down the rabbit holes, you know, if they start going down and missing certain things, let them order the the unnecessary invasive tests that are not going to add any value to the to the workup and then use that as the debriefing opportunity at the end. And, you know, going full circle to go back to the idea about technology, you know, Sim, it's still that human component is vital. Especially for you know, given that that real sense of debrief, I think, you know, having the opportunity even if it's just the cohort speaking among themselves in terms of iPhoto status, I tried this, what were your experiences, and that's, that's still vital. So even though a lot of it is technology orientated and technology based, like that human component is still a key driver for success, that's for sure. 

Alexandra Howson 44:50 

Oh, definitely happy to hear that and it makes total sense. We've been talking mostly about simulation. Let's kind of broaden the gaze a little bit to touch on what makes for interesting and effective learning design. Generally, I mean, you must, in your current role, you must see, you know, have a pretty wide view, and on your, in your experience as well, a pretty wide view of different kinds of learning, design and modalities. So can you talk a little bit about what, what's interesting, what's effective? 

Martin Warters 45:29 

Yeah. And I think, you know, I think what mirrors, good simulation, and effective education are very, very similar. And in the sense that anything that is unlinking it also goes back to the concept of learning experience design, you know, something that is learner centered, perhaps as a constructivist slant in terms of learning and teaching. And, you know, that the one that I think is, is really exciting right now. The big influences that have off storytelling and narrative design, you know, I think this is growing exponentially, I think it's going to grow even further, with more uptake in VR, and AR. Again, just linking that back to the the idea of the, the immersive nature of the of the medium, you know, that the whole VR/AR industry is essentially an exercise in storytelling as, as virtual experiences, they're delivering the grammar and a narrative structure for for educating, informing, teaching, and entertaining really, in new ways. So I think, yeah, I think storytelling narrative design is going to be the big one definitely, you know, factors into so many educational interventions. And, going back to wires, you know, friends, myself has been lucky for choosing to go through the humanities route. Certainly, it's a skill set that seems to be in demand a lot more, a lot more nowadays. You know, I think there's been a big pendulum shift towards this more technical focused side, you know, in the last five, seven years, but I think it’s moving back to more of the humanities now, which is a really interesting change. Now, I think it's, it's a natural extension to technology being so user friendly, you know, we could rattle off a website relatively quickly, with, with limited coding experience, you know, a lot of it is pre built, user friendly design, which you can incorporate into, into things that you want to do what's missing now? Is that, that humanity, the humanities component, in terms of, okay, we've got this amazing technology, we've got this learner with a need, how do we marry the two? What's the best way to do that? So that's really why the learner experience design is such an integral position, I think, in education, and just in terms of developing these innovative ways to engage and empower the learners in these new environments that we're seeing in with this multi disciplinary, iterative, learner centered approach. I think it goes beyond just effective courses designed to create the entire end to end learning experience. So like I say, the psychology of learning, the user interface, user experience, design, all of that good stuff that goes into creating an opportunity for learning to take place. So yeah, but going back to the question that you'd raised, I think narrative designer storytelling is going to be absolutely the big thing for any modality moving forward. 

Alexandra Howson 48:58 

I do want to talk about that, in what you said, there's just so much good stuff, and I want to break it down. Do we have time, by all means? So first of all, you talked about constructivist learning when I hear constructivist, you know, my background is as a sociologist, I hear the co-construction of meaning and that gets me really excited. What do you mean when you talk about constructivist learning? 

Martin Warters 49:28 

So this is a learning theory which I learned about maybe again, you know, age disclaimer going on right now. I think it's about 18-19 years ago. And really it's all about focusing on the learners previous knowledge and their and their starting point. It's pretty much coming along the lines of business--my current understanding how am I going to get to to the next level, so it is is that building the reconstructions, the elements along the different ways, I'm probably going to butcher the pronunciation of this, Lev Vygotsky and his theory of proximal development. That's the one. So that's all about the idea of how you experience the world and how you reflect upon what you've seen, that's going to help you develop to the next quote unquote level, as you say. So rather than just just passively taking the information, you're actively using this to increase and improve your schematic theory about the world as a whole. So I think, yeah, that's, that's co-constructivism, and that is such a great approach for for technology, technology influenced learning, because it provides their personalized component feedback and providing you with what you need at the right time to really take you to that next level, and help you you'd like you say, help you make sense of the world. And back to storytelling, it's just a natural fit as well. 

Alexandra Howson 51:10 

So meaning perspective, context, and you touched earlier on user experience. So I can see how those two things kind of fit together. And I and I, but I do think that actually getting that sense of what the learners starting point is not often something that we're very good at, in the continuing medical education field, because so much of it is based so much of that data collection is a kind of pre test. Approach the correct me if I'm wrong here, whereas in the things that you're talking about, I hear, okay, you need a really deep dive into what that learner world looks like, in order to be able to set the foundation for building on that learning experience. 

Martin Warters 52:09 

I think that is an incredible point, you just raise. And I think the key component, there is just this sensor of finding that personalized barrier as to why for one of a better turn of phrase, why the schema for that person might be some more wonky or offline in comparison to what would be anticipated in terms of their knowledge base. So yeah, I think linking back to that personalized approach, my barrier to understanding may be completely different to yours, just based on background, previous learning, previous experience. So if we can really pass down and discover that then we're winning, that's for sure. 

Alexandra Howson 53:02 

That's a great point. And then the other part of that is, and you've mentioned it a few times now is storytelling, narrative design. What are you seeing in education that excites you around narrative design? And I think you're right about, it's interesting to track the way that narrative has emerged within medical education. I mean, there's a whole program on Narrative Medicine at Columbia University. Now. In the last 15, maybe even 20 years or so, you know, we've seen a real expansion of writers from within medicine who are telling that story of medicine, as medical practitioners as as clinicians, so you know, a tool Gawande is Siddhartha Mukherjee mucker Jay Abraham Verghese he there, you know, there's a whole cadre of writers from within medicine, her really driving home that point about the patient's story is, is at the heart of everything. So is that what you mean? Or are you talking about something else? 

Martin Warters 54:19 

There's so much good stuff to unpack there. It's exactly the intention, you know, certainly for the simulations that I've helped create, it was always putting the patient's story front and center. So you might, again, speaking as a lay person, you might have a premise for the simulation of white female early 20s, dyspnea on exertion after two blocks walk in-- something like that--just based on that real, dry clinical explanation, you can already start formulating ideas about this person. So how is it affecting them? What are their socio economic backgrounds? You know, are they just just even saying that now are they so I've got this, this idea of perhaps a single parent low income, struggling to, you know, get to work because of the dyspnea. And that's bringing on all sorts of issues personally, well, it seems you've just got that, you know, four or five bullet points sentence of, of the patient, then that's, it's going to be a very different experience to how you go about treating that person, when they're saying in front of you in real life based on what you've just read on the on the soap notes before you before you enter the room. And speaking with physicians in the field, as well, it's those people, it's all the stories that they tell from the battle stories and the war stories that they tell. It's never white male, 70s. It's always, you know, he was, you know, he was a farmer for seven years. And it adds that quality and adds that teaching moment and in the same way, that we remember that the nursery rhymes from when we were a kid, you know, it's just ingrained into us about the parables and the stories and the best way forward. And I've probably be even so bold as to say, as technology, encroaches further into into medicine, and not just necessarily for for a teaching tool, but for for diagnostic tool, that is that bedside manner and the humanism of the physician, which is going to be perhaps more important than anything else, you know, I'm hesitant to say, okay, it's a safe we're an algorithm or artificial intelligence can make a diagnosis and treatment protocol, but it's certainly been used already as a subsidiary tool to make this and assist in the care and then is going to follow up on their physician sees to be be to be the teacher to be the explainer to to talk freely about the options with a real life human rather than just those those four sentences on a piece of paper before they enter the room. So yeah, I think it's going to be that and not to bash doctors in the sense that they're all clinical with no sense of empathy. But I think it is going to become more and more apparent as we are doing back to more of that, that technological advancement in medicine as well. 

Alexandra Howson 57:21 

That's a lovely way of describing all of that, I tend to agree. And I also think that when when you listen to those stories from from the trenches, often the devil really is in the detail, it is in the fact that somebody is in a particular occupation that exposes them to particular risk factors that you're not necessarily going to know about unless you ask those really detailed questions about who the person is, versus the clinical part of, you know, history taking, and the right and the physical exam. 

Martin Warters 57:56 

Great point, you know, yeah, I've not been able to take my medication thoroughly because I can't afford it. There you go. That's, that's, that's a whole new set of barriers. Huge. Yeah, it's massive, isn't it? 

Alexandra Howson 58:11 

It is interesting when you look at kind of evaluations of learner experience and outcomes in continuing education programs, I mean, often the biggest barriers to clinical practice are time and funding. So either their own funding and the context that they're working in, they don't have access to the resources, the materials or assistance that are going to enable them to deliver the care that they want to deliver, whether we're talking about nurses or pharmacists, or physicians. And then the other part of that resource piece, what patients have access to, I'm conscious of time, you have worked in this space, for a while this space being clinical education broadly defined. And you mentioned at the beginning of our conversation that most of us land here by serendipity. What keeps you here? 

Martin Warters 59:16 

Um, I think because there's so much chase such a fascinating field, just in terms of innovations and, and changes and, and new things coming along, you know, even just from a technological standpoint, from a from an approach standing, so many, it's almost, you know, innovation after innovation for all of the all of the years. And, you know, it's such a fascinating area, but I think the underlying theme for me is that I'm in an exceptionally privileged position, to be able to have direct impact on the quality of life of an individual to do this with no medical training, but still empower and enable a healthcare professional to improve the quality of life, the quality of care for an individual, and seeing the impact of the education that I've helped develop in terms of the metrics and the outcomes and behavior changes, it's, it's a privilege, it's an honor. And it is humbling as well. So I think that's what probably keeps me in the field. 

Alexandra Howson 1:00:31 

And to kind of wrap up our conversation, you've mentioned storytelling, you've mentioned being learner centered, what are some of the key things that this field really needs to pay close attention to, in order to keep building on that platform for developing effective education? 

Martin Warters 1:00:52 

I think it's the same for any type of education, regardless of the of the industry, it's just making sure that the tool, the approach the design is, is fit for purpose, I think it's really, really, really easy to be enamored by the the latest tech or the latest approach, but just having that, that wherewithal to be able to make a judicious selection as to what your outcomes need to be, and how best to achieve them is going to be beneficial. Otherwise, we're just gonna have a really expensive, really inefficient education. And, you know, people are going to start questioning the roles and responsibilities of what we're doing as a cohort. 

Alexandra Howson 1:01:43 

It's a great way to wrap up our conversation. And I also love that you use the word judicious, it's one of my favorite words. Martin, thank you so much for sharing some of your insights on Write Medicine. Anything we haven't talked about that is really important to what you do? 

Martin Warters 1:02:07 

I really don't think so. I think we touched upon all of the things that made me take all of the things that, you know, I think we both agree on as being integral and important for education right now. And yeah, thank you. That was actually a wonderful conversation. You know, definitely a highlight of the year so far. So thank you for that. 

Alexandra Howson 1:02:29 

Great talking to you. 

Martin Warters 1:02:30 

Thanks so much. Thank you. 



Martin's early career as a teacher
Annie the mannequin
Simulation that are effective for clinical learners.
What is feedback and why is it important in continuing healthcare education?
How can simulation tools help to cultivate teamwork?
What are the components of interesting and effective learning design?
Defining what constructivist learning means.
puttingPutting the patient's story front and center—the significance of narrative design
Key take aways