Write Medicine

Punchline! Humor and Facilitated Learning in Continuing Healthcare Education

November 28, 2021 Alexandra Howson PhD
Write Medicine
Punchline! Humor and Facilitated Learning in Continuing Healthcare Education
Show Notes Transcript Chapter Markers

This episode's guest is no stranger to many of you in the world of continuing healthcare education. Lawrence Sherman FACEHP, CHCP is president of Meducate Global, LLC and describes himself as a learning facilitator, a global educator, and an education futurist. He is deeply committed to lifelong learning and to humor as a learning tool.

Join us for a conversation that touches on:

  • Needs assessments as a continuum 
  • Skills required for moderation and collaboration
  • Controversy about learning styles 
  • Importance of context in teaching and learning 

Association for Medical Education in Europe
American Association of Psychiatry
European CME Forum
LinkedIn CME Group
Meducate Global LLC

Connect with Lawrence: Twitter, LinkedIn
See Lawrence's TEDx Talk
Connect with Alex

Podcast Team
Host: Alexandra Howson PhD
Sound Engineer: Suzen Marie
Shownotes: Linzy Carothers

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 Alexandra Howson  00:01

Hello and welcome to Write Medicine. I'm your host, Alex Howson. And I'm here today with Lawrence Sherman, who is president of Medicaid Global. Welcome, Lawrence. So nice to see you after all these years, it's good to have you here. And when I say have you here, of course, I mean, in a virtual space where we're all hanging out more and more these days. So, as with all of our episodes, so far, you know, I like to start with asking you the question about how you ended up in in the continuing healthcare education world. So, could you share with listeners, who you are and what you do and how you landed here?


Lawrence Sherman  00:49

Sure, sit back, put your feet up, this is going to take a while. So, I initially thought I was going to be a clinician, I really thought medicine was what I was going to do. And so that was my initial pursuit. And during those years, I was also a volunteer, EMT, and medic and all that. And very quickly, one of my professors said to me, I think you'll have the ability to teach, now I was a wallflower. Now, you know me, I don't come across as a wallflower. But until college, I was a wallflower. And Professor Harold Liebowitz, I have to thank for who I am today, because he said, why don't you give a lecture in my EMT course this year, and just a year into being an EMT. So, I was 19. I taught for the first time and I loved it. I absolutely loved it. And just a side note, that was 1984. I still teach pre hospital providers today. Okay. So, I mean, we're talking, that was my very first teaching gig. So, it was always there. And I always did some teaching. As I progressed through deciding whether I was going to be a clinician or not, I realized that I did not want to be a clinician. And so, I kept teaching. And I got a variety of different jobs, where I could develop my skills as an educator, as many of us did, I started out as a medical education company, and I ran projects and then I sold projects. And then I realized that I was very much into the educational design. And through my pre hospital teaching, I was able to get a certificate in adult education. So, I have a little bit of the medical background, I have a little bit of the education background. So, when I say I'm a health professionals educator, I really have sort of all that stuff. And I have been doing this full time for over 27 years. Now, it may shock you to know that because I look like I'm 29, but, I've been doing this for about 27 and a half years. One of the other things and I know we'll talk about this a little bit later is I've also done stand-up comedy. And part of my teaching skills, abilities, I think the ability to be improvisational comes from, you can put me in front of an audience and I can teach anybody to be in front of an audience that can't be as bad as being at a comedy club in Brooklyn at two o'clock in the morning on a Saturday night, where everybody thinks they're funnier than you are. So, there's a lot of stuff that contributed to getting me where I am today. And I'll tell you that currently my focus is not as a CME provider, but I'm working on the increasing the capacity of CPD educators around the world. Doing faculty development, I spent a lot of the last 18 months helping health professions, educators in schools, pivot to do digital teaching and things like that. So, my areas of interest have grown outside but right in the dead center is CME, CPD and IPC. And I love it.


Alexandra Howson  04:14

And so, uh, gosh, there's so many different things in there and so many threads to pick up. But why do you think education is at the center of what you're doing? I hear that you had that taste of speaking publicly and sharing information with EMT providers early on in your career. But why is education at the heart of what you do?


Lawrence Sherman  04:41

Well, so, I use the term lately learning facilitator rather than educator because I think it's about helping people to learn and understanding how different people learn differently and understanding that there's some elegance to being able to help different people learn the same stuff differently. So, I've always enjoyed that. And I think it's about telling a story. I think it's about building the story and telling a story, right? So, a good comedian knows how to build the story up to the point of the punchline. And then the punchline should work, right. People should laugh. Sometimes it does. Sometimes it doesn't. But you have to assess, well, why didn't it work? Is it the audience? Is it the material? Is it the predisposition? Did they not understand it, because the context wasn't there. So, there's a lot of parallels there. So, it's really nice. And it goes back to the EMT teaching days early on, where a lot of the people that I taught, were not EMTs by their primary job, they were volunteers. And it was sort of what they were doing to get back to their community. So, you have people who were professionals, who had other day jobs, whatever they were doing. And now we're teaching them some stuff that's kind of deep, right? I mean, anatomy physiology. And when you get into the advanced life support, you're teaching them pharmacology, you're teaching people who may during the day, be a lawyer, and you're teaching them to defibrillate on the weekends. I mean, that's not what most people do on the weekends. So, you know, being able to understand how to teach people who aren't necessarily still in the, I'm a student learning mode. And that's a lot like CME, right, because we can't treat health professionals who are practicing for 20-30 years, as if they're a medical or nursing student, right, they learn differently. So that's why it's right at the center. It's about facilitating learning and different types of people.


Alexandra Howson  06:44

I love that description. So, let's kind of walk that back a little bit, there are three things that you've mentioned there that I think are important to unpack a little bit, one is people learning differently. So that kind of takes us into that slightly controversial territory of learning styles. You talked about context, making sure that the context for learning is there. And then you talked about you didn't use the word but I think you're talking about scaffolding, you know, kind of creating that layered approach so that people are kind of building in a systematic and logical way. Can you talk first, then about what do you mean by learning differently, because, you know, I've read a couple of posts lately on I guess, kind of LinkedIn and some other areas where, you know, this notion that there are different learning styles keeps kind of coming back into the CME CPD world as something that isn't quite accurate. And yet people themselves will tell you, this is how I learned. So, I'd really like to hear your perspective on that.


Lawrence Sherman  07:58

So, I saw that same post that you saw, I commented on that post, but it was a funny comment. So, the reality is whether or not you can put learning styles in a box is probably very controversial. But people subjectively know what they think that they need then what they have found that they need to learn better, right? So, I'm actually doing a webinar tomorrow for medical students in Europe, to help them learn better. That's what they asked me to do. How can they learn better? And so, I think there is something to be said for I will use something you said before mixing methods, right? Because there's nothing worse than sitting in a lecture hall with 1000 other people hearing one person at the front of the room telling you about their favorite enzyme, okay to me, I just I can't learn, right? You can tell me that hypo xanthine guanine phosphoribosyltransferase is the coolest enzyme in the world. Well, maybe it's got the coolest name. But there's nothing cool about it to me. Now the person next to me may say, oh my god, I have waited my whole life, to hear Professor Howson and talk about hypoxanthine guanine phosphoribosyltransferase this is the best thing ever. I am getting everything I need. So, one could argue that the person next to me has a different style or appreciation or ability to learn better. Now does it mean that they're completely an auditory learner, and I'm completely a visual learner and, and no, but I would also argue that when a surgical trainee uses a simulation model, they are getting some level of kinesthetic learning because they have to feel what it's like the first time you put a suture in someone, you're kinesthetically learning, whether you like it or not. Now, you may also be auditory learning because the surgeon was saying what do you do. And then you may be visually learning say, oops. Right. So, there are different styles. But I think that's sort of my thought on we need multiple levels of learning. And we need multiple formats of learning facilitation to make something work.


Alexandra Howson  10:21

Right, I do sometimes wonder whether that expression of here's what I need to learn is as much an expression of I need to be seen and heard. And I need you to understand where I'm coming from, in order for me to learn what you want me to learn.


Lawrence Sherman  10:43

But you know, what that does, Alex, is it also speaks to the way we teach our teachers. Because if our teachers aren't learning facilitators, think of it in Europe, where someone who is a teacher, they're called a reader. Right? There's no worse term than a reader. I don't want somebody standing in the front of the room with a huge book, turning page by page saying, today, we'll learn about this, and I'll tell you about this, right, but think of that just nomenclature alone, presents a challenge. So we need the teachers to be the learning facilitators, they're the experts beyond experts. But we also need to understand that the students are absorbing and the students are retaining. And the students may have questions, and students are allowed to have questions. And they shouldn't be told, hey, wait, wait till the end. And then ask me all your questions. Because then you lose them, then what you want to do is keep them and engage them and interest them and thrall them and make them love the stuff that you're talking about just like you do, even if they don't


Alexandra Howson  11:58

Do I think that's true, I kind of wonder how much we're regressing in this sort of virtual space now to being in a few presentations, where exactly that has happened. There's been a request to keep your questions to the end. And you know, if you can keep your concentration going for 40 minutes without asking questions, then, you know, kudos to you. But it's a terribly kind of dry and challenging way to, you know, it's not teaching it's not learning?


Lawrence Sherman  12:30

Well, it's funny that you say that, because I think I mentioned earlier, I spent a better part of the last 18 months helping teachers teach better virtually, and there are some best practices, you know, I hyper use the chat box, I hyper use the Q&A function, I always encourage people to have a wing person who's watching the chat box while I'm giving a talk or vice versa. So that there's a constant opportunity for engagement. But there's also a constant opportunity for formative assessment, right? Because if you're not hitting that button, if you're not getting that message across, you're not losing the people, you don't have to have them wait 40 minutes, right. But you have the opportunity to say I need to engage now. And man, when you do that, that's a big thing. The other thing I've started doing in digital presentations is I start out by saying, why are you here? Right? What your burning question? And so, I start with a real time needs assessment. And I keep that assessment going through. And then at the end, I'll say, Did I answer all the questions? So, it's an assessment based approach. It's not dissimilar from the paper we wrote with, Don Moore, a couple years ago, where we talk about there's a continuum of assessment, right needs assessment, formative assessment, summative assessment, what do you need to know? Am I meeting your needs? And did I meet your needs?


Alexandra Howson  13:56

Do you see much formative assessment in the work that you do? Can you talk a little bit about that?


Lawrence Sherman  14:03

It depends on which environment you ask. There's probably not as much formative assessment, certainly in the standard CME CPD stuff that you see a lot. And there's opportunities. It's funny when we were writing the paper, Don, and I were going back and forth on whether you could have formative assessment within an individual activity because most educators think of it within the context of a curriculum, right? And so, if you train faculty, well, during a synchronous educational activity, you can build in some level of formative assessment to say, am I meeting your needs and that's where that constant questioning comes in. So, I'm seeing more of that digitally. I like to see it when we get back to face to face remember what face to face is where there's lots of people in a room all together dimly.


Alexandra Howson  14:55

Oh, you remember definitely. I see. A meeting.


Lawrence Sherman  15:01

That's right, dimly lit or dimly taught either. But yeah, but I think there's the opportunity to help faculty who deliver those presentations, to build that in whether it's through polling, raise your hand, green card, red card, whatever it is. And yet side note, remember, a lot of the people that we used to teach in the CME stuff that you and I have done through the years, are not necessarily all trained as educators, they're clinician educators with the emphasis on clinician. And so, when we have the opportunity to provide them with additional skills, and help them to be better teachers and learning facilitators, you do see that formative assessment and you do see that built in, I will say, where I do see it in CME is when you have a digital activity up, and you're doing pre and post questioning or some level of engagement. And you're seeing that a question is not being answered correctly, consistently, then you have to go back and say, is it the faculty or is that the content? Is it the context and you have the opportunity to change, you know, the nice thing now is the digital tools are so much better than they were when we started e-learning 20-30 years ago, right where it took a Herculean effort to make an edit. But now you have the opportunity to do that. I do see formative assessment, and I'm exposed more to the undergraduate and postgraduate education now, and I do see it built in there. And part of that is because undergraduate and postgraduate educators are usually more likely to have received some training and education and certainly outside the US rather than inside the US, you see that it's not the on the job training. But that there are people who get masters in medical education. And they do it purposely and are part of a masters or a PhD or in the UK, what they call an MD is the heart of it is in how do you teach? And how do you facilitate learning. So, I do see it there more, and I see it more outside the US than inside the US. But I certainly see it to a critical mass here.


Alexandra Howson  17:09

So, I definitely want to circle back to that different kind of approach to education outside the US. One of the things that you mentioned earlier that I said that those three things, scaffolding context and learning styles context, you've talked about that a couple of times now. So, what do you see as best practices in identify in determining context, the context of not only learning, but the context in which people are going to put that learning into practice?


Lawrence Sherman  17:42

So, it's content plus context, right? I think we sometimes leave out the context part. And the educators of the world, some of them call it germane learning, right? So, what it is, it's learning that's relevant to your need workplace environment, etc. So, what you have is the opportunity to say not this is the best new antihypertensive ever, but understand who's in your audience, right? I gave a talk once. That was how a stand-up comedy like medical education, the answer is know your audience, you can't teach every audience the same way. Same way, you can't tell a joke to the same two different audiences the same way. So, understanding who's in the audience, what's their level of understanding? What are their needs? How do they practice, etc, provides the context. So again, it goes back to who's doing the teaching, if who's doing the teaching is using tools to understand who they're teaching at the moment. It's almost a real time needs assessment, Alex, right. So, we've done our needs assessment, we know that there's a knowledge gap or a professional practice gap. But what are the needs of the people in the room may be very different than your expectations. So, you can't teach the same way. You have to teach up or teach down depending on what's necessary or totally go 180 degrees, the opposite. You could go in and the room knows more than you do about the topic. So, what do you do then? So that's where context matters. Context also matters. Something I think you want to talk about later is when you think about cultural issues, racial issues, social issues, not every patient looks the same, and where you practice matters, and who's in your practice as patients matters, and who you're likely to encounter to provide care to matters. So, when I'm teaching you, I need to make sure that I'm teaching you within the context in which you're practicing. Not here. That's why you know, we've, I'm sure you and I have seen dozens of these activities where they bring international experts in. So, the international expert goes up and gives a presentation. Now they have a great name and a great pedigree, but if they don't know the practice environment, and they're teaching about how they do it in their house, hospital and products aren't available. Certain types of technicians aren't available, like the environment isn't right. I'm tuning you out, and I'm going to start to text somebody. So, you know it, that's that contextual need.


Alexandra Howson  20:17

And what best practices Do you see that really are able to kind of dig into that contextual need, because I'm sure that you've seen a lot of generic education activities and programs that have clearly paid no attention whatsoever to who's doing the work, where they're practicing, the patients they're serving, and what some of the constraints are in their ability to deliver quality care.


Lawrence Sherman  20:47

So let me give you a worst practice, before I give you a best practice, a worst practice is asking demographic questions and not using the results. Right. So, the best practice is asking demographic questions, and then teaching based on that. So, who's in the room who's participating, or offering a collection of educational activities, so that it fits based on either a self-assessment, or a self-selection, right, because there's all of the theories that go out there on readiness to change. But I think a lot of that ties back to having best practices in making sure the context is appropriate, right. So, if you're a, let's use oncology, as an example, if you're a community-based oncologist, and you see people with a variety of solid and liquid tumors, then you have a need to know a lot about a lot of stuff, right? It's like being a GP in oncology. So, there's that if you are a hyper specialist, if you are in left lung, a non-small cell lung cancer only person, then that's your context. You don't even worry about the right one, right? It's just the left one. So, understanding that you can't teach those two people the same way is very important. And understanding that the content is not the same as an undertaking. So, I think the best practice is embracing heterogeneity. The best practice is understanding that even if you have a roomful of oncologists, there's still a bell-shaped distribution of those oncologists and what they do. So, embracing the heterogeneity and, helping learning facilitators, slash educators slash teachers to understand who's in the room and teaching to it.


Alexandra Howson  22:42

And how much of that understanding Do you think really occurs? I mean, you've talked about faculty and training faculty and working with faculties to help them become you know, better facilitators, better educators, particularly those who are, you know, have really kind of focus their attention on clinical education. What kind of things do you well, I guess there's a couple of questions there. One is, what are some of the things that you recommend for working with faculty to enable them to become better facilitators and read the room. And second, you know, who knows, when we'll all be able to be back in such a room again, but I feel that this probably relates to virtual learning environments as well is that agility to not only read the room, but change to pivot? The way in which you're going to teach and what you're going to teach depending on what's in front of you. So, two questions there. And forgive me if I can repeat them again. No, you couldn't? No, I probably couldn't, because I couldn't remember.


Lawrence Sherman  23:55

So, I think part of it goes to faculty identification selection, right? So, we often have seen through the years that we pick the smartest people, the lead researcher, the person who knows the most about a topic, and so we say, well, there's the person who could teach it, you know what, sometimes they can, but sometimes they can't. And I'm on record saying, you know, sometimes I've seen the smartest person in the world on a topic be the worst educator about it. And it's hard for them to convey how much they know about something to a room of people who don't love it as much as he or she does. So. part of it is identification selection of the appropriate faculty. The other thing because the majority of folks who listen to this are probably CME CPD IPC people, is built in when you recruit the faculty, prepare them, that you're going to work with them to help them to teach and you know, the ones who say I know how to teach I don't need it. That could be a no-go decision. And I've through the years not recruited those people to teach, because I knew that either the educational methodology, or what we were trying to accomplish needed someone who was fast style and agile and willing to work with others, and willing to be that learning facilitator and willing to take a step back and say, if you don't understand this, let me regroup, let me address it a different way, let me see what's holding you up. But if it's one person out of 100, that's not getting it have the ability to pivot and say, I hear your concerns. But I need to make sure that I meet the needs of everybody else here, I will stay afterwards, or I'll give you my phone number. And we can talk through that one issue that sticking with you, too, you have to recruit the right person, then you have to have the ability to provide that training in the context of, we're not telling you you're not a good teacher, we're giving you skills that you may not have. And one of the places and best practices I've seen it work well is when you bring all of the faculty for an activity together, and you let them cross pollinate. So, it feels like a peer-to-peer training session. It's not some knucklehead in the front of the room saying, this is how you're going to teach. And this is what we need you to do. Right? But it's really, how can we add to our teaching toolbox? And so, if you have the right people and give them the right skills, I think it leads to your second question that gives them the ability to pivot. The other thing that I often did was, we would use one of our own staff to moderate the meeting, I often did this. So, you had a chair person at a moderator. So, the moderator was able to be the bad guy. And keep people on time on target, stimulate, ask the questions, save the chair, person will look at that response to that audience response question. What do you think about that? So, the weight doesn't fall on their shoulders to see those? One of the things we always call them teachable moments, right? I think when the data come from the learners there learnable moments, right? So, it's identified by the learners and the data up there, give the faculty a teachable moment, but give the learners a learnable moment. And so, I think that's  where you see it work really well.


Alexandra Howson  27:22

I love that. Do you think that and I'm guessing that there are differences here between academic healthcare education, CME, CPD and commercial companies. I'll backtrack there. You know, one of the things I hear a lot from, you know, people who are in the role of planning and delivering CME/ CPD programs is that it's really challenging to work with faculty in that role, because they are not trained to do so very often. And there's also this, I'm going to call a deferential dialectic, there is a kind of deference to faculty, because their faculty after all, and they are the experts, but that difference gets in the way of being able to train them to be good facilitators in a continuing healthcare education context.


Lawrence Sherman  28:17

Well, you know, I think it goes back to what's the relationship you formed with the faculty, that the difference happens because of my least favorite phrase ever, which is, because that's the way we've always done it. Right? We've always said, okay, well, we've got this great education. And we've recruited the faculty, oh, there's the faculty. So, they don't like the slides, or they want us to prepare it, or they have a canned presentation that they want to give, right? The reality is, if you're setting up a relationship to say, this is our educational activity, and you are a really important part of it. In fact, you are the most important part of it separate from the learners, is you because you're the ones who have to help the learners understand. And so, here's what we need you to be able to do and while you can still be deferential and respectful, you have to have the right person from the provider side, whether it be academic, commercial, or any specialty society anywhere, who, whose job it is to have that relationship with the faculty and it has to be someone that is able to build a relationship that the faculty respects them, as much as they respect the faculty. If you put up an untrained person, as the main point of contact for the faculty, I can tell you as someone who has been in that faculty spot, it is very uncomfortable, and it could turn you off before you really get a chance to dig into what the activity is. So, it's incumbent upon the provider organization to own the activity and own the relationship and make sure that you put in the right person in front of the faculty because they are that important. To the success of the activity.


Alexandra Howson  30:02

And is that something that you do in your capacity building role in in a European context at the moment?


Lawrence Sherman  30:09

Well, so what the capacity building project is just kicking off. And what we're trying to do is we're trying to get people who will be teaching in the CPD activities, but we'll also be CPD developers. And so what we want to do is that's a skill set that we have to develop. It's a competency, right? So the ability to teach or the ability to develop education and collaborate with a teacher is an incredibly important skill. And I will say that it's a global issue. So, while I'm working with the Association for medical education in Europe, AMEE, on a CPD capacity building project that just kicked off, we've also just done assessments of CPD systems in China, Latin America, the Middle East to supplement the ones that I previously done in Japan and Southeast Asia. What we're finding is who's teaching in CPD, and CME varies greatly and the skills that they have, and one of the things that I always ask is, when I'm doing that research, have you had any formal training in education, and the majority worldwide who do see me teaching haven't the ones that have are the ones that CME or CPD teaching is a bolt on to their postgraduate teaching, or their undergraduate teaching. So, they're teachers, and then they're brought into CPD rather than CPD people who are teaching, if that makes sense.


Alexandra Howson  31:41

It does. And you know, what, I'm guessing that there are probably more people in CME/CPD in a European context who do have some exposure to formal training and in education than many academics in European universities. Because in the academic context, that's not how you end up, you know, you end up teaching through research. And there's this whole kind of assumption and kind of smoke and mirrors, to some extent that if you are, you know, able to do research, get your PhD, your masters, whatever you will be able to teach. And I don't think that's changing very much at the moment. So, it’ll be interesting to see how that kind of parallel system in medical education, you know, shifts.


Lawrence Sherman  32:36

Yeah, you know, I think part of it is where you are. So, for instance, in the UK, the emphasis in CPD is on revalidation. Right. So, it's a checklist system. I mean, that hyper simplifies it, but there really are things that you have to do in order to sort of like, maintenance of licensure, right maintenance of certification here. There's revalidation, but that's the emphasis of CPD is keeping people validated. Right. And that's fine. Okay. There are other places where it's more on a very local grassroots level. And it's just it's a lot of peer-to-peer teaching. And, you know, another area of interest for me is this informal and incidental education, a lot of CME and CPD happens accidentally. Right, right. Like, you know, two people are talking and they're both clinicians and one says to the other, hey, you know, I just had this really interesting case. And the other says, you know, I had one like that, too. Here's what I did. Oh, wow, I didn't consider that. Well, you know what, that's as important a form of CPD as sitting in a room learning about that enzyme I mentioned earlier. So, I think, you know, the big picture of what CPD and CME is that's also context, right? Is what forms the big package of it. So, you know, it's not just that formal teaching by people who shouldn't be teaching. And it's not just the phenomenal simulation-based education, or the great education that's being provided by people who do have the gift of being a learning facilitator. But it's all of that. And it really, it's incumbent upon the learner, right? Because we talked about these master adaptive learners that we're trying to create, right? So, it's incumbent upon these learners not just to be satisfied with the information that's given to them, but to say I have a question that arose. I know how and where to go to find the information. Now I need to see if what I've learned is applicable, and I will make a change because of that. So we have to change it. So, it's sort of like what we need to create these on demand, CPD learners, and not just say, here's a curriculum because one of the things that I've seen in assessing CPD systems is there are some countries where a ministry of health sets the topics that are of importance for CME this year. And that's all that's available. So, if you don't see patients with those 10 things, then there's no CME that's relevant, contextually, for you. And it just doesn't work. And other places, they don't even care if you do any CME, there are countries in this world that have no system in place at all. And it doesn't matter. Once you graduate, and you get your license. However, in that country, you get your license, you are not required to have one iota of additional education. So, this is a very, very, very heterogeneous environment in which we chose to work.


Alexandra Howson  35:40

No, you're absolutely right. Do you see you mentioned adaptive learners? Do you see generational changes in you know, I'm at the tail end of the baby boom. And so, you know, are there different? Are the differences in the way in which boomers learn Gen X, Gen Z? And, and how adaptable they are? When it comes to figuring out what it is they need to learn and how they need to learn it?


Lawrence Sherman  36:12

Yes, kinda, with an asterisk. Because, again, in any population, you're going to have a huge distribution of different types of the way people learn, I think, when you're a digital native, that, from that point forward, you have expectations of how technology needs to be used. When you're the last of the baby boomers, you have the way you learned pedagogically, right, as a kid, but there are a lot of us. So, I'm just at the beginning of Gen X. So, you and I are at the Continental Divide there, right? So I am as tech, as mobile, as driven by learning quickly, fast with expectations, as many millennials, there are equally, a big number of folks who still want to sit in the classroom and want to learn and aren't, don't want to be made turned into something that's hyper adaptable, they want to be told how to learn. Yeah, and quite frankly, a lot of this goes into the selection process in the health profession schools there, you know, you talk to the folks who are on admissions committees, they're looking for different skill sets now. Yeah, they're not just looking for the science kid. Like when I was applying right there, they're looking for other skill sets. So, it's not just the generation, but it's the pool of people who are making up the learners now, too. So, I think there's more of a mix. We're also seeing more female than male students being accepted, at least in the US into health, professional schools and medical schools. And I think we're seeing a nice level of diversity, equity and inclusion. So, we're seeing lots of new and different folks with new and different requirements, needs and wants. And I think that's what to answer your question, Alex. I think we're seeing that not just intra generationally, but inter generationally. Now, I talk a lot, don't I?


Alexandra Howson  38:34

Well, that's the point, I asked the questions you answer. And now of course, I've lost my train of thought, yeah, I know that conversation about art, you mentioned changes in the selection process of you know, who's entering health professions. And thank goodness, because that conversation about selection has been going on for decades. And, you know, we need to have more than the Science Guy first. Yeah, but for a long time, it was the Science Guy. It was a white male. person who was fully invested in science, who kind of ended up in particularly Madison, I'm conscious of time. You know, you describe yourself as a global education educator, global middle medical education futurist, what does that mean? And what do you see in the future for CME/CPD?


Lawrence Sherman  39:37

So, a lot of what we've talked about was what I saw happening in the future in the past, right. So, it's how do we pick the right faculty? How do we do the right thing? How do we set ourselves up for success? So, for instance, one of the things that I think about in CPD future resume is where do we start teaching the learners about CPD, I'm talking about this in my webinar that I'm leading tomorrow, we need to get the students thinking about CPD when they're still students, right? We need to prepare them to be lifelong learners, not just tell them that they're like, oh, we need to watch. So, I think we need to watch trends and technology, but we need to watch it from early on. So how are we training our healthcare professionals so that we are prepared to do the CPD for them later, right. Because to your point, there are changes. And it can't just be the satellite symposium at the major medical Congress. And it can't just be an hour-long online activity, we need to think about how they learn, where they learn, why they learn, and how they learn. And sort of thinking about that, we need to think about who's going to be teaching these folks in CPD in five years, and in 10 years, and in 20 years, because the people who are medical students now are going to have very different, they're gonna have a greater need for information, because we see the information revolution continuing, we see how much comes out on a daily basis, on an hourly basis. So, we need to be ready to teach to what's needed in the future, not for what we're doing now. So, we need to be so I think of it, there's sort of a timeline, there's an innovator, right? An innovator does things a little bit differently, but it's kind of cool. There's a disrupter who says, I'm gonna change the way we do things. And then there's a futurist who says, we're going to need to do things differently downstream. So, we need to start thinking about it now. So, it's sort of a timeline, and I sort of skated on that timeline, and that now I'm downstream, because I want to make sure that the practitioners of tomorrow will receive their CPD and all of their health professions education together. Yeah, and, appropriately. And the other thing is, we have to think earlier in the profession, right?  There are schools where they commingle medicine, nursing, pharmacy, physiotherapy, etc. In school, and then we need to teach them from the beginning that they're going to be part of a team, we can't say you don't teach a violinist only by themselves, and then send them out to play in an orchestra. Right, that would not be good. But we need to teach them what the skills they need to have individually. And very quickly, we need to show how they're going to be part of a bigger team, so that the ultimate end product is right. And I think, sadly, we're still a little behind in that the whole joint accreditation process that a CCNA and CCNA, CPE started now they're up to what eight or nine different professions that you can get with a unified application process is a huge step towards into professionalism. But we still need to have systems in place where the systems support interprofessional collaborative practice. So being a futurist is we have to make sure that the environment is always going to be receptive for the teams to come in to be successful.


Alexandra Howson  43:32

And you've mentioned heterogeneity, and diversity, inclusion access a few times as well, where do you see these things in framing the kind of education that we need to be thinking about, for now and for the future? 


Lawrence Sherman  43:49

Well, what a great world we live in that there are so many different people, and how diverse it is, right? And everybody's the same. And I think this has to form the foundation of how we teach health professionals, practitioners, and how we teach health professions, educators, I am blessed in that I have traveled to dozens of countries around the world where I represent the minority where I represent diversity. And you know, it's really eye opening. And I, again, it's a blessing it really is because you get to look at the world through a different lens. And, we're doing this capacity building project and one of the modules that it looks like we're going to have not only in our CPD training course but we're hoping that it will be applicable across all because we have great programs that train health professionals educators across the continuum, but it'll focus on diversity, equity and inclusion. And it's got to focus on how we teach who we do. Teach what we teach when we teach. So, it's our patients are diverse, our patients have equity, and we are inclusive. Our students have them, our faculty have them. And so, we have to look at the world through that lens. And if we don't, we're making a huge mistake. So, it used to only be the hierarchy of profession. And then there was the hierarchy of race or gender. Now, we are all an admixture of equality, and our education and our training, and our practice has to be reflective of that.


Alexandra Howson  45:41

And, you know, you've talked about, so there's a connection here, you've talked about humor a couple of times, and how important humor is in education. But humor, of course, is highly contextualized. And, you know, and what is funny to you might not be funny to me, and all those kinds of things. So, tell me a little bit and we're coming up against the end of our so if you need to kind of wrap up here, but if you have a couple of minutes, tell us the role that you think humor plays in professional education, and how we can capture its magic for heterogeneous genetic heterogeneity.


Lawrence Sherman  46:26

So, let's contextualize here, you can't make somebody funny. And to your point, humor is very individual. So, I will tell you that back in 2007, I actually got a grant to study the impact of humor and continuing medical education, I present the results at the Alliance meeting the following January. And what we did was we tried to use a little bit of humor. In an online activity, we did two identical online activities with the same faculty member, one was a straight as developed CME e-learning activity. And one we built in some funny slides, the guy happened to be kind of funny, but we built in some slides. And what we found was humor supported the education supported engagement, had better outcomes at the end, and was more highly evaluated. So there's a role for it. It's a small study, right? But it tells you that but you'd probably think that anyway. The reality is, when I talk about humor, there's two different components, the part of humor that's most relevant to teaching education and learning is improv, the ability and that goes back question you asked earlier, it's the ability to think on your feet and comedians, by and large, are able to think on their feet. So, when somebody yells something out from the audience, you use it, you don't ignore it. Right. So that's the one of the competencies of humor that's adaptable to health professions education. There is also I'd like to think that at least some of the presentations I've given, or some of the things that I've taught, were not designed to be funny, but because the environment work know, your audience, contextually humor was able to be used to keep the education going. But I don't think I would ever support saying let's just develop, you know, comedy, education, right? Because it doesn't work. And certain topics do not work with human. But, it also helped in a clinical environment, it also helps to break the ice, right? It also helps it so you know, where you can use it as icebreaking in an educational activity or something like that, but in a very controlled environment. And it's got to be pressured check before you do it. Because you say the wrong thing once and it never goes away. So carefully calibrated comedy. Si, si, si, yes. And by si, si, si, I mean, yes, three times in Spanish.


Alexandra Howson  49:18

Okay, there you go. I love it. Actually, Nina Taylor, who's the Vice President of education at the I'm going to forget American Society of radiation oncologists, I think, and I will double check that for the show notes. I first met Nina at an alliance quality summit. And she used me, she was at the American Association of psychiatry, then but she used improv and improv is my worst nightmare. I do not want to engage in improv. But of course, the point is, you know, when you're kind of up against your discomfort zone, it sort of pushes you a little bit and then you relax. And then all those magic physiological things happen that make you more receptive to learning. So, there's kind of some interesting processes there that I think need to be further explored in the role of comedy. And so maybe that's another grant, for you to pursue in, in your spare time, because I know you're super busy. We are up against the end of our hour. Where can people find you?


Lawrence Sherman  50:26

Well, I'm a hyper Twitter user. And on Twitter, I am at Meducate, educate writers medical education. I'm on LinkedIn. They could look at the Meducate Global website. I'm proud as anything that I gave a TED talk on medical education. And that's still what it was 10 years ago.


Alexandra Howson  50:51

Wow, that must have been pretty early on in the in the TED phenomenon.


Lawrence Sherman  50:54

It was the red circle was still growing at that time. And by that, I mean, the red circle that they require you to stand on to your electric unit if you step off, right. Yeah. So that's really the easiest way to find me. I'm very Google. But I will say I have a Google ganger. And a Google ganger is like a doppelganger. But if you google Lawrence Sherman, you'll find either me, or Lawrence Sherman, the Cambridge criminologist. And I can't tell you how many people view my LinkedIn profile with criminal logical pedigrees. So, if you look for me or my stuff, it's best to do Lawrence Sherman medical education. Because otherwise, you'll get the dude in Cambridge, who is far more out there than I am.


Alexandra Howson  51:46

Well, nothing sinister there. Of course. Um, anything that you want to share with listeners, before we wrap up?


Lawrence Sherman  51:56

I will say that if you're interested on the global side of CME, because I know that's one of the things we were going to touch on. There are several conferences, in addition to the Alliance conference that I think it's worth checking out. There's the European CME forum. And that's going to be in November. And that's going to be a hybrid event. But it's worth checking out. Because you really do get a nice perspective on what Europe is doing. And there's great stuff when folks from the from North America participate in that they always leave with some great take home messages that I don't get anything from, but I'm just saying that I get that question a lot about global stuff. I will say that at some point at we will be launching this capacity building project where we will have a formalized training program for CPD folks. And it might be interesting to see. And really, we have a LinkedIn CME Group. And I know you're a part of that. We really try to get questions and answers. They're focused on CME and CPD. And so folks have questions or best practices or how things have been done, feel free to join that group. And we try to share there and the moderators and I really try to keep it free from other stuff. And we really try to keep it focused on discussions around what we do.


Alexandra Howson  53:29

Lawrence Sherman comedian, learning facilitator, not a criminologist, thank you so much for spending time talking to me today.


Introducing Lawrence
Learning styles
Content plus context
The smartest person in the world on a topic can be the worst educator
Adaptive learners
The future for CME/CPD
Humor in/as learning
Some take aways