March’s Q&A features Rebecca Harrison, MD, FACP, Associate Professor, Department of Medicine, Section Chief, and Division of Hospital Medicine.
Dr. Harrison teaches internal medicine in a variety of clinical and classroom settings. She is the Clerkship Director for the fourth-year students rotating in internal medicine and the course director for the Internal Medicine Interest Group, where she has the opportunity to mentor and advise a countless number of students pursing Internal Medicine. For the past five years, she has also taught students, residents, and faculty on an international level as a frequent visiting professor at Otowa Hospital in Kyoto, Japan, and completed a four-month Visiting Professorship at Tokyo University, in Tokyo, Japan.
She was nominated by Alan Hunter, MD, FACP, Associate Professor, Department of Medicine, Head, Division of Hospital Medicine. “Dr. Harrison has excelled as a respected clinician, a wonderfully loved and respected educator and mentor, and an evolving education scholar, with an expanding international reputation,” said Dr. Hunter.
Q&A With Rebecca Harrison, MD, FACP
What first attracted you to education?
My father was an academic pathologist and educator at the Mayo Clinic. My mother was an actress and director at a community theater. From observing them, I saw how fulfilled they were influencing the understanding, connection, and lives of others as teacher/director/mentors. One of my greatest informal teachers was a family friend woman psychiatrist who remains a close force in my life. Prior to medical school, I worked in a children’s theatre for underserved youth, teaching improvisation and acting skills. After college, I moved to Japan for two years, where I taught English to elementary and middle school Japanese students in Fukui, Japan, where I experienced a whole different way of thinking and teaching. These initial experiences were inspiring and gave me insight into the fact that I felt fulfilled connecting with people on an ongoing basis, particularly learners, and that I thrived in an academic environment where there is a vibrant diversity of people and activity.
Is it a two-way street, do you also learn from your students?
I have learned a tremendous amount from my students and residents. It’s one of the core reasons why I remain in academic medicine. If it weren’t for students and residents and their questions, I wouldn’t be here. My students keep me curious by the things they ask. They are open to ideas, exploring questions which I may have never thought of. By nature of inexperience and less exposure, they sometimes have a broader view of how certain disease processes work, focus on long forgotten but essential physiology, or get at the heart of a psycho-social problem that is germane to the care. Students keep me patient-centered because they are often the ones who get to know their patients better than anyone on the team. All of this allows me to learn from them. Also, many medical students have passionate, deeply considered reasons why they want to be doctors when they enter medical school. I think it’s our job as educators to help them retain and develop that drive and passion. Through that process, we as educators have an opportunity to reflect on why we do what we do. It’s through this kind of reflection that the teacher and the learner support each other.
Did you have an influential teacher after whom you have modeled your own teaching?
The beauty of being in this university setting is that I have observed the talents of so many great teachers. I try to pay attention to what these individuals do, and try to incorporate their strengths into my own teaching. Seeing how other people teach and learn is an important and vital piece of being an inspired teacher. There are also opportunities at OHSU to reflect on how one teaches, the Department of Medicine has an Educator’s Curriculum, or the Stanford Faculty Development Program done locally. Both have helped me develop as an educator. I think it’s important to do more than just observe and teach, but also take the time to consider how effectively I’m teaching and how I can do better.
Are educators born or made?
There’s something innate that makes us curious people or less so, without a doubt, but I also think good teachers are made. We can nurture each other to be curious, reflective, and open to new concepts and questions. That’s how we influence each other to learn and to teach. If we keep our minds curious and open, then we ask better questions and discover more. An important technique many medical educators do is to encourage self-directed learning and find answers to their questions, and then share what they’ve learned with everyone. Medicine is the great equalizer, learners can be teachers and teachers are also learners. I know it’s a good day when I’ve experienced both sides of it.
What are the top challenges for educators today at OHSU? How would you address them? How do you deal with them every day?
There are endless challenges to education in general but one that stands out is simply the numerous competing demands placed upon educators, while there remains the expectation for them to offer high quality teaching. At OHSU, we state “patient care, research, and education come together for the next generation of health care providers,” yet, we are not consistently willing to pay for teaching. We have an increasing number of learners all over OHSU who are here to be trained and we are expected to assist in that critically important mission. We therefore support teaching time with clinical revenue, teach on the fly, and squeeze it in when we can. Duty hours further compress the time for questioning and teaching. We don’t always have support of time to reflect, or support to go to a seminar on how to be a better teacher. So teaching something of value well, in compressed time, to multi-level learners, and at times, across departments, with little support, is the complex landscape that I think all medical educators face today.
How can these challenges for educators be addressed?
We have created the clinician educator pathway for P and T [Promotion and Tenure] which has helped legitimize the career path for educators. Feedback from learners about teaching quality helps and matters in our development. We need a re-working of how we define and support the work of educators. As an example, some institutions have gone to educator RVUs to give some equivalency to work RVUs. As we move toward team-based patient care, we need to consider team based educational models. How can everyone contribute to the educational goals of the group? How can teaching venues, and cost to support those venues, be shared? We need to always be mindful of educational scholarship opportunities as medical education and the careers of educators evolve. We need to create an intra-departmental resource office and leadership role at OHSU to support all clinician educators and teaching faculty, like a faculty affairs office for education. We would all benefit as I am certain that the challenges a teaching internist and surgeon face are fundamentally the same. We need to break down the silos we have built locally in medical education and work together.
How do you deal with these hurdles every day?
Passion to teach and mentor carries me and my colleagues. Students inspire us to recognize the innate value of this job, and sometimes it’s years later. The best is when you see a former student in a forum—teaching you. When there is little time to prepare my style is often to simply determine what question the patient, or the clinical situation in front of us is “asking,” then assigning a learner to seek out the answer, return to the group and discuss what they found out. We call this self-directed learning, and with the extraordinary amount of information that is available to us, it is really an essential life long skill to foster in others. Then, there is the politics of legitimizing the role of teachers, documenting teaching activities, demonstrating value to the institution. Working toward a system that keeps the stated mission of teaching at the forefront but not being afraid to raise the issue of support, is critical. Burnout is a real phenomenon and unsupported educators are at high risk.
What do you see as the future direction in education?
There are so many directions and challenges I see before us! U.S. medical school capacity doesn’t meet current health care needs so this conversation will need to continue on both a local and national level. If medical school class sizes expand then creative-minded educators need to be at the table to help shape the future of medical education.
We need to carefully consider how to equip and educate more students and residents to enter primary care medicine to help with this growing need. We will continue to see an increasing number of women and hopefully minority medical educators and we will need to carefully consider how to foster their careers as teachers and mentors.
How do you continue to learn so that you can continue to teach?
My main source of learning is through patient care and the questions that come up throughout the day with this interaction. I also turn to literature to find answers for evidence-based questions. I discuss cases with colleagues because experience is still vital. Sometimes the strongest evidence can be there, but there may be something anecdotally that doesn’t support using a certain treatment. Learning from mistakes and error, from times when the best decision wasn’t made is also very important. Participating in morbidity and mortality conferences and discussing problems in a public forum with learners is also an important place to generate the skill of self-reflection. “Wow that didn’t go very well. What could I/we do better next time?” Being a clinician educator is a phenomenal but humbling job. Learning and teaching is about being open and listening (to the student, to the patient) as much as it is about speaking.