Medical Education in Neurology with Dr. Galina Gheihman

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How can neurology education improve patient care? In this episode, we explore the significance of structured teaching, effective learning frameworks, and transferable skills that benefit students, trainees, and educators alike.

Dr. Galina Gheihman, assistant professor of neurology at Harvard Medical School and neurologist at Mass General Brigham, shares insights on mentoring the next generation and the importance of educating the educators to amplify impact.

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Episode Transcript

Dr. Michael Kentris (00:02):
Hello and welcome back to the
Neurotransmitters.
I am your host, dr MichaelKentris, and today I am, as
always, excited to introduce ourguest, who will be talking
about medical education inneurology, a topic, obviously,
if you've been listening to thispodcast, that is very near and
dear to my heart.
So, to help us with thatjourney, today we have Dr Galina

(00:23):
Gheihman, an instructor inneurology at Harvard Medical
School and a neurologist at theMassachusetts General Hospital
and Brigham and Women's Hospitalin Boston, massachusetts.
Galina, thank you so much forjoining me today.

Dr. Galina Gheihman (00:35):
Michael, thank you so much for having me.
It's really an honor to be onthe Neurotransmitter podcast and
have a chance to talk with you.
I'm really excited as well.

Dr. Michael Kentris (00:43):
Awesome or podcast and have a chance to
talk with you.
I'm really excited as well,awesome.
So I had the opportunity tomeet you last fall or spring God
, the seasons just run togetherat the American Academy of
Neurology and it was veryinteresting because you were
part of a group that were doingsome very new and interesting
things in neurology education.
But before we get to that, whydon't you give us a little bit

(01:05):
of your background and what ledyou kind of into this somewhat
niche area of neurology?

Dr. Galina Gheihman (01:10):
Sure, thanks for asking.
So I guess I've been interestedin education for a while.
I always you know, even back inmiddle school and high school
was kind of like the one whowould tutor other students or
help others out and was alwaysinterested in making material
more memorable.
I studied like biology.
I had a friend who was betterat physics, so I taught him

(01:31):
biology, he taught me physics,and so that kind of peer
learning and peer support wassomething that I even thought
about a long time before.
When I got to medical school Ialso experienced a very
innovative curriculum thecase-based collaborative
learning curriculum at HarvardMedical School at the time
basically required freepreparation, sort of like a

(01:53):
flipped classroom model, andthen in the classroom
essentially you learn from yourpeers.
You had support andfacilitation by our instructors,
but it was very engaged, activetype of learning and I found it
to be both exciting and alsoquite empowering as a learner
because it was very engaged,active type of learning and I
found it to be both exciting andalso quite empowering as a
learner because it wasself-directed, it was team-based
and it kind of was reallyclinically relevant.

(02:16):
It wasn't sitting in lectureslistening to how serotonin is
formed, but it was really likewhat do we do with this patient
who has MS and how do we treatthem?
And then we would sort of diveinto the neurosciences as needed
.
So on the background of thatcontext I felt like there was
almost like a kind of the fourthyou know wall was lifted in

(02:37):
terms of education because themedical school was undergoing
that change actively and theyencouraged us as students to be
involved.
We called it sort of like theco production of education
between faculty and students andso kind of like whether you
wanted to be a medical educatoror not, you were part of this
process.
It was being co-created andthen those of us who had an
interest in medical education, Ithink, kind of got swept into

(02:59):
that process a little bit.
More concretely, I also countmyself lucky because I was
interested in a project relatedto longitudinal clinical
education, joined this projectand then the senior mentor on
that project is someone who'sone of my closest mentors in
medical education, dr DavidHirsch, not in neurology and

(03:22):
internal medicine, but one ofthe leaders in the world.
Actually are related tolongitudinal clinical
experiences and research in that, and so by first year of
medical school I was working andstarting to do research in
education, educationalstructures and evaluation and
really, if anything, I feel likeI found education before I
found neurology and really, ifanything, I feel like I found
education before I foundneurology.

(03:44):
So that was really a threadthat I pulled through into my
residency and was very happy tosee that neurologists were very
receptive to the learning organand to the concepts of education
.
So kind of high speed across acouple of years.
But as a resident I continue tobe involved in educational

(04:07):
experiences and in particular Isort of distinguish it wasn't
just teaching, but it was reallythis idea of trying to get into
educational scholarship, so thecreating new programs,
evaluating those programs, youknow, publishing on medical
education and so thinking alittle bit more higher levels
than just the bedside teachingand the peer-to-peer teaching,
but really thinking around likehow do we deliver programs and

(04:30):
how do we adapt them todifferent learners.
This journey has led me to meetmany mentors, network with
others in the field, getinvolved with lots of
experiences and most recentlysort of culminated in the
co-creation with a group ofother organizers of the
neurology education room whichyou referenced, and what we

(04:51):
envisioned actually two yearsago when we first came up with
this idea was really a placewhere people like us, those
interested in neurologyeducation, could gather, meet
and network, and so I can gointo a little bit more if you
want to hear more, but in termsof my background I think it's a
lot of you know, braidedtogether threads, one thread

(05:15):
being a long term interest inteaching, a second thread being
kind of, I think, thecircumstantial experiences,
honestly, of my medical schooltraining and how
transformational the curriculumchange had been and really
seeing the impact of that andtrying to think about creating
that for others.
And I'd say the last thread isjust like deep principles of

(05:38):
education that matter to me,things like mentorship and
person development and kind oflike getting helping people
reach their potential, I thinkis like ultimately my goal, and
education seems like a reallyincredible means to do that.
So that's what drives meforward.

Dr. Michael Kentris (05:53):
Excellent.
Yeah, I know I personally youknow my mom is a school teacher,
so I definitely had thatelement of like education is
good, you know, as a formativehousehold experience, like
through my childhood and, youknow, teen years and, like you,
I did some tutoring in collegeas well and it is one of those

(06:13):
things where you kind of get,you know, a lot of fulfillment
from it and maybe it's just memoving, you know, kind of more
towards my middle career years.
But I am seeing this push ormaybe I'm just becoming more
aware of it where we're seeingsome more rigorous, as you said,
research about the actualtheory of education in neurology

(06:35):
specifically, and, I think, toan extent in medical education
kind of at large.
And you know I'm certainly not atheorist, I don't have a
master's of education or any, uh, formal training, so it's just
kind of what I pick up off thestreets but it's it's very
interesting, uh, because itseems like there is a big push

(06:55):
towards a kind of quote unquoteeducating the educators and I'm
kind of curious like what causethat that's?
I wasn't able to attend all thesessions at the AAN's education
program, but the ones I did, itdefinitely felt like there was
a lot a very collaborativespirit there and people kind of
comparing what they're doing atthese different institutions

(07:16):
across the country and, you know, both in the undergraduate and
graduate medical educationsphere, kind of looking at like
what are people's experiences,what are the things that have
been successful, both on aadministrative as well as kind
of a educational side of thing.

Dr. Galina Gheihman (07:31):
Yeah, you make a great observation and I
think that what we'reexperiencing is kind of the
natural evolution of a field tohigher quality, like our
ultimate goal is higher qualitylearning, because that will lead
to higher quality care.
And so the fact is that, likeas learning science evolves,

(07:52):
like as we learn more about howwe learn, there has to be kind
of this, like you know,subsequent evolution in how we
teach.
And I love I think it's Dr DrRoy Stroud who says, like you
know, learning is an evidencebased science, like, just like
medicine, and we, while weaccept a lot of kind of you know
time, honored traditions, wherewe can, we use evidence, and I

(08:15):
think that education is nodifferent.
It's like we can accept sometime, honored traditions, some
things that we're doing, but wealso it sort of behooves us, as
you know, experts in teaching toalso use evidence where we can.
The other analogy I would makeis I feel like it's the Olympics
now, and you know how peoplealways say like well, people's

(08:36):
bodies haven't really changed inmany years, but like the
technology has changed, right,like they can wear extra
swimsuits and the coaching haschanged, and what's really
different now is that the waythe swim coach's coach is
different, and that is the ideathat we could help those who are
in the teaching position toteach and coach better, and we

(09:09):
actually know how to do that.
And so this idea is our idea,is kind of we, as I'll just say
neurology, I'll keep itneurology, but it's really true
for all medical educators have aduty to teach.
We teach our patients, we teachour trainees.
I mean, the entire medicalmodel is precedented on an
apprenticeship model.
So it's not like we're sayingsomething novel, we're just

(09:29):
saying can we take this model,use technology?
Here's how it might be mostuseful, or how to structure
objectives, or how to structureevaluations.

(09:50):
And so, while I don't want itto be so structured that it
maybe turns away people whodon't have the experience, I
think what we tried to createwas just a place where you can
begin that conversation, so like, if you just want to use the
best evidence, like you can usesomeone else's cases, like you
can kind of come and say, ohgreat, I also want to do

(10:12):
simulation.
Well, you don't have toreinvent the wheel.
You know we could have acollaborative across the US, for
example, or or internationally.
That's like here's a, here's adatabase of simulation cases
that are vetted, peer reviewed,that you can use and here's how
you do it.
So, just the same as you, priorto us recording you had said

(10:32):
you know I had a complex case.
I called a specialist.
I'm envisioning that we couldhave education specialists.
So maybe you're interested inteaching this topic and you call
, you know myself or a colleague.
Okay, I really want to improveour EEG curriculum.
Well, here's a set module.
Here's like a set module.
I've studied it has theseoutcomes.
It's for this type of learner.
You can use it or you can adaptit to your learner and again

(10:54):
study it and see if it staysvalid and stays rigorous.
So that's the idea is, I think,kind of lifting the quality of
you know all boats and focusingnot so much on the end learner
but actually a step upstream ofthat of how do we coach the
coaches, educate the educatorsat least where we have evidence
and support them in kind ofmoving the higher quality of

(11:16):
education forward within ourfield.
I'll say one more point, whichis that you know a lot of the
audience matters and youmentioned undergrad versus
graduate, medical educationversus other learners.
They're going to need differentapproaches.
The undergraduate learner theremay be a little bit more
integration with basicneurosciences.

(11:36):
There may be integration acrossdisciplines the resident fellow
.
They're going to want detailedclinical information as well as
thinking around clinicalreasoning, management, follow-up
when we teach other learners.
For example, a growingpopulation within neurology is
advanced practice providers whoare entering our field.

(11:57):
It's a different audience.
They have a different trainingbackground than residents, for
example, even if they may beperforming similar duties.
And so even just the littlequestions of who is my learner,
what are my objectives and howwill I know if we've been
successful in that like thatframework, that framework of an

(12:18):
educational mindset, issomething that we want to
empower people to have and thinkabout as they design their
teaching or their training,whatever that looks like.

Dr. Michael Kentris (12:27):
Yeah, and that's.
You know that, anecdotally,that experience is kind of what
has guided me a little bit as Ifumble through the dark.
Yeah, I was at a small teachingprogram for neurology.

Dr. Galina Gheihman (12:43):
Come see the light.
No need to fumble in the dark.

Dr. Michael Kentris (12:46):
Yeah, so I was an instructor at a neurology
residency at Wright StateUniversity for a few years and
there I was mostly doing likeneurophysiology instruction,
like EEGs primarily and kind ofsome general neurology stuff.
But then we moved and so I'm ata community teaching hospital
and here we have more internalmedicine, family medicine,

(13:09):
emergency general surgery etc.
So my learners have changedsignificantly.
I'm not teaching theseneurologist-specific skills
anymore.
So I had to think like what doI think it's important for an
internist to know as they gointo practice?

(13:30):
Or a family medicine doctor,and can I, with the limited time
, with all the other things theyhave to learn, how can I get
their attention right?
Because obviously those of uswho are in the know know about
neurophobia and these kind ofantipathy towards neurology as a
practice.
Like I don't want to know aboutthat, it's confusing, get out

(13:52):
of here.
And so how can I make itinteresting and approachable and
make it so that these peopleare comfortable with managing
some of these common complaints,like, for instance, the the
Alzheimer's conference is goingon this week as well and there
was a big announcement in JAMAabout this new biomarker for

(14:13):
diagnosing Alzheimer's disease.
What kind of can of worms isthat going to do, right?
Is this going to be like?
Is Alzheimer's managed byprimary care?
Now, right, big questions, bigshifts happening, and it's just
one of these continuingevolutions of what can we?
Because we all know therearen't enough neurologists.
So how can I educate thesepeople, my colleagues, my future

(14:37):
colleagues, so that they'reable to handle some of these
more hopefully straightforwardcases like headaches or TIAs or
things like that, where maybethey don't have a neurologist on
staff?
And it's one of those thingswhere I've been kind of, you
know, for the last three years,just been iterating on this and
trying to find something thatworks.

(14:57):
And you know, some successes,some failures, and it's a
constant process, right?

Dr. Galina Gheihman (15:02):
I mean, the work you're doing is so
commendable and so importantbecause there's no way I think
there's data on, like, theshortfall of neurologists that
are anticipated in the comingyears and we are going to have
to share the burden and the loadfor patients with neurological
symptoms and complaints.
I wanted to point out oneaspect, which is you know you

(15:24):
shared that your task has beento iterate your curriculum we
can call it a curriculum foryour audience, and so my
interest is sort of like onestep removed.
It's kind of like, how do Ihelp the Michael Kentresses of
the world like out there, likewhat is it that would help you
to be more, you know, structuredin your approach, or to be more

(15:46):
effective in your approach, forexample, and and not just me
helping you directly but like,who is it that you need to talk
to?
Like?
And maybe there's a forum where, hey, it turns out there's, you
know, similar people trying todo similar things in their
communities.
And maybe your EEG module, whichI guess probably is not less
relevant for this audience, butlet's say your stroke module,

(16:07):
would be of great use to likesome other neurologist in a
community who has we're alreadydoing and the lens being
education or teaching, but it'salso can be quite clinical and

(16:28):
can be quite useful, and theidea here is just to augment
those efforts, like having youas the like as you sit as the
educator, like matching you tothe others sitting at your level
of the as the educator andhaving you guys be the network
that then has spokes and andkind of um from there yeah, and

(16:51):
I've I've seen some things beingwritten about this maybe not in
journals, but you know, onlineand kind of from personal
experiences where there is somuch good medical education
material out there but it's sofragmented across institutions
or different platforms or thingslike that.

Dr. Michael Kentris (17:07):
I know there are some hearty souls out
there who have been undertakingthat.
I apologize, I think it wasAaron Zolikovic.
I might be mispronouncing hisname, but I know he's been
collecting a lot of neurologyeducation resources recently and
they're making some prettyimpressive progress there.
And I think it's one of thosethings where, like you were

(17:29):
saying earlier, thesecross-institutional
collaborations can be veryhelpful.
And we see, historically in theneurology sphere, the epilepsy
teaching course, and thenthere's the movement disorders
teaching course, which has abunch of experts from across the

(17:50):
country doing these virtuallectures online
cross-institutionalcollaboration for a lot of these
more niche topics so thatthey're able to reach these
residents who might not haveexposure to certain things.

(18:12):
I know, certainly five, sevenyears ago when I was in training
it's getting longer, but it'sthings that weren't available.
I know that sometimes I wouldmake a trip down to Cincinnati,
which was like an hour drivewhen I got down there a handful
of times during residency I'd beable to listen to their
movement disorders panel talkabout all these bizarre cases,

(18:37):
but the residents who were therewere able to go every month.
So it's one of those thingswhere maybe you don't have these
things available at yourinstitution, whether that is for
neurologists specifically, oryou know there's a lot of family
medicine programs or internalmedicine programs out there that
maybe have one staffneurologist you know at the
hospital and you know, as you'reintimating, perhaps not

(19:02):
directly some people are moreinvested in education and might
have better or lesser skills foreducation depending on their
particular enjoyment of it.
So we probably have hundreds tothousands of physicians going
into primary care things likethat who may have very minimal

(19:24):
neurology background.

Dr. Galina Gheihman (19:26):
Yeah, so a few comments.
With regard to teaching skillcertainly it varies, but I
believe it's teachable.
So so I believe it's.
You know, it can improve withpractice and it can improve with
coaching and, you know, evensomeone has a lecture.
Let's say, okay, let's sit downand have a conversation about
how to make this lecture moreinteractive.

(19:46):
How to, you know, use principlelike even simple tweaks and
changes, start with a case orstart with the student's own
experience, you know, get theminvested and then go into, like
your 40 minutes of lecture orchange the whole idea.
You know you have 40 minutes,but no one said it had to be a
lecture.
So, just trying to get peopleto be a little more creative in
that within educationalstructures and then with with

(20:08):
how they deliver content, I will.
I agree with you.
I think that the explosion ofonline resources and sort of
democratization of access toneurology and neurology
education really did change withCOVID.
It was sort of the, you know,golden age of like the Twitter,
med Twitter and like the neuroTwitter, and there's a lot of

(20:30):
folks like Casey Altman comes tomind and Aaron Berkowitz were,
you know, were superb kind ofleaders on the tutorial front
who've actually done research,looking at like the impact of
those and the impact on theircareers and the impact on
connecting part of the residentand fellow section of the

(20:56):
neurology journal, and that's asection that has an editorial
board made primarily ofresidents as well as some
fellows.
We have a three-year term, soyou have some continuity and we
work with the editors to peerreview cases and do help with
the publications.
But what's the unique slant ofthat section?
Is that really the purpose ofits education and teaching?
And so when you submit a casereport, it's not novelty that

(21:16):
matters, but like what's theteaching point?
And so that's been a reallygreat immersive environment to
be in.
But it's been surprising to me,like how few people know about
us as a resource.
You know, medical students don'tlike go to the RFS, residents
don't necessarily go to the RFS,and so I think one of the big
challenges we have in educationis one, the collection of

(21:36):
resources, which Aaron isworking on he's one of our
editorial board members actuallyas well but two kind of like,
almost I would say, the curationfor a learner of these
experiences, like I can imagine.
You know, I totally understandthat I'm sitting like within the
richness of the Mass GeneralBreakup System.
You know, you know I totallyunderstand that I'm sitting like
within the richness of the massgeneral breakup system.
You know we have, like you saidmovement rounds and epilepsy

(21:58):
there's too many rounds to go toversus someone else who doesn't
have that access to them.
Like that, you know RFS case ofsome rare disease might be some
beacon.
That's like, hey, like I readabout this, I know about this,
I'm interested and I thinkhaving that, that like humility,
that perspective, is veryhelpful and I think that that's
happens when you gather and you,when you get to talk to others

(22:20):
and being part of the RFS, wehave global members who are just
like no, these cases are likethat.
This is like why I went intoneurology.
Like we don't even have aneurologist in my country, like
you know my city or my block umand it's it's exciting to think
about how we can one spread whatwe're, what we have here, and

(22:41):
like spread that wealth.
But but also, how do we kind ofbring the wealth of those
diverse experiences like here?

Dr. Michael Kentris (22:47):
yeah, and I've been seeing more like on,
like on the neurology blogsection and things like that, of
of people writing about thoseexperiences, which are always
very eyeopening.
Um, like you said, people fromuh countries in Africa or the
subcontinent or things like that, and you know just my own
conversations with people fromthose areas or even South
America and they're they'rereally doing some impressive

(23:10):
work with significantly lessresources than what we have in
most of the parts of the US, andit's, yeah, it's one of those
things where we're seeing thesepeople making these kind of
Herculean efforts to botheducate themselves as well as
their peers, and it's veryimpressive in a lot of ways.

Dr. Galina Gheihman (23:31):
If you think about the impact one can
have and it's very impressive ina lot of ways.
If you think about the impactone can have, arguably you could
have more impact as an educator, like if you could deliver an
effective intervention I'll sayintervention because I don't
know that it's a Zoom lecturebut even a Zoom lecture would
help to a group of clinicians ina different country, like you
could potentially have, augmentthe care that they're able to

(23:52):
provide to their patients.
If you know, when we thinkabout volunteer and service,
like I think it's very appealingto go and like have your hands
on the patients and talk and andmaybe it's a combination that
there's.
You know you build arelationship through annual
visits and then you've got alecture series as well.
But thinking around, liketenfold, hundredfold,

(24:13):
thousandfold, like how are yougoing to have an impact?
It's really in educating thatnext generation coming behind
you and coming up and thosearound you.
That's the only way we're ableto scale high quality
neurological care.
So I kind of feel like maybeI'm a neuro advocate or a neuro
evangelist, as someone oncecalled me, which I wasn't sure

(24:34):
if I was flattered orcomplimented but this idea is
that you know, education cansolve so many of the big
problems we face in neurology.
It can help with access.
It can help with higher qualitycare.
It can help with our training.
It can because education is atool you can.
You can move it to where you're.
What your target is right.

(24:54):
If your target is well-being,okay, well, let's redesign our
programs.
If your target is clinical care, that's a different story.
If your target is quality andsafety, okay, great, you've
identified a morbidity case.
How are you going to changethings?
You're going to educate people,right?
So it's kind of like alwaysgoing to be part and parcel to
any iterative improvement wewant to make.

(25:16):
And my thought is kind of takingthat educational mindset,
thinking around what's myaudience, what are the
objectives?
What will be the design of themethods of teaching to get to
those objectives?
And then how will I actuallyknow that I've been successful?
I think there's a lot ofparallels between quality
improvement and education, inthe sense that you have an aim,

(25:37):
you have an objective, you havesome kind of ideally measured
getting there.
You can improve iteratively.
And so I didn't mention this inmy brief bio, but I have a
little bit of a background in QIand I think that I blend those
perspectives when I think muchmore around an educational
stance or an educational mindset, like kind of like as you
approach a problem.
You know you don't have to haveall the full rigor of like

(26:02):
every single thing I do has tobe, you know, a completely
complete, like art, likerandomized study with, like this
, many controls and a perfect,perfect data plan.
But can you at least invokethose questions as you begin a
new innovation and think alittle around like how will I
know it's working?
What feedback will I get?

(26:23):
How, how will I interact withmy learners?
And those are some of theprinciples that I like to.
I would want people to take awaythat it's all or nothing, it's,
you know, completely randomteaching off the side of like
your desk versus like it's acompletely rigorous thing, but
that there's this big gray areain between.

(26:44):
And if we can even shift alittle bit towards some more
scholarship, that means that oneas a teacher could be a little
bit more effective.
Like, for example, say, you'reusing a known validated
simulation case.
So you've decided I'm gonnasimulate.
You know, I'm gonna give mylearners an opportunity to

(27:04):
practice stroke care.
Well, you can use a validatedcase.
So there you go.
You've like what one step upthe ladder, you want to go a
step higher.
Maybe you'll also survey yourresidents and add to the
literature, and so if all of usjust have a little bit like one
step up from where we are now,we're actually contributing in
parallel to the literature, aswe're contributing to the

(27:27):
learning I would say is sort oflike clinical research.
There's a lot of clinicalresearchers, especially in rare
diseases.
I've seen, I saw a talkrecently and the presenter had a
big slide and he was like everypatient with X condition should
be in a clinical trial and hispoint was that we're losing the

(27:47):
opportunity to gather data.
Of course you have to consultthe patient, all that, but his
point being that you know everyinteraction and in his case,
between that clinical drug andthe patient was informing.
This area that's in need ofgreater research and I think
education is the same is that wehave an opportunity to make

(28:08):
sure that every learner is partin is in some way helping us
contribute to acceleratingoverall our field of neurology
education.

Dr. Michael Kentris (28:18):
Yeah, that's a lot to take in.
So one of the things Isometimes and this is probably
more of like maybe anepistemology type question is
because how do we measure asuccess of our intervention?
I know some of the studies andthings that we look at right, we

(28:38):
look at maybe pre and post testperformance or, like you said,
surveys that are often lookingat things like confidence of the
learner in managing X condition, things like that and we don't
necessarily know how well thattranslates to actual patient
care.
At least I'm not aware ofanything that shows a direct

(28:59):
correlation.
But what are your thoughtsabout that in terms of the
limitations, like you said, ofour measurement of improvement?

Dr. Galina Gheihman (29:07):
Yeah, that's a great question.
It's a real sticky point foreducation, education, research.
There's a concept, um calledthe kirkpatrick levels of
outcomes, um you may or may notbe familiar with, where there's
a, a scheme of kind of levels,one through four, and each are
considered of higher impact.

(29:28):
Level one is that like reactionto the, to the intervention,
like oh, oh, were they satisfied?
Did they like it?
Like it was well-organized, Ilike that it was at 3 pm on a
Tuesday and not in the evening.
The next level is kind ofknowledge, like are they able to
apply the knowledge?
So, for example, you might havea post-test.

(29:48):
Level three is behavior.
So okay, they did the post-testand then when you saw them in
clinic, they did in fact order,you know, nortriptyline for
migraines, as opposed to likeTylenol which they used to order
.
And then number four is outcome.
That's the highest leveloutcome of the patient.
So like, after thisintervention, a year later, you

(30:10):
know all the migraine patientshad the right diagnosis in their
note and they were all on apreventative medication, if that
was indicated.
So I think what we have not hadin knowledge, education as well
, in throughout the past is sortof this ability to push the

(30:30):
outcomes, as they say, push upthe level of kirkpatrick's um
evaluation outcomes.
I am optimistic because I think, like this whole ai chat gpt
like scrubbing the epic, or Isorry, epic is our um ehr.
So like scrubbing the ehr yeahmay create an opportunity to

(30:53):
marry, like clinical outcomesand educational outcomes in a
way that we haven't seen before.
So one idea is this that youknow, could we create an
intervention and then kind ofuse like data from the, from the
medical record, as evidencethat a learner is implementing
what they're learning?
Like how are their and I don'tknow that notes are really the

(31:15):
best measure, but like are theirdifferential changing is the
problem was changing?
Is the time to a preventativemigraine medication changing?
Like is, um, the number ofneurology consults going down,
which may or may not be ameasure, a good measure, you
know it's, it's got pros andcons, but in the sense of, or or
maybe are those consultquestions of higher quality as

(31:38):
rated by, say, a subjectivemeasure, but nonetheless rated
by two to three neurologists, islike yes, this is a clear
question as opposed to no.
So I think every measure andevery study is going to have,
every change will have, you know, study is going to have
everywhere.
Every change will have pros,cons and kind of unexpected
outcomes.
But I do think that we shouldpush ourselves to try to get up

(32:00):
that hierarchy and I thinkleading into new technologies
may help us do that.

Dr. Michael Kentris (32:06):
No, I think that's a great great thought
and certainly I know there's alot of effort being made to
integrate AI into a lot ofdifferent electronic records and
it'll certainly be a brave newworld once that happens.

Dr. Galina Gheihman (32:22):
What's really exciting is actually in
the neurology education roomthis year, one of the first
sessions, one of the sessions wehad One of the sessions we had

(32:55):
because one of the drives behindthis education room was was
that there were, I think, fiveparticipants who pitched their
research project and said, hey,join my project.
Like my project is so cool.
Um, I need help.
And one of the people, um, drRachel, uh got let's uh Smith, I
think, get her name right.
Um, and she pitched.
Essentially they're doing like aneuro, she's a pediatric

(33:19):
neurologist, so they're focusingon pediatric neuro and they're
doing a like clinicalinformatics, informed
educational intervention, wherethey're basically like looking
at what residents are seeing inclinic and what they're seeing
on the wards and like using that, like documented data, to sort
of create a tailored curriculumplan.

(33:40):
Like hey, you saw these thingslast week, like here's, what
reading points?
Or like you haven't seen thesethings, so here's, I'm going to
feed you more training or morequestions, training or more
questions.
And, I think, a step two theyhave a plan where they will
essentially like have a kind ofscorecard of what residents are
seeing and then like book clinicpatients based on like where

(34:01):
they're lacking, because theyhave a way to kind of
essentially use ai to review therecord, create a educational
scorecard and and then adapt andtailor the teaching so it's
like precision-informededucation.
I'm probably getting thedetails wrong.

(34:22):
We'll have to ask Rachel toclarify, but she presented this
and there were so many peoplejumping on board, mostly adult
neurologists, being like, whenis this coming to adult neuro?
And the decision I think wasmade to start first in
pediatrics and then expand.
But what was really cool to seewas one the huge appetite for
this, like program directorsbeing like sign me up right.

(34:42):
Like, and this opportunity thatshe could augment what she's
doing by doing it at multipleinstitutions, proving from the
get go it's a multiinstitutional effort, it's
feasible, implementable from theget-go.
It's a multi-institutionaleffort, it's feasible,
implementable, adaptable.
She has larger N numbers to getat, the outcome of this being,
you know, a valid measure, andshe was able to garner more

(35:03):
expertise.
So, for example, one personpointed out that hey, well, what
about the faculty who are goingto have to meet with these
residents and review thesereport cards?
Like, what is facultydevelopment going to look like
for this?
Someone else was like youshould really do some you know
qualitative research, like withthese residents, and she's like,
oh, that's not a skill set,maybe she has, but or actually
she does have qualitativeresearch, but like kind of

(35:26):
gathering people who were goingto like fit into a little
project.
And I think for me it was veryexciting to see what I think are
the sparks of what it must havefelt like 100 years ago when
clinical trials were firststarting and people were
thinking about platform trialsand we had site PIs.
And I remember Dr GaletaStephen Galeta, who was

(35:48):
organizing, is standing up andintroducing this short tag and I
just felt like I was like a newera, starting an education.
It's like we're going to havelike a site PI, we're going to
have like site coordinators,we're going to have cross
institutional work, we're goingto be able to gather, you know,
data in a different way and Ithink it's all the early stages,

(36:11):
but I'm really hoping that.
You know, looking back in 50years, um, some of us would say
like this was.
We were at the beginning of it.

Dr. Michael Kentris (36:20):
Yeah, that's.
Yeah, it really sparked somethoughts because, like you said
earlier, right, medicinetraditionally it's, it's an
apprenticeship model, and soit's one of those things where
you're in residency training forso many years, fellowship
training for so many years.
If you decide to go that pathand you become most intimately

(36:41):
familiar with those things thatyou see and manage and it is it
is really one of those thingswhere, if you are able to find
those gaps, like oh, I haven'tseen you know X, y, z, rare
diseases, it's like well, youneed to spend time with the
geneticist or the movementspecialist or whomever, and
we're going to slot you an extraweek into your training

(37:04):
schedule to supplement thatshortcoming so that you get
these skills.
And I think that that is justfascinating to be able to do
that with that kind of precision.
Potentially and it really isinteresting because I know, and
probably a lot of peoplelistening it's like you hear
about oh, we've got this strangecase of such and such over on

(37:26):
the neurology unit and maybe youstop by with the rounding team,
even if you're not on servicethat day, just to see the case.
So you see what's going on, youkind of get familiar with it a
little bit, even if you're notthe one taking care of it.
But you know time is limitedand sometimes you can get there,
sometimes you can't.
Not everyone is that motivated,uh, so sometimes there does

(37:48):
have to be a little bit of aforce feeding involved, but uh,
but yeah, it's very fascinatingIf that, if that's able to bear
that kind of fruit in theeducation experience, I think
it'll, like you said, reallyrevolutionize things.

Dr. Galina Gheihman (38:02):
I think time will tell.
Yeah, I think you're.
I think you're right that we'llsee what's effective, and
what's effective will probablystick.
I think.
I think what you're sayingabout the different goals is
super important to.
Uh, you know, there's like areason.
I think we have specializationand it probably is like that

(38:24):
higher order, refined diagnosticapproach.
But let's say, like you and Iare both general neurologists,
there's, you know, a certainskill set to saying which
specialty does this go to?
Like, you know, is thismovement, is this or is this a
neuromuscular problem?

(38:45):
Like if a patient says I'm weakin the leg, well, is it, you
know?
Is it stiff?
Or is it, like you know, what'sthe issue here?
So, or is it just like sensoryattacks yeah, I don't know?
Like it's interesting for us.
And so, thinking a little bitaround, like kind of what is the
knowledge point that you'retrying to transfer and being

(39:08):
adaptable in that and not justlike here's my set thing that I
say, but like if I'm talking toum, you know, I'm talking to
neurolog like the approach toweakness talk is going to be
very different than if you'retalking to, as you said, say,
much more transferable skills isimportant.
So what I mean by that is, forexample, in neurology, our exam

(39:41):
matters a lot and how youperform does matter.
But even if you don't know thespecific terms like being
descriptive is something that Iwould teach someone is like
describe, you know the amplitude, the frequency of the tremor,
like what?
How it changes.
And, and even if you don't knowthe terms, like it's actually
more useful.
I often find when I gettransfer calls it's like oh,

(40:01):
there's a korea.
You're like what does it looklike?
And they're like oh, you meanit's more like a tick, or it's
more like a tremor, or like it'smore it's like I have no idea.
So, um, we have a series that welovingly call Movement After
Dark.
For our residents it's anelective, like dinner series
with a video submitted byresidents, pre-reviewed by the
fellow and attending for someteaching points.

(40:22):
But everyone goes around theroom and practices describing
the phenomenology and that's avery clear objective of the
series.
It's not like, oh, got it.
Like that's, you knowHuntington's career.
It's more like this is apatient.
Like what do we observe?
We watch the video.
Is it symmetric?
Is it asymmetric?
Is it one limb?
Is it multiple limbs?
Does it involve the face?

(40:43):
Like, how frequent, what doesit happen?
And I think that that kind ofskillset of like you know not
jumping to the answer, you knownot jumping to the answer but
learning frameworks of anapproach is, I think, what is
most useful to the generalizablelearner.
Is the same as if you you don'thave an intern at a business,

(41:04):
like yes, your business mightsell cars, but if you can teach
them like to manage a calendar,to manage their time, to like
know about how to customerservice, like that's something
they can take to their next joband that's kind of an investment
in the learner, outside of yourspecific need for their role.
And so I think that we aseducators, I would like to push

(41:26):
us to kind of think a little bitaround, not just like did I
transmit to this knowledge?
Like did I transmit like thesefour seizure medications, but
more like did I transmit to thisknowledge?
Like did I transmit like thesefour seizure medications, but
more like did I help develop thelearner and give them a skill
set that they can take awaybeyond the session that we
talked about today.
And often that depends on thekind of teacher you are.

(41:47):
There's actually it's funny,there's actually teacher scales
and like kind of quote unquoteteacher personality tests you
can take.
I've done this in teachertraining courses and people vary
.
There's one, one type that somepeople are very high in
knowledge transmission, likethat's their number one
objective.
Um, others are a little bitmore around coaching.
Some are about moreprofessional, like kind of

(42:08):
personal development of thelearners, a relationship
building.
Uh, so I know that's my bias.
I'm a little on therelationship building side of
seeing my learners evolve andbecome kind of independent
rather than just being aspecific learning point.
But I think even among useducators our collective impact
can be across these domains, notjust the knowledge translation,

(42:29):
but the development of thelearner into kind of their own.
You know, lifelong learner iswhat I think we want to support.

Dr. Michael Kentris (42:38):
Yes, yes, you have to kindle that
curiosity and it's it's veryfunny.
I remember when I was a fellowwe would do a lot of like
epilepsy video reviews and stufflike that, and it was, it was
that exact same thing.
I think epilepsy and movementhave a lot of similarity in that
particular respect, althoughthey call it phenomenology and

(43:01):
we call it semiology, but that'sokay Two specialties divided by
a common language.
But it is one of those thingswhere I was literally like
everything you were just sayingwas like hitting me home.
I was ranting to the internalmedicine resident just this last
week about like you have totrain your mind to recognize

(43:25):
what your eyes are seeing, right, because obviously I do a lot
of inpatient work and probablythe second most consult we get
after like altered mental statusand stroke I guess it'd be
number three is quote unquoteseizure-like activity and so
really like getting into thenitty gritty.
Or if you even have a videolike literally this last month I

(43:49):
was shouted from the nurse Iwas two beds down the hallway
and it's like, oh, the patient'shaving a seizure and we come in
and oh, the patient's havingirregular jerking, side-to-side
movements, pelvic thrusting, andit's like, oh, this does not
look epileptic and we kind ofkept an eye on her and stopped
in two minutes and it was prettyclearly not an epileptic

(44:11):
seizure and we didn't give herbenzos or anything, so we were
able to avoid those negativeinterventions.
Um, but if she had called likesort of a rapid response team,
you know, then the ICU teamcomes up and all this kind of
stuff and maybe people whoaren't as familiar and they
don't recognize what is anon-epileptic versus an
epileptic seizure, and right,it's this whole thing where you

(44:33):
just want them to Like I give alecture, probably once a year or
so, and it's just a series ofvideos and the only question is
is this an epileptic seizure ornot?
And then we go into the why foreach video and and most of the

(45:03):
time people are about 50-50.
It's about six, seven videos.
And it is one of those thingswhere it's like for us as a
neurologist like figure out,like what, what's going on here?
And when you see like all thepapers out there, like the rates
of intubation for non-epilepticevents is going up over the
last like 20, 30 years, thingslike that, and so you wonder
like how can I change myinterventions to be more

(45:26):
effective, like, do I need tojust be giving the lecture more
to more people?
Uh, because it is right.
It's one of those things where,like you know, repetition so
quote unquote is the mother oflearning.
So you do wonder, like, am Italking enough?
Like you were saying theinformation transfer, is the
information just not gettingthrough or is it the way, is it

(45:47):
me, is it the way I'mcommunicating it?
And again, right, I don't knowthat there's been necessarily
studies looking at more largeacademic versus smaller
community hospitals.
Is there a difference inrecognition of some of these
common neurologic entities?
And to your story earlier whereyou were getting calls for Korea

(46:07):
, it's like if I get consultedfor a tremor in the hospital,
it's like if I get consulted fora tremor in the hospital, in my
mind it's myoclonus andasterixis, until proven
otherwise.
Um, because it's usually liketoxic metabolic type stuff,
right, but um, but it is one ofthose things where it's like I
kind of think back to the, theprincess bride, uh, you know.

(46:28):
And ego montoya, it's like keepusing that word.
I don't think it means what youthink it does, and kind of like
the vocabulary becomes soimportant.
And I know us as nerdologists.
It definitely is one of thosethings where, like we're very,
we can be very into thesemantics of like well,
technically, no, it's more likethis thing, not that thing.

(46:49):
But in broad strokes, words domatter to an extent because they
have different treatments, theyhave different prognoses and so
on and so forth.
So it's hard, I think, to getacross that nuance without
feeding into, kind of going backthat underlying distaste of

(47:10):
neurology as a specialty tonon-neurologists.
But what, what are yourperspectives on that whole word
vomit I just issued forth?

Dr. Galina Gheihman (47:20):
No, honestly, I have, like my mind
just went in like five differentdirections that I'm trying to
like rail in to either a singlepoint or like, keep them all in
mind.
So much of what you saidresonates so much.
So let me just say a couplepoints, maybe not in perfect

(47:41):
order, but the first is I love,I like, I love every teaching
opportunity, like never miss ateaching opportunity.
So one example is this idea oflike we you know we do these
like consults in isolation.
We're like oh, patient hastremor, question where you go,
you're like oh, asterixis.
Oh, you walk out, you're atyour run out.

(48:02):
What about bringing the team inbeing like this is what
asterixis look like.
This is the qualities that makeit not a tremor.
Um, here's a little oh, thepatient can't hold up their arm.
Well, you can just look at thefinger.
Like you know, you can teachthese little things.
And sometimes people we knowthat people kind of learn by
stories and cases and so that'sa case that maybe will stick in

(48:24):
their mind and maybe they'llstill call you.
But they'll be like I thinkit's asterixis, like can you
come and check?
And then the next one will belike oh, it's asterisk, is there
anything else we should do?
And then next time you won'teven hear.
But the idea is, like you know,I used to love the consult
service because we got to talkto the teams and we were trying
to kind of, yeah, bring themalong to our vocabulary, not to

(48:46):
be specific, but to kind ofclarify, and I also try to avoid
the jargon, because I don'tthink it's helpful.
I think being descriptive ismost helpful.
The other point I'll make aboutthe language, though, is that
language begets action.
So when a nurse is like this isseizure-like activity, like
someone's already drawing up thebenzo, and I think that that is
good, but it's kind of like theflip side of the negative side

(49:11):
of protocols, right, it's likeit's the same thing as in the ED
, when the ED calls a codestroke, and we're like rolling
our eyes, we're like, really,because when you call a code
stroke, there's a protocol, andwe're just like, okay, it's not
even like a stroke syndrome,right, but that's, in a way,
it's kind of like you know, ifour threshold was too high, we'd
miss them.

(49:31):
You know, if we, if ourthreshold was too high, we'd
miss them, and so that's, that'skind of like the flip it's, it
comes with the territory andsame with the seizure, like
episodes, like our threshold hasto be high, it has the benzo
has to be drawn up maybe notgiven, but maybe drawn up.
And I once had this experiencewhere I was teaching internal
medicine residents, causethey're like we really want help
from neurology about managingseizures.
And so I was like they're likewe really want help from

(49:55):
neurology about managingseizures.
And so I was like they're likewhat do you do?
Like like okay, here's the case.
Like what is the first thingyou do?
And I was like well, I walkinto the room and I say I'm the
neurologist and then I take outmy phone and put a timer for two
minutes and then I press thevideo and then I stand at the
foot of the bed.
They were like very confusedbecause they're like Wait, what
do you mean?
Like I mean the nurses, likeyou know, check.
I mean okay, like I wasexaggerating a little bit, but

(50:16):
the idea being that thatinformation is like very key, is
like that is actually the keyinformation that I need in that
moment is like what does thislook like?
Of course, abcs, as long asthat's the patient is, you know
breathing and okay, vitals areokay, like then you stand back
and and part of it is teachingthem the natural history.
And so I think that the more wecan, like talk out loud and

(50:40):
quote, unquote, like show outloud, like, even if you're with
residents or with the beststudent, like bring them with
you, say, like when you weresaying I observed this event,
the pelvic thrusting, like it'shard with a patient in the room,
but let's say you had a studentwith you.
You could say I noticed thepatient's.
You know her eyes are hers, hisor her eyes are closed.
This pelvic thrusting is, youknow, asymmetric.
Look how the arm moves in andout, like look at how you know

(51:03):
this and that we're going tolook at the postictal state.
Is the patient going to wake upright away?
Say, oh, what happened to me?
Immediately, speakingimmediately, not confused, so
like just you know, pointing outto others what you're seeing.
I think one teaches them butalso inspires them because I, I
mean, I think like neuro ispretty cool and neurologists who
are effective at, as you said,connecting our eyes to our mind

(51:25):
and then connecting that to ourmouth and articulating that.
Um, that's the skill set thatwe're practicing.
As as to your reach with yourvideos.
I love that idea, I love thosevideos.
But the thing is like, thelesson is not like right or
wrong, like oh, I got that onewrong, I got this one right.

(51:45):
The lesson is like what in thevideo made you think this?
What in the video made youthink that?
Are you familiar with visualthinking strategies?

Dr. Michael Kentris (51:55):
I'm not vts .

Dr. Galina Gheihman (51:57):
It's a type of um arts-based educational
approach, where you use art tohone observation skills, and
it's been applied in medicine.
So the idea is you gather as agroup of people about painting
and you're like this you know, Ihave heard of this.
Yeah, like this, and the artseducator the educator who's in

(52:18):
charge, standing with the grouplooking at the painting, is
really there to facilitate thearticulation of what
observations have led to aconclusion.
So, for example, someone willsay, oh, the woman on the right,
and the arts educator willinterrupt and say what makes you
think it's a woman?
And they'll be like, oh, um,the figure with the longer hair.
You're right.

(52:39):
Actually, I don't know, thefigure with the longer hair is
wearing blue, like, like, likeyou realize, kind of like you
really break down, and itpromotes observation,
articulation and also teambuilding and perspective taking,
because once I've stared atthis, you know, figure with
longer hair.
Someone else is like what doyou mean?
Figure?
It's like I don't even see ahuman form, like I see just

(53:00):
blotches of colors.
And suddenly you're like whoa,like I thought what I saw was
the truth as opposed to what weall together break down into
like just the objectivity of it.
So long story short.
Out into like just theobjectivity of it, so long story
short.
I feel like what you've beendoing is like the VTS of seizure
, simulogy, and so how do you?
Yeah, so the concept is, how doyou spread that?

(53:22):
And you can go to theliterature, maybe answer that
you know you can say maybe it'sonline modules, maybe you record
your lecture, you make it free,maybe it's simulation, like
maybe what we really need is Ithink it's hard to simulate
seizure symbiology, but like interms of like stroke management,
for example, like why don't wehave routine simulation for oral

(53:42):
emergency room providers?
You know things like that likethat's not a routine thing and
if we're, I think we need tothink strategically and about
what will have most efficacy ifwe want to have the most reach.

Dr. Michael Kentris (53:56):
Yeah, no, that's I mean.
It makes sense, being moreefficacious is better right.

Dr. Galina Gheihman (54:04):
To me there's such a parallel with
quality and safety in medicine,because when you learn about
errors or lack of quality, it'sjust so shocking.
It's like how can this be?
You know, how can this be thecase in our system?
Like you, it's.
No one would disagree withimproving quality right right
and I think it's similar ineducation is that, you know, no

(54:26):
one would disagree with theimprovement of education,
because that would also lead toour ultimate outcome of improved
patient care, improvedexperiences.

Dr. Michael Kentris (54:35):
And so I, I do think, taking a little bit
of um kind of a stance andsaying like we, we can't just
kind of rest on our laurels orsay we're doing this, but we
really have to do it and sothat's an excellent point, right
, right, I think you like, asyou said, right, no one's going
to say better quality is bad,and if we make the assumption

(54:59):
that better education leads tobetter physicians and advanced
practice providers and thenbetter outcomes for patients,
but if we look at how educationis valued within the, the
three-legged stool of medicaltraining, right, where we have
research and clinical care asthe other two legs, uh, it's

(55:23):
often, you know, given veryshort shrift, relatively
speaking yeah, it's a lopsidedstool.

Dr. Galina Gheihman (55:28):
It's kind of falling over it's, it's, it's
like basically two legs it's,and it's very unfortunate, I
think, that it doesn't have thesame value, as you said, because
I find a lot of the time it'skind of taken for granted.
It's kind of like oh, of coursewe teach, and it's like, yeah,

(55:48):
we teach, like of course, likewe're gonna, you know, natural
the fact that our residentsdon't know things when they're
coming in and that they work andthey learn and they read, and I
probably shouldn't say thiswhere I can be quoted.
But we sometimes joke that ourresidents are superb despite our
educational curriculum.
Educational curriculum Not notnot truly, but in the sense that

(56:13):
we really took a hard look.
For example, last year, I wasone of our chief residents last
year and, as part of that, hadthe opportunity to be part of
redesigning just a little bitour educational curriculum and
we sort of took a hard look atour goals for residents and like
whether or not these wereactually that are goals for
residents and like whether ornot these were actually
intentionally implemented, likeintentionally designed.

(56:36):
Sure, they were probablyhappening.
That residents got mentorshipSure, it was probably the case
that they learned the physicalexam, but it wasn't
intentionally designed into thecurriculum, and so we introduced
a few even small tweaks.
And this is where I thinkquality improvement can guide us
right, like these kind of quoteunquote educational PDSA cycles
of saying, hey, listen, ourresidents don't actually get

(56:58):
formal, formal meaning.
Like you can point to where ithappened teaching in the neuro
exam and so we introduced a fewkind of specialists high skill
sessions where they had directhands on teaching in
neuromuscular and we didheadache and occipital nerve
blocks.
We also did like ophthalmologyof endoscopy, and then we also

(57:18):
had, like our movement disorderrounds, and so those are an
example where, like up untilthen, yes, you could certainly
check the box, like I'm sureit's happening on the ward
somewhere, but there was nointentional design around.
When would this be?
How would it be?
Kind of, you know, quote unquote, not marketed, but kind of like
, like, like shown the valuebecause it's actually part of

(57:39):
the formal didactics.
And we had a few other sessionsas well.
Like our Wednesday lecturesincluded topics among four
categories wellness, leadership,medical teaching, like resident
as teacher, and then sort ofteam management and professional
identity.
So we then use that structureand that kind of coveted space

(58:13):
to invite lectures or invitegroup work sessions or workshops
.
And then the final thing we didwas we realized that of course
we were graduating amazingresident educators right.
Like that just naturally happens.
And we're like well, yes, weassume that happens, but there's
no formal opportunity forresidents to teach or no formal

(58:33):
requirement.
And so we created small groupsessions where a third year
teaches the first years and soevery third year graduating can
say yep.
In fact I led a small groupsession, I gave a small group
lecture.
That's part and parcel.
When we say we're graduatingthe type of well-rounded
neurologist we want to graduate,well, we're giving them
research training, we're givingthem clinical training, but

(58:53):
where's the educational piece?
And that was kind of my biasand that's sort of the role
myself and my co-education chiefbrought in last year?

Dr. Michael Kentris (59:01):
excellent, yeah, that is something I know.
When I'm mentoring medicalstudents, a lot is they'll, you
know, want to know, like, whatkind of residency program am I
looking at?
And you know, at the one end wehave places like mgh, where
there is, you know, a multitudeof subspecialists and resources

(59:21):
and all that, and then on theother side they're, you know,
smaller programs that have maybetwo to four residents per year
and maybe no fellowships at thatinstitution, and so it's like,
what do you envision for yourcareer?
Do you see yourself like one ofmy former residents Shout out
to Dr Sarah Liston, if she everlistens to this, but she is a

(59:41):
neurologist in Montana and sheis the only neurologist in 100
miles and so she can call peopleup for advice, but if she needs
them to see somebody, that's ahaul.
So you, you really have to thinkabout, like, where do I see
myself in my career?

(01:00:02):
Not just, you know, in mymedical training, but, you know,
am I, am I going to be like aclinician, researcher, or do I
want to just take care ofpatients in a, a rural area or
an underserved community orthings like that?
Because you know, differentplaces may provide you with kind
of a differently weighted skillset, and so you kind of have to
think about that to an extent.

(01:00:22):
But yeah, it is one of thosethings where we, you know, we
all want to graduate, you know,well-rounded physicians, but
it's, you know, it's definitelya different path there,
depending on the environment.

Dr. Galina Gheihman (01:00:34):
I agree with you that the environment
can impact you, and I think whatI would focus on a little bit
is like role modeling and thisidea that we just want people to
know that this is an like, thisis a path if you, if you,
choose to follow it.
What I would sort of say is, Ithink that teaching is a

(01:00:55):
fundamental skill set that weshould be teaching our residents
and we should be teachingpeople as they come up through
neurology training because youmentioned your former mentee,
like I'm sure she's having toeducate PCPs in her region about
referrals or her patients andthings like that and so for her
to have education as a skill set, even at a basic level, being

(01:01:19):
an effective clinical teacher ina busy clinical environment,
that's like a one type of skillset.
For those who gather a littlebit more interest, you know,
like the stone gathering alittle bit more Moss is like we
want them to know that there'splaces they can go, there's
resources, like you can go toeducator training programs for
residents or whereas a facultyof the Macy Institute comes to

(01:01:41):
mind, one that offers trainingfor clinician educators.
And then I think more broadly,I think those, those of us who
are like committing a more majorpart of their career to that.
That's where kind of thatadvocacy piece comes in around
representation, equity, value ofthis as a career in balance
with the other domains of adepartment, that we're committed

(01:02:04):
not just to research andclinical education but to
education, and I think thatwe're making some progress there
, we're moving some ground.
Um, I think, and for me it'ssort of like you know, when
you're at the forefront ofsomething like this and you're
pushing, it's helpful to thinkof, like those that are coming
behind you.
It's helpful to think that likeI want others to know that you

(01:02:28):
know a pursuing, if not, thatthey have to, but if this is of
interest they don't have to turndown that interest.
They can make a career out ofit.
I remember at the educationroom even that sort of role
modeling was super, veryinspiring for a lot of the
junior trainees saying like oh,I thought the only way you could
do education was like to be aprogram director and like that's

(01:02:50):
great, but not everyone wantsto do essentially administration
, educational administration.
Some want to maybe work more oncurriculum innovation, for
example, and sometimes thoseroles overlap and I remember one
of the trainees was like weshould have like a careers night
, and I know you're talkingabout what's your mix of the
three and I'm like zoning it oneducation, being like well

(01:03:11):
within education, like wellwithin education also, what's
your mix like?
Are you a PD and you do someresearch, or you you maybe serve
on a national committee, oryou're super interested in
simulation and you do simulationacross different domains, or
maybe you work with theemergency room and you know,
because you're not so focused onneurology, you're more focused
on education.
So even within that there'slots of roles and I think the

(01:03:33):
more we can support thatdiversity, find that spark that
motivates an individual andsupport them, I think the more
creativity and good outcomeswe're going to have.

Dr. Michael Kentris (01:03:44):
No, I think that's absolutely right.
It kind of goes back to whatyou said earlier about kind of
educating the educators and thatwhole downstream cascade.
So I think it is superimportant to to make sure, cause
, you know, those graduates aregoing to go out there, they're
going to teach more people andthey'll their you know their
students will teach more people,and so on and so forth down the
line.
And it becomes like one ofthese things where you have

(01:04:06):
these like chains of people likeoh, you know, so-and-so was
trained by Dr X and they were anamazing physician and I learned
all these tricks and thingslike that.
And it is right, we can't getaway from that apprenticeship
mold to an extent, just becauseit is such a relatively small
community and you almost havethis, to borrow something from

(01:04:31):
the Christian community, thisapostolic cessation of neurology
training, and it's just, it'svery fascinating sometimes when
you see, like where I am, youknow we've got Hans Luters up in
Cleveland who's kind of likeyou know this legend in epilepsy
, and so we run into histrainees and they have all these
little you know kind of nuancesthat they pick up from him from

(01:04:53):
the last you know so manydecades, and it is one of those
things where there's like almostschools of practice in
neurology that you can traceback to certain like kind of
founding physicians, and it'svery fascinating, in a way, to
kind of see that evolution, orthese different schools of
thoughts evolve over the decadeskind of see that evolution, or

(01:05:14):
these different schools ofthought evolve over the decades.

Dr. Galina Gheihman (01:05:17):
I'm very fortunate to have trained at
Mass General Brigham when DrSamuels was alive and he was one
of my early mentors for so manyof us.
And recently when we were in theinpatient service, one of the
residents was he's like I'm nowcalculating how early it is in
the morning when someone firstmentions likey used to and he's
like yesterday was 801, uh, andlike today it's like 7, 39, like

(01:05:37):
like five minutes into ourmorning report and it was just
kind of um, you know, there'sit's bittersweet to have that
memory, but it's so true thatpeople pass on stories and pass
on exam findings or like, oh, Ialways do this and x person you
know taught me that, or wheneverI'm like doing a really good
neuromuscular exam, in my mindthere's like the, the, the

(01:05:58):
person who taught me that islike.
It's like.
It's like scrutinizing my youknow whether I'm like isolating
the joys well enough, um, and sothere is a kind of heritage
there and I think that that's abig part of you know, education
as well is really therelationship building that is
sort of sacred between a teacherand a learner, where I get the

(01:06:28):
drive and the motivation to keepit going, cause it is
fulfilling to see someone learn,and it's fulfilling to you know
, see them teach you somethingback.
Um, in fact, uh, and it's, it'sreally a full circle.

Dr. Michael Kentris (01:06:45):
And I think I might've mentioned this
before we started recording.
You know, I was calling up oneof my, one of my former
residents, who she she's now anMS specialist and I was asking
for her advice.
So it is right it's come fullcircle.
I'm reaching out to the peopleI helped educate and now they
have skills that I don't orexperiences that I don't, and

(01:07:05):
they're able to help me learnhow to take care of challenging
patients and things like that aswell.
And it is right Now that I'mkind of moved into that stage of
my career.
It's a little surreal almost tosee people, because I remember
them as these junior residentsand now they're out there,
independent, practicing, makingcomplex decisions, and it's like

(01:07:28):
it's very satisfying and almostlike I can't believe that you
know, you, I had a hand in anypart of this.
So it's it is very satisfyingas a kind of look back on those
aspects of your career.

Dr. Galina Gheihman (01:07:43):
I think, as an educator, like you, you've
got it like you are a learnerand you're a teacher too and
you're kind of both and and.
The more you're open to that, Ithink, the the better, the more
effective you'll be, because,like, for example, um, I love
the book, thanks for thefeedback, and I think the first
sentence in it is likeeverything is feedback and it's

(01:08:05):
just this idea that, like youkind of choose which data to
pull in and like if you'regiving a lecture, you're giving
a session like confused,quizzical looks like you know
you may have to adjust or youmay have to adapt to every
learner and the idea is like youcan't even you can't even
guarantee that it will have thesame land, the same way or have
the same impact, and soconstantly being open to change,

(01:08:28):
to adapt, to adapt, to adapting, if you need to, to the
feedback, I think those areimportant skill sets that you
get as you think around, as you,as you think about becoming a
teacher, and I think that thoseare also like we haven't really
talked about patient education,but that's something we do every

(01:08:49):
day in our clinic and that alsohas to you to be most effective
.
It's better if you don't have aboilerplate spiel, but you have
something that's adapted to theindividual in front of you.

Dr. Michael Kentris (01:08:59):
I mean I can't just print out the epic
AVS after visit summaries andjust give that to the patient
and walk out of the room.

Dr. Galina Gheihman (01:09:06):
Well, my favorite quote is the biggest
misconception aboutcommunication is that it
happened.

Dr. Michael Kentris (01:09:12):
Ooh, that's , that's cutting.

Dr. Galina Gheihman (01:09:16):
When you asked me about like I know you
asked me like, is it my lecturesof a communication?
I was like, yeah, I mean youcan print it out, but that
doesn't mean anything.

Dr. Michael Kentris (01:09:25):
Right, it's one of those things.

Dr. Galina Gheihman (01:09:27):
Doesn't mean the cutie.

Dr. Michael Kentris (01:09:27):
Right, it's like I sent this email or I
recorded this lecture, but didanyone listen to it?

Dr. Galina Gheihman (01:09:33):
You know, it is one of those things where
it's like if no one's listening,if no one's paying attention,
it never happened is not so muchlike giving the lecture,
because then, like you're right,you have no idea, but like,

(01:09:53):
maybe a few days later thestudent is like using what you
taught them.

Dr. Michael Kentris (01:09:56):
You're like , yeah, like that is satisfying.
Yes.

Dr. Galina Gheihman (01:10:00):
I remember there was yeah, I was, I was on
service with some medicalstudents and then later that
month I was running thesimulation session and I was
obviously observing.
I was kind of like a purchase,uh, compassion, you know, uh
participating in the simulationand the student was like, well,
like you know, the this onsetwas acute and there's a focal

(01:10:22):
finding of the, you know, rightside ataxia so we have to
consider stroke and I was justlike beautiful, just beautiful,
it wasn't just you know, it wasuh, just like his reasoning was
very much like what we hadtalked about, the whole rotation
.
It was just nice to see thateducation in action ways of

(01:10:55):
educating, needs for education,needs for educators.

Dr. Michael Kentris (01:10:56):
So I want to say thank you again to Dr
Galina Gheihman.
Thank you so much for coming ontoday.
If people want to find youonline, if they want to check
out your work, where should theylook?

Dr. Galina Gheihman (01:11:02):
Good question.
I think the best is probably toemail me.
I don't have an online presenceMaybe that will change after
this, but I'm happy to includemy email in the show notes and
you can also catch me, hopefully, at the resurgence of the
education room at futureconferences.
And just want to thank youagain for taking the time to

(01:11:24):
really, you know, have us, Iguess, kind of put forward a
call for educators and educationand the exciting opportunities
that neurology education isgoing to allow us in the future.

Dr. Michael Kentris (01:11:37):
I'm very excited about it as well, and if
you'll want to find moreneurotransmitters content, you
can find me on Twitter slash Xat Dr Kentris or at neuro
underscore podcast, and you canalso find us more of our content
on the neurotransmitterscom atour website.
Thank you again.
I really appreciate you takingthe time.

Dr. Galina Gheihman (01:11:59):
Thank you.