The Neurotransmitters: Clinical Neurology Education
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The Neurotransmitters: Clinical Neurology Education
Medical Education in Neurology with Dr. Galina Gheihman
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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Hello and welcome back to the Neurotransmitters. I am your host, dr Michael Kentris, and today I am, as always, excited to introduce our guest, who will be talking about medical education in neurology, a topic, obviously, if you've been listening to this podcast, that is very near and dear to my heart. So, to help us with that journey, today we have Dr Galina Gheihman, an instructor in neurology at Harvard Medical School and a neurologist at the Massachusetts General Hospital and Brigham and Women's Hospital in Boston, massachusetts. Galina, thank you so much for joining me today.
Dr. Galina Gheihman:Michael, thank you so much for having me. It's really an honor to be on the Neurotransmitter podcast and have a chance to talk with you. I'm really excited as well.
Dr. Michael Kentris:Awesome or podcast and have a chance to talk with you. I'm really excited as well, awesome. So I had the opportunity to meet you last fall or spring God, the seasons just run together at the American Academy of Neurology and it was very interesting because you were part of a group that were doing some very new and interesting things in neurology education. But before we get to that, why don't you give us a little bit of your background and what led you kind of into this somewhat niche area of neurology?
Dr. Galina Gheihman:Sure, thanks for asking. So I guess I've been interested in education for a while. I always you know, even back in middle school and high school was kind of like the one who would tutor other students or help others out and was always interested in making material more memorable. I studied like biology. I had a friend who was better at physics, so I taught him biology, he taught me physics, and so that kind of peer learning and peer support was something that I even thought about a long time before.
Dr. Galina Gheihman:When I got to medical school I also experienced a very innovative curriculum the case-based collaborative learning curriculum at Harvard Medical School at the time basically required free preparation, sort of like a flipped classroom model, and then in the classroom essentially you learn from your peers. You had support and facilitation by our instructors, but it was very engaged, active type of learning and I found it to be both exciting and also quite empowering as a learner because it was very engaged, active type of learning and I found it to be both exciting and also quite empowering as a learner because it was self-directed, it was team-based and it kind of was really clinically relevant. It wasn't sitting in lectures listening to how serotonin is formed, but it was really like what do we do with this patient who has MS and how do we treat them? And then we would sort of dive into the neurosciences as needed. So on the background of that context I felt like there was almost like a kind of the fourth you know wall was lifted in terms of education because the medical school was undergoing that change actively and they encouraged us as students to be involved. We called it sort of like the co production of education between faculty and students and so kind of like whether you wanted to be a medical educator or not, you were part of this process. It was being co-created and then those of us who had an interest in medical education, I think, kind of got swept into that process a little bit.
Dr. Galina Gheihman:More concretely, I also count myself lucky because I was interested in a project related to longitudinal clinical education, joined this project and then the senior mentor on that project is someone who's one of my closest mentors in medical education, dr David Hirsch, not in neurology and internal medicine, but one of the leaders in the world. Actually are related to longitudinal clinical experiences and research in that, and so by first year of medical school I was working and starting to do research in education, educational structures and evaluation and really, if anything, I feel like I found education before I found neurology and really, if anything, I feel like I found education before I found neurology. So that was really a thread that I pulled through into my residency and was very happy to see that neurologists were very receptive to the learning organ and to the concepts of education. So kind of high speed across a couple of years. But as a resident I continue to be involved in educational experiences and in particular I sort of distinguish it wasn't just teaching, but it was really this idea of trying to get into educational scholarship, so the creating new programs, evaluating those programs, you know, publishing on medical education and so thinking a little bit more higher levels than just the bedside teaching and the peer-to-peer teaching, but really thinking around like how do we deliver programs and how do we adapt them to different learners.
Dr. Galina Gheihman:This journey has led me to meet many mentors, network with others in the field, get involved with lots of experiences and most recently sort of culminated in the co-creation with a group of other organizers of the neurology education room which you referenced, and what we envisioned actually two years ago when we first came up with this idea was really a place where people like us, those interested in neurology education, could gather, meet and network, and so I can go into a little bit more if you want to hear more, but in terms of my background I think it's a lot of you know, braided together threads, one thread being a long term interest in teaching, a second thread being kind of, I think, the circumstantial experiences, honestly, of my medical school training and how transformational the curriculum change had been and really seeing the impact of that and trying to think about creating that for others.
Dr. Galina Gheihman:And I'd say the last thread is just like deep principles of education that matter to me, things like mentorship and person development and kind of like getting helping people reach their potential, I think is like ultimately my goal, and education seems like a really incredible means to do that. So that's what drives me forward.
Dr. Michael Kentris:Excellent.
Dr. Michael Kentris:Yeah, I know I personally you know my mom is a school teacher, so I definitely had that element of like education is good, you know, as a formative household experience, like through my childhood and, you know, teen years and, like you, I did some tutoring in college as well and it is one of those things where you kind of get, you know, a lot of fulfillment from it and maybe it's just me moving, you know, kind of more towards my middle career years.
Dr. Michael Kentris:But I am seeing this push or maybe I'm just becoming more aware of it where we're seeing some more rigorous, as you said, research about the actual theory of education in neurology specifically, and, I think, to an extent in medical education kind of at large.
Dr. Michael Kentris:And you know I'm certainly not a theorist, 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 the streets but it's it's very interesting, uh, because it seems like there is a big push towards a kind of quote unquote educating the educators and I'm kind of curious like what cause that that's? I wasn't able to attend all the sessions at the AAN's education program, but the ones I did, it definitely felt like there was a lot a very collaborative spirit there and people kind of comparing what they're doing at these different institutions across the country and, you know, both in the undergraduate and graduate medical education sphere, kind of looking at like what are people's experiences, what are the things that have been successful, both on a administrative as well as kind of a educational side of thing.
Dr. Galina Gheihman:Yeah, you make a great observation and I think that what we're experiencing is kind of the natural evolution of a field to higher quality, like our ultimate goal is higher quality learning, because that will lead to higher quality care. And so the fact is that, like as learning science evolves, like as we learn more about how we 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 Dr Roy Stroud who says, like you know, learning is an evidence based science, like, just like medicine, and we, while we accept a lot of kind of you know time, honored traditions, where we can, we use evidence, and I think that education is no different. It's like we can accept some time, honored traditions, some things that we're doing, but we also it sort of behooves us, as you know, experts in teaching to also use evidence where we can. The other analogy I would make is I feel like it's the Olympics now, and you know how people always say like well, people's bodies haven't really changed in many years, but like the technology has changed, right, like they can wear extra swimsuits and the coaching has changed, and what's really different now is that the way the swim coach's coach is different, and that is the idea that we could help those who are in the teaching position to teach and coach better, and we 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 it neurology, but it's really true for all medical educators have a duty to teach. We teach our patients, we teach our trainees. I mean, the entire medical model is precedented on an apprenticeship model.
Dr. Galina Gheihman:So it's not like we're saying something novel, we're just saying can we take this model, use technology? Here's how it might be most useful, or how to structure objectives, or how to structure evaluations. And so, while I don't want it to be so structured that it maybe turns away people who don't have the experience, I think what we tried to create was just a place where you can begin that conversation, so like, if you just want to use the best evidence, like you can use someone else's cases, like you can kind of come and say, oh great, I also want to do simulation. Well, you don't have to reinvent the wheel. You know we could have a collaborative across the US, for example, or or internationally. That's like here's a, here's a database 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, prior to us recording you had said you know I had a complex case. I called a specialist. I'm envisioning that we could have education specialists. So maybe you're interested in teaching this topic and you call, you know myself or a colleague. Okay, I really want to improve our EEG curriculum. Well, here's a set module. Here's like a set module. I've studied it has these outcomes. It's for this type of learner. You can use it or you can adapt it to your learner and again study it and see if it stays valid and stays rigorous. So that's the idea is, I think, kind of lifting the quality of you know all boats and focusing not so much on the end learner but actually a step upstream of that of how do we coach the coaches, educate the educators at least where we have evidence and support them in kind of moving the higher quality of education forward within our field.
Dr. Galina Gheihman:I'll say one more point, which is that you know a lot of the audience matters and you mentioned undergrad versus graduate, medical education versus other learners. They're going to need different approaches. The undergraduate learner there may be a little bit more integration with basic neurosciences. There may be integration across disciplines the resident fellow. They're going to want detailed clinical information as well as thinking around clinical reasoning, management, follow-up when we teach other learners. For example, a growing population within neurology is advanced practice providers who are entering our field. It's a different audience. They have a different training background than residents, for example, even if they may be performing similar duties. And so even just the little questions of who is my learner, what are my objectives and how will I know if we've been successful in that like that framework, that framework of an educational mindset, is something that we want to empower people to have and think about as they design their teaching or their training, whatever that looks like.
Dr. Michael Kentris:Yeah, and that's. You know that, anecdotally, that experience is kind of what has guided me a little bit as I fumble through the dark. Yeah, I was at a small teaching program for neurology.
Dr. Galina Gheihman:Come see the light. No need to fumble in the dark.
Dr. Michael Kentris:Yeah, so I was an instructor at a neurology residency at Wright State University for a few years and there I was mostly doing like neurophysiology instruction, like EEGs primarily and kind of some general neurology stuff. But then we moved and so I'm at a community teaching hospital and here we have more internal medicine, family medicine, emergency general surgery etc. So my learners have changed significantly. I'm not teaching these neurologist-specific skills anymore. So I had to think like what do I think it's important for an internist to know as they go into practice? Or a family medicine doctor, and can I, with the limited time, with all the other things they have to learn, how can I get their attention right? Because obviously those of us who are in the know know about neurophobia and these kind of antipathy towards neurology as a practice. Like I don't want to know about that, it's confusing, get out of here.
Dr. Michael Kentris:And so how can I make it interesting and approachable and make it so that these people are comfortable with managing some of these common complaints, like, for instance, the the Alzheimer's conference is going on this week as well and there was a big announcement in JAMA about this new biomarker for diagnosing Alzheimer's disease. What kind of can of worms is that going to do, right? Is this going to be like? Is Alzheimer's managed by primary care? Now, right, big questions, big shifts happening, and it's just one of these continuing evolutions of what can we? Because we all know there aren't enough neurologists. So how can I educate these people, my colleagues, my future colleagues, so that they're able to handle some of these more hopefully straightforward cases like headaches or TIAs or things like that, where maybe they don't have a neurologist on staff? And it's one of those things where I've been kind of, you know, for the last three years, just been iterating on this and trying to find something that works. And you know, some successes, some failures, and it's a constant process, right?
Dr. Galina Gheihman:I mean, the work you're doing is so commendable and so important because there's no way I think there's data on, like, the shortfall of neurologists that are anticipated in the coming years and we are going to have to share the burden and the load for patients with neurological symptoms and complaints. I wanted to point out one aspect, which is you know you shared that your task has been to iterate your curriculum we can call it a curriculum for your audience, and so my interest is sort of like one step removed. It's kind of like, how do I help the Michael Kentresses of the world like out there, like what is it that would help you to be more, you know, structured in your approach, or to be more effective in your approach, for example, 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 to do similar things in their communities.
Dr. Galina Gheihman:And maybe your EEG module, which I guess probably is not less relevant for this audience, but let's say your stroke module, would be of great use to like some other neurologist in a community who has we're already doing and the lens being education or teaching, but it's also can be quite clinical and can be quite useful, and the idea here is just to augment those efforts, like having you as the like as you sit as the educator, like matching you to the others sitting at your level of the as the educator and having you guys be the network that then has spokes and and kind of um from there yeah, and I've I've seen some things being written about this maybe not in journals, but you know, online and kind of from personal experiences where there is so much good medical education material out there but it's so fragmented across institutions or different platforms or things like that.
Dr. Michael Kentris:I know there are some hearty souls out there who have been undertaking that. I apologize, I think it was Aaron Zolikovic. I might be mispronouncing his name, but I know he's been collecting a lot of neurology education resources recently and they're making some pretty impressive progress there. And I think it's one of those things where, like you were saying earlier, these cross-institutional collaborations can be very helpful. And we see, historically in the neurology sphere, the epilepsy teaching course, and then there's the movement disorders teaching course, which has a bunch of experts from across the country doing these virtual lectures online cross-institutional collaboration for a lot of these more niche topics so that they're able to reach these residents who might not have exposure to certain things.
Dr. Michael Kentris:I know, certainly five, seven years ago when I was in training it's getting longer, but it's things that weren't available. I know that sometimes I would make a trip down to Cincinnati, which was like an hour drive when I got down there a handful of times during residency I'd be able to listen to their movement disorders panel talk about all these bizarre cases, but the residents who were there were able to go every month. So it's one of those things where maybe you don't have these things available at your institution, whether that is for neurologists specifically, or you know there's a lot of family medicine programs or internal medicine programs out there that maybe have one staff neurologist you know at the hospital and you know, as you're intimating, perhaps not directly some people are more invested in education and might have better or lesser skills for education depending on their particular enjoyment of it. So we probably have hundreds to thousands of physicians going into primary care things like that who may have very minimal neurology background.
Dr. Galina Gheihman:Yeah, so a few comments. With regard to teaching skill certainly it varies, but I believe it's teachable. So so I believe it's.
Dr. Galina Gheihman:You know, it can improve with practice and it can improve with coaching and, you know, even someone has a lecture. Let's say, okay, let's sit down and have a conversation about how to make this lecture more interactive. How to, you know, use principle like even simple tweaks and changes, start with a case or start with the student's own experience, you know, get them invested and then go into, like your 40 minutes of lecture or change the whole idea. You know you have 40 minutes, but no one said it had to be a lecture. So, just trying to get people to be a little more creative in that within educational structures and then with with how they deliver content, I will. I agree with you. I think that the explosion of online resources and sort of democratization of access to neurology and neurology education really did change with COVID. It was sort of the, you know, golden age of like the Twitter, med Twitter and like the neuro Twitter, and there's a lot of folks like Casey Altman comes to mind and Aaron Berkowitz were, you know, were superb kind of leaders on the tutorial front who've actually done research, looking at like the impact of those and the impact on their careers and the impact on connecting part of the resident and fellow section of the neurology journal, and that's a section that has an editorial board made primarily of residents as well as some fellows. We have a three-year term, so you have some continuity and we work with the editors to peer review cases and do help with the publications. But what's the unique slant of that section? Is that really the purpose of its education and teaching? And so when you submit a case report, it's not novelty that matters, but like what's the teaching point? And so that's been a really great immersive environment to be in.
Dr. Galina Gheihman:But it's been surprising to me, like how few people know about us as a resource.
Dr. Galina Gheihman:You know, medical students don't like go to the RFS, residents don't necessarily go to the RFS, and so I think one of the big challenges we have in education is one, the collection of resources, which Aaron is working on he's one of our editorial board members actually as well but two kind of like, almost I would say, the curation for a learner of these experiences, like I can imagine.
Dr. Galina Gheihman:You know, I totally understand that I'm sitting like within the richness of the Mass General Breakup System. You know, you know I totally understand that I'm sitting like within the richness of the mass general breakup system. You know we have, like you said movement rounds and epilepsy there's too many rounds to go to versus someone else who doesn't have that access to them. Like that, you know RFS case of some rare disease might be some beacon. That's like, hey, like I read about this, I know about this, I'm interested and I think having that, that like humility, that perspective, is very helpful and I think that that's happens when you gather and you, when you get to talk to others and being part of the RFS, we have global members who are just like no, these cases are like that. This is like why I went into neurology.
Dr. Galina Gheihman:Like we don't even have a neurologist in my country, like you know my city or my block um and it's it's exciting to think about how we can one spread what we're, what we have here, and like spread that wealth. But but also, how do we kind of bring the wealth of those diverse experiences like here?
Dr. Michael Kentris:yeah, and I've been seeing more like on, like on the neurology blog section and things like that, of of people writing about those experiences, which are always very eyeopening. Um, like you said, people from uh countries in Africa or the subcontinent or things like that, and you know just my own conversations with people from those areas or even South America and they're they're really doing some impressive work with significantly less resources than what we have in most of the parts of the US, and it's, yeah, it's one of those things where we're seeing these people making these kind of Herculean efforts to both educate themselves as well as their peers, and it's very impressive in a lot of ways.
Dr. Galina Gheihman:If you think about the impact one can have and it's very impressive in a lot of ways. If you think about the impact one can have, arguably you could have more impact as an educator, like if you could deliver an effective intervention I'll say intervention because I don't know that it's a Zoom lecture but even a Zoom lecture would help to a group of clinicians in a different country, like you could potentially have, augment the care that they're able to provide to their patients. If you know, when we think about volunteer and service, like I think it's very appealing to go and like have your hands on the patients and talk and and maybe it's a combination that there's. You know you build a relationship through annual visits and then you've got a lecture series as well. But thinking around, like tenfold, hundredfold, thousandfold, like how are you going to have an impact? It's really in educating that next generation coming behind you and coming up and those around you. That's the only way we're able to scale high quality neurological care. So I kind of feel like maybe I'm a neuro advocate or a neuro evangelist, as someone once called me, which I wasn't sure if I was flattered or complimented but this idea is that you know, education can solve so many of the big problems we face in neurology. It can help with access. It can help with higher quality care. It can help with our training. It can because education is a tool you can. You can move it to where you're. What your target is right. 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 and safety, okay, great, you've identified a morbidity case. How are you going to change things? You're going to educate people, right? So it's kind of like always going to be part and parcel to any iterative improvement we want to make.
Dr. Galina Gheihman:And my thought is kind of taking that educational mindset, thinking around what's my audience, what are the objectives? What will be the design of the methods of teaching to get to those objectives? And then how will I actually know that I've been successful? I think there's a lot of parallels between quality improvement and education, in the sense that you have an aim, you have an objective, you have some kind of ideally measured getting there. You can improve iteratively. And so I didn't mention this in my brief bio, but I have a little bit of a background in QI and I think that I blend those perspectives when I think much more around an educational stance or an educational mindset, like kind of like as you approach a problem. You know you don't have to have all the full rigor of like every single thing I do has to be, you know, a completely complete, like art, like randomized study with, like this, many controls and a perfect, perfect data plan. But can you at least invoke those questions as you begin a new innovation and think a little around like how will I know it's working? What feedback will I get? How, how will I interact with my learners? And those are some of the principles that I like to.
Dr. Galina Gheihman:I would want people to take away that it's all or nothing, it's, you know, completely random teaching off the side of like your desk versus like it's a completely rigorous thing, but that there's this big gray area in between. And if we can even shift a little bit towards some more scholarship, that means that one as a teacher could be a little bit more effective. Like, for example, say, you're using a known validated simulation case. So you've decided I'm gonna simulate. You know, I'm gonna give my learners an opportunity to practice stroke care. Well, you can use a validated case. So there you go. You've like what one step up the ladder, you want to go a step higher. Maybe you'll also survey your residents and add to the literature, and so if all of us just have a little bit like one step up from where we are now, we're actually contributing in parallel to the literature, as we're contributing to the learning I would say is sort of like clinical research.
Dr. Galina Gheihman:There's a lot of clinical researchers, especially in rare diseases. I've seen, I saw a talk recently and the presenter had a big slide and he was like every patient with X condition should be in a clinical trial and his point was that we're losing the opportunity to gather data. Of course you have to consult the patient, all that, but his point being that you know every interaction and in his case, between that clinical drug and the patient was informing. This area that's in need of greater research and I think education is the same is that we have an opportunity to make sure that every learner is part in is in some way helping us contribute to accelerating overall our field of neurology education.
Dr. Michael Kentris:Yeah, that's a lot to take in. So one of the things I sometimes and this is probably more of like maybe an epistemology type question is because how do we measure a success of our intervention? I know some of the studies and things that we look at right, we look at maybe pre and post test performance or, like you said, surveys that are often looking at things like confidence of the learner in managing X condition, things like that and we don't necessarily know how well that translates to actual patient care. At least I'm not aware of anything that shows a direct correlation. But what are your thoughts about that in terms of the limitations, like you said, of our measurement of improvement?
Dr. Galina Gheihman:Yeah, that's a great question. It's a real sticky point for education, education, research. There's a concept, um called the kirkpatrick levels of outcomes, um you may or may not be familiar with, where there's a, a scheme of kind of levels, one through four, and each are considered of higher impact. Level one is that like reaction to the, to the intervention, like oh, oh, were they satisfied? Did they like it? Like it was well-organized, I like that it was at 3 pm on a Tuesday and not in the evening.
Dr. Galina Gheihman:The next level is kind of knowledge, like are they able to apply the knowledge? So, for example, you might have a post-test. Level three is behavior. So okay, they did the post-test and then when you saw them in clinic, they did in fact order, you know, nortriptyline for migraines, as opposed to like Tylenol which they used to order. And then number four is outcome. That's the highest level outcome of the patient. So like, after this intervention, a year later, you know all the migraine patients had the right diagnosis in their note and they were all on a preventative medication, if that was indicated. So I think what we have not had in knowledge, education as well, in throughout the past is sort of this ability to push the outcomes, as they say, push up the level of kirkpatrick's um evaluation outcomes. I am optimistic because I think, like this whole ai chat gpt like scrubbing the epic, or I sorry, epic is our um ehr.
Dr. Galina Gheihman:So like scrubbing the ehr yeah may create an opportunity to marry, like clinical outcomes and educational outcomes in a way that we haven't seen before.
Dr. Galina Gheihman:So one idea is this that you know, could we create an intervention and then kind of use like data from the, from the medical record, as evidence that a learner is implementing what they're learning? Like how are their and I don't know that notes are really the best measure, but like are their differential changing is the problem was changing? Is the time to a preventative migraine medication changing? Like is, um, the number of neurology consults going down, which may or may not be a measure, a good measure, you know it's, it's got pros and cons, but in the sense of, or or maybe are those consult questions of higher quality as rated by, say, a subjective measure, but nonetheless rated by two to three neurologists, is like yes, this is a clear question as opposed to no. So I think every measure and every 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 should push ourselves to try to get up that hierarchy and I think leading into new technologies may help us do that.
Dr. Michael Kentris:No, I think that's a great great thought and certainly I know there's a lot of effort being made to integrate AI into a lot of different electronic records and it'll certainly be a brave new world once that happens.
Dr. Galina Gheihman:What's really exciting is actually in the neurology education room this year, one of the first sessions, one of the sessions we had One of the sessions we had because one of the drives behind this education room was was that there were, I think, five participants 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, dr Rachel, uh got let's uh Smith, I think, get her name right. Um, and she pitched.
Dr. Galina Gheihman:Essentially they're doing like a neuro, she's a pediatric neurologist, so they're focusing on pediatric neuro and they're doing a like clinical informatics, informed educational intervention, where they're basically like looking at what residents are seeing in clinic and what they're seeing on the wards and like using that, like documented data, to sort of create a tailored curriculum plan. Like hey, you saw these things last week, like here's, what reading points? Or like you haven't seen these things, so here's, I'm going to feed you more training or more questions, training or more questions. And, I think, a step two they have a plan where they will essentially like have a kind of scorecard of what residents are seeing and then like book clinic patients based on like where they're lacking, because they have a way to kind of essentially use ai to review the record, create a educational scorecard and and then adapt and tailor the teaching so it's like precision-informed education. I'm probably getting the details wrong. We'll have to ask Rachel to clarify, but she presented this and there were so many people jumping on board, mostly adult neurologists, being like, when is this coming to adult neuro?
Dr. Galina Gheihman:And the decision I think was made to start first in pediatrics and then expand. But what was really cool to see was one the huge appetite for this, like program directors being like sign me up right. Like, and this opportunity that she could augment what she's doing by doing it at multiple institutions, proving from the get go it's a multi institutional effort, it's feasible, implementable from the get-go. It's a multi-institutional effort, it's feasible, implementable, adaptable. She has larger N numbers to get at, the outcome of this being, you know, a valid measure, and she was able to garner more expertise. So, for example, one person pointed out that hey, well, what about the faculty who are going to have to meet with these residents and review these report cards? Like, what is faculty development going to look like for this? Someone else was like you should really do some you know qualitative research, like with these residents, and she's like, oh, that's not a skill set, maybe she has, but or actually she does have qualitative research, but like kind of gathering people who were going to like fit into a little project.
Dr. Galina Gheihman:And I think for me it was very exciting to see what I think are the sparks of what it must have felt like 100 years ago when clinical trials were first starting and people were thinking about platform trials and we had site PIs. And I remember Dr Galeta Stephen Galeta, who was organizing, is standing up and introducing this short tag and I just felt like I was like a new era, starting an education. It's like we're going to have like a site PI, we're going to have like site coordinators, we're going to have cross institutional work, we're going to be able to gather, you know, data in a different way and I think it's all the early stages, but I'm really hoping that. You know, looking back in 50 years, um, some of us would say like this was. We were at the beginning of it.
Dr. Michael Kentris:Yeah, that's. Yeah, it really sparked some thoughts because, like you said earlier, right, medicine traditionally it's, it's an apprenticeship model, and so it's one of those things where you're in residency training for so many years, fellowship training for so many years. If you decide to go that path and you become most intimately familiar with those things that you see and manage and it is it is really one of those things where, if you are able to find those gaps, like oh, I haven't seen you know X, y, z, rare diseases, it's like well, you need to spend time with the geneticist or the movement specialist or whomever, and we're going to slot you an extra week into your training schedule to supplement that shortcoming so that you get these skills. And I think that that is just fascinating to be able to do that with that kind of precision.
Dr. Michael Kentris:Potentially and it really is interesting because I know, and probably a lot of people listening it's like you hear about oh, we've got this strange case of such and such over on the neurology unit and maybe you stop by with the rounding team, even if you're not on service that day, just to see the case. So you see what's going on, you kind of get familiar with it a little bit, even if you're not the one taking care of it. But you know time is limited and sometimes you can get there, sometimes you can't. Not everyone is that motivated, uh, so sometimes there does have to be a little bit of a force feeding involved, but uh, but yeah, it's very fascinating If that, if that's able to bear that kind of fruit in the education experience, I think it'll, like you said, really revolutionize things.
Dr. Galina Gheihman:I think time will tell. Yeah, I think you're. I think you're right that we'll see what's effective, and what's effective will probably stick. I think. I think what you're saying about the different goals is super important to. Uh, you know, there's like a reason. I think we have specialization and it probably is like that higher order, refined diagnostic approach.
Dr. Galina Gheihman:But let's say, like you and I are both general neurologists, there's, you know, a certain skill set to saying which specialty does this go to? Like, you know, is this movement, is this or is this a neuromuscular problem? Like if a patient says I'm weak in the leg, well, is it, you know? Is it stiff? Or is it, like you know, what's the issue here? So, or is it just like sensory attacks yeah, I don't know? Like it's interesting for us. And so, thinking a little bit around, like kind of what is the knowledge point that you're trying to transfer and being adaptable in that and not just like here's my set thing that I say, but like if I'm talking to um, you know, I'm talking to neurolog like the approach to weakness talk is going to be very different than if you're talking to, as you said, say, much more transferable skills is important. So what I mean by that is, for example, in neurology, our exam matters a lot and how you perform does matter. But even if you don't know the specific terms like being descriptive is something that I would 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 know the terms, like it's actually more useful. I often find when I get transfer calls it's like oh, there's a korea. You're like what does it look like? And they're like oh, you mean it's more like a tick, or it's more like a tremor, or like it's more it's like I have no idea.
Dr. Galina Gheihman:So, um, we have a series that we lovingly call Movement After Dark. For our residents it's an elective, like dinner series with a video submitted by residents, pre-reviewed by the fellow and attending for some teaching points. But everyone goes around the room and practices describing the phenomenology and that's a very clear objective of the series. It's not like, oh, got it. Like that's, you know Huntington's career. It's more like this is a patient. 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? Like, how frequent, what does it happen?
Dr. Galina Gheihman:And I think that that kind of skillset of like you know not jumping to the answer, you know not jumping to the answer but learning frameworks of an approach is, I think, what is most useful to the generalizable learner. Is the same as if you you don't have an intern at a business, like yes, your business might sell cars, but if you can teach them like to manage a calendar, to manage their time, to like know about how to customer service, like that's something they can take to their next job and that's kind of an investment in the learner, outside of your specific need for their role. And so I think that we as educators, I would like to push us to kind of think a little bit around, not just like did I transmit to this knowledge? Like did I transmit like these four seizure medications, but more like did I transmit to this knowledge? Like did I transmit like these four seizure medications, but more like did I help develop the learner and give them a skill set that they can take away beyond the session that we talked about today.
Dr. Galina Gheihman:And often that depends on the kind of teacher you are. There's actually it's funny, there's actually teacher scales and like kind of quote unquote teacher personality tests you can take. I've done this in teacher training courses and people vary. There's one, one type that some people are very high in knowledge transmission, like that's their number one objective. Um, others are a little bit more around coaching. Some are about more professional, like kind of personal development of the learners, a relationship building. Uh, so I know that's my bias. I'm a little on the relationship building side of seeing my learners evolve and become kind of independent rather than just being a specific learning point. But I think even among us educators our collective impact can be across these domains, not just the knowledge translation, but the development of the learner into kind of their own. You know, lifelong learner is what I think we want to support.
Dr. Michael Kentris:Yes, yes, you have to kindle that curiosity and it's it's very funny. I remember when I was a fellow we would do a lot of like epilepsy video reviews and stuff like that, and it was, it was that exact same thing. I think epilepsy and movement have a lot of similarity in that particular respect, although they call it phenomenology and we call it semiology, but that's okay Two specialties divided by a common language. But it is one of those things where I was literally like everything you were just saying was like hitting me home. I was ranting to the internal medicine resident just this last week about like you have to train your mind to recognize what your eyes are seeing, right, because obviously I do a lot of inpatient work and probably the second most consult we get after like altered mental status and stroke I guess it'd be number three is quote unquote seizure-like activity and so really like getting into the nitty gritty. Or if you even have a video like literally this last month I was shouted from the nurse I was two beds down the hallway and it's like, oh, the patient's having a seizure and we come in and oh, the patient's having irregular jerking, side-to-side movements, pelvic thrusting, and it's like, oh, this does not look epileptic and we kind of kept an eye on her and stopped in two minutes and it was pretty clearly not an epileptic seizure and we didn't give her benzos or anything, so we were able to avoid those negative interventions. Um, but if she had called like sort of a rapid response team, you know, then the ICU team comes up and all this kind of stuff and maybe people who aren't as familiar and they don't recognize what is a non-epileptic versus an epileptic seizure, and right, it's this whole thing where you just want them to Like I give a lecture, probably once a year or so, and it's just a series of videos and the only question is is this an epileptic seizure or not? And then we go into the why for each video and and most of the time people are about 50-50. It's about six, seven videos.
Dr. Michael Kentris:And it is one of those things where it's like for us as a neurologist like figure out, like what, what's going on here? And when you see like all the papers out there, like the rates of intubation for non-epileptic events is going up over the last like 20, 30 years, things like that, and so you wonder like how can I change my interventions to be more effective, like, do I need to just 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 of learning. So you do wonder, like, am I talking enough? Like you were saying the information transfer, is the information just not getting through or is it the way, is it me, is it the way I'm communicating it? And again, right, I don't know that there's been necessarily studies looking at more large academic versus smaller community hospitals.
Dr. Michael Kentris:Is there a difference in recognition of some of these common neurologic entities?
Dr. Michael Kentris:And to your story earlier where you were getting calls for Korea, it's like if I get consulted for a tremor in the hospital, it's like if I get consulted for a tremor in the hospital, in my mind it's myoclonus and asterixis, until proven otherwise.
Dr. Michael Kentris:Um, because it's usually like toxic metabolic type stuff, right, but um, but it is one of those things where it's like I kind of think back to the, the princess bride, uh, you know. And ego montoya, it's like keep using that word. I don't think it means what you think it does, and kind of like the vocabulary becomes so important. And I know us as nerdologists. It definitely is one of those things where, like we're very, we can be very into the semantics of like well, technically, no, it's more like this thing, not that thing. But in broad strokes, words do matter to an extent because they have different treatments, they have different prognoses and so on and so forth. So it's hard, I think, to get across that nuance without feeding into, kind of going back that underlying distaste of neurology as a specialty to non-neurologists. But what, what are your perspectives on that whole word vomit I just issued forth?
Dr. Galina Gheihman:No, honestly, I have, like my mind just went in like five different directions that I'm trying to like rail in to either a single point or like, keep them all in mind. So much of what you said resonates so much. So let me just say a couple points, maybe not in perfect order, but the first is I love, I like, I love every teaching opportunity, like never miss a teaching opportunity. So one example is this idea of like we you know we do these like consults in isolation. We're like oh, patient has tremor, question where you go, you're like oh, asterixis. Oh, you walk out, you're at your run out. What about bringing the team in being like this is what asterixis look like. This is the qualities that make it not a tremor. Um, here's a little oh, the patient can't hold up their arm. Well, you can just look at the finger. Like you know, you can teach these little things.
Dr. Galina Gheihman:And sometimes people we know that people kind of learn by stories and cases and so that's a case that maybe will stick in their mind and maybe they'll still call you. But they'll be like I think it's asterixis, like can you come and check? And then the next one will be like oh, it's asterisk, is there anything else we should do? And then next time you won't even hear. But the idea is, like you know, I used to love the consult service because we got to talk to the teams and we were trying to kind of, yeah, bring them along to our vocabulary, not to be specific, but to kind of clarify, and I also try to avoid the jargon, because I don't think it's helpful. I think being descriptive is most helpful. The other point I'll make about the language, though, is that language begets action. So when a nurse is like this is seizure-like activity, like someone's already drawing up the benzo, and I think that that is good, but it's kind of like the flip side of the negative side of protocols, right, it's like it's the same thing as in the ED, when the ED calls a code stroke, and we're like rolling our eyes, we're like, really, because when you call a code stroke, there's a protocol, and we'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, if our threshold was too high, we'd miss them. You know, if we, if our threshold was too high, we'd miss them, and so that's, that's kind of like the flip it's, it comes with the territory and same with the seizure, like episodes, like our threshold has to be high, it has the benzo has to be drawn up maybe not given, but maybe drawn up.
Dr. Galina Gheihman:And I once had this experience where I was teaching internal medicine residents, cause they're like we really want help from neurology about managing seizures. And so I was like they're like we really want help from neurology about managing seizures. And so I was like they're like what do you do? Like like okay, here's the case. Like what is the first thing you do? And I was like well, I walk into the room and I say I'm the neurologist and then I take out my phone and put a timer for two minutes and then I press the video and then I stand at the foot of the bed.
Dr. Galina Gheihman:They were like very confused because they're like Wait, what do you mean? Like I mean the nurses, like you know, check. I mean okay, like I was exaggerating a little bit, but the idea being that that information is like very key, is like that is actually the key information that I need in that moment is like what does this look like? Of course, abcs, as long as that's the patient is, you know breathing and okay, vitals are okay, like then you stand back and and part of it is teaching them the natural history. And so I think that the more we can, like talk out loud and quote, unquote, like show out loud, like, even if you're with residents or with the best student, like bring them with you, say, like when you were saying I observed this event, the pelvic thrusting, like it's hard with a patient in the room, but let's say you had a student with you. You could say I noticed the patient's. You know her eyes are hers, his or her eyes are closed. This pelvic thrusting is, you know, asymmetric. Look how the arm moves in and out, like look at how you know this and that we're going to look at the postictal state. Is the patient going to wake up right away? Say, oh, what happened to me? Immediately, speaking immediately, not confused, so like just you know, pointing out to others what you're seeing. I think one teaches them but also inspires them because I, I mean, I think like neuro is pretty cool and neurologists who are effective at, as you said, connecting our eyes to our mind and then connecting that to our mouth and articulating that. Um, that's the skill set that we're practicing.
Dr. Galina Gheihman:As as to your reach with your videos. I love that idea, I love those videos. But the thing is like, the lesson is not like right or wrong, like oh, I got that one wrong, I got this one right. The lesson is like what in the video made you think this? What in the video made you think that? Are you familiar with visual thinking strategies?
Dr. Michael Kentris:I'm not vts.
Dr. Galina Gheihman:It's a type of um arts-based educational approach, where you use art to hone observation skills, and it's been applied in medicine. So the idea is you gather as a group of people about painting and you're like this you know, I have heard of this.
Dr. Galina Gheihman:Yeah, like this, and the arts educator the educator who's in charge, standing with the group looking at the painting, is really there to facilitate the articulation of what observations have led to a conclusion. So, for example, someone will say, oh, the woman on the right, and the arts educator will interrupt 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. Actually, I don't know, the figure with the longer hair is wearing blue, like, like, like you realize, kind of like you really break down, and it promotes observation, articulation and also team building and perspective taking, because once I've stared at this, you know, figure with longer hair. Someone else is like what do you mean? Figure? It's like I don't even see a human form, like I see just blotches of colors. And suddenly you're like whoa, like I thought what I saw was the truth as opposed to what we all together break down into like just the objectivity of it. So long story short. Out into like just the objectivity of it, so long story short.
Dr. Galina Gheihman:I feel like what you've been doing is like the VTS of seizure, simulogy, and so how do you? Yeah, so the concept is, how do you spread that? And you can go to the literature, maybe answer that you know you can say maybe it's online modules, maybe you record your lecture, you make it free, maybe it's simulation, like maybe what we really need is I think it's hard to simulate seizure symbiology, but like in terms of like stroke management, for example, like why don't we have routine simulation for oral emergency room providers? You know things like that like that's not a routine thing and if we're, I think we need to think strategically and about what will have most efficacy if we want to have the most reach.
Dr. Michael Kentris:Yeah, no, that's I mean. It makes sense, being more efficacious is better right.
Dr. Galina Gheihman:To me there's such a parallel with quality and safety in medicine, because when you learn about errors or lack of quality, it's just so shocking. It's like how can this be? You know, how can this be the case in our system? Like you, it's. No one would disagree with improving quality right right and I think it's similar in education is that, you know, no one would disagree with the improvement of education, because that would also lead to our ultimate outcome of improved patient care, improved experiences.
Dr. Michael Kentris:And so I, I do think, taking a little bit of um kind of a stance and saying like we, we can't just kind of rest on our laurels or say we're doing this, but we really have to do it and so that's an excellent point, right, right, I think you like, as you said, right, no one's going to say better quality is bad, and if we make the assumption that better education leads to better physicians and advanced practice providers and then better outcomes for patients, but if we look at how education is valued within the, the three-legged stool of medical training, right, where we have research and clinical care as the other two legs, uh, it's often, you know, given very short shrift, relatively speaking yeah, it's a lopsided stool.
Dr. Galina Gheihman: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 the same value, as you said, because I find a lot of the time it's kind of taken for granted. It's kind of like oh, of course we teach, and it's like, yeah, we teach, like of course, like we're gonna, you know, natural the fact that our residents don't know things when they're coming in and that they work and they learn and they read, and I probably shouldn't say this where I can be quoted. But we sometimes joke that our residents are superb despite our educational curriculum. Educational curriculum Not not not truly, but in the sense that we really took a hard look. For example, last year, I was one of our chief residents last year and, as part of that, had the opportunity to be part of redesigning just a little bit our educational curriculum and we sort of took a hard look at our goals for residents and like whether or not these were actually that are goals for residents and like whether or not these were actually intentionally implemented, like intentionally designed. Sure, they were probably happening. That residents got mentorship Sure, it was probably the case that they learned the physical exam, but it wasn't intentionally designed into the curriculum, and so we introduced a few even small tweaks.
Dr. Galina Gheihman:And this is where I think quality improvement can guide us right, like these kind of quote unquote educational PDSA cycles of saying, hey, listen, our residents don't actually get formal, formal meaning. Like you can point to where it happened teaching in the neuro exam and so we introduced a few kind of specialists high skill sessions where they had direct hands on teaching in neuromuscular and we did headache and occipital nerve blocks. We also did like ophthalmology of endoscopy, and then we also had, like our movement disorder rounds, and so those are an example where, like up until then, yes, you could certainly check the box, like I'm sure it's happening on the ward somewhere, but there was no intentional design around. When would this be? How would it be?
Dr. Galina Gheihman:Kind of, you know, quote unquote, not marketed, but kind of like, like, like shown the value because it's actually part of the formal didactics. And we had a few other sessions as well. Like our Wednesday lectures included topics among four categories wellness, leadership, medical teaching, like resident as teacher, and then sort of team management and professional identity. So we then use that structure and that kind of coveted space to invite lectures or invite group work sessions or workshops. And then the final thing we did was we realized that of course we were graduating amazing resident educators right.
Dr. Galina Gheihman:Like that just naturally happens. And we're like well, yes, we assume that happens, but there's no formal opportunity for residents to teach or no formal requirement. And so we created small group sessions where a third year teaches the first years and so every third year graduating can say yep. In fact I led a small group session, I gave a small group lecture. That's part and parcel. When we say we're graduating the type of well-rounded neurologist we want to graduate, well, we're giving them research training, we're giving them clinical training, but where's the educational piece? And that was kind of my bias and that's sort of the role myself and my co-education chief brought in last year?
Dr. Michael Kentris:excellent, yeah, that is something I know. When I'm mentoring medical students, a lot is they'll, you know, want to know, like, what kind of residency program am I looking at? And you know, at the one end we have places like mgh, where there is, you know, a multitude of subspecialists and resources and all that, and then on the other side they're, you know, smaller programs that have maybe two to four residents per year and maybe no fellowships at that institution, and so it's like, what do you envision for your career? Do you see yourself like one of my former residents Shout out to Dr Sarah Liston, if she ever listens to this, but she is a neurologist in Montana and she is the only neurologist in 100 miles and so she can call people up for advice, but if she needs them to see somebody, that's a haul.
Dr. Michael Kentris:So you, you really have to think about, like, where do I see myself in my career? Not just, you know, in my medical training, but, you know, am I, am I going to be like a clinician, researcher, or do I want to just take care of patients in a, a rural area or an underserved community or things like that? Because you know, different places may provide you with kind of a differently weighted skill set, and so you kind of have to think about that to an extent. But yeah, it is one of those things where we, you know, we all want to graduate, you know, well-rounded physicians, but it's, you know, it's definitely a different path there, depending on the environment.
Dr. Galina Gheihman:I agree with you that the environment can impact you, and I think what I would focus on a little bit is like role modeling and this idea that we just want people to know that this is an like, this is a path if you, if you, choose to follow it. What I would sort of say is, I think that teaching is a fundamental skill set that we should be teaching our residents and we should be teaching people as they come up through neurology training because you mentioned your former mentee, like I'm sure she's having to educate PCPs in her region about referrals or her patients and things like that and so for her to have education as a skill set, even at a basic level, being an effective clinical teacher in a busy clinical environment, that's like a one type of skill set. For those who gather a little bit more interest, you know, like the stone gathering a little bit more Moss is like we want them to know that there's places they can go, there's resources, like you can go to educator training programs for residents or whereas a faculty of the Macy Institute comes to mind, one that offers training for clinician educators. And then I think more broadly, I think those, those of us who are like committing a more major part of their career to that. That's where kind of that advocacy piece comes in around representation, equity, value of this as a career in balance with the other domains of a department, that we're committed not just to research and clinical education but to education, and I think that we're making some progress there, we're moving some ground.
Dr. Galina Gheihman:Um, I think, and for me it's sort of like you know, when you're at the forefront of something like this and you're pushing, it's helpful to think of, like those that are coming behind you. It's helpful to think that like I want others to know that you know a pursuing, if not, that they have to, but if this is of interest they don't have to turn down that interest. They can make a career out of it. I remember at the education room even that sort of role modeling was super, very inspiring for a lot of the junior trainees saying like oh, I thought the only way you could do education was like to be a program director and like that's great, but not everyone wants to do essentially administration, educational administration.
Dr. Galina Gheihman:Some want to maybe work more on curriculum innovation, for example, and sometimes those roles overlap and I remember one of the trainees was like we should have like a careers night, and I know you're talking about what's your mix of the three and I'm like zoning it on education, being like well within education, like well within education also, what's your mix like? Are you a PD and you do some research, or you you maybe serve on a national committee, or you're super interested in simulation and you do simulation across different domains, or maybe you work with the emergency room and you know, because you're not so focused on neurology, you're more focused on education. So even within that there's lots of roles and I think the more we can support that diversity, find that spark that motivates an individual and support them, I think the more creativity and good outcomes we're going to have.
Dr. Michael Kentris:No, I think that's absolutely right. It kind of goes back to what you said earlier about kind of educating the educators and that whole downstream cascade. So I think it is super important to to make sure, cause, you know, those graduates are going to go out there, they're going to teach more people and they'll their you know their students will teach more people, and so on and so forth down the line. And it becomes like one of these things where you have these like chains of people like oh, you know, so-and-so was trained by Dr X and they were an amazing physician and I learned all these tricks and things like that.
Dr. Michael Kentris:And it is right, we can't get away from that apprenticeship mold to an extent, just because it is such a relatively small community and you almost have this, to borrow something from the Christian community, this apostolic cessation of neurology training, and it's just, it's very fascinating sometimes when you see, like where I am, you know we've got Hans Luters up in Cleveland who's kind of like you know this legend in epilepsy, and so we run into his trainees and they have all these little you know kind of nuances that they pick up from him from the last you know so many decades, and it is one of those things where there's like almost schools of practice in neurology that you can trace back to certain like kind of founding physicians, and it's very fascinating, in a way, to kind of see that evolution, or these different schools of thoughts evolve over the decades kind of see that evolution, or these different schools of thought evolve over the decades.
Dr. Galina Gheihman:I'm very fortunate to have trained at Mass General Brigham when Dr Samuels was alive and he was one of my early mentors for so many of us.
Dr. Galina Gheihman:And recently when we were in the inpatient service, one of the residents was he's like I'm now calculating how early it is in the morning when someone first mentions likey used to and he's like yesterday was 801, uh, and like today it's like 7, 39, like like five minutes into our morning report and it was just kind of um, you know, there's it's bittersweet to have that memory, but it's so true that people pass on stories and pass on exam findings or like, oh, I always do this and x person you know taught me that, or whenever I'm like doing a really good neuromuscular exam, in my mind there's like the, the, the person who taught me that is like.
Dr. Galina Gheihman:It's like. It's like scrutinizing my you know whether I'm like isolating the joys well enough, um, and so there is a kind of heritage there and I think that that's a big part of you know, education as well is really the relationship building that is sort of sacred between a teacher and a learner, where I get the drive and the motivation to keep it going, cause it is fulfilling to see someone learn, and it's fulfilling to you know, see them teach you something back. Um, in fact, uh, and it's, it's really a full circle.
Dr. Michael Kentris:And I think I might've mentioned this before we started recording. You know, I was calling up one of my, one of my former residents, who she she's now an MS specialist and I was asking for her advice. So it is right it's come full circle. I'm reaching out to the people I helped educate and now they have skills that I don't or experiences that I don't, and they're able to help me learn how to take care of challenging patients and things like that as well. And it is right Now that I'm kind of moved into that stage of my career. It's a little surreal almost to see people, because I remember them as these junior residents and now they're out there, independent, practicing, making complex decisions, and it's like it's very satisfying and almost like I can't believe that you know, you, I had a hand in any part of this. So it's it is very satisfying as a kind of look back on those aspects of your career.
Dr. Galina Gheihman:I think, as an educator, like you, you've got it like you are a learner and you're a teacher too and you're kind of both and and.
Dr. Galina Gheihman:The more you're open to that, I think, the the better, the more effective you'll be, because, like, for example, um, I love the book, thanks for the feedback, and I think the first sentence in it is like everything is feedback and it's just this idea that, like you kind of choose which data to pull in and like if you're giving a lecture, you're giving a session like confused, quizzical looks like you know you may have to adjust or you may have to adapt to every learner and the idea is like you can't even you can't even guarantee that it will have the same land, the same way or have the same impact, and so constantly being open to change, to adapt, to adapt, to adapting, if you need to, to the feedback, I think those are important skill sets that you get as you think around, as you, as you think about becoming a teacher, and I think that those are also like we haven't really talked about patient education, but that's something we do every day in our clinic and that also has to you to be most effective.
Dr. Galina Gheihman:It's better if you don't have a boilerplate spiel, but you have something that's adapted to the individual in front of you.
Dr. Michael Kentris:I mean I can't just print out the epic AVS after visit summaries and just give that to the patient and walk out of the room.
Dr. Galina Gheihman:Well, my favorite quote is the biggest misconception about communication is that it happened.
Dr. Michael Kentris:Ooh, that's, that's cutting.
Dr. Galina Gheihman:When you asked me about like I know you asked me like, is it my lectures of a communication? I was like, yeah, I mean you can print it out, but that doesn't mean anything.
Dr. Michael Kentris:Right, it's one of those things.
Dr. Galina Gheihman:Doesn't mean the cutie.
Dr. Michael Kentris:Right, it's like I sent this email or I recorded this lecture, but did anyone listen to it?
Dr. Galina Gheihman: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 much like giving the lecture, because then, like you're right, you have no idea, but like, maybe a few days later the student is like using what you taught them.
Dr. Michael Kentris:You're like, yeah, like that is satisfying. Yes.
Dr. Galina Gheihman:I remember there was yeah, I was, I was on service with some medical students and then later that month I was running the simulation session and I was obviously observing. I was kind of like a purchase, uh, compassion, you know, uh participating in the simulation and the student was like, well, like you know, the this onset was acute and there's a focal finding of the, you know, right side ataxia so we have to consider stroke and I was just like beautiful, just beautiful, it wasn't just you know, it was uh, just like his reasoning was very much like what we had talked about, the whole rotation. It was just nice to see that education in action ways of educating, needs for education, needs for educators.
Dr. Michael Kentris:So I want to say thank you again to Dr Galina Gheihman. Thank you so much for coming on today. If people want to find you online, if they want to check out your work, where should they look?
Dr. Galina Gheihman:Good question. I think the best is probably to email me. I don't have an online presence Maybe that will change after this, but I'm happy to include my email in the show notes and you can also catch me, hopefully, at the resurgence of the education room at future conferences. And just want to thank you again for taking the time to really, you know, have us, I guess, kind of put forward a call for educators and education and the exciting opportunities that neurology education is going to allow us in the future.
Dr. Michael Kentris:I'm very excited about it as well, and if you'll want to find more neurotransmitters content, you can find me on Twitter slash X at Dr Kentris or at neuro underscore podcast, and you can also find us more of our content on the neurotransmitterscom at our website. Thank you again. I really appreciate you taking the time.
Dr. Galina Gheihman:Thank you.
