367To maximize engagement, physicians should feel that they are in control of the
learning process and not have information simply tossed at them. Leadership content
needs to be structured in an integrated learning sequence. Physicians will learn
better if they can get direct feedback in an intuitive learning environment. The
sessions should allow learners to make direct connections with what they already
know and identify the gaps in what they don’t know. The faculty can guide them to
obtain the knowledge they want to acquire.
I have used a wide range of pedagogical tools, such as lecturing, leading a dis-
cussion, case studies, simulations, and role-playing. Lecturing to smart, creative
people does not promote the active learning. People begin to feel isolated unless
steps are taken to reduce the distance between the “talking head” facilitator and the
physicians. It is important that a sense of the learning community is created by per-
sonalizing lectures, encouraging participation by asking many open-ended ques-
tions, and structuring “icebreaker” sessions for people to get to know each other
informally before the formal sessions begin.
Adults learn best when they are participating and actively involved in a face-to-
face process and when there is group work involved. Formal learning groups should
be established at the beginning of a program and used even in sessions with a lecture
format. There are many alternatives to lecturing. Four examples of active learning
will be discussed: (1) case method, (2) role-playing, (3) simulations, and (4) multi-
rater feedback coaching.
The Case Method
I suggest using the case method and flipped classroom approach for physician pro-
grams. In the flipped classroom, the physicians read a health care case or view a
short video case before the session. In-class time is devoted to an introduction of
concepts and tools. Group work and plenary discussions are used to discuss the
case, and the facilitator avoids lecturing but instead poses questions and probes.^39
The case method shifts the focus of instruction from the instructor to the physi-
cian. A good case brings reality into the classroom by telling a story that provokes
discussion. Physicians read the case in advance and try to apply analytic concepts
and tools. It encourages participants to take a position on a tough issue, challenging
problem, or an intriguing opportunity. It acknowledges the physician’s voice as cen-
tral to the learning experience. Thus, physicians are given more freedom to choose
what they will learn, how they will learn, and how they will assess their own learn-
ing. In this approach, the faculty takes on the role of facilitator.
(^39) In an attempt to get class members to become full partners in the learning process, I encourage
the formation of study groups and group work, where students not only present their ideas to fel-
low students and work collaboratively, but also experience the growing importance of collective
intelligence.
20 Teaching Surgeons How to Lead