One of the main disadvantages of the teaching-hospital model is the potential for misinterpretation and misanthropy. Residents who view — accurately or inaccurately — their attending doctors as unduly mean will be less likely to view them as credible or listen to their instruction. This is precisely the kind of situation that Justin Lombardo, Northwestern Memorial Hospital’s chief learning executive, cautions against.
Lombardo acknowledges that the training communication model used in teaching hospitals can be severe at times and thus might not always transfer well to the corporate world.
“You want to make criticism in a constructive way,” he said. “If you close off the channel of communication and receptivity in the way you’ve communicated feedback, then your feedback isn’t going to be particularly useful, no matter how much you give them.”
This style of communication stems from the learning model used in medicine that extends back several centuries, he explained.
“If you look at the traditional model around teaching hospitals, it’s pretty much driven by an ancient apprentice model. You see it, you do it, then you teach it. But one of the things that isn’t covered in that is how you give feedback that’s constructive, helpful and buildable.”
In this respect, teaching hospitals can learn from corporate employee development functions, which Lombardo said are much more sensitive to the ways in which feedback is communicated.
“The notion of feedback as being immediate, constructive, including clear signals about what to do next and involving two-way dialogue has been mastered in many corporate environments, but I don’t think that’s universally held in hospitals.”
Of course, that’s not to say corporations can’t learn anything from teaching hospitals’ training techniques.
“The attention to detail in working with individuals in the teaching-hospital model is an excellent thing for corporations to look at, especially those that give lip service to managers who coach and develop their people,” Lombardo said. “In the medical community, it’s not lip service. It’s built in. It’s part of the DNA of the profession. There’s an expectation that, as you have been trained that way, you’ll train others that way.”
At Northwestern Memorial Hospital, Lombardo consciously has blended the most beneficial aspects of teaching hospitals and corporate learning to create a formidable strategy for developing talented medical professionals.
“We use the best of both systems,” he said. “We use the best of clinical and medical education by having one-on-one coaching and working closely with people, and we use the best of the corporate side by using instructional design principles and mediated instruction to provide baseline information. That merge has worked rather well, and in point of fact, two major medical centers have asked to import our model.”
He also predicted this trend will continue to grow.
“As the employee education function grows, learning about how to develop and train people is becoming more of a dialogue between the clinical and nonclinical side. In our case, we just worked very closely with physicians and nurse clinicians using corporate models to develop team training to teach communication patterns to improve the safety and quality of the interchange within operating rooms to reduce medical error.
“The system needs to be designed so that the act of developing the next generation is looked at as one of the energizing parts of the work,” he added. “We need to figure out what tools we need to give them so they see this as a pleasurable duty instead of a distasteful one.”