Episode 10: A Need for Excellence with Devin D. Mackay, MD

When life hands you an opportunity, you can try and make it excellent. That is the mantra that drives the work of Devin D. Mackay, MD, FAAN, founding director of the Neuro-Ophthalmology clinic at Indiana University School of Medicine, founder and director of the Neuro-Ophthalmology fellowship at IUSM and Statewide Assistant Neurology Clerkship Director at IUSM, the largest medical school in the country. On this month’s episode, we discuss how to build and sustain new educational programs, integrate the science of learning into curriculum design, and adapt teaching to different levels of learners, all while striving for excellence.

Neuropraxis: The Neurology Educator's Podcast is not recorded as an official podcast of any institution or organization. The views and opinions are those of the individual speakers themselves. Music from Pixabay. Cover art by Carolin Wollny. Editing by Valeria Roldan. New episodes drop first Monday of the month!

Ideas, suggestions, questions? Contact us at neuropraxispodcast@gmail.com. 

Transcript

SPEAKER_01 0:01

Hello and welcome to Neuropraxis, a podcast for clinician educators and trainees passionate about neurology education. I'm your host, Gelena Gekeman. I'm a neurologist and medical educator. On the Neuropraxis Podcast, we churn our attention to neurology education. We discuss the latest topics in education literature, meet the innovators shaping the future of neurology education, and hear about the career journeys of other educators in neurology. Whether you're building a career in medical education or looking for inspiration in your teaching, you're part of our community. So let's reflect and grow together as we blend the art and science of neurology education and put theory into praxis.

SPEAKER_00 0:59

I realize it's not just for me, it's for a better cause. We need more neuroophthalmologists, and any small role I can play in that is it is really a privilege and an honor.

SPEAKER_01 1:14

Today I'm joined by Devin Mackey, a neuroophthalmologist, a fellowship director, and an upcoming clerkship director at Indiana University Health. We talk about role modeling excellence, building and sustaining programs, the art of teaching to different learners all at different levels at the same time, and how some of the best ideas in education are in fact copied from someone else. He's the founding director of neuroophthalmology at Indiana University Health. After completing medical school at the University of Virginia, he completed neurology residency training at the Bringover Women's Hospital and Mass General Hospital at Harvard Medical School. He then completed a neuroophthalmology fellowship at Emory University in Atlanta and currently serves as the inaugural neuroophthalmology fellowship director and the assistant statewide neurology clerkship director at the IU School of Medicine. He's been doing this since 2016, and as of May 2026, later this year, we'll be stepping into the clerkship director role. Welcome, Devin.

SPEAKER_00 2:38

Thank you. Thank you very much. It's good to be here.

SPEAKER_01 2:40

So uh let's get started, Devin. And I'd love to hear uh I often start some of the podcasts, which is just what's something new that you learned recently?

SPEAKER_00 2:48

Wow, something new I learned recently. Um related to education or just related to anything at all? Anything at all? Okay, well, um, so I learned about some of the uh basis uh for not prescribing anti-platelet medications in addition to an anticoagulant. Um so this question I feel like has come up endlessly on service sometimes, and I just recently um uh became familiar with the study kind of behind the evidence of why we why that's not a good idea. We've always said, well, that's uh that's not a great idea, but I I'm not sure what the evidence is for that, and now I now I have something to say about that. So that's been one thing I learned recently.

SPEAKER_01 3:26

Well, I think that's a perfect example of lifelong learning because nowhere in your introduction did I say, you know, stroke neurologist. And so really this idea that if we're gonna be on service and continuing to provide clinical care in these settings with learners often in the hospital, and we're kind of roaching in and out. I always joke that my time on service is my annual CME. And I think you're illustrating that for us.

SPEAKER_00 3:48

Yes, that's one of the things I love about being on service, is I kind of I get stretched a little bit on the boundaries of my my knowledge. And um, in fact, I this the study I just mentioned was actually taught to me by one of the residents uh taught me about it. So I I love that we get to work with people that that teach us, it's not just me doing the teaching, a lot of it is me doing the learning.

SPEAKER_01 4:07

Absolutely. So welcome to the podcast, and there's a lot that I want to talk to you about, um, but some of our listeners may not be familiar about all the various things that you're involved in and that you've done. So I was wondering if you could maybe paint us like an overview of your career journey so far and some of the highlights, and then we'll dive into some more of these stages that I wanted to ask you questions about.

SPEAKER_00 4:29

Yeah, I've I've always had a lifelong interest in education, and I I knew from a very early age I wanted to be a physician. I think I was in third grade when I decided I wanted to be a physician, so that that part was said, and then later on I think I realized how much I loved education and maybe I would have continued or considered a career as a teacher if I hadn't gone into medicine. But um I remember being in medical school and had a chance to to uh serve on a curriculum committee, and that was one of my first kind of formal introductions into the world of uh education administration. And although the the meetings themselves weren't terribly exciting, I thought the the concept of of influencing someone's education uh was was really a profound thing that really seemed to call to me. So that was my first exposure, and then uh during residency I was privileged to to be with so many other uh wonderful clinicians and educators, and um education was really valued, and I think that kind of an environment allowed my interest to blossom further and really carried me forward. I I I sh you know I hate to think about what would have happened if I had gone someplace that didn't value education and that was kind of suppressed in me. I don't know that that part would have developed, so I was really grateful for that in my and my upbringing um medically speaking. Uh and then um I've been blessed to train with a number of different uh you know mass what I would consider master clinicians and master educators over time that have really influenced me. And then by the time I was kind of on my own as a as an attending physician, um I so I was there wasn't anyone doing neuroophthalmology at Indiana University uh when I started, and so I had the chance to pick up some educational um assignments, and so I there were some lectures that no one else was giving or that that were given by non-specialist for neuroophthalmology, for example, so I stepped into those. And then there were additional roles for uh in the first year of medical school where lectures were needed, and so anyways, it just one thing led to another and just eventually uh had a whole bunch of lectures I was in charge of giving, and then there were other educational programs. Uh ended up joining the neurology clerkship in 2016 as the assistant director and um have been able to shape some of the education across the state with regard to that, and then we added a fellowship for neuroophthalmology just a few years ago, and so um that's been a whole nother level of learning, and it's been interesting to try to teach different levels of learners and and see how to how to modify that for different uh for different audiences.

SPEAKER_01 6:51

Well, that was the perfect roadmap and preview for everything we're gonna talk about. We'll see if we get to it all, but you've just done so many things that are different, and I really wanted to delve into it a little bit more. I mean, one of the things that um stands out really is it seems like you've been kind of a builder uh throughout your career journey. Like come places where you're the only one doing something, and then being asked to either step into it or just or to see that gap. And there are definitely educators who find themselves like in a kind of among a rich bounty of other educators, and that's great because you learn from them, we work together, and maybe you're working on a little piece of something, but there are others who find themselves kind of alone um in a place where you're the only one. And so I was wondering if you could talk a little bit about that. What was that like for you? And and is that something you've chosen or like to do in your career? Like have you sought out these building opportunities or did they seek out you?

SPEAKER_00 7:47

Yeah, I do I do really love the building opportunities, and I think I I probably thrive more in that kind of an environment. So yeah, I I was interested in that aspect when I learned that uh you didn't really have someone, you know, when I was applying for for jobs, so so that was a a big plus about it. And um it's there's definitely challenges about it. It's it's hard to build something, you know, from from scratch in some ways, and it's um make a lot more mistakes than I probably would have if I had you know stronger guardrails in place or someone else was telling me what to do. But it's also I don't know, it's uh it's not quite as fulfilling that way. It's um you know, it's kind of like I don't know, it's like turning 18 and you know, you get to go out into the big world and do your own thing. You don't want mommy and daddy holding your hand your whole life. You know, you need to get out there and have experiences that that form you and that you make mistakes and that's that's okay. And it's just I don't know, it's it's a it's a richer experience when you get to kind of be the one directing that part of your uh of your life and your influence on others.

SPEAKER_01 8:44

That makes sense. It sounds like it takes a little bit of uh courage and independence, but and maybe some humility of those mistakes along the way. It's interesting that you had the opportunity to build different types of programming. There was the fellowship, there was a clerkship, um, and I'm curious that you know, in doing that, are are there elements of kind of training that you needed along the way? Like were there things that you felt would help you do that better, or are there elements of training that you incorporated to make those to do that building well?

SPEAKER_00 9:22

Yeah, there there was some formal training. I um I'm embarrassed to admit I didn't have a lot of formal training in in really anything education related earlier in my career, and and to to some degree that's okay. I mean, you really can get by on just having a passion for education in some ways and and doing your best at it and having an interest in uh getting better and uh and having an enthusiasm for it. There's something to be said for that, but there's also something to be said for being trained in the in the principles that make for good education, and that's something I've focused on a little bit probably later later in the game. Uh in fact, just recently I took a course um about it was called uh teaching um what's it called? Uh transforming healthcare education was the name of the course, and um that was through the Harvard School of Public Health, and really a wonderful course and went over a lot of the foundational principles for learning and for education and why things are effective that are effective. And I think that really helped uh shape a lot of the way I see the the infrastructure of our clerkship. For example, neurology, I see little aspects that aren't just because someone said that it should be that way, it's actually, oh no, there's evidence that says this is the way this is the way effective teaching is done. And it's been exciting to see how education has changed. If we look back 20 or 30 years ago and what education looked like then, it's really different now, and a lot of that has been informed by the uh evidence that we've uh accumulated that shows what good education looks like, and also the the the environment of our learners has changed too, like what what learners are doing and what they value, and you know the technology revolution has played a role in that, and there's just been so many dynamic aspects of it that has really made it an exciting time to be an educator.

SPEAKER_01 10:57

I think you're so right that we have to accept this change and be flexible to morph to it. I did want to, though, kind of track back a little bit to your own beginning, to your own origins, because at one point you were that student who now you're mentoring. But you mentioned something that stood out to me, which is that you felt you were in a place that was a place where your passion for education wasn't sort of suppressed or wasn't, you know, um taken away. And so I'm curious if you could speak a little bit more about what was it about that kind of early medical education and uh medical school and then residency environment that let you have that feeling.

SPEAKER_00 11:34

Yeah, so there were there were a couple of uh mentors that were just really um influential, I think. Um one was Sashink Prasad, who I know you know well. In fact, I think that's how we were introduced for the first time was was through him. But uh he was really a model educator in a lot of ways, and there was a um an effortlessness with which he made um things interesting and um really held a high standard uh for what he did. And it wasn't it wasn't driven by RVUs and and what his paycheck was, it's it was driven by um this I'm not sure how to describe it, like this this um I don't know, I'd call it maybe a need for excellence um and and to to share that with other people um and that that was that was fulfilling in itself. And I th I thought, yes, you're you're absolutely right, that is fulfilling. And I've and uh you know he really had the kind of career that I that I really wanted, an academic clinician who was great at what he did, love teaching, and really specialized in neuroophthalmology. And I am fortunately I've been able to you know do most of that, not not obviously to the degree of success that he's had, but um but to follow in that mold has been very fulfilling. Um so that was fun to see him. And then um there are people like like Marty Samuels, um, who uh you know really made a career on being a dynamic um master clinician. And you know, he wasn't doing bench research and doing these other things that seemed to be part of what would make someone successful in academics, and and he he did it in his own way, um, and and really a way that uh I think spoke to me too about like, wow, you can be a master clinician and that can be your thing, and you can be a wonderful leader of people and a great educator that way, and and he he did that. And there were you know many other examples of of, but it it seemed to be a uh a patchwork of of exciting mentors that demonstrated how excellent education is done that really helped me through residency and help helped me realize that hey, this is that this is something you can do.

SPEAKER_01 13:25

I'm so glad that you mentioned some of those names. Those are also kind of warm names uh in my memory, Marty Samuels, of course, and I was fortunate as well to uh kind of grow up under the um under Shishank Prasad's uh sort of when he was program director. And I was actually thinking that it's super cool to me that we both trained in the same residency program, though some years apart, but I think what you're talking a little bit about is like values and principles, right? Like that striving for excellence, but a particular type of excellence, excellence for patients and for trainees. And I'm curious as you look back, and I think you're starting to hint at it a little bit, but maybe if you could be more explicit about it, as how in what ways do you think your training has influenced kind of what you do now? And are you still in touch with some co-residents or former mentors? And and do you think they're still influencing what you do today?

SPEAKER_00 14:16

Yeah, yeah. So I still keep in touch with with a number of different um residency classmates. I feel like we we always see each other at the meetings. It feels like a big family reunion when I go to you know American Academy of Neurology or some of these other meetings and get to see people from back in the day. Um, same thing with you know mentors. Um I've had uh Tracy Cho came to give grand rounds here a number of years ago. Uh Shank Prasad's given grand rounds here a couple of times. So it's fun to catch up with them in moments like that. Um I see Tracy Milligan at the some of the meetings and some of these people that are really giants in the field, and um and it's been been fun to reconnect with them. And um uh Edison Miywaki has been another, um he's been a a great influence and a a great educator. So um yeah, they've they've really shown me the way. And I think you had another part to that question that I can't remember what it was now.

SPEAKER_01 15:01

I just in what ways you think that experience working with them or that earlier training is influencing what you do today.

SPEAKER_00 15:07

Oh, right. Yeah, so that's um it's it's really I think taught me to f to uh uh I guess focus on education and and leave leave the rest uh the rest of it is not so important. I I when I get together with some others that are not so education focused, sometimes that it's all talk about the the RVUs and how disgruntled we are with the system and the just all the things we have to complain about. Um I remember Marty Samuels talking about that and you know kind of sh shaming all of all of us as a profession. Like, why are we complaining about this? Like you are not you're not having trouble putting food on the table for your family, you're you're doing fine, you get to do an amazing job, you get to help people with it. Like, why why are we complaining about these things? And I I I I love that. I love to just try to not worry about those other things and try to you get lost in a moment where you're educating someone or you're you know experiencing some really awesome, you know, I don't know, exam finding or uh some really cool case together, you can kind of get lost in that and and that and that's uh it's fun, it's part of what makes me excited to come to work in the morning and um and I think to try to convey that to students as well and uh try to get away from cynicism and some of these other things that we see creeping into to medicine. I think uh I think education is a really fun way to get away from cynicism.

SPEAKER_01 16:25

I think education is the special intersection, right? It's like kind of at the heart of like you, the patient, and and the student, I think when it's at its best, because it's in the service of the patient care and it's in the service of the development of the learner. And um it's so funny though, because I hear you talking about your focus on education, and then I'm like, but you've had quite a few education administration roles, and those can get a little bit messy too with the paperwork. Um, so I was actually wondering if we could dive into that because um, you know, you've started a couple programs, but maybe we would start with the neuroophthalmology fellowship first, and that was after you transitioned over to Indiana. Um, and so I'm curious what that was like. Uh, what was it like to start a new fellowship in a place that didn't have one? Did you have to make a case for it or was it open and and what was that experience like?

SPEAKER_00 17:16

Yeah, the uh the by far the hardest part was getting funding. That was by far the hardest part. Um the there weren't funds in a department level or school level um for anything related to to fellowship education, especially one that was not um uh like ACGME funded, um, which is neuroophthalmology is not one of those fellowships. So uh so we we were had to rely on philanthropy really and tried for some time unsuccessfully to to uh attract a donor um for the cause. And then um uh Dr. Melissa Koe, who I work with, um a grateful patient, saw her and um was really touched by what we did and um happened to have the means to to donate for the fellowship, and that was really how it how it got started. I feel like we had the kind of the desire and the a lot of the infrastructure really for probably a few years and then just really didn't have the funding. And once that piece fell in, it's like, oh all right, now we're now we're ready. And so we did that and um got it started. And there's some regulatory stuff to get through to make it happen, but um fortunately we're in a you know a place where we have certainly enough patient volume, enough um clinicians with us that it made sense to do it. We uh so yeah, just all the pieces fell together and it it got started that way. So so then the next job was to recruit a a resident. We started out with um one of our residents who was uh an ophthalmology resident and um went on into the fellowship and uh was an absolutely outstanding uh inaugural fellow. Um and then we've just kind of continued since then.

SPEAKER_01 18:43

That's fun. Congratulations on securing that investment. And what's it like to kind of move it forward? Is it um is it do you struggle to recruit year to year, or is it that you have like too many people applying? And I'm just curious like what it's like. I mean, most of you know the experience I have and that I think is much more available out there as like program uh you know, program director, because there's the match, there's like everyone has that experience as a resident, but I think we don't have enough of a showcase for our fellowship leaders and and the kind of work that it takes to do that.

SPEAKER_00 19:18

Yeah, and it's um, you know, it yes, it has been actually hard to recruit people. I think just into neuroophthalmology in general, uh, unfortunately. Um the you know, I can't I can't remember how many programs there are in the United States and Canada, it's thir 30 something. And there there's actually a good number of those programs who are very well qualified that don't fill every year. And so um, and so we we actually don't get a ton of applicants, and um, and so we have to be you know kind of cognizant of that. We also want to make sure that we're maintaining the integrity of the fellowship and doing having a situation where we um you know aren't just having a fellow to have a fellow, but we're really having someone that we can uh train and develop and and really mesh well with. So um so that so that is a challenge. Um and so uh you know, a big part of the job that I didn't really realize before is actually advertising, and so I'm having to be a salesman in some ways, which I'm I'm not naturally a salesman at all, so that's really had to I've had to get outside of my comfort zone a little to to advertise and to try to recruit people into the field, but it's I realize it's not just for me, it's this is for a better cause. We we need more neurophalmologists, and any small role I can play in that is is really a privilege and an honor.

SPEAKER_01 20:26

That's a good line. You can use that for the recruitment. So what's really fascinating to me is that you really span the spectrum of types of learners that you work with. So on the one hand, you've got, you know, as fellowship director, this kind of Uber subspecialty training for this advanced um advanced uh trainee. And then on the other hand, in assisting with the clerkship, you're really helping to start to teach the students who really are novices in neurology. And so I'm curious about that balance in your day-to-day or in how you're you know week to week. Um, how do you balance teaching to the novice versus those who are kind of at the tail end of their subspecialty training and what different strategies work?

SPEAKER_00 21:12

Yeah, that's a great, that's a great uh question. I I gave a talk about this concept a little bit recently where uh you know how do you teach to multiple levels of learners and do it at the same time? Because I sometimes hear the you know the kind of complaint that, oh, I I've already got a such and such student with me, I can't I can't teach another like a resident or someone else with me. And and I I would I would challenge that. I I realize that it's it is more effort, but um I think there are ways, even in the same case, to have um multiple ways to teach different levels of learners. Um the concept that's really resonated with me is the concept of of nodes of a network. So, for example, if we take a case of myasthenia gravis, and let's say we're seeing this patient in clinic and we're trying to uh teach, let's say, an ophthalmology resident, a neurology resident, and a uh third year medical student. About myasthenia gravis. So maybe a node of this network may be the clinical presentation and the fact that phosis and double vision are two of the most common ways that ocular myasthenia gravis manifests itself. Well, maybe that kind of a nugget is more of a node for this network for the you know for the third-year medical student. Whereas the the resident and the fellow, that well, they're gonna they're gonna know that already. That's not news to them, right? So so then maybe it's getting into some of the the more subtle signs of of myasthenia gravis, like, okay, what are the different physical exam signs that we can see and how do we elicit those? Maybe that's something that we focus on for the level of the resident. And then maybe for the fellow, maybe it's maybe they already know all that stuff, maybe it's the the level of evidence that we have to support what we're gonna do. If we're gonna treat in a certain way, um, you know, what what is the evidence that supports what we do for that? And so so that you know, in that way you have the same case, and then you have just different levels of that same case that are appropriate for each learner. And I love that they can teach each other as well. So if I'm busy doing paperwork or something, sometimes there may be something where, okay, well, you know, Kogan's Lid Twitch, um, you know, Dr. So-and-so, who's the resident, please please teach our third-year medical student about the Kogan's Lid Twitch while I respond to an email real quick, or you know, something like that where that helps them consolidate the information in terms of teaching it. They may even identify some knowledge gaps that they have, and then they're also helping the student at the same time. Uh, it builds connections, it frees up some time for me to do other things when I need to. Um, although I'm not, you know, giving away all of my teaching responsibilities, it's it's a it's a shared responsibility.

SPEAKER_01 23:37

I really like how you painted a picture for us. I can imagine we're in your clinic and there's the patient in front of us, and there's maybe like three people lined up, and there's a role for each of them to play, so they're engaged because you know that they're gonna be learning or being being asked a question. There's also a natural kind of scaffolding, is maybe the term I would use to kind of use educational theory lingo, is sort of this idea that you want to match to what they know and then add to that knowledge. And so even in reviewing the you know, the basics for the medical student that like lights up those nodes for the seniors, and then when you ask that next question, they're gonna be embedding that knowledge that you teach to the scaffolding that they already have there. And then I also love the idea of near-peer teaching. I mean, we can't speak enough about the importance of that, both for their development as a teacher and their professional identity formation as an educator, but then also this idea that that resident probably knows better in a way, like what the med student knows or doesn't know than even you might, right? Like we kind of forget at what point do people learn something, and so it can be a little bit more approachable than talking to the faculty about that. So I love how you're really embedding all like, as you said, the science of learning in your day-to-day practice.

SPEAKER_00 24:47

Yeah, it's it's been been fun to see all that kind of come together. And I've it's uh fun to pick up little pieces along the way. You you kind of as you you know, as you educate, I don't know, I I get in the routine of doing things similarly each time, and then I observe someone that, oh wow, that's a really cool idea. I'm gonna do start doing that too. And then, oh hey, that person did this, I'm gonna try that too. And you you get this like um mosaic of of your own teaching style that pieces are borrowed from different different places, and it's it's been fun to see you know the origins of different things that I that I do, and you know, uh virtually none of it is my own thing that I've came up with. I guess um, I'm usually gathering things from others and kind of putting it together in the the way that makes sense for for my situation.

SPEAKER_01 25:25

Yeah, I think it may have been Dr. Samuels, they'll have to fact check this, who would say mimicry is the highest form of flattery. This idea that if you steal someone's great teaching method, they'll just be flattered. And he also used to say that he um he checked that he said that he said something like Adam's hands are in my reflexes, and this idea was that like the way he had been taught and the way he would teach, and so that we actually replicate one another when we're like doing the exam in a certain way. And that certainly stands out for me. I always think of the way I check dorsiflexion strength as from a specific neuromuscular attending who taught me his way. And in my head, I'm always like, this is his way, it's not my way, it's like his way. I'm gonna do it right. That's great. One thing that I actually wanted to talk about was that you know, one of the things that I was a little bit intimidated by about neuroophthalmology was like the devices and the setup, and actually the need to like titrate the lens and move them around and look up and look down, and it's it was almost this beautiful choreography. And so I'm curious from your perspective as someone who practices this every day and teaches it, is neuroophthalmology like just a cognitive practice, or is there also like a procedural skill development that you have to do? And how do you teach those? And do you teach those differently?

SPEAKER_00 26:45

Yeah, it's um that there is a skill development, and that's that was probably one of the hardest things as a fellow uh try trying to learn was how to you know manipulate the lenses and do all those kinds of things, and it's it's kind of second nature now. I don't even give a second thought to it, but um certainly when you're first starting, it's uh it's it's challenging. And I even thought about an ophthalmology residency, and I remember talking myself out of it because I thought, well, I can't do these lenses. It's like I I could hardly see in the eye during my medical student you know rotations. I'm like, I don't think I can do this. And and I fortunately I was completely wrong about that, and it helped me recognize how my own limiting beliefs can sometimes get in the way. And fortunately, there were other paths that led me into neuroophthalmology and realized that that was not true. But I feel like the the the physical exam skills, like once you've done them enough, are not uh not really a a challenge, uh so to speak. It's it really is more the cognitive part because you can see uh you know a hundred cases of my senior gravist, and for example, and but they're all a little different, and some of them are really challenging and blow your mind, and then you know others are are very textbook and it's like wow, this was there's nothing else this could have been. This was very, very obvious. And um, so I'm still humbled by the the complexity of that breadth. And I think as I get more experience, it's fun to call upon those different outliers and and recognize how the the variability in presentation occurs. And I feel like those that is probably more challenging than adapting to any physical exam skill or how to hold the lens or you know those kinds of things. So um so yeah, I think that that was a probably an issue earlier in in training, but you know, the more you get on, it's not like there's new I don't know, new exam things to learn usually. Uh usually the exam is is is pretty set or is has been done a certain way for a long time.

SPEAKER_01 28:27

That actually makes a lot of sense now that you walk me through it, because I it's really cognitive load. Like I think when you don't know how to do a skill, you're it's like when I watch my third-year med students and they're struggling with like what even order to put the exam in, and so then they're and then they're struggling with the maneuver, and then let alone like how do we even interpret what I find. Like even if they find a brisk reflex, they're like so surprised they even got the reflex that they're like forgetting to interpret what it means. So I think when you lay it out that way, it makes sense that as you practice the cognitive load fades a little bit more into the background as you become more spontaneous. And then what's really left is like, gosh, these these interesting cases and and how they're how they differ.

SPEAKER_00 29:07

That's a great way to put it. I think I think of it as kind of like it's like driving. When you first when you're first driving, you're like you're you're knuckle tight on the steering wheel and you're like, you know, you're super alert to everything, and just and now it's it's like wow, I you know, 10 minutes ago by driving and I wow, I didn't remember touching the steering wheel at all, and I you know was thinking about something else or enjoying the view, or you know, you you're kind of freed up because, like you said, your cognitive load is elsewhere. You can you're freed up to think about other things. And I I love that about uh the neuroophthalmic exam when you you know you do it enough, you can it's like my my hand just knows where to go with the lens, and so and I just I'm focused more on what am I seeing rather than how am I doing it.

SPEAKER_01 29:43

Yeah, I mean I think with twin between two neurologists, we can't help but comment on like the beauty of the motor system as well as we go through this conversation.

SPEAKER_00 29:51

Right.

SPEAKER_01 29:52

But I think it also aligns a little bit to teaching because you mentioned like you know, people who say, Oh, I'm not sure I can fit a student into my clinic, is you have to recognize there's an additional cognitive load to that teaching, and that will also improve over time. And something I it's almost like a public service announcement to those young attendees out there who maybe are just trying to figure out clinic for the first time, have always wanted to be a teacher and then volunteered, and then suddenly the students there, suddenly you're having a hard time balancing it. So I I wonder if you could comment a little bit on that because it sounds like you have multiple learners in your setting now.

SPEAKER_00 30:24

Yeah, yeah, we do. And in fact, I was just in a meeting earlier today where people were talking about it was a uh kind of uh meeting with the different um site directors at the the different statewide campuses and uh for IU and that there were concerns brought up about um incentivizing um preceptors, and because it's you know, well it's you know, students are slowing them down or they're you know they're kind of taking away or you understand all the kind of negative things about about teaching, and and it's like, oh no, that's uh there there is a way, I think there are ways to teach that don't necessarily have to slow you down. I mean it, you know, and I think to to recognize those you have to be a bit flexible in what you do you depending on the situation. Like, for example, um, in my neuroophthalmology clinic, it's not really appropriate for me to send a third-year medical student in by themselves and do an entire, you know, the whole thing, and then come out and present to me, and then that's that format just says that's not gonna work for that. So you have to be, you know, that's probably fine for the fellow or in probably even for the resident, but there's a different level for the student. So think about how do I incorporate this student where they're still active, they're doing something, they're not a passive, you know, shadower. Um, we're obviously not not in the business of having uh student shadow, but um giving them a responsibility, something to do, and then helping them with that. So, so for example, when I've been on by myself with a third-year student, I'll I'll bring them in with me actually, and I'll have them maybe do the history in front of me. And so I'm in the room, I get to hear it, I'm not losing any time there. And if they get off into a weeds or you know, the weeds or something, I can rescue them and bring them back into you know the mainstream, and um, I get to chance to ask anything I want to, I get to observe and see what their level is so I know how to teach to them better because I can see, oh, they need remedial help with such and such, or no, they're really advanced, and I can introduce some concepts that I haven't been able to introduce with other students of this level. So you get a sense for that. And then for the exam, maybe they don't know how to hold you know the lens or do the slight lamp or all that stuff. Well, that's okay, they can do a cranial nerve exam, and I can watch them do that and I can give them feedback on that. So so there's still still parts of the exam or parts of the evaluation that they're appropriate for, and I can get them involved in doing that without slowing myself down. So for busy clinicians that are worried about, oh, I I can't have a student because it's gonna slow me down too much. Well, don't have them do the whole thing. Like pick bits, bits, and pieces for them to do that where they're they're active, they get to learn, they get feedback, but we're not overwhelming them with the whole thing. It doesn't have to be this all or nothing, like you do the whole evaluation or you just shadow me. It's like, no, there's lots of lots of shades of gray in between that are uh very appropriate for learning. So I think that's probably the message I would have for uh preceptors that feel like, well, I I just I can't take on a student. It's like, well, you know, how how about we rethink about what that means to take on a student? Maybe they don't they don't need to do everything, they don't need to slow you down, they can you know do bits and pieces, or um so so I I wonder if there's a way for us to introduce that concept to preceptors to you know help them understand that like it's it's not it's not as uh I don't know overwhelming as as it may seem um based on what our you know previous conceptions are of what it means to have a medical student with you.

SPEAKER_01 33:21

I couldn't have said that better myself, just this idea of the gray shades in between, like not all or nothing in terms of involvement. And I think pieces of involvement, especially directly observed, like students are hungering for that, right? I'd love to get feedback on my history or my cranial nerve exam. And I try to do the same most of the time students, I'm with students at the bedside in the in hospital wards, and sometimes we say, okay, on this you know, specific patient where we're doing this targeted exam on let's say aphasia, like I'll have you do that part of the exam. You know, it could even just be a little segment, and then you're really reinforcing well, what are those elements to test for that segment and how to do it, how to give them feedback. And you said they have they have a role to play, it's so much more interesting than kind of even seeing, you know, seeing the whole thing in action.

SPEAKER_00 34:08

Yeah, they do, and I um and as you mentioned, you know, doing a part of the examination on rounds. Um I've done that as well, and I was trying to remember where I got that from. I think it probably was from residency, actually. I think someone was doing it there, and that and it's like, wow, that's that's great. We're I'm gonna do that. And then um I I've noticed that there are others now here at IU that do that too, and it's like the it's it's spreading and it's it's such a great practice. It's it's good for so many ways, but it's it's fun to see how um good educational principles can really um be passed generation to generation, I guess you could say.

SPEAKER_01 34:37

Absolutely. These are the things you want to steal, yeah. Go out there and and copy, copy what you like and what you see working well. So this is a great segue, actually, because I did want to talk in more detail about the statewide neurology clerkship that you're gonna be that you're assisting with and gonna be running um later this year. So, congratulations on the new role. So, what does that mean exactly? Like help people imagine this. What does statewide mean? And tell us some of the numbers, like students, sites, rotations. I really want people to get a picture of what this looks like. Because you showed me a map, like it was a great slide, and that really helped me visualize it. But for those listening, help us understand what what this model actually looks like.

SPEAKER_00 35:21

Yeah, so IU has um a nine campus system. So there's um, so I'm based in Indianapolis, which is kind of the main campus, and then there's nine satellite campuses, I guess nine including Indianapolis, um, where students can do their their rotations and and medical school in general. So the the preclinical years um tend to be more distributed to the regional campuses because a lot of it is is non-clinical work, and so you can do that in kind of classroom-based settings um just about anywhere. And then um in the clerkships, um, most of the students are in Indianapolis, but there's still you know a good percentage, and I I didn't come prepared with the exact numbers of how many are in different locations, but uh but it's still it's still a good number that are in the different satellite campuses as well. And so one of our challenges is to try to keep everything um equal and fair, and um uh and in fact the L the LCME really cares about that, about how fair and and that's a a big subject of our accreditation every seven years or whatever it is. We just had ours, I think it was this last year, and that they really focus on that a lot. How how are you making sure that you have the same educational quality in all these different locations as you do in your main campus? Um and fortunately, technology has really allowed us to to do some of that. We have similar, in effect, the exact same assignments and things like that for each um uh each learner during the clerkship. But then there's the wildcards of the preceptors and the clinical sites and the different hospitals and um, you know, the I don't know the the travel and the living conditions, and there's there's all these different wild cards that can can go into it. You know, some of those are gonna be varied, but I I would argue that that's actually a good thing. Um it's nice that we have different preceptors who do things differently. It's nice that we have different patient populations in different areas. Those are those enrich our education, they don't take away from it. So we want to be fair and equitable in the important things that need to be that way, and then we want to accept and embrace and celebrate diversity in in the ways that that enrich our education. Uh so that so that's part of the challenge of this whole you know nine campus system is how do you you know take the good and leave the bad of the you know of having different different campuses and and trying to keep tabs on what's going on at each one.

SPEAKER_01 37:36

It's a great idea because it kind of talks about this opportunity, as you said, for students to be in different places to see slightly different practice, potentially expanding the volume or you know, the number of students who get exposed to so there's some schools that don't have a required neurology clerkship or don't feel like they could support, and maybe this is a good example of like, well, actually, if you expand to more sites, maybe you can offer this to everyone.

SPEAKER_00 38:00

Absolutely, yeah. So it's um each each site has its own strengths as well. Um, you know, some that are very very rural, there's others that are much more urban, there's some that have you know different socioeconomic status is more common in some some than others, and just all these different variables, and it's it's really a great part of a student's education to uh to get experience in all those different areas. And then they also you know get to see different practice patterns too. There are some that are you know very kind of private practice type model, and there's others that are um much more academic or super subspecialized, and so they get a um an exposure to all of that too, which I think is really helpful in a formative time when students are trying to figure out what they're gonna do with their careers, right? They're making up their minds usually in the third year of medical school what they're gonna do with their career. So, you know, what better time than that to have exposure to different practice types and specialties and things so they can students can you know try on, try them on and see what they love and what what really speaks to them.

SPEAKER_01 38:57

It's so important to have a chance to see it in person and try to imagine yourself there and know either way, right? Yes, it's a fit for me, or no, it's not a fit for me.

SPEAKER_00 39:06

Right, right.

SPEAKER_01 39:08

I understand the need to balance this idea of an equitable experience as much as possible across sites. And you mentioned when we were talking about this a little bit earlier that there's a big focus on faculty development. And sort of you've identified that, well, you know, our students are gonna go across all these sites, and how can we ensure that that experience is somewhat uniform and and what's the role of the faculty? You've sort of identified that as a key element. So why is faculty development so key and why is that gonna be your focus?

SPEAKER_00 39:40

Uh yeah, I mean that's that's probably one of the biggest variables um about the different sites. And it can be you know variable in in a very positive way or in a or in a very negative way. And um and and some of the negative, I think a lot of the negative can be avoided by adhering to certain just principles of good education. And so we want to make sure that our preceptors are trained in those ways. Uh we have ways to standardize things a little bit and you know make sure that uh, for example, the students have to have a um have someone witness a portion of a of a history and physical examination uh done within a certain period of time in the clerkship. And so um so there's that. There's they have to have a certain number of encounters with a patient with a sensory complaint or a patient with a motor complaint, and so things like that are meant to um you know prompt students to get the opportunities that they need. And then we're we're also encouraging you know preceptors that you know shadowing's not okay at this stage. Um, you know, they're just you know some of the some of the basic principles of of how we educate. We want to have students uh involved, you know, give them feedback. We have standardized ways to help them do like mid-rotation feedback, for example. So there's all these tools and mechanisms that we have to try to uh prompt uh a relatively you know equal experience with the different preceptors, um notwithstanding they have their different strengths and different you know things that they're interested in. And again, those things are all great. We just want the the baseline of what they need to be learning to be fairly similar.

SPEAKER_01 41:09

That makes sense. You mentioned like the experience of the students, the support for the faculty, and then it sounds like in a way you almost have like a core faculty model, at least that's the term that we use here, like those who've been identified to play that role as part of the clerkship. And I'm curious, is that something that exists at the level of your clerkship, or is that expected by the medical school across clerkship? So you're kind of thinking about how neurology fits into the larger clerkship model, or how much room do you have to be innovative within your own clerkship?

SPEAKER_00 41:39

Yeah, we have a we certainly have a core kind of core faculty that are mostly involved with teaching. There's also what's known as a community division in neurology here at IU, where there's there's um certain practitioners that are really focused on clinical care and don't do as much education and um or that you know don't do as much with the academic mission of the of the university. Um and and that's great, we need them too. And um so but yes, the education part tends to be in a more focused uh group. It's still a large group and there's still a lot of variety in um you know how preceptors do. There's some that are outstanding and some that need some help, and and so we you know we have all those things to to deal with as well. As far as the individual sites, there are certain uh preceptors that are identified as as uh teaching preceptors, and um, and so the the students will be assigned to rotate specifically with them. And there's a coordinator at the different sites that helps make the actual assignment of who's gonna go with who on what day and uh make sure that we don't have too many or too few students and um you know it's gonna take care of all those logistical ends. So it's really essential with uh such a widespread net of of uh campuses to make sure that we have infrastructure supported each of those. I think it's just too much if we just had one coordinator in Indianapolis and they had to coordinate all these different things, that just wouldn't work. So fortunately there's a coordinator in each location that actually coordinates for multiple clerkships. Um there's like a campus dean, there's um you know there's there's others to kind of help us with the mission, so it's not just us on our own with the with the preceptor. It's like well, we have these others to to help support us as well.

SPEAKER_01 43:09

That seems to be the answer anytime I talk about scaling, it's boots on the ground.

SPEAKER_00 43:16

They need boots on the ground.

SPEAKER_01 43:18

You mentioned earlier that you recently took this um transforming healthcare leadership um class, and that some things you saw in what you were learning already being done in your clerkship and kind of having that resonance of like, hey, this is there's a science for this, and we're doing it great. Um, and then maybe there were some other areas that you saw that were gaps, maybe new ideas that you're not yet doing. So I'm curious as a two part question, um, if you would be able to share any of like the things you're already doing and some of the science behind it. And then was there anything that you want to change or you're thinking about innovating around as you start into the leadership role?

SPEAKER_00 43:54

So, as far as things that we're already doing that that were good, um so one thing is we we do still do some like Lectures in the in the clerkship, and we found that so some of the things we were doing were great. So one was making sure that students were in a location where they can focus without distraction. So that was important. Making sure if it's like right after lunch or something, make sure that they had time to eat lunch and that they're not distracted by being hungry or something like that. So those things are really important for focusing, and focusing is really important when we're trying to gain new knowledge. We need to pay attention to it well. And so not having distractions is really important for that. Another was that we we have the practice of randomly calling on people in the lecture. And so that the lecture is done virtually via Zoom, and so sometimes it's hard to gauge who's engaged and who isn't. But one of the ways we can get around that is by we have a list of all the students, and we can say, okay, um, you know, um Joanna, let's um, you know, uh what do you think about but you know, just and ask them a question. And we usually do these like super simple questions that like pretty much everyone gets them right, but just that that stress of like knowing, oh my goodness, I'm gonna get called on in front of all my peers, and I better not look silly in front of all my peers by saying something wrong. That that little bit of stress is actually really good. Um and it's helpful for us. And I and I've I've really recognized that since and realized that like a little bit of stress in learning is good. Like we want um I want, you know, when I'm with a student, I want them to be just a tiny bit stressed so that they are alert and and ready. But I don't want them to be uh I we're not talking about pathologic stress or unsafe learning environment, no, none of that. Just a little bit of stress, and it's usually self-imposed stress, it's usually like again, like I don't want to look silly in front of my peers, that kind of stress. But that kind of stress was is actually really helpful for uh helping some make sure someone's doing their best and and paying attention well. So some of those things I was like, oh wow, that's uh makes sense that we're doing those things that way. Um as far as gaps, um, one thing I I was really struck by was the how short our attention spans are. Um, you know, we we don't do well with sitting through an hour lecture and just yeah, that's just not not how we are meant to learn. You know, we have um you know our attention drops off probably every eight to ten minutes, and then we have and then we need something to reset us, something to grab us and say, Oh hey, this is exciting. And and so um uh learning that we can either you know take lectures and break them up into really small eight to ten minute chunks, or even just take the same lecture and have a like a way to reset or a way to um have them engage with us or or participate in some way, or some way to, you know, maybe there's a take a break and share with your peer what you think about blah blah blah, or teach them about that, you know, just something to break it up a little bit. Um, those those moments of resetting someone's attention are really important, and I don't think we have we've had enough of that. And so I think that's something that we are gonna try to change to um better recognize that attention drops off quickly.

SPEAKER_01 46:46

I can't emphasize that point enough. Um, hopefully we're not losing too many people, but I still remember the lecture where I learned that as well, and the person sharing it was teaching about like best practices for lectures and and being a good teacher. And in her lecture, every 10 to 15 minutes there was some kind of activity. It was like reflect to yourself on like your last good lecture or your last bad lecture, or she said, like, um, showed us a graph, like what might this mean? Put it in the chat, it was a virtual talk, and then she kind of pulled the blind back, you know, pulled off the fourth wall and said, What I'm doing here is what I recommend all of you do, which is like have some kind of engaging activity at least every 10 to 15 minutes, even like raise your hand if you know XYZ, and it's a practice I've tried to implement with my lectures, even where it's very much like you've been asked to do a lecture, not a workshop, you know, try not, it doesn't have to be super interactive, but having that interactivity, if nothing else, even like reflect yourself or talk with a partner. I love what you're what you said there as strategies.

SPEAKER_00 47:49

Yeah, totally, totally agree. That's that's perfect.

SPEAKER_01 47:53

So I think as we're kind of wrapping up here, um, I just really wanted to like take a big picture step back once again and just comment on how phenomenal it's been that you've had these different stages in your career and like different hats that you wear and balance as an educator. I mean, you're clearly a clinician, you're a clinician educator who's teaching on the wards too, but also have been an administrator and a leader. And so I'm curious about like these various hats you wear and different phenotypes. Um, is there one you like best? Do they inform each other? Is there one that's hardest for you? Um, just curious how you've announced it.

SPEAKER_00 48:31

Yeah, great question. Um, yeah, the the role I like best is is um a clinician educator. It's the it's in the in the clinic or on the words and and teaching in that moment and and like uh seeing seeing a really awesome case and be able to dissect parts of it in a way that that changes how the student learns about it and that they they recognize and feel like wow, that was really cool. Like that that that moment. That that's the stuff I live for. That's really that's that's what it's all about. So I I love those moments. I I have to admit it's a little harder for me to sometimes get excited about the administrative aspects and the sitting through many meetings and those things because there's they seem so far removed from that moment that I just described. Uh on the other hand, I recognize that we still need to have administration, we still need to have leadership, we need structure to you know not have the the wheels fall off the bus. And I so I I get that and we we we need that, but um yeah, h hopefully there's ways for us to minimize, you know, minimize that part and and get more to the you know being a clinician educator and enjoying those moments with with students.

SPEAKER_01 49:36

I love that. I think you anticipated my question. I I liked I think you already answered it. I like to end with why do you teach?

SPEAKER_00 49:43

That's it, that's it. I just you're right, I answered it. It's um I I I there's such a joy in um finding that you you left a student better than you found them. Um and and it's not I you know you can't I I realize I can't take all the credit for that. Like some of it was the patient and the the own effort that they put in and so forth, but to even just be a part of that process is really exciting. It's I so um fun fact about me, I have eight children, and so I I also my my hobby is that I re I raise children. So um so I I've just been struck about how many parallels there are between parenting and medical education. So, so many. And um it's really informed me a lot, and it's um it is similar in a way to the joy you feel when you're when your children succeed at something and they're growing into the kind of people that you hoped that they would be. And to see that even in a small degree in a student and see them transformed and changed is really exciting, and and they don't forget that often. And just like I haven't, you know, I've just rattled off a bunch of names of mentors that I've had that really left lasting impressions on me, you know, here 10 and 15 years later. And um, I still remember you know, teachers I had in in elementary school and in medical school that left a you know a specific moment that I remember learning from them and uh and how that I've carried that with me since. And so um to to be that to be that for someone is is is really fun, and that's uh I think uh why I do what I do.

SPEAKER_01 51:09

I love that. Wow, eight children. I think you can claim you can claim more for credit for for the for their achievements. You know, it's been so wonderful to talk with you because I am reminded of some of these same mentors and this idea that you almost have to do it whether you get that feedback or not, because when I think about some of the mentors I've had, and while I do my very best to say thank you, I haven't always had the chance to let the people know who still like as I say sit on my shoulder, it's like when I'm doing dorsiflexion, as I mentioned, you know, but they have this outsized influence um for the learner. And so I hope, if nothing else, people hear like even if you don't get that direct feedback, uh, you know, hopefully keep doing what you're doing, if those are your values and your principles. And that's what I'm hearing today. And it was just so wonderful to talk with you and like re-center that at the heart of what we do.

SPEAKER_00 52:04

Thank you. That's that's such a great reminder of what it um, I think also what it what it feels like to be appreciated as an educator. And I think there's some people I need to go back and just thank and and just think about if if a learner came back to you years later and said, you know, you really had a a profound impact on me and in such a positive way. I I mean I would just melt if someone did that to me, right? I mean that would just be the most wonderful thing in the world. Um and so I I think uh I I need to do that to some some people who have been great mentors for me, and hopefully that's something we can pass forward. Because I, you know, um I think uh a lot of uh challenges we have in medical education are with um recognizing and recruiting and and appreciating teachers, and I think that's you know, recognition is a is a really important thing that we all need psychologically. We we need to know that what we're doing matters and that we're we're having a good impact on people, and um, so for us to verbalize that and and share that with mentors that we've had is a is a really great gift we can give back to them, I think.

SPEAKER_01 53:01

Well, we mentioned um Dr. Prasad a couple times, and he is in fact the one who put us in touch who he's gonna have to listen to this episode.

SPEAKER_00 53:08

That's right.

SPEAKER_01 53:08

So we're gonna send it to him, we're gonna say our thanks. You can say yours, I'm gonna say mine, because I still think that whenever I'm trying to, you know, orchestrate the perfect bedside teaching, it's Chishek's uh, you know, uh show that's in my mind. Um so we'll both have to say our thanks.

SPEAKER_00 53:24

Absolutely.

SPEAKER_01 53:25

Well, with that, we're at the end. Is there anything else, Devin, that you wanted to say? Anything else coming to mind?

SPEAKER_00 53:31

No, just a big big thank you to all my mentors that have uh challenged me and um helped me grow throughout the years and have not given up on me and you know, seen potential in me, maybe that I didn't see in myself, and just some of those things. It's um um I you know I'm not sure what I would be without them. So I just very, very grateful for them and to have a chance to influence the uh generation going forward now. And um I think medical education is in is in good hands, and I'm excited to see what the future brings with AI and a number of different other changes in our just new generation of learners. I think it's gonna things will keep evolving, and we'll see how it goes.

SPEAKER_01 54:05

So big thanks to all those mentors. What you do is meaningful, and thanks to you as well today, Don. Thanks for the conversation.

SPEAKER_00 54:12

Thank you, Glina.

SPEAKER_01 54:15

NeuroPraxis, the Neurology Educators Podcast, was created and produced by Gelena Gayman. It is not recorded as an official podcast of any institution or organization. The views and opinions are those of the individual speakers themselves. Music from Pixabay, cover art by Carolyn Folney, editing by Valeria Ralden. Want more content like this? Be sure to subscribe to the Neuropraxis Podcast wherever you get your podcasts. Have questions, comments, or suggestions for other podcast episodes? Contact us at neuropraxispodcast at gmail.com. Tell your friends and spread the word. Thanks for joining us.