http://www.jhltonline.org
PERSPECTIVE
Educational affairs at the International Society for Heart and Lung Transplantation: Perspective and governance of post-graduate learning dimensions Christopher H. Wigfield, MD, FRCS (C/Th),a and Mandeep R. Mehra, MD, FACC, FACPb From the aDepartment of Surgery, University of Chicago, Chicago, Illinois; and the bBrigham and Women’s Hospital Heart and Vascular Center, Harvard University, Boston, Massachusetts.
KEYWORDS: ISHLT; postgraduate learning; educational governance; Journal of Heart and Lung Transplantation
The purpose of this contribution is to review the development and scope of postgraduate training and educational affairs of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2014;33:1189–1192 r 2014 International Society for Heart and Lung Transplantation. All rights reserved.
“It is only the ignorant who despises education.” Publilius Syrus (100 BC), Maxims The founding of the International Society for Heart and Lung Transplantation (ISHLT) was a magnificent endeavor. The ISHLT’s multinational community of practitioners has helped to establish the most respected institution in the field of advanced heart and lung disease. Clinicians and scientists have worked together over the decades in productive collaborations that have influenced clinical standards and outcomes in cardiopulmonary disease. Members have implemented groundbreaking medical advances in a number of countries across all continents. Clinical data collated worldwide at its registries verify the key role the ISHLT has assumed in recording and monitoring outcomes.1 We now must address the educational challenges throughout the world, an emerging central mandate at the ISHLT.
Defining education in the setting of an international professional society The process of academic development and medical professional education is commonly divided arbitrarily into Reprint requests: Christopher H. Wigfield, MD, FRCS (C/Th), Department of Surgery, MC 5040, University of Chicago, Ste. 500, 5841 South Maryland Avenue, Chicago, IL 60637. Telephone: 773 702 3551. Fax: 773 702 4187. E-mail address: cwigfi[email protected]
separate stages. Individuals’ graduate programs are followed by post-graduate qualifications obtained at various nationally recognized institutions. Within the multidisciplinary context of the ISHLT, professional education is seen as a lifelong endeavor.2 Thus, in the setting of this professional society, educational affairs may be defined as: “All matters related to the organizational provision and individual members’ efforts to provide significant learning experiences and allow for optimal professional development in accordance with the ISHLT mission statement.”3 Post-graduate professional development requires intrinsic individual motivation and external provision of relevant learning opportunities. In health-care fields and allied professions, expert interest groups contribute to such provision. Often these efforts are made on an ad-hoc basis, not providing a sustained or internationally recognized level of learning. The ISHLT has the professional expertise and logistic means to advance foundational knowledge, practice guidelines, clinical skills and learning in other scientific professional domains. This has prospects well beyond the traditional limited postgraduate pathways. In essence, this collaborative educational provision enables expert development with global relevance. The ISHLT has already assumed a prominent role in postgraduate training and education for heart and lung transplantation. The scope of this mandate, however, is still evolving. Success in this domain depends primarily on understanding the changing needs of professional “learners” and their critical competencies.4
1053-2498/$ - see front matter r 2014 International Society for Heart and Lung Transplantation. All rights reserved. http://dx.doi.org/10.1016/j.healun.2014.07.006
1190
The Journal of Heart and Lung Transplantation, Vol 33, No 11, November 2014
Figure 2 Figure 1
ISHLT membership per year (1992–2014).
ISHLT meeting registration per year (1994–2014).3
Growth of the ISHLT and the annual meeting The annual meeting of the ISHLT has been our primary educational effort, serving multiple purposes. This has been achieved by development of visionary content and exchange of timely scientific discourse. Seeing a need to elevate core competency-based education, the ISHLT created an official mandate for a director for educational affairs to allow for integrative oversight and prospective development of the educational content beyond the traditional setting of the annual meetings. In 2010, ISHLT launched its Master Academy series, and its dramatic acceptance represented the starting point of core education as a central theme. Figures 1 and 2 show the vibrant growth of the ISHLT on a yearly basis since its inception. Peer interest can be expected to rise further along with the increasing demand for a multidisciplinary forum in the field of advanced heart and lung diseases. Dramatic advances and clinical application of circulatory support devices, the advent of regenerative medicine, and a plethora of therapeutic innovations in addition to solid-organ transplantation have provided continued impetus for ISHLT expansion. A receptive board of directors has allowed for the successful adaptation of a state-of-the-art approach to educational affairs to enhance the raison d’etre, as defined in the mission statement. ISHLT Mission Statement “The International Society for Heart and Lung Transplantation is a multidisciplinary, professional organization dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support and innovative therapies via research, education and advocacy.”
scientific forum was introduced in 2010. This concerted effort has since provided dedicated core competency courses (CCCs) and established a unique educational approach for developing experts in this professional realm. Competence in this setting is defined as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served.”5 As such, competence is not an achievement per se, but rather a result of lifelong learning attitude.6 The ISHLT promotes this habituation of learning as part of expert development and the strategic plan was developed for the specific “learner” target groups. The ISHLT engaged in a deliberate curricular design process while selecting extracurricular educational contributions. The ultimate aim is to serve members and non-member professionals through advancement of proficiency and career development.7 The post-graduate expert development is promoted as a lifelong learning commitment. This is exemplified by the members providing the know-how and time to serve at the annual meeting and the Academy. An international “cadre” of professionals serve as voluntary faculty by providing formative education in addition to seminal science at the ISHLT. All educational endeavors are designed with overarching goals and defined learning objectives. Developed by small workforce groups within the ISHLT specialty councils, the process is guided by the director of educational affairs. A task force to ensure educational governance makes recommendations to the board of directors and assist in the continued expansion of the ISHLT Academy (Figure 3). Four hundred sixteen participants attended the latest installment of the ISHLT Academy for Mechanical Circulatory Support (MCS) in San Diego, just before the
The ISHLT Academy The concept for the ISHLT Academy was born out of the need for a more deliberate focus on post-graduate education for a range of developing experts in this field. The notion of a complementary learning pathway in addition to the
Figure 3 Combined attendance at ISHLT Academies, 2010– 2014 (includes CCCs and MCMs).
Wigfield and Mehra
Educational Affairs at ISHLT
annual meeting. The Academy consisted of both core competency and master class levels with approximately one third of attendees traveling in from 25 non-U.S. countries, exemplifying the international nature of ISHLT. Analysis of the participants’ backgrounds shows the heterogeneity of the target audience of these Academy contributions (Figure 4). A planned diversification of council-generated learning activities is now underway and will result in further representation of the membership interested and will provide multiple opportunities for interdisciplinary study.8
The strategic plan A strategic plan for ISHLT educational affairs was introduced in 2012.9 The high demand for post-graduate training in this realm and the heterogeneity of the target audience required a more concerted effort to provide a meaningful range of educational offerings at the ISHLT Academy. Responsive to identified gaps in professional development, key concepts were defined and core competency documents were utilized for each Academy contribution.9 Didactic refinements allowed for interactive delivery of contents.10 Deliberate programming of the CCCs allowed for sustainability of the educational provision. Complementary to the foundational nature of the CCCs, the more advanced dimensions of application and integration of expert learning and development were conceptualized in the master class modules (MCMs), introduced in 2014. Participation at the ISHLT Academy increased markedly within the 5 years of its inception and allows for subsequent attendance at the annual scientific meeting. Feedback mechanisms have led to identification of future refinement and afforded an overwhelmingly positive response to the ISHLT Academy contents and delivery. Among multiple “fringe benefits,” the extended opportunity for professional networking has been cited frequently.
Joint extracurricular educational events Beyond the boundaries of the ISHLT Academy, a range of international collaborations have allowed for focused engagement with other professional associations and societies with comparable areas of interest. The ISHLT primarily provides expert faculty and educational content development to enhance
1191 the educational experience and context of other national meetings or international venues. This, in turn, can provide recognition of the ISHLT’s leadership role in educational accomplishment. The joint extracurricular events are catered to target audiences less likely to attend the ISHLT Academy and annual meeting proceedings. A wide-range of joint efforts have been delivered over the last decade.
Self-directed learning at the ISHLT Several modalities were established to facilitate individual study and provide expert reviews of the various aspects of advanced heart and lung disease. The Journal of Heart and Lung Transplantation, the ISHLT monograph series, the guideline and consensus statements and new core competency documents are available through the ISHLT councils’ pages on the www.ishlt.org website. Currently, eight volumes of monographs have provided dedicated guidelines and exhaustive reviews of clinical subspecialties as well as historic context. Clinical guideline publications and consensus statements are published in this journal at various intervals and can be accessed at the ISHLT website. Core competency documents (CCDs), linked to www. ishlt.org, follow a structured approach to allow for comprehen sive self-directed study when required. These documents facilitate individual review and detailed clinical program assessment and improvement. The ISHLT has therefore provided state-of-the-art revision tools for expert development.
The Journal of Heart and Lung Transplantation Widely identified as the premier scientific voice of our field, JHLT has grown dramatically in the past 5 years. Cardiothoracic transplantation has remained steady while MCS and pulmonary hypertension have gained a greater footing in the journal. Over the past 5 years, the impact of the journal has continued to rise yearly and its top-tier status has become entrenched in the areas of cardiovascular medicine, respiratory medicine, transplantation and surgery. JHLT’s leadership is now evaluating ways in which to join with the educational affairs committee of the ISHLT and develop core educational content as a vital partner to consider assessment of core competency, developing video-based depictions of innovative surgical techniques, and providing young trainees and faculty a forum to publish state-of-the-art reviews that can serve as a “one-stop shop” in the distinct fields. Each year, JHLT is featured at the annual meeting in the form of a symposium where the top published content from the previous year is presented by early-career speakers and then discussed by seasoned senior leaders and experts in the field.
Future dimensions of education at the ISHLT
Figure 4 Professional backgrounds of participants at the MCMs and CCCs for nechanical circulatory support at the ISHLT Academy, San Diego, 2014.
In an era of striking inequities in health-care provision, postgraduate training worldwide may allow for a gradual improvement of outcomes in our field. The continuum of patient advocacy, vocational learning and care outcomes should become a template and effective source of expert development in the field of end-stage heart and lung disease and treatment.
1192
The Journal of Heart and Lung Transplantation, Vol 33, No 11, November 2014
Disclosure statement The authors have no conflicts of interest to disclose.
References 1. Stehlik J, Hosenpud JD, Edwards LB, et al. ISHLT International Registry for Heart and Lung Transplantation—Into the Fourth Decade, From Strength to Strength. J Heart Lung Transplant 2013;32:941-50. 2. Candy PC. Self-direction for lifelong learning: a comprehensive guide to theory and practice. San Francisco: Jossey-Bass; 1991. 3. Wigfield CH. ISHLT quick links: https://www.ishlt.org/ContentDocuments/ ISHLT_Education_White_Paper.pdf. Accessed April 15, 2014.
4. Gardiner L. What are the critical competencies? In: redesigning higher education: producing dramatic gains in student learning. 1994 ASHEERIC Higher Education Report 7. Washington, DC: George Washington University. 5. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002;287:226-35. 6. Leach DC. Competence is a habit. JAMA 2002;287:243-4. 7. Fink LD. Creating significant learning experiences. San Francisco, CA: Jossey-Bass/Wiley; 2003. 8. ISHLT Academy. https://www.ishlt.org/meetings/ishltAcademy.asp. Accessed April 15, 2014. 9. Diamond RM. Designing and assessing courses and curricula: a practical guide. San Francisco, CA: Jossey-Bass; 1998. 10. ISHLT publications. https://www.ishlt.org/publications/monographSeries. asp. Accessed April 15, 2014.
PERSPECTIVE
Educational affairs at the International Society for Heart and Lung Transplantation: Perspective and governance of post-graduate learning dimensions Christopher H. Wigfield, MD, FRCS (C/Th),a and Mandeep R. Mehra, MD, FACC, FACPb From the aDepartment of Surgery, University of Chicago, Chicago, Illinois; and the bBrigham and Women’s Hospital Heart and Vascular Center, Harvard University, Boston, Massachusetts.
KEYWORDS: ISHLT; postgraduate learning; educational governance; Journal of Heart and Lung Transplantation
The purpose of this contribution is to review the development and scope of postgraduate training and educational affairs of the International Society of Heart and Lung Transplantation. J Heart Lung Transplant 2014;33:1189–1192 r 2014 International Society for Heart and Lung Transplantation. All rights reserved.
“It is only the ignorant who despises education.” Publilius Syrus (100 BC), Maxims The founding of the International Society for Heart and Lung Transplantation (ISHLT) was a magnificent endeavor. The ISHLT’s multinational community of practitioners has helped to establish the most respected institution in the field of advanced heart and lung disease. Clinicians and scientists have worked together over the decades in productive collaborations that have influenced clinical standards and outcomes in cardiopulmonary disease. Members have implemented groundbreaking medical advances in a number of countries across all continents. Clinical data collated worldwide at its registries verify the key role the ISHLT has assumed in recording and monitoring outcomes.1 We now must address the educational challenges throughout the world, an emerging central mandate at the ISHLT.
Defining education in the setting of an international professional society The process of academic development and medical professional education is commonly divided arbitrarily into Reprint requests: Christopher H. Wigfield, MD, FRCS (C/Th), Department of Surgery, MC 5040, University of Chicago, Ste. 500, 5841 South Maryland Avenue, Chicago, IL 60637. Telephone: 773 702 3551. Fax: 773 702 4187. E-mail address: cwigfi[email protected]
separate stages. Individuals’ graduate programs are followed by post-graduate qualifications obtained at various nationally recognized institutions. Within the multidisciplinary context of the ISHLT, professional education is seen as a lifelong endeavor.2 Thus, in the setting of this professional society, educational affairs may be defined as: “All matters related to the organizational provision and individual members’ efforts to provide significant learning experiences and allow for optimal professional development in accordance with the ISHLT mission statement.”3 Post-graduate professional development requires intrinsic individual motivation and external provision of relevant learning opportunities. In health-care fields and allied professions, expert interest groups contribute to such provision. Often these efforts are made on an ad-hoc basis, not providing a sustained or internationally recognized level of learning. The ISHLT has the professional expertise and logistic means to advance foundational knowledge, practice guidelines, clinical skills and learning in other scientific professional domains. This has prospects well beyond the traditional limited postgraduate pathways. In essence, this collaborative educational provision enables expert development with global relevance. The ISHLT has already assumed a prominent role in postgraduate training and education for heart and lung transplantation. The scope of this mandate, however, is still evolving. Success in this domain depends primarily on understanding the changing needs of professional “learners” and their critical competencies.4
1053-2498/$ - see front matter r 2014 International Society for Heart and Lung Transplantation. All rights reserved. http://dx.doi.org/10.1016/j.healun.2014.07.006
1190
The Journal of Heart and Lung Transplantation, Vol 33, No 11, November 2014
Figure 2 Figure 1
ISHLT membership per year (1992–2014).
ISHLT meeting registration per year (1994–2014).3
Growth of the ISHLT and the annual meeting The annual meeting of the ISHLT has been our primary educational effort, serving multiple purposes. This has been achieved by development of visionary content and exchange of timely scientific discourse. Seeing a need to elevate core competency-based education, the ISHLT created an official mandate for a director for educational affairs to allow for integrative oversight and prospective development of the educational content beyond the traditional setting of the annual meetings. In 2010, ISHLT launched its Master Academy series, and its dramatic acceptance represented the starting point of core education as a central theme. Figures 1 and 2 show the vibrant growth of the ISHLT on a yearly basis since its inception. Peer interest can be expected to rise further along with the increasing demand for a multidisciplinary forum in the field of advanced heart and lung diseases. Dramatic advances and clinical application of circulatory support devices, the advent of regenerative medicine, and a plethora of therapeutic innovations in addition to solid-organ transplantation have provided continued impetus for ISHLT expansion. A receptive board of directors has allowed for the successful adaptation of a state-of-the-art approach to educational affairs to enhance the raison d’etre, as defined in the mission statement. ISHLT Mission Statement “The International Society for Heart and Lung Transplantation is a multidisciplinary, professional organization dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support and innovative therapies via research, education and advocacy.”
scientific forum was introduced in 2010. This concerted effort has since provided dedicated core competency courses (CCCs) and established a unique educational approach for developing experts in this professional realm. Competence in this setting is defined as “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served.”5 As such, competence is not an achievement per se, but rather a result of lifelong learning attitude.6 The ISHLT promotes this habituation of learning as part of expert development and the strategic plan was developed for the specific “learner” target groups. The ISHLT engaged in a deliberate curricular design process while selecting extracurricular educational contributions. The ultimate aim is to serve members and non-member professionals through advancement of proficiency and career development.7 The post-graduate expert development is promoted as a lifelong learning commitment. This is exemplified by the members providing the know-how and time to serve at the annual meeting and the Academy. An international “cadre” of professionals serve as voluntary faculty by providing formative education in addition to seminal science at the ISHLT. All educational endeavors are designed with overarching goals and defined learning objectives. Developed by small workforce groups within the ISHLT specialty councils, the process is guided by the director of educational affairs. A task force to ensure educational governance makes recommendations to the board of directors and assist in the continued expansion of the ISHLT Academy (Figure 3). Four hundred sixteen participants attended the latest installment of the ISHLT Academy for Mechanical Circulatory Support (MCS) in San Diego, just before the
The ISHLT Academy The concept for the ISHLT Academy was born out of the need for a more deliberate focus on post-graduate education for a range of developing experts in this field. The notion of a complementary learning pathway in addition to the
Figure 3 Combined attendance at ISHLT Academies, 2010– 2014 (includes CCCs and MCMs).
Wigfield and Mehra
Educational Affairs at ISHLT
annual meeting. The Academy consisted of both core competency and master class levels with approximately one third of attendees traveling in from 25 non-U.S. countries, exemplifying the international nature of ISHLT. Analysis of the participants’ backgrounds shows the heterogeneity of the target audience of these Academy contributions (Figure 4). A planned diversification of council-generated learning activities is now underway and will result in further representation of the membership interested and will provide multiple opportunities for interdisciplinary study.8
The strategic plan A strategic plan for ISHLT educational affairs was introduced in 2012.9 The high demand for post-graduate training in this realm and the heterogeneity of the target audience required a more concerted effort to provide a meaningful range of educational offerings at the ISHLT Academy. Responsive to identified gaps in professional development, key concepts were defined and core competency documents were utilized for each Academy contribution.9 Didactic refinements allowed for interactive delivery of contents.10 Deliberate programming of the CCCs allowed for sustainability of the educational provision. Complementary to the foundational nature of the CCCs, the more advanced dimensions of application and integration of expert learning and development were conceptualized in the master class modules (MCMs), introduced in 2014. Participation at the ISHLT Academy increased markedly within the 5 years of its inception and allows for subsequent attendance at the annual scientific meeting. Feedback mechanisms have led to identification of future refinement and afforded an overwhelmingly positive response to the ISHLT Academy contents and delivery. Among multiple “fringe benefits,” the extended opportunity for professional networking has been cited frequently.
Joint extracurricular educational events Beyond the boundaries of the ISHLT Academy, a range of international collaborations have allowed for focused engagement with other professional associations and societies with comparable areas of interest. The ISHLT primarily provides expert faculty and educational content development to enhance
1191 the educational experience and context of other national meetings or international venues. This, in turn, can provide recognition of the ISHLT’s leadership role in educational accomplishment. The joint extracurricular events are catered to target audiences less likely to attend the ISHLT Academy and annual meeting proceedings. A wide-range of joint efforts have been delivered over the last decade.
Self-directed learning at the ISHLT Several modalities were established to facilitate individual study and provide expert reviews of the various aspects of advanced heart and lung disease. The Journal of Heart and Lung Transplantation, the ISHLT monograph series, the guideline and consensus statements and new core competency documents are available through the ISHLT councils’ pages on the www.ishlt.org website. Currently, eight volumes of monographs have provided dedicated guidelines and exhaustive reviews of clinical subspecialties as well as historic context. Clinical guideline publications and consensus statements are published in this journal at various intervals and can be accessed at the ISHLT website. Core competency documents (CCDs), linked to www. ishlt.org, follow a structured approach to allow for comprehen sive self-directed study when required. These documents facilitate individual review and detailed clinical program assessment and improvement. The ISHLT has therefore provided state-of-the-art revision tools for expert development.
The Journal of Heart and Lung Transplantation Widely identified as the premier scientific voice of our field, JHLT has grown dramatically in the past 5 years. Cardiothoracic transplantation has remained steady while MCS and pulmonary hypertension have gained a greater footing in the journal. Over the past 5 years, the impact of the journal has continued to rise yearly and its top-tier status has become entrenched in the areas of cardiovascular medicine, respiratory medicine, transplantation and surgery. JHLT’s leadership is now evaluating ways in which to join with the educational affairs committee of the ISHLT and develop core educational content as a vital partner to consider assessment of core competency, developing video-based depictions of innovative surgical techniques, and providing young trainees and faculty a forum to publish state-of-the-art reviews that can serve as a “one-stop shop” in the distinct fields. Each year, JHLT is featured at the annual meeting in the form of a symposium where the top published content from the previous year is presented by early-career speakers and then discussed by seasoned senior leaders and experts in the field.
Future dimensions of education at the ISHLT
Figure 4 Professional backgrounds of participants at the MCMs and CCCs for nechanical circulatory support at the ISHLT Academy, San Diego, 2014.
In an era of striking inequities in health-care provision, postgraduate training worldwide may allow for a gradual improvement of outcomes in our field. The continuum of patient advocacy, vocational learning and care outcomes should become a template and effective source of expert development in the field of end-stage heart and lung disease and treatment.
1192
The Journal of Heart and Lung Transplantation, Vol 33, No 11, November 2014
Disclosure statement The authors have no conflicts of interest to disclose.
References 1. Stehlik J, Hosenpud JD, Edwards LB, et al. ISHLT International Registry for Heart and Lung Transplantation—Into the Fourth Decade, From Strength to Strength. J Heart Lung Transplant 2013;32:941-50. 2. Candy PC. Self-direction for lifelong learning: a comprehensive guide to theory and practice. San Francisco: Jossey-Bass; 1991. 3. Wigfield CH. ISHLT quick links: https://www.ishlt.org/ContentDocuments/ ISHLT_Education_White_Paper.pdf. Accessed April 15, 2014.
4. Gardiner L. What are the critical competencies? In: redesigning higher education: producing dramatic gains in student learning. 1994 ASHEERIC Higher Education Report 7. Washington, DC: George Washington University. 5. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002;287:226-35. 6. Leach DC. Competence is a habit. JAMA 2002;287:243-4. 7. Fink LD. Creating significant learning experiences. San Francisco, CA: Jossey-Bass/Wiley; 2003. 8. ISHLT Academy. https://www.ishlt.org/meetings/ishltAcademy.asp. Accessed April 15, 2014. 9. Diamond RM. Designing and assessing courses and curricula: a practical guide. San Francisco, CA: Jossey-Bass; 1998. 10. ISHLT publications. https://www.ishlt.org/publications/monographSeries. asp. Accessed April 15, 2014.
