Dr. Shelley Howk has been a family physician in full-time clinical practice for 25 years, subsequently transitioning to full-time medical regulation at CPSA for over 6 years. Throughout her career, she has been passionately involved with CME, clinical teaching and mentoring students, clerks, residents, and colleagues in all stages and phases of their professional development. Dr. Howk is currently active in the Cummings School of Medicine PGME and CME/PD Departments, as well as in educational physician support with the Alberta Medical Association ACTT Physician Leads program.
Q: Let’s talk about your role as a residency facilitator trainer. How did you link up with FMPE, and how did that evolve?
I spent 25 years in clinical practice and became involved with teaching students and residents in 1999, focusing primarily on clinical instruction. About a dozen years ago, I trained as a small-group facilitator for residents, which evolved into a coordinator role at the University of Calgary’s Cumming School of Medicine. This role involves selecting modules and training future facilitators, including first-year residents, to mentor second-years in a peer-based learning model. Faculty members also attend these sessions, helping residents develop facilitation skills for their future practices.
I believe we often don’t recognize what we don’t know, and isolation in medicine can exacerbate this issue. Despite advancements in communication technology, physicians often work in silos, limiting opportunities for collaborative learning. This isolation increases the challenge of identifying knowledge gaps without fear of judgment.
During my time at the College of Physicians and Surgeons of Alberta, I saw how learning environments shaped physicians’ ability to absorb new information. If education is perceived as punitive, defences increase, making learning difficult. This applies to everyone, from first-year students to seasoned practitioners. An environment that encourages curiosity and open discussion is essential.
Q: What challenges do residents face in admitting uncertainty, and how do you address this in your training?
In conversations with family physicians, I’ve observed that nonjudgmental group learning settings allow them to admit uncertainty, discuss mistakes, and refine their approaches. Many residents, however, come from a medical school culture that prizes certainty, making it difficult for them to shift their mindset. Residency still requires passing exams and meeting rotation expectations, reinforcing the idea that admitting uncertainty feels risky. Yet, as they move into practice, it becomes clear that no one knows everything, and practicing physicians face the same difficulty.
Residents benefit from observing diverse approaches under different preceptors, which helps them question processes and adapt best practices. They are more technologically adept and can integrate new strategies into their workflows.
Q: How does the resident peer-learning model support continuous professional growth?
Medical training provides structured feedback, but in practice, that feedback can disappear. Initially, this may feel like a relief, but over time, the absence of structured evaluation can be a challenge. Physicians must actively seek out learning opportunities and supportive communities. The resident peer-learning model fosters this mindset early, creating a foundation for lifelong learning and collaboration. This sense of community is crucial for avoiding isolation and ensuring continuous professional growth.
Each month, residents participate in about one session, similar to many practicing communities. We strive to maintain consistent groups month-to-month, creating an ideal collaborative learning environment, even if there are programming challenges.
Though residents may not apply their skills immediately, I emphasize to new facilitators—who can also be faculty—that this training is a starting point. They will have the opportunity to meet monthly with resident colleagues over the next year to practice facilitation skills, which they can hopefully use in their future communities of practice. It’s essential for them to understand the distinction between facilitation and teaching. Facilitation is about learning together, while teaching implies imparting knowledge from one person to another. Our goal is to acknowledge that we all have gaps in knowledge and collaboratively explore those gaps.
Q: What does the training for facilitators entail, especially for those unfamiliar with group settings?
Our modules are structured to provide specific examples, though facilitators can adapt cases to fit discussion topics. Each module includes sample cases, information points, resources, and thought-provoking questions to guide the group through discussions rather than just seeking “correct” answers. During training, I focus on education and learning process, emphasizing why we engage in small groups instead of traditional lectures.
I facilitate discussions on how we learn, encouraging participants to share experiences and identify learning obstacles. It’s common for physicians to attend conferences based on perceived knowledge gaps, but self-selection can lead to missed growth opportunities. This reinforces the need for a safe environment where residents can share mistakes and learn from one another.
I typically choose modules that challenge residents or are outside their comfort zones, ensuring they engage with less familiar topics. The second half of the training allows participants to step into the facilitator role, guiding a mock group discussion. We explore challenges, such as managing dominant voices and creating a safe atmosphere for sharing.
After the mock facilitation, we debrief, allowing participants to reflect on their experiences. I provide constructive feedback, emphasizing their progress. We also discuss in-person versus virtual facilitation, acknowledging the unique challenges each format presents.
Q: How do you view the dynamic between younger residents and more senior colleagues during discussions?
Facilitators often face age and scope of practice differences in community groups, with younger residents leading discussions among more senior colleagues. However, I believe this can be an advantage. Each participant brings unique knowledge and experiences, fostering a rich learning environment. I encourage residents to leverage these diverse perspectives, reinforcing that learning is a two-way street.
The aim is to create a safe and effective learning environment where all participants feel valued. If individuals feel uncomfortable, they miss the opportunity to contribute and benefit from others’ knowledge. It’s vital to find a group where everyone feels at ease to foster meaningful discussions and shared learning.
Q: Is there anything else you want to add about the program or your experiences?
I believe this model is unique and effective for continuing professional development among physicians. It provides a structured environment that prevents individuals from floundering in their learning. The modules are continuously updated, ensuring participants access the latest information.
What sets this approach apart is the emphasis on discussion around the module content, which elevates the learning experience beyond mere memorization. Hearing real-life experiences from colleagues fosters a deeper understanding and retention of knowledge. Those conversations create lasting impressions, allowing important insights to resurface when faced with similar patient scenarios.
By sharing experiences and discussing challenges, participants can better recall valuable information and apply it in practice. This model not only enhances learning but also helps build a supportive community among physicians, ultimately improving patient care.