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Interview with Ryan Palmer, Ed.D. from AMOpportunities on Completing his Ed.D. Dissertation from Portland State University

About Ryan Palmer, Ed.D., M.F.A.: Ryan Palmer Head of Clinical Partnerships for AMOpportunities (AMO), a clinical training organization that supports clinical students and schools with clinical training opportunities. In this role, Dr. Palmer establishes partnerships with healthcare institutions in order to create clinical training offerings for domestic and international clinical education learners. Prior to his role as Head of Clinical Partnerships, Dr. Palmer was a Principal for Kennedy & Company Education Strategies, an agency that specializes in higher education solutions design and implementation.

Dr. Palmer has an extensive background in medical education leadership, having served as Associate Dean of Medical Education for Northeast Ohio Medical University, and as Director of Education for the Oregon Health & Science University (OHSU) Department of Family Medicine. He earned his B.A. in Theatre Arts from California State University, Chico, his M.F.A. in Acting from DePaul University, and his Ed.D. in Higher Education Leadership from Portland State University.

Interview Questions

[] May we have an overview of your professional background and current role as Head of Clinical Education Partnerships for AMOpportunities?

[Dr. Ryan Palmer] AMOpportunities focuses on pairing students with clinical rotations. AMO started with international medical students and now it’s expanded to also include domestic clinical training students and schools across the nation. As Head of Clinical Partnerships, I work with clinical systems (hospitals, clinics, physician groups, etc.) to help build their workforce pipeline by hosting clinical learner rotations. I work with these healthcare systems to try to build clinical capacities for learners.

Clinical students have to do rotations with clinicians in family medicine, pediatrics, and other specialties. AMO manages the whole process, enabling individuals to search and apply for clinical rotations and allowing institutions to manage the clinical rotations and training process through one platform. For this role, I leverage a lot of my medical education background. Prior to this role, I was at Kennedy & Company Education Strategies, where I created their medical education services department.

[] Why did you decide to pursue an Ed.D. in Higher Education Leadership from Portland State University? What were your career goals and how did you see the EdD as helping you to achieve these goals?

[Dr. Ryan Palmer] When I was at Oregon Health and Science University (OHSU), I went in with a Master’s of Fine Arts in Acting, of all things. At OHSU, I started out as a staff member helping to administer a course for first- and second-year medical students. I wanted to advance in my position in higher ed, and people said I needed to get a doctorate if I wanted to move up in higher education. So, I decided to get my doctorate.

Once you get into higher education, your credentials really determine your ability to move into different positions. I had topped out at the master’s level, and I really wanted to make a career move. I wanted the keys to the higher-level administrative positions. For that, I really needed a terminal degree, so I decided to pursue a doctoral degree for career advancement. Portland State University had an EdD program and was just down the hill from where I was working. OHSU helped pay for some of the costs. Portland State was willing to admit me, even though I didn’t have an academic background in education leadership, because of my education work at OHSU.

I thought I would get a job as an administrator. But then there was an opportunity where I was asked to come on as a faculty member in OHSU’s Department of Family Medicine, which is how I got that job.

In many instances, physician educators have the clinical knowledge, but they don’t have formal education training. My job in working with clinician educators has always been to partner with them to help create the context and structure for medical students to learn better. I’ve always worked very closely and well with physicians. We create these great educational offerings and doctors can infuse it with their clinical knowledge.

[] Could you elaborate a bit more on that process of how you create a platform for the doctors? How do you work with doctors to help translate their knowledge into something that is digestible and also structured well for students?

[Dr. Ryan Palmer] Some of it comes down to basics, like expectations of the student and what their deliverables are, that physicians with no formal education training experience don’t necessarily inherently understand. I certainly don’t want it to come off like I’m critical of their work. It’s just that for some clinicians, it is a challenge to put together an educational offering that is well laid out. I ask them, “How can you organize this content in a way that best helps the students meet the learning objectives?”

I frequently work with physicians to frame their educational offerings, which often have a ton of complex information. Oftentimes the education design process necessitates asking key questions, narrowing the scope. I will ask physicians, “What are you trying to teach about this topic?” Let’s create learning objectives around that and focus the session on those objectives. I really made my mark by helping physicians make their educational sessions interactive rather than a static lecture. For instance, let’s give the students a case study because it is a hands-on activity.

When designing an educational offering with a clinician, I establish structure and content parameters. For example, I’ll write the simulation up and I’ll leave blank parts for doctors to add drug names and information about drug interactions. I consult and help people write educational content in addition to writing content myself. I’ve become increasingly involved in writing. I wrote one of the first tele-med simulations, called the TeleOSCE, which is now widely used in clinical and residency trainings, and is referenced in numerous scholarly works. My current work builds upon that past experience.

[] Your dissertation is entitled Exploring Online Community Among Rural Medical Education Students: A Case Study. Could you elaborate on how you decided upon this specific topic, and what your central research questions were?

[Dr. Ryan Palmer] At OHSU I developed a reputation for innovative ways of using technology around education. There was one physician who ran an organization called an Area Health Education Center (AHEC). AHECs basically help bring healthcare access to underserved populations by building workforce pipeline to serve them.

There was an AHEC in Oregon, and this physician, Lisa Dodson, was the Director. She had a grant to create a program for learners who were interested in rural medicine, which is an underserved population in Oregon. These learners would go on extended rotations in rural areas, with the theory being that the longer they stayed there, the more affinity they would have towards those communities and maybe they would go back and practice there.

There were a couple of technical problems she had in delivering the curriculum to these learners, and we had to find a way at the time to replicate some curricular elements that required live interaction in real time over the Internet, which is crazy to think about now since we have Zoom. But at the time in 2010, there weren’t many technologies that were very good at synchronous, online group discussion and collaboration. She got some of my time through her grant to come and help her. I figured out how to do this program with interactive case studies despite using cheap netbook computers and getting wi-fi on mobile hotspot devices, which was some of the only reliable internet in some of the rural communities students were in.

At the time I was also enrolled at Portland State. My doctorate was a very pragmatic program. They were constantly telling us to use what we were doing in our jobs for our doctoral work. I was noticing so many cool things happening in these online interactive sessions for the medical students on their rural rotations. We were using something at the time called Adobe Connect, which was complex and a bit clunky but also really robust. Real-time, interactive online education was just a space that not too many people were playing in. Almost all online courses at that point were asynchronous, with students maybe posting on discussion boards but otherwise completing lectures or modules without real-time discussions. Nobody was really doing the video back and forth. So, I decided that I was going to figure out how to study this learning environment for my dissertation because I thought this was a novel way to deliver education in a synchronous online space. That’s how I got into my specific research question that combined interactive online learning with a rural medical context.

I knew I was interested in technology, online education, and better ways of delivering education to learners. I always believed you don’t need to physically be present in order to be engaged. I was basically doing these interactive online sessions, and I thought this could be an innovative way to help get more people interested in a topic and to deliver better experiences to learners in rural areas. I had this desire and mission to get more people interested in practicing in super remote regions. Some of these communities have only one doctor for every county, so many of these people who live out there have poor access to healthcare. I wanted to understand how online learning communities could enhance rural medical students’ quality of life and sense of connection.

I discovered a lot of literature around online learning spaces and community building. My dissertation focused on rural physicians who face a huge challenge in that they are often professionally isolated. They don’t have opportunities to have these communities of practice with each other that they would normally have in more populous areas. Online, interactive learning is one way to help enhance community among dispersed learners who are in isolated regions. For example, you could go out to a remote area where you’re the only physician and feel professionally isolated, but if there’s a way to meaningfully come together with colleagues from other areas in this online space, then it could help you feel more connected to your peers.

If we can teach medical students how to create an online community as learners, then maybe they can go back and create communities as practitioners. For example, they can be the only doctor in a remote area, but they meet every Tuesday night with a group of colleagues and share information. They feel connected professionally and don’t feel so isolated. Isolation is one reason doctors don’t practice, or persist in practice, in remote areas. My dissertation converged all my interests with what I was frankly doing at the time. I was studying my work, which is really important.

[] Could you take us through the steps of your research process, from the design of the research study to the collection and analysis of qualitative and/or quantitative data? What were the key findings of your research, and how have you applied the insights from your dissertation research to your current work?

[Dr. Ryan Palmer] I specifically studied the online, interactive activity the rural med students were doing called student clinical rounds. I made it a very specific, intrinsic case study, so all my research was qualitative–part of that was a necessity because I’m less drawn to doing quantitative research. When forming my research question, it was almost like the form followed the function. I applied the theories I read about in literature to this issue. Then I figured out questions I wanted to ask and how to study the topic. A lot of it was about knowing what I wanted to look for. Then I conducted an in-depth literature review and found different frameworks, such as a framework called Community of Inquiry (CoI). This framework was a game changer because it was the way to measure a sense of community in online, mainly asynchronous spaces.

The scholars who developed CoI were looking at all the chat boards in an online course, and they created this body of literature around it. They had a really detailed coding system, which I decided to apply to the interactive sessions I was studying, which ran for an hour and a half on Adobe Connect. I could record to the cloud and drop it into NVivo qualitative research software; and then I could code it and see what happened over time. This was how I identified my research method.

I then triangulated the data. I did some interviews with the students and took some field notes to help answer my research questions. A few of my research questions were focused on the impact of this unique brand of synchronous online education on a group of rural learners. The intrinsic case study can be very specific because there was no literature around it.

In my research, I found that these individuals’ sense of community basically grew. I found that the shift went from focusing on working on the project in the beginning to becoming focused on their online community. They were moving away from just focusing on the task at hand and much more towards interacting with each other.

The literature showed that you can create virtual communities of practice. I actually observed this happening where a group of students taking a course became a community of practice. They were chatting, and everyone was sharing knowledge, not just the physician who was the most knowledgeable person there. So, a student who was using this activity as a way to satisfy their course requirements is now generating and gaining new knowledge in this community of practice.

This was a eureka moment. If you create the right context for this, you can create potential communities of practice in synchronous, online spaces. It reduced feelings of isolation amongst the students who did this activity, increased their sense of community amongst each other, and then actually positively influenced their ideas around going into rural practice. I essentially created a theory out of it, which I have applied to other work. I think this is one of those things that if it was applied more, there might be better ways of engaging people even now. The theory that came out of this dissertation can actually be applied at scale.

[] How has your research positively influenced other education leaders in understanding how to build supportive and dynamic online communities in rural medical education settings?

[Dr. Ryan Palmer] A colleague of mine was asked to go down to American University of the Caribbean (AUC) in Saint Maarten to do an analysis of the evaluation process at their school, and they needed somebody who understood the clinical part of education. My colleague invited me to participate based on my work in clinical medical education. So, I went down with her and we interviewed a lot of students. The Caribbean education model is one where you’re on the island campus for two years and then you travel all over the US and some international locations to do your clinical experiences. Many of these students reported feeling a sense of isolation due to being away from their peer community that had a detrimental impact in their educational experiences.

I told the AUC Dean at the time about the theory from my research where if you could bring these students together in groups in a synchronous, online space and have them go through certain types of activities, you might create a better sense of community, and they could have a better educational experience as they would feel more connected to their peers like they were on campus. The Dean said, “Let’s do it.” She hired me to basically take my theory and scale it.

I created this thing called the Transition to Clinical Medicine (TCM) program, where essentially at AUC, instead of students just being on their own for their third year, we organized every single student into a cohort of ten to 15 and then they came together online on a regular basis. They had to come together to do activities, such as case presentations. We hired AUC graduates who were off cycle in applying to their residency programs to facilitate the cohorts. I helped to create the whole program, worked with their staff, and trained the facilitators to pull it all together and basically scaled the theory that was based on my dissertation. The program worked and they’re still doing it. The program started almost eight years ago. I think it will continue given the way that online communities and learning communities have evolved since then.

Although people are much more used to meeting in synchronous online spaces now, I still don’t think online communities are being utilized deliberately enough. Are people being very intentional when they bring learners together in an online space? What are you having people do? Are people really thinking about optimizing learners’ sense of connectedness? A lot of the stuff that went to Zoom in the pandemic was simply broadcasting lectures and having awkward discussions. I still don’t think people are being deliberate enough with the medium, which is essentially cultivating synchronous online spaces and leveraging the power of it to create robust learning.

Few institutions learned this lesson in the pandemic. There are some schools that have done online education very well like Arizona State and Western Governors, but most institutions didn’t take the opportunity to reflect on how they are delivering content and what do they actually physically need students to be on campus for. While there is benefit to being on-campus, what can the institution do online and how can they do it in a way that maximizes learning? I think people defaulted back to what they think “works” in a classroom, which is lectures and on campus attendance.

Studying this interactive online space for my dissertation really helped me realize what you can do well online, and what the boundaries are and how far you can push them. For example, around the time of my graduation from my doctorate program, the same group of students from OHSU on rural rotations were coming together to discuss case presentations, as that was a requirement of the curriculum and for accreditation. And I noticed that the online students were missing out on one key part of the clinical rotations experience that their on-campus peers had.

The students on campus had a clinical simulation where they go in with a simulated patient and diagnose them. And I thought, why can’t we use this in our online students’ clinical rotations? Why do we have to deny our online students who are out there, if we’re doing these case presentations successfully? Why don’t we create a clinical scenario for them too? I know we can do an interactive one based on this technology. The scenario also made sense, as it emulates what you’d experience if you’re in a telemedicine consult. In our design of the clinical simulation, we integrated the concepts that were inherent to rural medicine, such as the patient didn’t want to drive two hours to the doctor’s office or didn’t have a drug store in their town.

I called this virtual simulation the TeleOSCE. It was really popular, and it worked. Students loved it. I wrote more on the students’ experiences and the results, and then the family medicine rotation in Portland integrated it for students who were on campus, so students walked into a room and there was a patient on the screen. After I published a bunch on it, it became my career path. When the pandemic happened, medical schools realized that they have to do clinical training virtually, and people really discovered my work.

My cases are all up on the Association of American Medical Colleges (AAMC)’s website, and I’m still doing consulting work based on these experiences. As part of my consulting work, I have helped build a whole curriculum for the University of Oklahoma in Tulsa and we have published several papers and done several presentations on it.

[] Where do you see yourself taking all of this knowledge about interactive online spaces and its relevance to medical pedagogy and community building in the next 10 years? Where do you see the higher education space going as well during this time?

[Dr. Ryan Palmer] I increasingly believe that the answers are not necessarily only going to come from inside the higher education field. In fact, I find it increasingly difficult to believe higher education will internally solve its inherent problems. I think you are going to get more ideas and solutions from outside of higher ed.

It’s not a corporatization of higher education or a takeover. I just think during the pandemic you saw lots of online resources get unprecedented attention. For instance, medical students use online resources all the time to get key information. They also go to medical school to get clinical experiences. The apprenticeship model wherein a medical student works directly with a physician in treating patients is something that you cannot easily replicate online.

As a result, I think that educational tasks that require information transfer will transition to the online space, while the interactive educational elements will morph into a hybrid of in-person experiences and online simulations. I think the confluence of the private/for-profit and public/nonprofit will blend more and people can pick and choose. Do you need to pay all this money to go to this institution, just to sit in an empty lecture hall? Or can you do it better by getting third-party resources and leveraging those resources effectively in a way that brings the cost down for the learner? This is talking more about the future of higher education in general, not just medical education.

So to me, where is it going to go? Where am I going to go? I personally feel like I’m going to ride the wave. I have an improvisational approach to my career that comes from my acting training, because in improv you don’t go in with an idea in your head of how something is going to turn out, but there are clear rules that you’re following. And so long as you follow those rules, magic happens, right?

I feel like I’m making a difference. I’m bringing novel solutions to real world problems. Whether it continues to take me into the private sector or back into the traditional higher education, non-profit settings–I don’t know, and I’m happy, as long as I’m moving forward.

I found that the path I was on was involving less of the work that I felt was important, which was rolling up my sleeves and solving problems. So I made some career shifts and now I’m back to where I started when my dissertation was happening—creatively solving problems again.

So getting back to your question, experience has taught me that I’d be a fool to tell you where I will end up. As long as I’m moving forward and making a positive difference in ten years, I’m happy. Wherever I am, I’ll be happy, so long as I still feel I’m still making a positive impact in the world.

Thank you, Dr. Ryan Palmer, for your fascinating insight into online community building in the medical education space, and for discussion of your dissertation research and its relevance to higher education!