Dr. Alex Johnson is a Speech Language Pathologist and the Provost at the Massachusetts General Hospital Institute of Health Professions. MGHIHP is an independent, but affiliated, higher education institution that offers degrees in nursing, speech pathology, Physical Therapy, and many more health professions. As such it has long embraced the blend of classroom-based teaching and experiential learning that characterizes most of medical field training. This conversation reviews that effort at integration for broad lessons learned for all of higher education. It begins with a discussion of Dr. Johnson’s own history as a student and early administration positions. It continues with a focus on experiences with simulations that work in the current virtual educational environment, resulting from the pandemic but that likely will continue as part of a growing trend. We note that Dr. Johnson was President of the large American Speech-Language Association and that he received its highest honors in 2013 for contribution to the field. His current research interests and publications range from medical speech-pathology to higher education itself and they include two co-edited textbooks.
Topics discussed in this episode include:
Resources Discussed in this Episode:
Music Credits: C’est La Vie by Derek Clegg
ExperiencED Season 3, Episode 3
Jim Stellar: [00:00:00] welcome to the experience ed podcast. I am Jim stellar.
Mary Churchill: [00:00:12] I am Mary Churchill
Adrienne Dooley: [00:00:13] and I'm Adrian Dooley.
Jim Stellar: [00:00:15] We bring you this podcast on experiential education
Adrienne Dooley: [00:00:20] from around the country and the world.
[00:00:23] Dr. Alex Johnson has served as provost at the MGH Institute since 2008. And prior to that served as a department chair and founding director of a large clinical program in a major Detroit teaching hospital at the MGH Institute, Alex oversees graduate programs and many different health professions, as well as PhD and research programs and clinical experiences for 1600 graduate students.
[00:00:50] Johnson's academic interests have focused on medical speech, language pathology, and neurologic communication disorders. Instead, he has been involved in the development of widely used outcome measures and voice and swallowing disorders. Recently his interest has turned to interprofessional issues and leadership across health and professions.
[00:01:09] In 2006, Johnson served as the president of the American speech language hearing association. A focus of current projects and teaching centers on interprofessional collaboration as a mitigating factor in reducing errors and healthcare. He has received awards from several professional associations and is a distinguished scholar and the national academies of practice.
[00:01:31] Dr. Johnson. It is a pleasure to have you on with us today, especially since I'm a practicing speech and language pathologist trained at Northeastern. And you have a doctorate in speech pathology from case Western reserve and teach at MGH Institute of Health Professions in Boston.
[00:01:51] Can you tell us what originally attracted you to this field? Was it the patients and how you're affected by our fields real strong experiential hands-on component or something else?
]Alex Johnson: [00:02:00] Well, I'm going to be very honest. It was not the hands-on component. And this is going to reveal something about my age and I won't make it a long story, but just a very quick story.
[00:02:12] In 1970, I was a freshmen at Kent State University in Ohio. And that may not ring a bell with you, but Kent state in 1970 was the place where the national guard came on campus and shot students. And there were all kinds of demonstrations and so forth. And at the time I was a freshman and I was majoring in journalism and the school closed because of the shootings and they sent us home.
[00:02:42] And when we came back the next fall, we all had a faculty advisor who took us under their wing to kind of talk to us about how we were coping with the shootings. And you can think of, this was kind of the early version of grief counseling and so forth that we see not so much now as school shootings have increased.
[00:03:01] Anyway my advisor happened to be for this experience happened to be this wonderful guy by the name of Dr. Bill … somebody. All right, I'll come back to it at a minute and think of him. And he was phenomenal and he happened to be the chair of the Speech and Hearing department at Kent State.
[00:03:25] And he was saying, you know, you don't seem very committed to this major. What could you do? Could you come down to the clinic sometime and meet with me and I'll show you around? And he did, and I changed my major and never left. So that was the story that came out of that. That's how I got into it.
[00:03:43] I literally stumbled into it because somebody was nice to me at that particular moment in time.
Adrienne Dooley: [00:03:49] I mean, I think that's a great story. And I think so many college kids are waiting for a moment like that to happen to them as well. And that pushes them in one direction or another.
Alex Johnson: [00:04:00] Yeah, it was a very interesting time.
Adrienne Dooley: [00:04:04] I mean the whole reason I ended up in speech and language pathology was I. I knew I was a good communicator. I loved communication and I was a communication major. And then my parents were like, Is that really specific enough? And then I found speech and language pathology and put all those things that I thought I was good at until one career path.
[00:04:26]. And that was only after doing a couple of co-ops and other media communications PR sort of jobs and realizing those jobs are not for me. And it was all thanks to that experience before I even graduated college, that helped me kind of redirect my path a little bit.
Alex Johnson: [00:04:50] That professor was Dr. Bill Weidner. And I kept up with him off and on over my whole career. And he was just a wonderful person, a wonderful mentor, and really inspired me over the course of my undergraduate and master's programs there.
Adrienne Dooley: [00:05:13] Yeah. And those mentors, as we know, through the experiential education aspect, are so important. They can change students' lives.
[00:05:19] So. After your period of process, you went into an academic departmental leadership position in Detroit. Can you tell us what attracted you there and how did you handle the experiential programs on the programmatic training side of things?
Alex Johnson: [00:05:37] Yeah. So after I finished my PhD at case Western I worked in the hearing and speech center at case Western reserve university for a couple of years.
[00:05:47] And then this wonderful opportunity presented itself at Henry Ford hospital in Detroit. Where else would Henry Ford hospital be? A wonderful big urban hospital. And it just turned out that the They were just ready to start a new speech language pathology program in the department of neurology.
[00:06:10] And it was, it was a remarkable experience to be able to go into an academic medical center and launch this new program and hire a lot of great people. And one of the things that we did from the very start was to say. This is such an interesting place with so much going on. We need to make sure that we have a strong educational component as part of this.
[00:06:33] And so we partnered with. The local university Wayne State University, which was right down the street, and developed an observation experience and a very early hands-on experience for graduate students in that program. But then we decided we wanted to go a little bit more in-depth and we then added on a two year clinical fellowship, which was a very interesting thing at the time because the field only requires a year-long fellowship postmasters.
[00:07:01] But we decided that for medical speech pathology, it was pretty complicated and so many people want it to do it. And so we really designed this very interesting hands-on experience for individuals a year to come after they had finished their master's degree and spent two years with us, really developing competencies across the major areas of adult medical speech pathology.
[00:07:34] That was a great experience and that program still goes on today.
Adrienne Dooley: [00:07:37] That sounds like an incredible program. And one that I think it's so necessary to our field. Had you worked in different types of settings previously that you felt contributed to your decisions and moving forward and making an impact?
Alex Johnson: [00:07:55] Yeah. Right out of undergraduate school, and this again will tell you a little bit about my age. Right out of undergraduate school, I had a job in a public school as a speech and language pathologist and working with elementary school children with all kinds of speech and language problems.
[00:08:18] And at the time, it was obvious to most people in our field (It was not obvious to people in education or to society at large.) that communication difficulties have a major impact on academic performance. And so it was really fun to work in that area and develop a very strong interest in language, particularly the area of language words, symbols, syntax, comprehension the way people use language socially, et cetera.
[00:08:52] And so that's what I took with me to my master's program, and my PhD program and it was really that interest and that morphed into a very strong interest in adult language disorders. And for listeners who don't know all the lexicon of speech, language pathology these are people who've had strokes or a traumatic brain injury that's affected their ability to communicate.
[00:09:15] So I had a lot of that experience over the course of my education. And then in some clinical work before I went into this other new role at Henry Ford hospital.
Adrienne Dooley: [00:09:27] And that brings us to now as Provost, which is the chief academic officer at MGH IHP, (It's a mouthful.) you oversee the entire school academic programs. Right. So first, can you tell us something about the school and mention a few of the programs you run?
Alex Johnson: [00:09:48] Sure. Well just. As a matter of explanation, the MGH Institute of health professions is a very unique school. It's just over 40 years old and was started by the Massachusetts general hospital with a desire to develop an interprofessional focused school, graduate school of health professions.
[00:10:12] And it started out with a program in nursing and in physical therapy at it speech pathology, and then many others along the way. But it's a very interesting environment compared to most graduate programs in our field of speech-language pathology that are housed in big universities. And this is a very small, about 1600 student, graduate school.
[00:10:36] It's only post bachelor's students. Students all have at least a bachelor's degree. And it is all focused on the various health professions. And some of those include nursing, which of course is a big one. This was one of the first schools to prepare nurse practitioners in the country.
[00:10:55] So those are nurses who have a master's degree to deliver primary care and other health services, physician assistant studies, speech language pathology, physical therapy, occupational therapy, genetic counseling. We have a PhD program in rehabilitation sciences. I'm sure I'm forgetting somebody.
[00:11:15] Oh, well we have a very interesting masters and PhD program in health professions education. So it really is a portfolio of programs that span healthcare and there will be more to come very soon.
Adrienne Dooley: [00:11:28] Yeah. And so how has the experiential learning aspect of it different across different professions and the healthcare arena? Have you noticed some trends or big differences?
Alex Johnson: [00:11:41] Well for, for one thing, it is to say that this whole broad area of experiential learning, which is in my experience in many universities, a nice option that's added on to undergraduate experiences in learning about a field or a discipline or work or some other focus that students are needing real world experience.
[00:12:08] And you look at programs like you went to at Northeastern which is designed around an experiential learning model, but that's pretty unusual. Contrast that with the health professions. Across, whether it's medicine nursing, all of the health professions have to have a hands-on practical component.
[00:12:30] And so while everyone probably because of media TV, et cetera, knows that sort of what the model is for educating physicians of internships and residencies and fellowships, et cetera. The variations in practice-based learning that occur for health professionals that are not physicians is probably less better understood.
[00:12:54] And part of the confusion comes because they all look very different. And so for example, some programs require extensive periods of observation before they have any hands-on experience. Others require more hands-on experience. Some require face to face and measure contact (This is true in speech language pathology), where minutes and hours of patient contact are the coin of the realm. Where in other fields like physical therapy, it may be how many weeks, .r how many 40 hour weeks did you spend with this experience?
[00:13:33] So the variations are all of those, but in reality, they all whittle down to some heavy didactic learning experience to prepare students, and then an equally heavy dose of exposure to patients in different settings, with different health conditions et cetera, that allow individuals in that profession to get the experience they need to enter practice.
Adrienne Dooley: [00:14:10] Absolutely. Our profession requires that to be a licensed practitioner. One must be trained in the clinic as well as the classroom. It's really important. And I'm sure you've seen that as a leader in the field and pushing those programs forward. We see a shift occurring in America toward more value placed on the skills one has personally, as well as academic knowledge. How does this impact MGH IHP? What are the different types of learning experiences for different types of learners?
Alex Johnson: [00:14:44] It's very interesting. You know, we're recording this during this time of COVID this pandemic, which has driven significant innovation in clinical education.
[00:14:57] As I mentioned, we have 1600 students. Probably on any given day, we have seven or 800 who are in some field experience somewhere. And again, they vary by time and what those experiences look like. So if you can imagine on March 9th the world shut down. And many health centers and hospitals and public schools and other places, community centers, other places where all of our students across our professions went said, we really can't take students right now.
[00:15:33] Either we're shutting down ourselves, or we need to protect the students and protect the patients and not have any extra people coming in and out of that setting because of exposure to COVID. And so very quickly we pivoted to expanding our experiences in tele-health, meaning communication with patients via just the way that we are now over a computer.
[00:15:57] And of course, anyone in the U.S. knows that much of the medical care right now being delivered, the non-urgent care especially, is being delivered through telepractice or telehealth. It's very, very common. And so in all of our fields, we have students who have taken that on. We've also expanded greatly the experience that of our students, hands-on experience, that our students have with what are called standardized patients or actors.
[00:16:27] And so you could imagine that a person who's learning to become a psychiatric nurse practitioner could also could get experienced in a psychiatric mental health setting. But if you wanted them to learn a lot about depression, you can train actors to come in and interact with those students and to actually design the scenario, the experience that occurs, so the students are actually learning very specific competencies that need to be developed.
[00:16:54] So how do you deal with a patient who is angry or how do you deal with a patient who interrupts all the time - all of those very specific skills that are very important to that particular discipline?
Adrienne Dooley: [00:17:10] Wow. I have to say that's a unique solution that I wouldn't have considered an option, but could be so beneficial because you can really have a lot of control about what the students are experiencing and focusing on that time, instead of trying to, you know, get out there and get this experience, and you have patients that are behaving sort of in one way, and you were hoping to get experience in another way. Bringing in those actors really gives you a lot of control in the learning process. That's very interesting.
Alex Johnson: [00:17:42] So these actors, these standardized patients have been used extensively in medicine, in nursing, more recently in physical therapy, but now we're extending it to literally all of our disciplines.
[00:17:55] So just to toss it back to speech pathology for a second, because that's what we're interested in, it's very difficult to have someone come in and imitate a speech disorder in a realistic way. However if you think about it what does the speech pathologist do? Well, they're working with children.
[00:18:14] They have to interview parents. They have to spend a lot of time getting the history. They have to talk to referral sources. So training the actors to do some of those roles, to be delivering the experience in those roles, really does do exactly what you're saying. That is to say, okay, here's a mother who has a child with a severe communication disorder, but she doesn't speak English and she has to use an interpreter.
[00:18:42] And so that's a very challenging situation for a student. And what a great thing to learn. Right? Cause they're all going to have to be able to do that. So those are some of the scenarios that are, and now there are dozens, probably hundreds of them that our students are using. And it's a great experience.
Adrienne Dooley: [00:19:01] That does sound like an incredible experience. I almost wish I could be a part of that, just because I think it's so unique and a great way to get a lot out of your education. I mean, that's what you're there for. So if you want to be the best at what you do, opportunities like that are so helpful. You know where do you think the future is going for your program and this post pandemic world that we're predicting?
Alex Johnson: [00:19:27] Well, we can't wait right till we're in the post pandemic world. Because this is a very hard time. In higher education, a very hard time in health professions education.
[00:19:39] So we can't wait until we get beyond it, but I think we've learned so much about education by having it disrupted through this horrible hurricane that we're living through. And it's forced a level of innovation that I'm sure this is not just an our program (I'm sure it's in many programs.), where a lot of these new modalities for teaching are going to be developed in such a way that they actually become part of the curriculum.
[00:20:08] So they're not just a band aid for today, but even after COVID, we will still be using it.
Adrienne Dooley: [00:20:15] Yeah. You see them becoming a permanent solution.
Alex Johnson: [00:20:18] Yes. Yeah. One, just one quick example of something we're experimenting with right now. We're working with an organization called the center for medical simulation, which is just a remarkable set of resources who do research and training in the area of simulation.
[00:20:38] And we're working with them. To take a set of experiences that we've identified for nurse practitioners, students and physician assistant students, and for each type of experience to build competencies into it so that the students will do these experiences before they actually go to a real clinical placement.
[00:20:58] And the idea is by the time they go to the real clinical placement, and let's just take a psychiatry, mental health, for a second, they will have had practice with actors and other using other technologies for interacting with people with different types of mental health conditions and experiencing some of the challenges and problems that come up in those situations before they ever have to go into the hospital or the clinic to deal with that.
[00:21:27] And of course this has great been a great learning benefit to the student, but on the other side, it also makes that student a very attractive candidate for practicum because people who work in these clinics and hospitals are so busy that taking a student that's going to require a lot of explanation and early development is a big challenge.
[00:21:50] And so if we can cut some of that time and effort for the person who's accepting the student. It's a great thing.
Adrienne Dooley: [00:21:58] I couldn't agree more. I know that if we're sending our students that still are in their programs out in their competitive candidates for the best positions, you know, hospitals and schools, they really want to see that.
[00:22:13] And now being on the other side of it, even though grad school is getting further and further in the past, I feel like it was yesterday. But I haven't had the opportunity to have my own grad student, but my friends in the field that have. I mean, there's competition, they want the best students that are going to step up and sometimes even bring something new to the table - not just there to learn, but hey, I learned this in class and you want to market your students to the best positions because those could be, you know, their future jobs.
Alex Johnson: [00:22:44] Exactly. So it works both ways. Yes, we want great people with great clinical experience and some teaching skills to take our students. And we want to support them in that. And on the other hand, you're right. We also want the student to deliver some value to this experience which we hear about all the time.
[00:23:02] And of course, in the health fields. And I don't know if this is true in all the other fields that you all are interested in experiential learning, but in the health fields, I would guess that 40% of all of our students end up with a job that they wanted. Out of that, some aspect of their clinical experience, of one of those placements, the light bulb it came on and they said, wow, I really like working with people in the hospital.
[00:23:31] Or I really liked little children or outpatient clinics with young families, et cetera. And because that's where they shine. The person says, hey, we're looking for someone you should apply for this job after you graduate. And so it's not unusual at all to hear those stories over and over.
Adrienne Dooley: [00:23:52] Yeah. Well, thank you so much for spending this time with us today. Before I let you go, is there anything else that you'd like to add?
Alex Johnson: [00:24:02] I just think that it's a wonderful opportunity to sort of reframe, to bring these two concepts of experiential learning as it's been discussed in higher Ed as a focused experience tied to a career, to a different kind of experiential learning, which is very focused - competency, goal directed, real-world experience. There's probably much room for more of this conversation and learning from each other. So for me, this is a great conversation and I appreciate all that you are doing.
Adrienne Dooley: [00:24:37] Well, thank you so much. Absolutely. You know, it was wonderful. You brought some points to my attention that I feel like, I should, should've put that all together. But you have such an eloquent way of putting it in and making some great examples that really have me thinking about different aspects of experiential learning that I hadn't considered before. So I appreciate you sharing that with us and taking the time. This was such an incredible conversation to have, because it's my field and this is where I'm passionate and it was, it was, I appreciate you sharing your insight.
Alex Johnson: Come visit us at the MGHIHP.
Adrienne Dooley: You know, now I'm really intrigued. I'm really intrigued. I've heard amazing things about the program of course. And you are very lucky to be a part of it.
Alex Johnson: I'm so fortunate.
Adrienne Dooley: All right. Well, thank you so much.
Alex Johnson: Thank you so much.
Adrienne Dooley: Have a great evening Dr. Johnson, and hopefully you'll come back and visit us on the podcast sometime soon.
Alex Johnson: I hope so. Thanks.
Mary Churchill: Thank you for listening. We hope you will come back soon for the next installation of ExperiencED,
Adrienne Dooley: as we continue to talk about the neuroscience and sociology of enhancing higher education
Jim Stellar: by combining direct experience with classical academic learning.