KeyLIME+

In this episode of KeyLIME+, Adam speaks with Dr. Gary Klein about how people make decisions in complex, high‑pressure environments. Drawing on decades of research, Gary describes how expert decision making often looks very different from the step‑by‑step models many of us were taught. The conversation explores what intuition really means in expert performance and how judgment develops over time. Gary emphasizes that experience alone is not enough, and that learning depends on how people reflect on their decisions, notice what they missed, and adapt their thinking. He also discusses the ShadowBox method as a practical way to make expert thinking visible and to support learning through comparison and self‑reflection, offering a clear window into how decisions are actually made in practice and what that might mean for how we prepare clinicians to think and act in real clinical settings. Episode Length: 34:26 Resources to check-out [42] La Concordance de Script et la Formation par Concordance : Des origines aux nouvelles applications Books Seeing what others don't Sources of Power: How people make decisions Kahneman D, Klein G. Conditions for intuitive expertise: a failure to disagree. Am Psychol. 2009 Sep;64(6):515-26. White, M. R., Braund, H., Howes, D., Egan, R., Gegenfurtner, A., van Merrienboer, J. J. G., & Szulewski, A. (2018). Getting Inside the Expert's Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations. Annals of Emergency Medicine, 72(3), 289-298. Merrienboer_2018_getting_inside_the_expert_head.pdf Website: https://www.shadowboxtraining.com/ Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

On this special live edition of KeyLIME+, recorded at the Sim Tank innovation event held at Queen's University, Adam brings together a panel of simulation and education leaders to explore how artificial intelligence is transforming medical simulation training. From personalized learning and adaptive assessment to concerns about de-skilling, data ownership, and the evolving role of educators, the conversation examines both the promise and the pitfalls of tech-enhanced simulation. Together, the panel reflects on how emerging technologies may reshape not just how we teach medicine using sim, but how clinicians learn, think, and perform in an increasingly complex healthcare system. Episode Length: 43:02 Resources to check-out Dizon JI, Mendoza NB, Gasevic D, Ganotice Jr FA. Assessing AI-driven metacognitive offloading: Initial development and validation of the Metacognitive Laziness Scale. ECNU Review of Education. 2026 Jun;9(2):20965311261450994. https://journals.sagepub.com/doi/full/10.1177/20965311261450994 Sears, K., Goldsworthy, S., & Goodman, W. M. (2010). The relationship between simulation in nursing education and medication safety. The Journal of Nursing Education, 49(1), 52-55. https://doi.org/10.3928/01484834-20090918-12 Journey of Nursing Regulation https://www.ncsbn.org/public-files/JNR_Simulation_Supplement.pdf Ke, Y., Jin, L., Ong, J.C.L. et al. AI-induced never-skilling in medical education. Nat Med 32, 1997–2006 (2026). https://doi.org/10.1038/s41591-026-04438-y https://www.nature.com/articles/s41591-026-04438-y Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

In this episode, Dr. Lea Harper joins Adam to discuss how behavioral economics can shape clinician behavior in medical education and clinical practice. They explore the difference between nudging and sludge, the role of default options, and how system design influences everyday decisions. Using examples from health care and beyond, the conversation examines how unnecessary friction slows progress and how thoughtful system design can help good ideas get over the finish line and effect meaningful change. Episode Length: 34:06 Resources to check-out Harper, L., Coderre, S., Lithgow, K., Kelly‐Turner, K., Davis, M., & McLaughlin, K. (2025). We should nudge clinicians and trainees to participate in health professions education programmes. Medical Education, 59(12), 1333-1340. Nudge: Improving Decisions about Health, Wealth, and Happiness. Thaler, R. H., & Sunstein, C. R. (2021). Nudge: The final edition. Penguin. Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

Are we chasing a standard of excellence that today's healthcare system can realistically sustain? On this episode of KeyLIME+, Adam speaks with medical education leaders Drs. Farhan Bhanji and Damon Dagnone about the future of medical education and healthcare in Canada. They explore Competence by Design, the tension between certification and licensure, the physician workforce crisis, and the changing role of internationally trained physicians in Canada. As pressures mount on healthcare systems, regulators, and training programs, the conversation explores an important question: how should medical education evolve to meet the needs of learners, physicians, and patients in today's healthcare environment Episode Length: 47:48 Resources to check-out John Norcini, Irina Grabovsky, Michael A Barone, M Brownell Anderson, Ravi S Pandian, Alex J Mechaber, The Associations Between United States Medical Licensing Examination Performance and Outcomes of Patient Care, Academic Medicine, Volume 99, Issue 3, March 2024, Pages 325–330, https://doi.org/10.1097/ACM.0000000000005480 Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

[43] The Hidden Curriculum Exposed: When the CEOs of Canada's Family Medicine and Specialist Colleges Compare Notes on Medicine's Unwritten Lessons This episode was first released on May 26, 2026 On this episode of KeyLIME+, Adam sits down with Chris Watling and Mike Allan (the CEOs of Canada's two national medical colleges) to unpack the hidden curriculum in medicine. Together, they explore how subtle signals in our learning and working environments shape identity, influence career pathways, and reinforce hierarchies both between and within disciplines. From the loss of shared spaces like physician lounges, to structural pressures such as competition for residents and fragmented training pathways, to the powerful role of public narratives, the conversation examines how these forces quietly sculpt our professional culture. Chris and Mike reflect on their own professional experiences, the impacts felt by learners in both family and specialty practice, and what it might take to move toward a more respectful, connected, and collaborative medical community. Length of Episode: 38:11 Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

[38] AI and Emerging Skill Gaps: Deskilling, Never‑Skilling, Mis‑Skilling—and What Educators Can Do About It All This episode was first released on March 17, 2026 In this episode, Adam sits down with Dr. Raja-Elie Abdulnour to explore how AI is reshaping medical education and why it has the potential to quietly erode clinical reasoning. They discuss the emerging risks of deskilling, never-skilling, and mis-skilling, and how AI can widen gaps between high-performing and low-performing learners. Raja-Elie introduces the DEFT-AI framework, a practical approach for turning AI-assisted moments into teaching opportunities that strengthen, rather than outsource clinical judgment. Their conversation highlights both the promise of AI and the need to help learners use it wisely so we do not lose the core of what it means to be a medical expert. Length of episode: 41:30 Resources to check out: - https://www.nejm.org/doi/full/10.1056/NEJMra2503232 https://www.ynharari.com/book/nexus/ Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

[32] Designing Learning That Learns: The Promise of Precision Medical Education This episode was first released on January 06, 2026 In this episode of KeyLIME+, Adam speaks with Dr. Sanjay Desai to explore the concept of precision education in medical training. They discuss how data and technology can personalize medical education, making it more efficient and tailored to individual learner needs. Sanjay emphasizes the importance of using data to assess learner performance and the need for a shift in power towards learners, allowing them greater agency in their education. The conversation also touches on the foundational principles of precision education, the challenges of implementing these innovations, and the balance between fostering innovation and ensuring trust in medical education. Length of episode: 35:28 Contact Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

[28] Cookies, Charisma & Bias: Exploring the Hidden Consequences and Impact of Teaching Evaluations This episode was first released on November 11, 2025 Description In this episode, Adam (and resident guest co-host Mario Corrado) speak with Dr. Lynfa Stroud about the complexities of teaching evaluations in medical education. They discuss some of the biases that influence evaluations, the unintended consequences that can arise, and the delicate power dynamics between learners and educators. Their conversation underscores the need for a more nuanced, supportive approach to assessing teaching quality - one that moves beyond student ratings to foster genuine growth and development in medical education. Length of episode: 48:34 Resources to check out How Teacher Evaluations Broke the University "We give them all A's, and they give us all fives." By Rose Horowitch https://www.theatlantic.com/ideas/archive/2025/09/teacher-evaluations-grade-inflation/684185/ The Doctor Fox Lecture: A Paradigm of Educational Seduction Donald H. Naftulin, M.D., John E. Ware, Jr., and Frank A. Donnelly https://romanfrigg.org/wp-content/uploads/links/Dr_Fox_Lecture.pdf Stroebe, W. (2020). Student Evaluations of Teaching Encourages Poor Teaching and Contributes to Grade Inflation: A Theoretical and Empirical Analysis. Basic and Applied Social Psychology, 42(4), 276–294. https://doi.org/10.1080/01973533.2020.1756817 https://www.tandfonline.com/doi/full/10.1080/01973533.2020.1756817 Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

On this episode of KeyLIME+, Adam sits down with 'the medical futurist', Dr. Bertalan Meskó, to explore what it means to prepare for the future of medicine in an era currently shaped by artificial intelligence. Using prompt engineering as a starting point, the conversation moves beyond the technical to focus on a deeper shift in how clinicians adapt in the face of rapid change. Together, they examine the risks of over-reliance on AI, the pitfalls of bold predictions, and the enduring role of human connection in healthcare. The discussion ultimately reframes AI not as the destination, but as a tool for helping clinicians prepare for what lies ahead. Length of Episode: 39:23 Resources to check out: Meskó B. Prompt Engineering as an Important Emerging Skill for Medical Professionals: Tutorial. J Med Internet Res. 2023 Oct 4;25:e50638. Episode 38 AI and Emerging Skill Gaps: Deskilling, Never-Skilling, Mis-Skilling – and What Educators Can Do About It All Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski

Clinical teaching happens in real time, but feedback about that teaching does not. Too often, feedback shows up late, feels vague, or never arrives at all, especially for the everyday teaching that happens on shift, in the hallway, or at the bedside. Adam speaks with Dr. Esther Bui about why that gap persists, and what it might look like to close it. Esther shares what led her team to build myTE, an app-based tool designed to capture in-the-moment teaching feedback. Together, they explore what traditional evaluation systems tend to miss, why authentic quality feedback is so important, and how trust and psychological safety shape the experience. Length of Episode: 30:27 Resources to check out: Halani S, Kumar SS, Lim DY, Hefferon D, Prakash V, Kumagai AK, Bui E. "In-the-moment" feedback: a novel app for clinical teaching evaluations. Can Med Educ J. 2025 Nov 6;16(5):86-88. Contact us: [email protected] Follow: Dr. Adam Szulewski https://x.com/Adam_Szulewski