A way to approach the strategic decisions facing academic health centers

Rapid changes taking place in the various markets served by academic health centers (AHCs) are forcing these institutions to make difficult strategic decisions that may change AHCs' historic priorities. The authors present an approach that can help AHCs visualize possible new configurations of their traditional services of research, education, and clinical care. This approach is based on successful strategic management methods from the private sector and involves a three-dimensional "topography of services" encompassing all possible configurations of AHCs' services. From among the many possible configurations, the authors discuss three in detail. The historic one, which they call the traditional model, is characteristic of AHCs that give high priority to biomedical and clinical research, have broad medical education activities, and deliver comprehensive, high-quality clinical care. In the future, this configuration will be rare, and two others are likely to predominate. First is the "revised" traditional model, which would offer "boutique" clinical services, biomedical research, and medical education for MD-PhD students, residents, and fellows seeking tertiary care or academic careers. The patient care required for undergraduate medical education and clinical research would be provided by partnerships with community-based providers. Second is the academic services model, which would focus on competitive primary and secondary clinical services, health services and operations research, and primary care medical education. The authors discuss the implications of these models for AHCs' organizational structures and faculty incentives. They conclude that the clarity with which AHCs' strategic decisions are made and communicated to faculties and the incentive systems that are selected to motivate faculty and to provide the selected services may ultimately determine which institutions survive.

The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes

Effective communication between doctor and patient is a core clinical skill. It is increasingly recognized that it should and can be taught with the same rigour as other basic medical sciences. To validate this teaching, it is important to define the content of communication training programmes by stating clearly what is to be learnt. We therefore describe a practical teaching tool, the Calgary-Cambridge Referenced Observation Guides, that delineates and structures the skills which aid doctor-patient communication. We provide detailed references to substantiate the research and theoretical basis of these individual skills. The guides form the foundation of a sound communication curriculum and are offered as a starting point for programme directors, facilitators and learners at all levels. We describe how these guides can also be used on an everyday basis to help facilitators teach and students learn within the experiential methodology that has been shown to be central to communication training. The learner-centred and opportunistic approach used in communication teaching makes it difficult for learners to piece together their evolving understanding of communication. The guides give practical help in countering this problem by providing: an easily accessible aide-mémoire; a recording instrument that makes feedback more systematic; and an overall conceptual framework within which to organize the numerous skills that are discovered one by one as the communication curriculum unfolds.

The changing role and work of British nurse tutors: a study within two demonstration Project 2000 districts

This study was designed to describe the main changes in the role and work of nurse tutors brought about by Project 2000 initiatives, with a view to exploring what the work of nurse tutors would be in the future. It was centred upon two demonstration Project 2000 districts, chosen to provide contrasts. Data were collected over a 15-month period from a range of stake-holders, but with the priority on nurse tutors themselves, using semi-structured individual and group interviews. The results showed that, in future, the role and work of nurse tutors would adapt to reflect the integration into a higher educational environment. The main changes expected include: alternative approaches to teaching and learning, for example student-centred teaching and open modes of study; greater subject specialization; more teaching across 'schools'; larger class involvement; more effective educational organization and management; closer liaison with the service provider units; and more effective time management. The study found that nurse tutors would be required to diversify their work through new initiatives, to undertake consultancy and research and to compete more for resources--developments which were not universally welcomed.

Teaching family nursing: strategies and experiences

The traditional hospital-based approach to Australian nurse education curricula was primarily based on the medical model and directed towards the preparation of nurses who were able to give care to individual clients. The major focus was on the needs of the individual. A notable absence in curricula was any consideration of the role or importance of families to individual and family health. This was despite the continuing involvement that nurses have in their practice with the families of their clients. This paper describes the experiences of introducing a family nursing subject in an undergraduate, preregistration nursing programme which focuses on the family as a unit of care. Educational strategies, clinical experiences, and evaluation of the unit of study are discussed.

[Freire's education model applied to a program of teaching of nursing practice]

The present study is a qualitative research supported by Paulo Freire's writings. It presents the structure of a discipline-Nursing Teaching Practice-which searches for an amplification of opportunities provided by the Nursing School in order to improve the student's consciousness of his/her role as a future educator.

Description and results of a needs assessment in preparation for the "Surgeons as educators" course

BACKGROUND

In August 1993 the American College of Surgeons sponsored a course entitled "Surgeons as Educators" (SAE) aimed at equipping academic surgeons with the knowledge and skills necessary to enhance surgical education administration, curriculum, teaching, and evaluation.

METHODS

The instructional design model used to construct the course called for a formal needs assessment to determine the importance, current skill level, and priority of what needed to be learned to be an effective educator. The needs assessment was accomplished using a job analysis and questionnaire approach. The 68-item questionnaire was mailed to 320 academic surgeons representing eight medical schools.

RESULTS

A 62% response rate was achieved. Results indicated the education-related tasks or activities that faculty felt were important to their careers, as well as their perceived level of development in each area. Descriptive statistics were used to summarize the responses that were critical to the SAE faculty in helping prioritize, sequence, and time ration course content. Collective results became the foundation for developing the SAE curriculum by the course's five faculty members.

CONCLUSIONS

A well-done needs assessment does not necessarily guarantee course success; however, it is the first and critical step to planning an educationally sound faculty development course or program designed for adult learners.

Long-term community-based attachments: the Cambridge course

This paper reports on the establishment of the Cambridge Community-based Clinical Course and places on record details of the organization, goals and teaching arrangements of the course. It also identifies the main questions which are being addressed in the course and which must be answered before it will be clear whether such attachments are generally viable.

Who will teach? A fundamental challenge to medical education

The level of expertise possessed by medical school faculty members is unprecedented. Unfortunately, faculty members' broad understanding of their domains has atrophied as the specialization they need to compete successfully in the clinical and research arenas has increased. Medical students are novices, needing teachers who possess broad knowledge and experience, who can integrate the specific areas of a subject with overarching themes, and who can teach at the students' level. Clinical subspecialists and researchers on faculties often are ill-equipped to teach medical students. Likewise, busy clinical preceptors may no longer have the latest understanding of pathophysiology. The usual solution of bringing a series of basic science and clinical faculty members to classrooms and seminar rooms often results in disjointed coverage of material. Expanding the values of the university to once again include the scholarship of integration and teaching would provide the best type of faculty.

The implementation of problem-based learning: changing pedagogy in nurse education

Problem-based learning (PBL) employs approaches to teaching and learning in nurse education that develop meaningful links between theory and practice. The adoption of such approaches, however, may require changes in pedagogical beliefs and practices which reflect a student-centred approach to teaching and learning. This paper focuses on a group of volunteer nurse educators (n = 14) who attended a 7-month professional development programme centred on introducing pedagogical changes when adopting PBL. From this group, three nurse educators participated in an in-depth study which aimed to examine the processes of conceptual change associated with adopting PBL as part of alternative teaching strategies. These three participants held common concerns about the changes required to their current teaching practices when moving to a new pedagogical approach. On completion of the programme, varying degrees of change in existing instructional practices were evident. This change was found to result from engaging educators in reflection about practice, providing opportunities to implement the new approaches on a trial basis, and providing feedback and support throughout the change process.

Dynamics of effective oral presentations. Strategies for nurse educators

Oral presentations can and should be exciting events for learners and educators. Inservice faculty members who are new educators have a plethora of sources that they can use to develop and refine their presentation skills. Just as individuals learn to read by reading and write by writing, staff instructors learn to teach well by teaching. Focus on developing your teaching versatility by combining strategies, because varying methods will appeal to learners' different learning styles. Whether you are a novice or seasoned teacher, you can constantly improve your teaching skills. When you execute an effective presentation, everyone wins. You experience and enjoy your own professional growth, and learners benefit from quality educational experiences. The most important benefit of effective presentations is that surgical patients receive competent care from well-informed, up-to-date clinicians.

The changing role of the nurse teacher

This paper concludes a series on the findings from a study on the emerging role of nurse teachers in Project 2000 programmes. The various aspects of the study, including the literature review and methodology, have been previously discussed (Crotty & Butterworth 1992, Crotty 1992, Crotty 1993a,b,c,d). This paper highlights the main findings and suggests recommendations regarding the key issues to be addressed in the future role and preparation of the nurse teacher. The study revealed two major changes which are contrary to the expectations of Project 2000. These are firstly, the teaching of academic subjects by nurse teachers, and secondly, the rejection of clinical teaching involving 'hands on care' by nurse teachers.

Domain specifications and content representativeness of the revised Value Orientation Inventory

Value orientations represent theoretical belief systems that guide teachers' curricular decision making. Research using the Value Orientation Inventory (VOI) to examine physical educators' value orientations in school settings found inconsistencies between the inventory findings, descriptions of class environments, and teachers' self-reports of their curricular goals. This article reports the VOI revision process that included (a) literature and research reviews resulting in domain specifications and new VOI item development and (b) item ratings that provide evidence of content representativeness for the revised items. The reviews supported four of five orientations that formed the original theoretical framework for the VOI: disciplinary mastery, learning process, self-actualization, and ecological integration. The fifth orientation, social reconstruction, was not supported by school-based research. Findings were more consistent with a social responsibility orientation. New items (K = 150) were written based on the literature reviews. The new items were sent to university and public school teachers (N = 298) to assess content representativeness. Eighty-one percent of the item means were > 4.0 on a 5-point scale. The social responsibility items were found to be domain representative and were included in the revised inventory.

Teachers' experiences of their role following the implementation of Project 2000: a qualitative approach

This study focuses upon the experiences of a group of six nurse teachers who experienced change in their role following the implementation of Project 2000 at their place of work. The teachers were interviewed using the informal interview method which allowed the researcher to obtain detailed information and get to know them as people. Qualitative analysis based on a modified grounded theory approach revealed four recurrent themes which were discussed in terms of the context of the study and existing theories. The study highlights the feasibility of the grounded theory approach and the informal interviews as a means of collecting detailed data and eliciting in-depth understanding of the participants' experience of their changed role from their perspective. The informal interviews and the researcher's knowledge of the participants and the context in which the study was conducted have proved to be helpful in generating categories which describe the teachers' experiences of the changes in their role.