A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8

Entering and navigating academic medicine: academic clinician-educators' experiences

OBJECTIVES

Despite a recognised need for richer narratives about academic medicine, much of the literature is limited to an analysis of the enablers and barriers associated with recruitment and retention, and focuses on analysing the development of research career pathways. We explored academic clinician-educators' experiences of entering into and navigating academic medicine, with a particular focus on those who privilege teaching above research.

METHODS

Data were collected through interviews and focus groups conducted across a medical school at one Australian university. We used socio-cognitive career theory to provide theoretical insight into the factors that influence academic clinician-educators' interests, choice and motivations regarding entering and pursuing a teaching pathway within academic medicine. Framework analysis was used to illustrate key themes in the data.

RESULTS

We identified a number of themes related to academic clinician-educators' engagement and performance within an academic medicine career focused on teaching. These include contextual factors associated with how academic medicine is structured as a discipline, cultural perceptions regarding what constitutes legitimate practice in academia, experiential factors associated with the opportunity to develop a professional identity commensurate with being an educator, and socialisation practices.

CONCLUSIONS

The emphasis on research in academia can engender feelings of marginalisation and lack of credibility for those clinicians who favour teaching over research. The prevailing focus on supporting and socialising clinicians in research will need to change substantially to facilitate the rise of the academic clinician-educator.

Supporting health professionals through information and communication technologies: a systematic review of the effects of information and communication technologies on recruitment and retention

Healthcare personnel shortage is a growing concern in many countries, especially in remote areas, where it has major consequences on the accessibility of health services. Information and communication technologies (ICTs) have often been proposed as having positive effects on certain dimensions of the recruitment and retention of professionals working in the healthcare sector.

OBJECTIVE

This study aims to explore the impact of interventions using ICTs on recruitment and retention of healthcare professionals.

MATERIALS AND METHODS

A systematic review of the literature was conducted, including the following steps: exploring scientific and gray literature through established criteria and data extraction of relevant information by two independent reviewers.

RESULTS

Of the 2,225 screened studies, 13 were included. Nine studies showed a positive, often indirect, influence that ICTs may have on recruitment and retention.

CONCLUSIONS

Despite the conclusions of 9 of 13 studies reporting a possible positive influence of ICTs on the recruitment and retention of healthcare professionals, these results highlight the need of a deeper reflection on that topic. Therefore, more research is needed.

A national survey of medical education fellowships

PURPOSE

The purpose of our study was to determine the prevalence, focus, time commitment, graduation requirements and programme evaluation methods of medical education fellowships throughout the United States. Medical education fellowships are defined as a single cohort of medical teaching faculty who participate in an extended faculty development programme.

METHODS

A 26-item online questionnaire was distributed to all US medical schools (n=127) in 2005 and 2006. The questionnaire asked each school if it had a medical education fellowship and the characteristics of the fellowship programme.

RESULTS

Almost half (n=55) of the participating schools (n=120, response rate 94.5 %) reported having fellowships. Duration (10-584 hours) and length (<1 month-48 months) varied; most focused on teaching skills, scholarly dissemination and curriculum design, and required the completion of a scholarly project. A majority collected participant satisfaction; few used other programme evaluation strategies.

CONCLUSIONS

The number of medical education fellowships increased rapidly during the 1990s and 2000s. Across the US, programmes are similar in participant characteristics and curricular focus but unique in completion requirements. Fellowships collect limited programme evaluation data, indicating a need for better outcome data. These results provide benchmark data for those implementing or revising existing medical education fellowships.

Commentary: faculty development: the road less traveled

The 2020 Vision of Faculty Development Across the Medical Education Continuum conference, and the resulting articles in this issue, addressed a number of topics related to the future of faculty development. Focusing primarily on the development of faculty members as teachers, conference participants debated issues related to core teaching competencies, barriers to effective teaching, competency-based assessment, relationship-centered care, the hidden curriculum that faculty members encounter, instructional technologies, continuing medical education, and research on faculty development. However, a number of subjects were not addressed. If faculty development is meant to play a leading role in ensuring that academic medicine remains responsive to faculty members and societal needs, additional themes should be considered. Medical educators should broaden the focus of faculty development and target the various roles that clinicians and basic scientists play, including those of leader and scholar. They must also remember that faculty development can play a critical role in curricular and organizational change and thus enlarge the scope of faculty development by moving beyond formal, structured activities, incorporating notions of self-directed learning, peer mentoring, and work-based learning. In addition, medical educators should try to situate faculty development in a more global context and collaborate with international colleagues in the transformation of medical education and health care delivery. It has been said that faculty development can play a critical role in promoting culture change at a number of levels. A broader mandate, innovative programming that takes advantage of communities of practice, and new partnerships can help to achieve this objective.

Reframing research on faculty development

Research on faculty development has focused primarily on individual participants and has produced relatively little generalizable knowledge that can guide faculty development programs. In this article, the authors examine how current research on faculty development in medical education can be enriched by research in related fields such as teacher education, quality improvement, continuing medical education, and workplace learning. As a result of this analysis, the authors revise the old model for conceptualizing faculty development (preferably called professional development). This expanded model calls for research on educational process and outcomes focused on two communities of practice: the community created among participants in faculty development programs and the communities of teaching practice in the workplace (classroom or clinic) where teaching actually occurs. For the faculty development community, the key components are the participants, program, content, facilitator, and context in which the program occurs and in which the faculty teach. For the workplace community, associated components include relationships and networks of association in that environment, the organization and culture of the setting, the teaching tasks and activities, and the mentoring available to the members of that academic and/or clinical community of teaching practice. This expanded model of faculty development generates a new set of research questions, which are described along with six recommendations for enhancing research, including establishment of a national center for research in health professions education.

Faculty development in assessment: the missing link in competency-based medical education

As the medical education community celebrates the 100th anniversary of the seminal Flexner Report, medical education is once again experiencing significant pressure to transform. Multiple reports from many of medicine's specialties and external stakeholders highlight the inadequacies of current training models to prepare a physician workforce to meet the needs of an increasingly diverse and aging population. This transformation, driven by competency-based medical education (CBME) principles that emphasize the outcomes, will require more effective evaluation and feedback by faculty.Substantial evidence suggests, however, that current faculty are insufficiently prepared for this task across both the traditional competencies of medical knowledge, clinical skills, and professionalism and the newer competencies of evidence-based practice, quality improvement, interdisciplinary teamwork, and systems. The implication of these observations is that the medical education enterprise urgently needs an international initiative of faculty development around CBME and assessment. In this article, the authors outline the current challenges and provide suggestions on where faculty development efforts should be focused and how such an initiative might be accomplished. The public, patients, and trainees need the medical education enterprise to improve training and outcomes now.

Decoding the learning environment of medical education: a hidden curriculum perspective for faculty development

Medical student literature has broadly established the importance of differentiating between formal-explicit and hidden-tacit dimensions of the physician education process. The hidden curriculum refers to cultural mores that are transmitted, but not openly acknowledged, through formal and informal educational endeavors. The authors extend the concept of the hidden curriculum from students to faculty, and in so doing, they frame the acquisition by faculty of knowledge, skills, and values as a more global process of identity formation. This process includes a subset of formal, formative activities labeled "faculty development programs" that target specific faculty skills such as teaching effectiveness or leadership; however, it also includes informal, tacit messages that faculty absorb. As faculty members are socialized into faculty life, they often encounter conflicting messages about their role. In this article, the authors examine how faculty development programs have functioned as a source of conflict, and they ask how these programs might be retooled to assist faculty in understanding the tacit institutional culture shaping effective socialization and in managing the inconsistencies that so often dominate faculty life.

Towards effective outcomes in teaching, learning and assessment of law in medical education

CONTEXT

Law is slowly emerging as a core subject area in medical education, alongside content on the ethical responsibilities of doctors to protect and promote patient health and well-being. Curriculum statements have begun to advise on core content and methods for organising teaching and assessment. However, no comprehensive overview of approaches to the delivery of this law curriculum has been undertaken.

OBJECTIVES

This paper reports an assessment of the nature and strength of the published evidence base for the teaching, learning and assessment of law in medical education. It also provides a thematic content overview from the best available literature on the teaching of law to medical students and on the assessment of their legal knowledge and skills.

METHODS

A systematic review of the evidence base was completed. Detailed scrutiny resulted in the inclusion of 31 empirical sources and 11 conceptual papers. The quality of the included material was assessed.

RESULTS

Significant gaps exist in the evidence base. Empirical studies of the teaching of law are characterised by insufficient sample sizes and a focus on individual study programmes. They rely on measures of student satisfaction and on evaluating short-term outcomes rather than assessing whether knowledge is retained and whether learning impacts on patient outcomes. Studies reveal a lack of coordination between pre- or non-clinical and clinical medico-legal education. Although evidence on the development of students' knowledge is available, much learning is distant from the practice in which its application would be tested. Law learning in clinical placements appears to be opportunistic rather than structured.

CONCLUSIONS

The place of law in the curriculum remains uncertain and should be more clearly identified. A more robust knowledge base is needed to realise the aspirations behind curriculum statements on law and to enable medical students to develop sufficient legal literacy to manage challenging practice encounters. Further research is needed into effective methods of teaching, learning and assessing legal knowledge and skills during and following initial medical education.

Educational needs assessment, development of learning objectives, and choosing a teaching approach

BACKGROUND

How physicians are evaluated throughout their careers and how training programs are accredited has shifted from demonstrating what we teach and what we are learning to demonstrating the achievement of competence.

DISCUSSION

This article discusses some of the components involved with determining and providing necessary educational experiences. These steps apply to various educational needs and settings such as development of curriculum for training programs, clinical staff development, courses in continuing medical education, and identifying learning needs throughout practice. Covered in this article are three components to this process: needs assessment, development of learning objectives, and choosing a teaching approach. A needs assessment is a first step in this process and can be applied to determining revisions in curriculum, identifying needs in clinical staff development, and to self-identifying individual learner status. Once conducted, the identified curriculum needs are linked to the development of learning objectives and outcome statements that identify the knowledge, skills, and attitudes that learners are expected to demonstrate. Finally, understanding of teaching methods is essential to selecting the ones that best fit the identified needs and outcomes of the educational experience.

CONCLUSION

Understanding the separate components involved with learning and curriculum development can ultimately lead to improvement and enrichment of the experiences of learners and educators.

Investing in the future: building an academic hospitalist faculty development program

BACKGROUND

Academic hospital medicine (AHM) groups continue to grow rapidly, driven largely by clinical demands. While new hospitalist faculty usually have strong backgrounds in clinical medicine, they often lack the tools needed to achieve excellence in the other aspects of a faculty career, including teaching, research, quality improvement, and leadership skills.

OBJECTIVE

To develop and implement a Faculty Development (FD) Program that improves the knowledge, skills, attitudes, and scholarly output of first-year faculty.

INTERVENTION

We created a vision and framework for FD that targeted our new faculty but also engaged our entire Division of Hospital Medicine. New faculty participated in a dedicated coaching relationship with a more senior faculty member, a core curriculum, a teaching course, and activities to meet a set of stated scholarly expectations. All faculty participated in newly established divisional Grand Rounds, a lunch seminar series, and venues to share scholarship and works in progress.

RESULTS

Our FD programmatic offerings were rated highly overall on a scale of 1 to 5 (5 highest): Core Seminars 4.83 ± 0.41, Coaching Program 4.5 ± 0.84, Teaching Course 4.5 ± 0.55, Grand Rounds 4.83 ± 0.41, and Lunch Seminars 4.5 ± 0.84. Compared to faculty hired in the 2 years prior to our FD program implementation, new faculty reported greater degrees of work satisfaction, increased comfort with their skills in a variety of areas, and improved academic output.

CONCLUSION

Building FD programs can be effective to foster the development and satisfaction of new faculty while also creating a shared commitment towards an academic mission.

The digital pen as a novel device to facilitate the feedback process

BACKGROUND

To improve clinical performance assessment, checklist data should be immediately available to students to offer them detailed feedback and be stored in a database for quality assurance purposes.

AIM

To introduce the digital pen as clinical performance assessment tool, report examiner satisfaction and explore the utility of generated checklist data for quality assurance purposes.

METHODS

The digital pen technology transmits examiners' handwritten assessments to a database and exports PDF-files to students' mailboxes. Descriptive statistical analysis of examiner satisfaction and the generated checklist data was performed.

RESULTS

The examiners were satisfied with the digital pen. Valuable data were obtained to improve objective structured clinical examination stations and rating criteria, identify training needs for future students and provide examiners with feedback on their rating skills.

CONCLUSION

The digital pen technology is a practical device for sending completed checklists to students and providing valuable data for quality assurance purposes.

Exploring the validity and reliability of a questionnaire for evaluating veterinary clinical teachers' supervisory skills during clinical rotations

BACKGROUND

Feedback to aid teachers in improving their teaching requires validated evaluation instruments. When implementing an evaluation instrument in a different context, it is important to collect validity evidence from multiple sources.

AIM

We examined the validity and reliability of the Maastricht Clinical Teaching Questionnaire (MCTQ) as an instrument to evaluate individual clinical teachers during short clinical rotations in veterinary education.

METHODS

We examined four sources of validity evidence: (1) Content was examined based on theory of effective learning. (2) Response process was explored in a pilot study. (3) Internal structure was assessed by confirmatory factor analysis using 1086 student evaluations and reliability was examined utilizing generalizability analysis. (4) Relations with other relevant variables were examined by comparing factor scores with other outcomes.

RESULTS

Content validity was supported by theory underlying the cognitive apprenticeship model on which the instrument is based. The pilot study resulted in an additional question about supervision time. A five-factor model showed a good fit with the data. Acceptable reliability was achievable with 10-12 questionnaires per teacher. Correlations between the factors and overall teacher judgement were strong.

CONCLUSIONS

The MCTQ appears to be a valid and reliable instrument to evaluate clinical teachers' performance during short rotations.

Professional development is enhanced by serving as a mini-CEX preceptor

INTRODUCTION

The mini-clinical evaluation exercise (mini-CEX) is widely used for the evaluation of medical trainees' clinical competence. To our knowledge, no study has examined the effect of mini-CEX on the preceptors. Based on the principle of "to teach is to learn twice," we hypothesized that the act of precepting a mini-CEX would enhance preceptors' own learning and performance.

METHODS

A 21-item questionnaire incorporating the 3 out of 4 levels of Kirkpatrick's model was completed by experienced mini-CEX preceptors. Data collected from the questionnaire included ratings of Kirkpatrick's level of "Reaction" (level 1) and "Behavior" (level 3) and the frequencies of relearning the clinical skills related to mini-CEX, which assessed Kirkpatrick's "Learning" (level 2).

RESULTS

A majority of the respondents either strongly agreed or agreed that precepting the mini-CEX both increased reflection on their own clinical practice and had a positive impact on their clinical skills. More than 80% of preceptors reported relearning one or more of the mini-CEX clinical skills. Experienced preceptors relearned the clinical skills more frequently than the less experienced preceptors. About one-third of respondents indicated that being a preceptor of mini-CEX increased both self-confidence and health care quality in their own clinical practice.

DISCUSSION

These findings provide preliminary evidence suggesting that participating as a preceptor in a mini-CEX has a positive impact on the preceptor's professional development. Further studies are needed, including analyzing mechanisms of mini-CEX on the clinical skills of preceptor, and assessing whether similar effects can be observed in other teaching hospitals in different cultural contexts.

Teaching conceptions and approaches to teaching of medical school faculty: the difference between how medical school teachers think about teaching and how they say that they do teach

BACKGROUND

It is often assumed that the way teachers approach their teaching is determined by the way they think about learning. This study explores how teachers of an undergraduate medical programme (UMP) think about learning, how they approach teaching and whether their conceptions of learning relate to their teaching approaches.

METHODS

Quantitative data of academic teachers involved in the undergraduate programme in medicine were collected and analysed. We used a questionnaire designed to measure teachers' conceptions of their own learning (COL) and of student learning as well as teachers' approaches to teaching (AT).

RESULTS

Teachers of the medical undergraduate programme hold a variety of COL, of how students learn and their AT. No significant correlations were found between teachers' conceptions of learning and their AT.

CONCLUSIONS

Although UMP teachers' ideas on learning and teaching are very diverse, some of their conceptions are interrelated. Teachers' ideas on their own learning is sometimes - but not always - related to how they think about student learning. But most importantly, the way UMP teachers think about learning is not automatically converted into the way they approach teaching.

'The research compass': an introduction to research in medical education: AMEE Guide no. 56

This AMEE Guide offers an introduction to research in medical education. It is intended for those who are contemplating conducting research in medical education but are new to the field. The Guide is structured around the process of transforming ideas and problems into researchable questions, choosing a research approach that is appropriate to the purpose of the study and considering the individual researcher's preferences and the contextual possibilities and constraints. The first section of the Guide addresses the rationale for research in medical education and some of the challenges posed by the complexity of the field. Next is a section on how to move from an idea or problem to a research question by placing a concrete idea or problem within a conceptual, theoretical framework. The following sections are structured around an overview model of approaches to medical education research, 'The research compass'. Core to the model is the conceptual, theoretical framework that is the key to any direction. The compass depicts four main categories of research approaches that can be applied when studying medical education phenomena, 'Explorative studies'; 'Experimental studies'; 'Observational studies'; and 'Translational studies'. Future AMEE Guides in the research series will address these approaches in more detail.

A systematic review of the use and effectiveness of the Objective Structured Teaching Encounter

BACKGROUND

The Objective Structured Teaching Encounter (OSTE) has been proposed as a means of promoting and assessing the teaching skills of medical faculty.

AIMS

To describe the uses of the OSTE and the evidence supporting its effectiveness.

METHOD

MEDLINE (January 1966 through February 2010) was searched for English-language studies detailing the use of an OSTE for any educational purpose. Reference lists from relevant review articles and identified studies were also searched. Of the 354 papers initially identified, 22 were included in the review.

RESULTS

The OSTE has been used to assess and improve teaching performance and to assess the impact of other means of faculty development. Although qualitative results have been generally positive, there is little quantitative data to support using the OSTE as a means of improving teaching performance. There is moderate evidence suggesting the OSTE is a reliable and valid means of assessing teaching, although few ratings instruments have been adequately studied.

CONCLUSIONS

The OSTE is a promising innovation with potential application to assessing and promoting the teaching skills of medical faculty. Further study is required to determine the most effective OSTE design.

How to become a better clinical teacher: a collaborative peer observation process

BACKGROUND

Peer observation of teaching (PoT) is most commonly done as a way of evaluating educators in lecture or small group teaching. Teaching in the clinical environment is a complex and hectic endeavor that requires nimble and innovative teaching on a daily basis. Most junior faculty start their careers with little formal training in education and with limited opportunity to be observed or to observe more experienced faculty.

AIM

Formal PoT would potentially ameliorate these challenges.

METHODS

This article describes a collaborative peer observation process that a group of 11 clinician educators is using as a longitudinal faculty development program.

RESULTS

The process described in this article provides detailed and specific teaching feedback for the observed teaching attending while prompting the observing faculty to reflect on their own teaching style and to borrow effective teaching techniques from the observation.

CONCLUSION

This article provides detailed examples from written feedback obtained during collaborative peer observation to emphasize the richness of this combined experience.

Online teaching tool simplifies faculty use of multimedia and improves student interest and knowledge in science

Digital technologies can improve student interest and knowledge in science. However, researching the vast number of websites devoted to science education and integrating them into undergraduate curricula is time-consuming. We developed an Adobe ColdFusion- and Adobe Flash-based system for simplifying the construction, use, and delivery of electronic educational materials in science. The Online Multimedia Teaching Tool (OMTT) in Neuroscience was constructed from a ColdFusion-based online interface, which reduced the need for programming skills and the time for curriculum development. The OMTT in Neuroscience was used by faculty to enhance their lectures in existing curricula. Students had unlimited online access to encourage user-centered exploration. We found the OMTT was rapidly adapted by multiple professors, and its use by undergraduate students was consistent with the interpretation that the OMTT improved performance on exams and increased interest in the field of neuroscience.

Senior Resident Training on Educational Principles (STEP): A Proposed Innovative Step from a Developing Nation

Resident-as-teacher courses are pretty common in Western medical schools however they are a rarity in Asian and developing countries. The current report is a scholarly analysis of a three day orientation program for senior residents in order to improve their functioning by providing new template either for supplementing basic workshops for faculty or to advocate a change in system. The experience gained by Medical Education Unit of University College of Medical Sciences can be used to conduct training breeding grounds at national or regional levels. Resident as teachers educational interventions need to be designed taking into account their impact on education system.

Improving lecture skills: a time-efficient 10-step pedagogical consultation method for medical teachers in healthcare professions

BACKGROUND

Staff development initiatives proposed over the past few decades have, for the most part, suggested training environments such as workshops, short courses and seminar series. However, for many healthcare professionals, lecturing constitutes an ancillary activity, and a full-time occupation in the healthcare industry makes participation in such time-consuming programmes difficult to envision.

AIM

To develop and offer for critical review a time-efficient pedagogical consultation method to improve lecture skills for medical teachers of healthcare professions.

METHODS

Medical education literature was reviewed for factors known to facilitate successful pedagogical consultations. The result of this research was used to define the procedure of a consultation methodology. In subsequent trial runs, the consultation procedure was tested with eight healthcare professionals hired for lecturing in bachelor courses of healthcare professions.

RESULTS

The key elements of successful pedagogical consultations were isolated in the literature, and a 10-step consultation method was developed based on specific methodological components. Eight trial runs indicated feasibility, time-efficiency and effectiveness of the method.

CONCLUSION

The pedagogical consultation method presented here can help teachers to improve their lecture skills. It is a feasible model which can be easily adopted by medical educators to support staff development activities.

Aligning teaching practices with an understanding of quality teaching: a faculty development agenda

BACKGROUND

To guide the future faculty development practices in a better manner, it is important to determine how clinical teachers perceive their own skill development.

AIM

The objective of this study was to examine the extent to which clinical teachers aligned their teaching practices, as measured with a self-rating instrument, with their understanding of what constitutes good clinical teaching.

METHOD

A sample of 1523 residents and 737 faculty members completed the clinical teaching perception inventory (CTPI) online and ranked 28 single-word descriptors that characterized clinical teachers along a seven-point scale in two measures, "My Ideal Teacher" and "Myself as a Teacher."

RESULTS

Faculty and residents showed strikingly similar discrepancies, in both their magnitudes and directions, between their ratings of "My Ideal Teacher" and those of "Myself as a Teacher." Both residents and faculty found it most difficult to develop the stimulating, well-read, and innovative nature to meet their own standards.

CONCLUSIONS

Data did not support our hypothesis that faculty would demonstrate stronger congruence between "My Ideal Teacher" and "Myself as a Teacher" than residents. Medical faculty would benefit from future faculty development practices that are designed to assist them in becoming stimulating, well-read, and innovative teachers, while using less control and caution in their teaching.

Incorporating evidence-based medicine into resident education: a CORD survey of faculty and resident expectations

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence-based medicine (EBM) principles through the practice-based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists.

OBJECTIVES

The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non-journal club directors.

METHODS

A 19-question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum.

RESULTS

A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy-seven (77% of respondents) were either residency program directors or assistant/associate program directors. The majority of participants were from university-based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners' most important EBM skill is to identify secondary peer-reviewed resources, non-journal club directors identified residents' ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%).

CONCLUSIONS

Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation.

A framework for enhancing and assessing cultural competency training

The globalization of medical practice using accepted evidence-based approaches is matched by a growing trend for shared curricula in medicine and other health professions across international boundaries. Interest in the common challenges of curricular design, delivery and assessment is expressed in conferences and dialogues focused on topics such as teaching of professionalism, humanism, integrative medicine, bioethics and cultural competence. The spirit of collaboration, sharing, acknowledgment and mutual respect is a guiding principle in cross-cultural teaching. This paper uses the Tool for Assessing Cultural Competency Training to explore methods for designing and implementing cultural competency curricula. The intent is to identify elements shared across institutional, national and cross-cultural borders and derive common principles for the assessment of learners and the curricula. Two examples of integrating new content into existing clerkships are provided to guide educators interested in an integrated and learner-centered approach to assimilate cultural competency teaching into existing required courses, clerkships and elective experiences. The paper follows an overarching principle that "every patient-doctor encounter is a cross-cultural encounter", whether based on ethnicity, age, socioeconomic status, sex, religious values, disability, sexual orientation or other differences; and whether the differences are explicit or implicit.

Medical simulation in respiratory and critical care medicine

Simulation-based medical education has gained tremendous popularity over the past two decades. Driven by the patient safety movement, changes in the educational opportunities available to trainees and the rapidly evolving capabilities of computer technology, simulation-based medical education is now being used across the continuum of medical education. This review provides the reader with a perspective on simulation specific to respiratory and critical care medicine, including an overview of historical and modern simulation modalities and the current evidence supporting their use.

Faculty development: if you build it, they will come

OBJECTIVES

The goals of this study were three-fold: to explore the reasons why some clinical teachers regularly attend centralised faculty development activities; to compare their responses with those of colleagues who do not attend, and to learn how we can make faculty development programmes more pertinent to teachers' needs.

METHODS

In 2008-2009, we conducted focus groups with 23 clinical teachers who had participated in faculty development activities on a regular basis in order to ascertain their perceptions of faculty development, reasons for participation, and perceived barriers against involvement. Thematic analysis and research team consensus guided the data interpretation.

RESULTS

Reasons for regular participation included the perceptions that: faculty development enables personal and professional growth; learning and self-improvement are valued; workshop topics are viewed as relevant to teachers' needs; the opportunity to network with colleagues is appreciated, and initial positive experiences promote ongoing involvement. Barriers against participation mirrored those cited by non-attendees in an earlier study (e.g. volume of work, lack of time, logistical factors), but did not prevent participation. Suggestions for increasing participation included introducing a 'buddy system' for junior faculty members, an orientation workshop for new staff, and increased role-modelling and mentorship.

CONCLUSIONS

The conceptualisation of faculty development as a means to achieve specific objectives and the desire for relevant programming that addresses current needs (i.e., expectancies), together with an appreciation of learning, self-improvement and networking with colleagues (i.e., values), were highlighted as reasons for participation by regular attendees. Medical educators should consider these 'lessons learned' in the design and delivery of faculty development offerings. They should also continue to explore the notion of faculty development as a social practice and the application of motivational theories that include expectancy-value constructs to personal and professional development.

The essential value of projects in faculty development

Projects--planned activities with specific goals and outcomes--have been used in faculty development programs to enhance participant learning and development. Projects have been employed most extensively in programs designed to develop faculty as educators. The authors review the literature and report the results of their 2008 study of the impact of projects within the Pennsylvania State University College of Medicine Junior Faculty Development Program, a comprehensive faculty development program. Using a mixed-methods approach, the products of project work, the academic productivity of program graduates, and the impact of projects on career development were analyzed. Faculty who achieved the most progress on their projects reported the highest number of academic products related to their project and the highest number of overall academic achievements. Faculty perceived that their project had three major effects on their professional development: production of a tangible outcome, development of a career focus, and development of relationships with mentors and peers. On the basis of these findings and a review of the literature, the authors conclude that projects are an essential element of a faculty development program. Projects provide a foundation for future academic success by enabling junior faculty to develop and hone knowledge and skills, identify a career focus and gain recognition within their community, generate scholarship, allocate time to academic work, and establish supportive relationships and collaborative networks. A list of best practices to successfully incorporate projects within faculty development programs is provided.

The development and initiation of the NSW Department of Health interprofessional Fetal welfare Obstetric emergency Neonatal resuscitation Training project

BACKGROUND

The Fetal Welfare Obstetric emergency Neonatal resuscitation Training (FONT) project was initiated on a background of rising notifications of adverse events in NSW maternity units, the significant proportion of which were related to fetal welfare assessment.

AIMS

The aim of the study is to describe the development and introduction of the NSW state-wide interprofessional FONT project.

METHODS

Following development and risk assessment, FONT was launched in February 2008. The project consists of an online component and two face-to-face training days to be completed each 3 years; the first day for fetal welfare assessment and the second for obstetric and newborn emergencies. Eight, 2-day training sessions were conducted throughout NSW for FONT trainers. Each trainer underwent pre- and post-testing for changes in knowledge of fetal welfare assessment. The 2005-2008 NSW adverse event report numbers were assessed.

RESULTS

From 20 February to 17 April 2008, 240 trainers had been trained in fetal welfare assessment, and by the end of 2008 these trainers had trained 954 clinicians. There were significant improvements in the interpretation and management planning of electronic fetal heart rate patterns following training. Analysis of Severity Assessment Codes 1 and 2 showed no significant trend in the number of notifications for adverse events related to fetal welfare assessment.

CONCLUSIONS

In the first 11 months, 25% of the state's maternity practitioners had received training in the first stage of the FONT project. The FONT project has shown short-term improvements in learning and communication skills and in the participants of the project.

Relationships of the location and content of rounds to specialty, institution, patient-census, and team size

Objective

Existing observational data describing rounds in teaching hospitals are 15 years old, predate duty-hour regulations, are limited to one institution, and do not include pediatrics. We sought to evaluate the effect of medical specialty, institution, patient-census, and team participants upon time at the bedside and education occurring on rounds.

Methods and Participants

Between December of 2007 and October of 2008 we performed 51 observations at Lucile Packard Children's Hospital, Seattle Children's Hospital, Stanford University Hospital, and the University of Washington Medical Center of 35 attending physicians. We recorded minutes spent on rounds in three location and seven activity categories, members of the care team, and patient-census.

Results

Results presented are means. Pediatric rounds had more participants (8.2 vs. 4.1 physicians, p<.001; 11.9 vs. 2.4 non-physicians, p<.001) who spent more minutes in hallways (96.9 min vs. 35.2 min, p<.001), fewer minutes at the bedside (14.6 vs. 38.2 min, p = .01) than internal medicine rounds. Multivariate regression modeling revealed that minutes at the bedside per patient was negatively associated with pediatrics (−2.77 adjusted bedside minutes; 95% CI −4.61 to −0.93; p<.001) but positively associated with the number of non-physician participants (0.12 adjusted bedside minutes per non physician participant; 95% CI 0.07 to 0.17; p = <.001). Education minutes on rounds was positively associated with the presence of an attending physician (2.70 adjusted education minutes; 95% CI 1.27 to 4.12; p<.001) and with one institution (1.39 adjusted education minutes; 95% CI 0.26 to 2.53; p = .02).

Conclusions

Pediatricians spent less time at the bedside on rounds than internal medicine physicians due to reasons other than patient-census or the number of participants in rounds. Compared to historical data, internal medicine rounds were spent more at the bedside engaged in patient care and communication, and less upon educational activities.

The impact of a faculty development program: evaluation based on the self-assessment of medical educators from preclinical and clinical disciplines

Self-assessment tools have previously been used to assess the impact of a faculty development program on the teaching skills of medical educators. In this study, we aimed to assess the impact of a faculty development program on the teaching performances of faculty members in relation to their medical disciplines and academic positions. A faculty-training program consisted of "training skills" and "student assessment instruments" courses. The impact of the program was evaluated by self-reporting of faculty members (a total of 225 reports) 1-2 yr after the program. Both courses were found to be beneficial by nearly all of the attendants. Clinicians benefited more from some topics in the student assessment course and could apply the structured learning and assessment guides, structured oral examination, and objective structured clinical examination more efficiently than their peers from preclinical departments. In conclusion, the results demonstrated that the participants of the faculty development program modified their teaching activities according to the demands of their clinical practice. The correlations between the benefits and behavioral changes were statistically significant.

Faculty development in tobacco cessation: training health professionals and promoting tobacco control in developing countries

ISSUES

Cessation programs are essential components of comprehensive tobacco control. Health-care providers, especially physicians, have major responsibility for role modeling and promoting cessation. For successful, sustainable cessation training programs, countries need health-care professionals with knowledge and skills to deliver and teach tobacco cessation.

APPROACH

Review literature relevant to faculty development in tobacco cessation and discuss its strategic potential in tobacco control.

KEY FINDINGS

Faculty development is essential for sustainable tobacco cessation training programs, and a potentially powerful strategy to shift professional and societal norms towards cessation and support of comprehensive tobacco control in countries with normative tobacco use and underdeveloped tobacco control programs.

IMPLICATIONS

Medical faculty are in a key position to influence tobacco cessation and control programs because of their roles as educators and researchers, receptivity to innovation and, influence on competencies and standards for medical education and practice. Faculty development programs must consider the number and type of faculty, and tobacco cessation curricula needed. Faculty development fosters the ability to institutionalise cessation education for students and community practitioners. Academic faculty are often leaders in their professional disciplines, influential in establishing clinical practice standards, and technical experts for government and other key health organisations.

CONCLUSION

Training health-care professional faculty to become knowledgeable and committed to tobacco cessation opens opportunities to promote cessation and shift professional and societal norms away from tobacco use.

Teaching the competencies: using observed structured clinical examinations for faculty development

OBJECTIVES

Gastroenterology (GI) training programs must develop the teaching skills of their faculty and provide feedback to their fellows. Many faculty feel uncomfortable offering feedback or identifying specific areas for improvement to the fellows. We developed an Observed Structured Clinical Exam (OSCE) to assess fellows' skills and provided faculty with specific criteria to rate the fellows' performance. We propose that OSCEs can serve as tools for faculty development in delivering effective feedback.

METHODS

Faculty completed a Web-based training module and received written guidelines on giving feedback. Four OSCE stations were completed by each fellow with faculty using standardized checklists to assess the fellows' skills. Afterwards, faculty rated each program component and assessed their comfort level with feedback.

RESULTS

Eight faculty members and 10 fellows from 5 GI training programs in NYC participated. 100% of the faculty agreed that feedback is an important learning tool, should include the learner's self-assessment, and that feedback skills could improve with practice. Compared to faculty skills prior to the program, 87.5% of the faculty agreed that they focused more on specific behaviors and 75% agreed that giving negative feedback was now easier.

CONCLUSIONS

OSCEs can serve as practicums for faculty development in giving constructive feedback.

[First-year medical residents' self-assessment of skill in basic life support and automatic external defibrillation]

OBJECTIVE

To determine first-year medical residents' perception of their competence in basic life support (BLS) and the use of automatic external defibrillation (AED).

MATERIAL AND METHODS

Course in BLS and AED accredited by the European Resuscitation Council with pre- and post-course self-assessment. The post-training questionnaire was administered immediately after the course and 8 months later. The data recorded covered (a) prior training and experience, (b) self-assessment of BLS and AED skills (9 items, scored 1-5), (c) the skill considered most difficult, and (d) satisfaction (13 items, scored 0-10).

RESULTS

The questionnaire was initially completed by 71 residents; 31 also responded 8 months later. Self-assessment scores improved immediately after the course (P = .0001). Scores had fallen 8 months later (P = .0001) but were still significantly higher than pre-course perception of skill (P = .017). More than 95% of the residents considered themselves to be competent after the course and more than 80% felt competent 8 months later, with the exception of skills in bag-mask ventilation (74.2%) and removal of a foreign body (61.3%). The skill considered most difficult was bag-mask ventilation. Mean (SD) BLS and AED scores for real-life situations were 8.48 (1.33) and 9.19 (0.94), respectively, after the course and 7.32 (1.4) and 7.29 (1.32) at 8 months (P = .0001). Overall satisfaction was high.

CONCLUSIONS

The residents perceived themselves as competent to give BLS and AED immediately after the course and 8 months after training, although fewer felt as competent at the second assessment. Bag-mask ventilation was considered the most difficult skill.

Disseminating educational innovations in health care practice: training versus social networks

Improvements and innovation in health service organization and delivery have become more and more important due to the gap between knowledge and practice, rising costs, medical errors, and the organization of health care systems. Since training and education is widely used to convey and distribute innovative initiatives, we examined the effect that following an intensive Teach-the-Teacher training had on the dissemination of a new structured competency-based feedback technique of assessing clinical competencies among medical specialists in the Netherlands. We compared this with the effect of the structure of the social network of medical specialists, specifically the network tie strength (strong ties versus weak ties). We measured dissemination of the feedback technique by using a questionnaire filled in by Obstetrics & Gynecology and Pediatrics residents (n=63). Data on network tie strength was gathered with a structured questionnaire given to medical specialists (n=81). Social network analysis was used to compose the required network coefficients. We found a strong effect for network tie strength and no effect for the Teach-the-Teacher training course on the dissemination of the new structured feedback technique. This paper shows the potential that social networks have for disseminating innovations in health service delivery and organization. Further research is needed into the role and structure of social networks on the diffusion of innovations between departments and the various types of innovations involved.

The evolution of faculty development in Canada since the 1980s: coming of age or time for a change?

AIM

To determine the current status of university based faculty development at Canadian Medical Schools.

BACKGROUND

The roles and responsibilities of faculty members at Canadian medical schools are changing significantly as a consequence of influences such as the competency dictates outlined in the CanMEDS roles. One result of the changes is an increased need for faculty development to assist faculty members in carrying out their new and expanded roles.

METHODS

The changing climate in medical schools, and the enhanced performance expectations of academic faculty, led us to conduct a survey of current faculty development practices in Canadian medical schools to determine what is being done to address the new and expanded expectations of faculty members. We used an on-line survey instrument based on surveys of faculty development conducted in 1987 and 1997.

RESULTS

We received responses from faculty development directors at all 17 Canadian medical schools. Among the principal findings are a continued emphasis on faculty members' teaching roles, increased funding of faculty development activities at most schools, and a broadened emphasis on faculty roles other than teaching. Among these are research and scholarship, and management and administrative roles. The survey revealed a mismatch between what faculty development directors consider to be effective development practices and which practices are actually used in their schools. Another notable finding is the absence of credible faculty development impact studies.

CONCLUSION

The 2007 survey of faculty development practices in Canadian medical schools indicates that teaching is still the number one priority for faculty members and the main focus of faculty development programs. There are notable efforts to help faculty members deal with their newly identified roles including those outlined in the CanMEDS framework. In looking forward, Canadian faculty development directors should continue their efforts to devise credible program evaluation methods. Furthermore, they should expand their thinking beyond Canada's borders. It is time to aggressively explore and understand the approaches and experiences which have proven successful internationally in the United States and Europe.

As time goes by: Stakeholder opinions on the implementation and use of a virtual patient simulation system

BACKGROUND

Stakeholder opinions on the implementation of a particular virtual patient application might prove important for decision-making and implementation efforts in general. This study aimed to capitalize on experiences originated from two post-implementation settings of Web-based Simulation of Patients (Web-SP).

METHOD

We conducted a cross-sectional survey of stakeholder opinions (39 students, teachers, course directors, and university leaders) on the implementation and use of Web-SP in Colombia and Sweden, using a mixed method approach.

RESULTS

The respondents did not show equal preference in rating the ranking of the order of importance included in the variables (Friedman's Chi square: 26.5 to 115.1, df = 6, p < 0.001, Kendall's coefficient of concordance ranging from 0.11 to 0.50). The answers provided as free comments supported the statistical findings on the importance of end-user customization, need for authenticity in software design, and use of virtual patient simulations in a curricular context, for clinical reasoning development.

CONCLUSIONS

Virtual Patient design should allow extensive editing, support case authenticity and enhance clinical reasoning abilities, in an effort for ensuring accountability and sustainable development of the field.

Conducting a best evidence systematic review. Part 1: From idea to data coding. BEME Guide No. 13

This paper outlines the essential aspects of conducting a systematic review of an educational topic beginning with the work needed once an initial idea for a review topic has been suggested through to the stage when all data from the selected primary studies has been coded. It draws extensively on the wisdom and experience of those who have undertaken systematic reviews of professional education, including Best Evidence Medical Education systematic reviews. Material from completed reviews is used to illustrate the practical application of the review processes discussed. The paper provides practical help to new review groups and contributes to the debate about ways of obtaining evidence (and what sort of evidence) to inform policy and practice in education.

The importance of faculty development in the transition to competency-based medical education

Medical teachers trained in conventional educational systems need faculty development to prepare them to function effectively in a competency-based medical education (CBME) system. Faculty development can provide knowledge about CBME, training in new teaching techniques in different domains of medical practice, and new strategies for providing the authentic and regular assessment that is an essential aspect of CBME. A systems-wide approach as well as efforts to provide training in CBME to individual teachers in both the undergraduate and postgraduate systems will be important. The wide implementation of CBME will be challenging and slow, and will meet with resistance, but various strategies can be used address these challenges. Faculty development is fundamental to the effectiveness of those strategies.

The Colleague Development Program: a multidisciplinary program of peer observation partnerships

BACKGROUND

As an introduction to peer observation of teaching, a multi-disciplinary program of peer observation partnerships was implemented across Faculty of Health Sciences. The 'Colleague Development Program' focussed on formative feedback and on promoting collegiality within and across traditional discipline boundaries.

AIMS

To describe the development, implementation, and evaluation of the Colleague Development Program.

METHODS

Participants asked a trusted colleague to observe their teaching. Feedback on good practice and suggestions for improvement were sought. Colleague observations were guided by specific learning objectives articulated by participants. Following the teaching observation/s, the colleague observer and the participant discussed the extent to which the participant's learning objectives had been achieved. A written summary of mutually agreed outcomes was prepared. Program evaluation included anonymous participant questionnaire and focus group discussions.

RESULTS

Forty-two staff enrolled in the program with 23 completing all elements and participating in the evaluation. Participants reported increased confidence in teaching, confirmation of good practice, exposure to new ideas, and a greater sense of institutional support and collegiality.

CONCLUSIONS

Situating peer evaluation within a collegial partnership overcame participants' concerns about being the subject of 'evaluation' and 'criticism' by emphasising existing collegiality and trust amongst peers.

A systematic review of resident-as-teacher programmes

CONTEXT

Residents in all disciplines serve as clinical teachers for medical students. Since the 1970s, there has been increasing evidence to demonstrate that residents wish to teach and that they respond positively to formal teacher training. Effective resident-as-teacher (RaT) programmes have resulted in improved resident teaching skills. Current evidence, however, is not clear about the specific features of an effective RaT programme.

OBJECTIVES

This study was performed in order to investigate the effectiveness of RaT programmes on resident teaching abilities and to identify the features that ensure success. Methods of assessment used to ascertain the effectiveness of RaT programmes are also explored.

METHODS

The literature search covered the period between 1971 and 2008. Articles focusing on improving resident teaching skills were included. Each study was reviewed by two reviewers and data were collected using a standard abstraction summary sheet. Study outcomes were graded according to a modified Kirkpatrick's model of educational outcomes.

RESULTS

Twenty-nine studies met review inclusion criteria. Interventions included workshops, seminars, lectures and teaching retreats. Twenty-six studies used a pre- and post-intervention outcome comparison method. Subjective outcome measures included resident self-evaluation of teaching skills or evaluation by medical students, peers and faculty members. Objective outcome measures included written tests, evaluation of teaching performance by independent raters and utilisation of objective structured teaching examinations. One study objectively measured learning outcomes at the level of medical students, utilising the results of an objective structured clinical examination. Overall resident satisfaction with RaT programmes was high. Participants reported positive changes in attitudes towards teaching. Participant knowledge of educational principles improved. Study methodologies allowed for significant risks of bias.

CONCLUSIONS

More rigorous study designs and the use of objective outcome measures are needed to ascertain the true effectiveness of RaT programmes. Future research should focus on determining the impact of RaT programmes on learning achievement at the level of medical students.