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

Education Morbidity and Mortality: Reviving Intraoperative Teaching and Learning

BACKGROUND

Using the platform of morbidity and mortality conference, we developed and executed a combined faculty-resident intervention called "Education M&M" to discuss challenges faced by both parties in the operating room (OR), identify realistic solutions, and implement action plans. This study aimed to investigate the impact of this intervention on resident OR training.

MATERIALS AND METHODS

Two resident case presentations were followed by audience discussion and recommendations regarding actionable solutions aimed at improving resident OR training from an expert faculty panel. Postintervention surveys were completed by participants immediately and 2 mo later to assess perceived short and long-term impact on OR teaching and/or learning and the execution of two recommended solutions. Descriptive statistical analysis was applied.

RESULTS

Immediate post-intervention surveys (n = 44) indicated that 81.8% of participants enjoyed the M&M "a lot"; 90.1% said they would use some or a lot of the ideas presented. Awareness of OR teaching/learning challenges before and after the M&M improved from 3.0 to 3.7 (P = 0.00001) for faculty and 3.0 to 3.9 for trainees (P = 0.00004). Understanding of OR teaching and/or learning approaches improved from 3.1 to 3.7 for faculty (P = 0.00004) and 2.7 to 3.9 for trainees (P = 0.00001). In 2-mo post-intervention surveys, most residents had experienced two recommended solutions (71% and 88%) in the OR, but self-reported changes to faculty behavior did not reach statistical significance.

CONCLUSIONS

A department-wide education M&M could be an effective approach to enhance mutual communication between faculty members and residents around OR teaching/learning by identifying program-specific challenges and potential actionable solutions.

An Evaluation of Faculty Development Programs for Clinician-Educators: A Scoping Review

PURPOSE

Faculty development (FD) has become increasingly important for clinician-educators. An array of FD programs has been developed, but the impact of these programs on clinician-educators and their learners and workplace is less known. The authors conducted a scoping review to explore the status of program evaluation in FD for clinician-educators to inform future planning and research.

METHOD

Five databases were searched for articles published from January 1998 to August 2018 using Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Studies that described evaluation methods and outcomes of FD programs for clinician-educators were included. Data were collected and organized according to program domain (teaching, research/scholarship, leadership, or a combination of skills). A modified version of the Kirkpatrick model was used to compare results among studies.

RESULTS

From a total of 2,091 articles, 1,095 were eligible for full review, and 31 met the inclusion criteria. Seven programs targeted only teaching skills, 3 research/scholarship skills, 7 leadership skills, and 14 a combination of skills. Eighteen programs required the completion of a project; fewer offered fellowships, master's degrees, or certificates. Participant surveys were the most common evaluation method across all domains. Often used metrics included participant satisfaction and self-reported knowledge, skills, behavior changes, scholarly output, and leadership positions. Less common evaluation methods included learner and peer evaluations, interviews, and focus groups. Change at the institutional level was evaluated in 11 programs.

CONCLUSIONS

Program evaluation remains an underdeveloped area in FD for clinician-educators. Developers expend significant effort on program design and implementation but approach evaluation less purposefully. Rigorous metrics that align with program goals and are used longitudinally are needed to accurately assess the impact of FD programs on participants and their learners, workplace, and institutions at large.

The "Medical Education Roadshow:" Delivering Faculty Development to Busy Clinician Educators When They Least Expect It

INTRODUCTION

Designing impactful faculty development for busy clinicians is challenging. Many may not recognize their impact on the learning environment or prioritize their development as educators. Our objective was to evaluate the feasibility and acceptability of a faculty development approach, the "Medical Education Roadshow," which delivered succinct, actionable faculty development at regularly scheduled, departmental clinical business meetings.

METHODS

Between October 2018 and October 2019, we conducted six 15-minute "roadshows" for the Obstetrics and Gynecology faculty at one academic medical center. Each roadshow addressed a foundational education topic in an interactive manner with an emphasis on one take-away skill in teaching behavior. We utilized a simple, anonymous evaluation tool to obtain participant feedback and analyzed quantitative data descriptively and qualitative data thematically.

RESULTS

A total of 174 of 265 evaluations were returned (65.6% response rate). Participants indicated that the roadshows helped them think about teaching more effectively and offered one or more practical daily practice tips. Qualitative findings coalesced into two themes. First, participants identified multiple intended practice changes, including using more effective teaching strategies, being more deliberate about feedback, and modeling exemplary professional behavior. Second, participants recommended multiple improvement opportunities and future topics.

DISCUSSION

Busy clinical faculty were highly receptive to opportunities to improve as educators through the "roadshow" approach.

Curriculum renewal in the time of COVID-19: The Washington University School of Medicine Story

Washington University School of Medicine began a curriculum renewal process in 2017 with a goal of implementing the Gateway Curriculum in 2020. In this article, we describe the vision of this curriculum and the infrastructure that was built to support it. We also describe the impact of COVID‐19 on the legacy curriculum and the Gateway Curriculum as well as the lessons learned to date.

MERIT: a mentor reflection instrument for identifying the personal interpretative framework

BACKGROUND

Essential to the professional development of mentors is making explicit and critically challenging the knowledge and beliefs underpinning their mentoring practice. This paper reports on the development of a survey instrument called MERIT, MEntor Reflection InstrumenT, which was designed to support mentors' systematic reflection on the how, what and why of their practice.

METHODS

In 2019, a twenty-item survey instrument was developed and piloted. Initial validation data (N = 228) were collected by distributing the survey through the authors' network. An exploratory factor analysis (EFA) was conducted and internal consistency reliability coefficients were calculated.

RESULTS

The Principal Axis EFA with Direct Oblimin rotation (Delta = 0) resulted in four factors: 1) supporting personal development, 2) modelling professional development, 3) fostering autonomy, and 4) monitoring performance. The four factors explained 43% of the total variance of item scores. The Cronbach's alphas for the subscale scores were between .42 and .75.

CONCLUSIONS

The MERIT can help mentors reflect on their beliefs and professional knowhow. These reflections can serve as input for the faculty development initiatives mentors undertake, which may ultimately improve their knowledge and skills as a mentor.

Knowledge syntheses in medical education: A bibliometric analysis

PURPOSE

This bibliometric analysis maps the landscape of knowledge syntheses in medical education. It provides scholars with a roadmap for understanding where the field has been and where it might go in the future, thereby informing research and educational practice. In particular, this analysis details the venues in which knowledge syntheses are published, the types of syntheses conducted, citation rates they produce, and altmetric attention they garner.

METHOD

In 2020, the authors conducted a bibliometric analysis of knowledge syntheses published in 14 core medical education journals from 1999 to 2019. To characterize the studies, metadata were extracted from PubMed, Web of Science, Altmetrics Explorer, and Unpaywall.

RESULTS

The authors analyzed 963 knowledge syntheses representing 3.1% of the total articles published (n = 30,597). On average, 45.9 knowledge syntheses were published annually (SD = 35.85, median = 33), and there was an overall 2620% increase in the number of knowledge syntheses published from 1999 to 2019. The journals each published, on average, a total of 68.8 knowledge syntheses (SD = 67.2, median = 41) with Medical Education publishing the most (n = 189; 19%). Twenty-one types of knowledge synthesis were identified, the most prevalent being systematic reviews (n = 341; 35.4%) and scoping reviews (n = 88; 9.1%). Knowledge syntheses were cited an average of 53.80 times (SD = 107.12, median = 19) and received a mean Altmetric Attention Score of 14.12 (SD = 37.59, median = 6).

CONCLUSIONS

There has been considerable growth in knowledge syntheses in medical education over the past 20 years, contributing to medical education's evidence base. Beyond this increase in volume, researchers have introduced methodological diversity in these publications, and the community has taken to social media to share knowledge syntheses. Implications for the field, including the impact of synthesis types and their relationship to knowledge translation, are discussed.

"PLEASE Complete Your Evaluations!" Strategies to Engage Faculty in Competency-Based Assessments

Competency-based assessments (CBAs) have gained traction in graduate medical education and inform important learner outcomes through the continuum of medical training. Active participation in new CBAs presents challenges to faculty working in a busy clinical environment. As such, the implementation of new CBAs can be approached with intention to foster acceptance and engagement with new evaluations. This paper describes strategies utilized to implement CBAs among clinician educators during a national assessment pilot. Our methods are grounded in educational, psychological, business, ecological, communication, and information technology theory. Our primary interventions included creating a multilevel vision, engaging a dedicated work group, incorporating quality improvement methodology, and integrating technology to successfully implement the assessments. These practical and effective interventions may also be applied to the implementation of other educational innovations.

Funding the Educational Mission in Neurology

Although it is self-evident that education in neurology is important and necessary, how to fund the educational mission is a frequent challenge for neurology departments and clinicians. Department chairs often resort to a piecemeal approach, cobbling together funding for educators from various sources, but frequently falling short. Here, we review the various sources available to fund the educational mission in neurology, understanding that not every department will have access to every source. We describe the multiple different teaching models and formats used by the modern student and educator and their associated costs, some of which are exorbitant. We discuss possible nonfinancial incentives, including pathways to promotion, educational research, and other awards and recognition. Neurological education is commonly underfunded, and departments and institutions must be nimble and creative in finding ways to fund the time and effort of educators.

A Curriculum for Enhancing Physician Teaching Skills: The Value of Physician-Educator Partnerships

Developing as a physician requires an enormous amount of complex training, and quality of instruction greatly affects training outcomes. But while physicians are expected to teach trainees within the clinic, they often do not receive formal training in effective instructional practices. Providing faculty development programs is one way that institutions can help physicians develop teaching skills, but these programs often are developed without the input of educational specialists and not based in educational theory. In this methodology paper, we describe a 5-module curriculum that was developed in a cross-disciplinary collaboration between instructional designers and physician faculty. By merging educational and medical expertise and using adult learning theory with the Charlotte-Danielson educational framework, an essentials for clinical teaching educational endorsement program (ECTEEP) was created as a feature of the institutional curriculum within a large, urban teaching hospital. Here we describe how the program was developed through a physician-educator partnership, outline the program's key content, and highlight essential aspects of successful implementation. The ECTEEP incorporates active learning approaches within an abbreviated format, distilling 5 critical aspects of effective teaching that are relevant to the clinical environment: cultural humility and safe learning environments, instruction practices for engaging learners, instruction and assessment strategies, receiving and giving feedback, and mentorship and coaching. A central feature of the program is that facilitators actively model the teaching behaviors they are conveying, which underscores the critical importance of facilitator preparation and skill. Our curriculum is offered here as a basic template for institutions that may want to establish a program for enhancing physician teaching skill.

Learning anatomy by virtual reality and augmented reality. A scope review

During the last century, there were no significant changes in the teaching methods of anatomy in universities, predominating expositive lectures, and anatomy laboratory activities. With the advent of new technologies, simulators, augmented reality, and virtual reality, new teaching possibilities have emerged that may provide assistance and, in some situations, replace traditional methods of teaching. In this narrative scope review we evaluate articles that compare traditional methods with virtual reality or augmented reality through a search on Cochrane library, MEDLINE, EMBASE, and LILACS databases, using the MeSH terms "Anatomy", "Virtual Reality", "Augmented Reality", "Video Games", "Education Medical, Undergraduate", "Teaching" and "Simulation Training". We concluded that virtual reality and augmented reality have a promising value for teaching anatomy in addition to a positive economic impact on universities.

Applying multiple frameworks to establish effective virtual collaborative teams in academia: a review and recommendations

Recently, academic health professionals have been increasing collaboration with peers at a distance for activities such as research, scholarship, and faculty development. Novel virtual technologies enable academic professional teams to overcome time and distance barriers to facilitate collaboration, but little research is available to guide academicians on how to effectively organize and manage virtual collaborative teams using these technologies. Based upon a literature review and six years of experience as a virtual collaborative team, the authors use Boyer's Scholarship of Integration paradigm to identify and critique four models for virtual collaboration. The literature search devised from the four identified models found references that had a theoretical foundation for peer virtual collaboration and have been adopted in some professional context. The authors present a review of this literature, describe the benefits for adapting these models to academic health profession contexts, and provide a reflective critique about the challenges for their adaptation in these contexts. They also provide a hypothetical scenario to exemplify the application of these models for health-care professionals along with important considerations and tips when forming new virtual peer collaborative teams or problem-solving teams who are not optimally functioning.

Is Asking Questions on Rounds a Teachable Skill? A Randomized Controlled Trial to Increase Attendings' Asking Questions

BACKGROUND

Morning bedside rounds remain an essential part of Internal Medicine residency education, but rounds vary widely in terms of educational value and learner engagement.

OBJECTIVE

To evaluate the efficacy of an intervention to increase the number and variety of questions asked by attendings at the bedside and assess its impact.

DESIGN

We conducted a randomized, controlled trial to evaluate the efficacy of our intervention.

PARTICIPANTS

Hospitalist attendings on the general medicine service were invited to participate. Twelve hospitalists were randomized to the experimental group and ten hospitalists to the control group.

INTERVENTION

A one-hour interactive session which teaches and models the method of asking questions using a non-medical case, followed by practice using role plays with medical cases.

MAIN MEASURES

Our primary outcome was the number of questions asked by attendings during rounds. We used audio-video recordings of rounds evaluated by blinded reviewers to quantify the number of questions asked, and we also recorded the type of question and the person asked. We assessed whether learners found rounds worthwhile using anonymous surveys of residents, patients, and nurses.

KEY RESULTS

Blinded analysis of the audio-video recordings demonstrated significantly more questions asked by attendings in the experimental group compared to the control group (mean number of questions 23.5 versus 10.8, p< 0.001) with significantly more questions asked of the residents (p<0.003). Residents rated morning bedside rounds with the experimental attendings as significantly more worthwhile compared to rounds with the control group attendings (p=0.009).

CONCLUSION

Our study findings highlight the benefits of a one-hour intervention to teach faculty a method of asking questions during bedside rounds. This educational strategy had the positive outcome of including significantly more resident voices at the bedside. Residents who rounded with attendings in the experimental group were more likely to "strongly agree" that bedside rounds were "worthwhile".

The training needs for gender-sensitive care in a pediatric rehabilitation hospital: a qualitative study

BACKGROUND

Gender is an important social determinant of health; however, clinicians often lack training in how to provide gender-sensitive care. Offering appropriate and relevant training could help to address some gender-based health inequalities. Our objective was to identify and describe the training needs for gender-sensitive care among pediatric rehabilitation healthcare providers.

METHODS

This study used an interpretive descriptive qualitative design to conduct interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man), from a pediatric rehabilitation hospital in a large urban center, in Ontario, Canada from a range of disciplines. Interviews were transcribed verbatim and analyzed using an open-coding inductive thematic analysis.

RESULTS

Our analysis revealed the following themes: [1] lack of knowledge about gender-sensitive care and the need for more training; [2] content of the desired training (i.e., gender differences, effective communication and how to practice gender-sensitive care) and [3] delivery method of the training.

CONCLUSIONS

Enhanced gender-sensitive training for healthcare providers is required for optimizing patient outcomes and addressing gender-based health inequalities. Educators in pediatric rehabilitation should consider developing gender-sensitive care training that is embedded within post-graduate education and also continuing education within hospitals and community care centers.

Faculty Development Initiatives at the College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman

Faculty development is necessary to improve and update teaching and learning methodologies. As such, a variety of learning activities have been designed to improve teaching competencies of individual teachers. The College of Medicine & Health Sciences at Sultan Qaboos University, Muscat, Oman, recognised the need for teacher training in order to bring faculty up-to-date in teaching and assessment methodologies. A programme of regular and one-time interventions consisting of short courses, workshops and a series of lectures was offered. Feedback from the participants and facilitators led to programme expansion and enhancement. This special contribution discusses the impact of the programme on faculty and the college.

Cross-Center Virtual Education Fellowship Program for Early-Career Researchers in Atrial Fibrillation

BACKGROUND

It is estimated that over 46 million individuals have atrial fibrillation (AF) worldwide, and the incidence and prevalence of AF are increasing globally. There is an urgent need to accelerate the academic development of scientists possessing the skills to conduct innovative, collaborative AF research.

METHODS

We designed and implemented a virtual AF Strategically Focused Research Network Cross-Center Fellowship program to enhance the competencies of early-stage AF basic, clinical, and population health researchers through experiential education and mentorship. The pedagogical model involves significant cross-center collaboration to produce a curriculum focused on enhancing AF scientific competencies, fostering career/professional development, and cultivating grant writing skills. Outcomes for success involve clear expectations for fellows to produce manuscripts, presentations, and-for those at the appropriate career stage-grant applications. We evaluated the effectiveness of the fellowship model via mixed methods formative and summative surveys.

RESULTS

In 2 years of the fellowship, fellows generally achieved the productivity metrics sought by our pedagogical model, with outcomes for the 12 fellows including 50 AF-related manuscripts, 7 publications, 28 presentations, and 3 grant awards applications. Participant evaluations reported that the fellowship effectively met its educational objectives. All fellows reported medium to high satisfaction with the overall fellowship, webinar content and facilitation, staff communication and support, and program organization.

CONCLUSIONS

The fellowship model represents an innovative educational strategy by providing a virtual AF training and mentoring curriculum for early-career basic, clinical, and population health scientists working across multiple institutions, which is particularly valuable in the pandemic era.

Inter-Institutional Collaboration for the Development of a Local Peer Observation Process to Enhance Teaching

Local peer observation of teaching is considered an important mechanism for instructors to improve the quality and effectiveness of their teaching, but there is an absence of uniformity to establish a best practice for this process in veterinary curricula. The Regional Teaching Academy (RTA) of the Consortium of Western Colleges of Veterinary Medicine is comprised of educational advocates from five western veterinary colleges with a common goal of enhancing the quality and effectiveness of education in veterinary medical curricula. Members of the RTA recognized this deficit in best practices for local peer observation (LPO) and formed a working group called "Local Peer Observation of Teaching." The goal was to meet a critical need for the enhancement of individual teaching skills by using a scholarly approach to develop robust methods for peer observation of teaching. Two rubric-based instruments were developed: one for large-group/didactic settings, and the second for small-group/clinical settings. Each is accompanied by pre- and post-observation worksheets which are considered instrumental to success. Results of a qualitative survey of instrument users' experiences are shared. Both observers and observees view the experiential learning from faculty peer colleagues very positively and the meaningful feedback is appreciated and incorporated by observees. Suggestions for implementation of the peer observation process are discussed, considering strengths and challenges. The purpose of this article is to describe in depth, the development process and output of the efforts of the Local Peer Observation of Teaching working group as a potential best practice guideline for peer observation.

Veterinary Educator Teaching and Scholarship (VETS): A Case Study of a Multi-Institutional Faculty Development Program to Advance Teaching and Learning

Content expertise in basic science and clinical disciplines does not assure proficiency in teaching. Faculty development to improve teaching and learning is essential for the advancement of veterinary education. The Consortium of West Region Colleges of Veterinary Medicine established the Regional Teaching Academy (RTA) with the focus of "Making Teaching Matter." The objective of the RTA's first effort, the Faculty Development Initiative (FDI), was to develop a multi-institutional faculty development program for veterinary educators to learn about and integrate effective teaching methods. In 2016, the Veterinary Educator Teaching and Scholarship (VETS) program was piloted at Oregon State University's College of Veterinary Medicine. This article uses a case study approach to program evaluation of the VETS program. We describe the VETS program, participants' perceptions, participants' teaching method integration, and lessons learned. A modified Kirkpatrick Model (MKM) was used to categorize program outcomes and impact. Quantitative data are presented as descriptive statistics, and qualitative data are presented as the themes that emerged from participant survey comments and post-program focus groups. Results indicated outcomes and impacts that included participants' perceptions of the program, changes in participant attitude toward teaching and learning, an increase in the knowledge level of participants, self-reported changes in participant behaviors, and changes in practices and structure at the college level. Lessons learned indicate that the following are essential for program success: (1) providing institutional and financial support; (2) creating a community of practice (COP) of faculty development facilitators, and (3) developing a program that addresses the needs of faculty and member institutions.

Didactic qualification of teaching staff in primary care medicine - a position paper of the Primary Care Committee of the Society for Medical Education

Having teaching staff with didactic qualifications in university teaching leads to a measurable improvement in academic skills among students. Previous recommendations on the type and scope of medical didactic qualification measures primarily apply to teaching staff at university and in-patient settings. The situation of primary care medicine, which often employs external lecturers and whose teaching takes place to a considerable extent in decentralized training facilities (teaching practices) is not adequately addressed. Taking into account a survey on the status quo at higher education institutions for General Practice in Germany, recommendations for minimum standards are made, based on national and international recommendations on the content and scope of medical didactic qualification measures. These recommendations include preliminary work by the Personnel and Organizational Development in Teaching (POiL) Committee of the Society for Medical Education (GMA), the MedicalTeachingNetwork (MDN), the Society of University Teaching Staff in General Medicine (GHA) as well as the experiences of the committee members, who hail from the field of general medicine, internal medicine and pediatrics amongst others.

Improving Medical Education Through Targeted Coaching

Medical education is shifting from a lecture-based teaching format toward an emphasis on active learning. Educators need support to build a collaborative learning environment where students interact with ideas and each other. In order to support medical educators who are new to teaching in the paradigm of active learning, we argue that targeted, educative coaching, rooted in educational theory, is needed. Coaching is a common practice in learning to teach and is not a new concept in medical education. What is new is targeted coaching situated within an assisted performance framework for the purpose of learning to teach effectively. Targeted coaching includes using coaching practices such as observing, debriefing, and co-planning in purposeful, educative ways. Assisted performance involves supporting the medical educator by identifying teaching skills to be learned, practicing those skills with support, and eventually preparing for unassisted performance. The purpose of this article is to describe a model of professional development that provides targeted support for medical teachers. In this paper, we outline a model of educator development and provide two stories of our model in practice, to further demonstrate how assisted performance and core coaching practices can be used together to impact teaching.

An international study on teachers' conceptions of learning and teaching and corresponding teacher profiles

Introduction: Teachers' conceptions of learning and teaching (COLT) affect their teaching behaviour. The 18 item COLT instrument has been developed in the Netherlands and comprises three scales, 'teacher centredness', 'appreciation of active learning' and 'orientation to professional practice'. Previously we found five teacher profiles. The aim of this study was to find out if the COLT instrument can be used in an international setting.Methods: Data were collected with the web-based COLT. Cronbach's alphas of the three COLT scales were calculated. Subsequently a cluster analysis was conducted to identify different teacher profiles, followed by a split half validation procedure.Results: Respondents (n = 708) worked in 28 countries. Cronbach's alphas were 0.67, 0.54, and 0.66. A six-cluster solution fitted best, based on meaning and explained variance. The sixth teacher profile scored high on 'teacher centredness', average on 'appreciation of active learning' and low on 'orientation to professional practice'. The split half validation resulted in a Cohen's kappa of 0.744.Discussion: Cronbach's alphas indicated acceptable reliablities for all three subscales. The new, sixth profile was labelled 'neo-transmitter'.Conclusion: We found evidence supporting the validity of the use of COLT in an international context and identified a new, sixth teacher profile.

Curriculum Changes and Trends 2010-2020: A Focused National Review Using the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II

Medical school curricula have evolved from 2010 to 2020. Numerous pressures and influences affect medical school curricula, including those from external sources, academic medical institutions, clinical teaching faculty, and undergraduate medical students. Using data from the AAMC Curriculum Inventory and the LCME Annual Medical School Questionnaire Part II, the nature of curriculum change is illuminated. Most medical schools are undertaking curriculum change, both in small cycles of continuous quality improvement and through significant change to curricular structure and content. Four topic areas are explored: cost consciousness, guns and firearms, nutrition, and opioids and addiction medicine. The authors examine how these topic areas are taught and assessed, where in the curriculum they are located, and how much time is dedicated to them in relation to the curriculum as a whole. When examining instructional methods overall, notable findings include (1) the decrease of lecture, although lecture remains the most used instructional method, (2) the increase of collaborative instructional methods, (3) the decrease of laboratory, and (4) the prevalence of clinical instructional methods in academic levels 3 and 4. Regarding assessment methods overall, notable findings include (1) the recent change of the USMLE Step 1 examination to a pass/fail reporting system, (2) a modest increase in narrative assessment, (3) the decline of practical labs, and (4) the predominance of institutionally developed written/computer-based examinations and participation. Among instructional and assessment methods, the most used methods tend to cluster by academic level. It is critical that faculty development evolves alongside curricula. Continued diversity in the use of instructional and assessment methods is necessary to adequately prepare tomorrow's physicians. Future research into the life cycle of a curriculum, as well optional curriculum content, is warranted.

Continuity of care and chronicity in medical students' education: 'adopt' a chronic patient

Purpose: Nowadays chronicity is one of the most frequent aspects of care doctors have to deal with. Students need to know and learn clinical, relational, social and managerial elements of chronicity and changes that disease causes in patients, families and doctors themselves. Methods: Students are supervised by a family doctor, in taking care of 'their' patient and of his/her family. They are asked to keep an updated diary, participate in the periodical revision of the medical history and write an end-report. Two focus groups were conducted, adopting a constructive qualitative approach in order to analyse results. Results: The focus groups and the SWOT analysis show common themes such as innovative learning and multidisciplinary approach. Clinical evolution of the disease, mental and body changes and the diagnostic and therapeutic future planning were also revealed. Conclusions: The main goal of this innovation was understanding the importance of a continuous clinical relationship and of the role of the doctor as 'therapy itself'. The project was demonstrated to be able to teach the future physicians how to practice more empathetic medicine and to improve the skills needed in a complex relational environment including that of chronic disease.

Becoming outstanding educators: What do they say contributed to success?

Aspiring medical educators and their advisors often lack clarity about career paths. To provide guidance to faculty pursuing careers as educators, we sought to explore perceived factors that contributed to the career development of outstanding medical educators. Using a thematic analysis, investigators at two institutions interviewed 39 full or associate professor physician faculty with prominent roles as medical educators in 2016. The social cognitive career theory (SCCT) informed the interview guide. Investigators developed the codebook and performed iterative analysis using qualitative methods. Extensive team discussion generated the final themes. Eight themes emerged related to preparation, early successes, mentors, networks, faculty development, balance, work environment, and multiple identities. Preparation led to early successes, which served as "launch points," while mentors, networks, and faculty development programs served as career accelerators to open more opportunities, and a supportive work environment was an additional enabler of this pathway. Educators who reported balance between work and outside interests described boundary setting as well as selectively choosing new opportunities to establish boundaries in mid-career. Participants described multiple professional identities, and clinician and educator identities tended to merge and reinforce each other as careers progressed. This study revealed common themes describing trajectories of success among medical educators. These themes aligned with the SCCT, and typically replayed and spiraled over the course of the educators' careers. These findings resonate with other studies, lending credence to an approach to career development that can be shared with junior faculty who are exploring careers in medical education.

Developing a Novel 4-C Framework to Enhance Participation in Faculty Development

Phenomenon: Universities offer a variety of voluntary faculty development to ensure quality education, but face inconsistent faculty participation. Therefore, all Dutch universities require all faculty to obtain a teaching qualification certificate. Yet, like other medical centers, University Medical Center Utrecht continued to struggle with faculty nonparticipation. It has been postulated that clinician teachers may face unique challenges with responsibilities for patient care in addition to teaching and research, challenges that cannot be overcome by merely mandating faculty development or a teaching certificate. This project was conducted to gain insight into factors that hinder faculty participation and better understand what is needed to enhance faculty engagement in their professional development as teachers. Approach: UMC Utrecht has had a teaching certificate requirement for over 20 years. In 2015-2016, we conducted a local needs assessment, gathering faculty perspectives about the teaching certification process. To convey seriousness of purpose and promote commitment to change, we formally engaged key stakeholders from the outset, obtained grant funding for the needs assessment, and had an outside consultant lead the project. Faculty who were stalled or never started were questioned via semi-structured interviews. A focus group with those actively in the process of obtaining their certificate discussed perceived challenges in the process and recommended solutions. Faculty who obtained their teaching certificate completed an anonymous evaluation form. All evaluation comments and transcripts were thematically analyzed using open and axial coding. A literature review was performed to contextualize our findings and identify potential solutions. We compared our initial themes to these findings and found key challenge/solution categories, which we subsequently developed into a novel framework. Findings from the study and literature review were organized using this framework and shared with different stakeholders, all of whom engaged in problem-solving. Ideas and potential solutions were incorporated into a final report with recommendations for improving faculty support and provided to the institutional leadership. Findings: Of 23 faculty teachers approached, 8 (34.8%) agreed to be interviewed; 7 of 25 (28.0%) participated in the focus group; and 83 of 156 (53.2%) completed the evaluation. From the transcripts and evaluation comments, three themes emerged related to context and barriers: (a) skill development versus certification; (b) workplace priorities and culture, and (c) visibility and feasibility of the teacher's role. Triangulation of these themes with the literature revealed four challenge/solution categories - Competence, Context, Community, and Career. This 4-C framework facilitated communication of findings, structured the development of an action plan in response to the findings, and assured implementation of new initiatives for faculty support beyond competence development. Insights: Simply adopting requirements for faculty development may be insufficient and even invoke resistance. Improving faculty participation in faculty development and the quality of education requires institutional attention to not just faculty Competence needs, but also the factors of Context, Community, and Career that together comprise the culture experienced by faculty teachers. With institutional buy-in and commitment to change, the 4-C framework can help focus institutional attention on existing gaps in all four domains and guide the development of comprehensive solutions.

Taking stock of what is known about faculty development in competency-based medical education: A scoping review paper

Purpose: The primary objective was to inventory what is currently known about faculty development (FD) for competency-based medical educations (CBME) and identify gaps in the literature.Methods: A scoping review methodology was employed. Inclusion criteria for article selection were established with two reviewers completing a full-text analysis. Quality checks were included, along with iterative consultation on data collection and consensus decision making via a grounded theory approach.Results: The review identified 19 articles published between 2009 and 2018. Most articles (N = 15) offered suggestions as to what should happen with FD in CBME, but few (N = 4) adopted an experimental design. Six main themes were identified with three main features of FD noted across themes: (1) The importance of direct and timely feedback to faculty members on their teaching and assessment skills. (2) The role of establishing shared mental models for CBME curricula. (3) That FD is thought of longitudinally, not as a one-time bolus.Conclusion: This work illustrates that there is limited, high quality research in FD for CBME. Future FD activities should consider employing a longitudinal and multi-modal program format that includes feedback for the faculty participants on their teaching and assessments skills, including the development of faculty coaching skills.

Sustaining a Collegewide Teaching Academy as a Community: 10 Years of Experience With the Master Teacher Program at the University of Tennessee College of Veterinary Medicine

On the basis of strategic initiatives and an evolving focus on educational program enhancement, faculty and staff members designed a structured program to provide leadership and resources for improving instruction and disseminating educational scholarship in a veterinary college. The University of Tennessee College of Veterinary Medicine Master Teacher Program was conceptualized in the teaching academy model as a forum for professional development and dialogue. A small leadership team worked with other faculty to develop the program proposal, including its mission, vision, values, and initial goals. Programming includes monthly meetings to discuss a range of policy, theoretical, and practical topics, as well as periodic workshops focused on current strategic initiatives or hot topics. Ten years later, the program continues to successfully connect educators and have an impact on the college and profession. Attendance has grown steadily; feedback has been positive. Participants rate the program's overall value highly, particularly its impact on their teaching, the opportunity to stay current in educational topics, and the opportunity to learn from colleagues. Discussions within the program have provided valuable input for college policy and practices. Keys to sustained success have included a historical culture emphasizing the teaching mission, alignment with college goals, consistency in leadership and programming, periodic revisions and rebranding, and attention to new faculty and staff needs. This article describes the development, growth, and perceived impact of the program and emphasizes lessons learned and actions taken to sustain its success without additional personnel and at minimal cost.

Faculty development in medical education: an environmental scan in countries within the Asia pacific region

PURPOSE

In recent years, faculty development (FD) research is more noticeable within an inter-professional context and in allied health education. However, there is a paucity of published literature on FD medical education programs in Asia. With the formation of the Asia Pacific Medical Education Network (APME-Net) in 2015, a scoping review of an environmental scan of FD medical education programs in main institutions in South East Asia and Australia in 2018 was conducted.

METHODS

A survey was developed to collect data on FD in medical education after several rounds of discussion with APME-Net members. The representatives from nine countries in Asia and Australia were invited to partner in this research project. They sent the questionnaire to the Dean of all different medical schools after ethical clearance. The data collected was analyzed using descriptive statistics.

RESULTS

Only institutions in four countries responded to the questionnaire. The medical/health professions education center/department/unit has been established in most educational institutions in these countries. These centers/departments/units mostly carry out FD programs to improve the teaching and learning skills of trained participants, particularly clinical teachers via workshops and seminars. Staffing issues and participant buy-in are the current key priorities of the center/department/unit in terms of FD. Lastly, research related FD program has not been well-supported in these countries, hence, the lack of publication in this area.

CONCLUSION

Collaboration between countries to address key areas of interest and develop more standardized and productive FD medical education is required especially in research.

Musculoskeletal Ultrasound Instruction in Adult Rheumatology Fellowship Programs

OBJECTIVE

Musculoskeletal ultrasound (MSUS) in rheumatology in the US has advanced by way of promotion of certifications and standards of use and inclusion of core fellowship curriculum. In order to inform endeavors for curricular integration, the objectives of the present study were to assess current program needs for curricular incorporation and the teaching methods that are being employed.

METHODS

A needs-assessment survey (S1) was sent to 113 rheumatology fellowship program directors. For programs that taught MSUS, a curriculum survey (S2) was sent to lead faculty. Programs were stratified according to program size and use of a formal written curriculum.

RESULTS

S1 (108 of 113 respondents; response rate 96%) revealed that 94% of programs taught MSUS, with 41% having a curriculum. Curricular implementation was unaffected by program size. Formal curricular adoption of MSUS was favored by 103 directors (95.3%), with 65.7% preferring such adoption to be optional. S2 (74 of 101 respondents; response rate 73%) showed that 41% of programs utilized a formal curriculum. Multiple teaching strategies were used, with content that was generally similar. Use of external courses, including the Ultrasound School of North American Rheumatologists course, was prevalent. Fewer barriers were noted compared to past surveys, but inadequate time, funding, and number of trained faculty still remained. Lack of divisional interest (P = 0.046) and interest of fellows (P = 0.012) were noted among programs without a formal curriculum.

CONCLUSION

MSUS is taught by a significantly larger number of rheumatology fellowship programs today. Multiple teaching strategies are used with common content, and barriers still remain for some programs. Most program directors favor inclusion of a standardized MSUS curriculum, with many favoring inclusion to be optional.

Identification of capacity development indicators for faculty development programs: A nominal group technique study

BACKGROUND

Although there have been many research studies of the effectiveness of faculty development in health profession education, the contribution of these programs to organizational development through capacity development has not been studied. Further understanding of capacity development requires appropriate indicators and no previous indicators for faculty development of health profession educators were identified. The aim of the study was to identify indicators of capacity development in the context of faculty development programs at Tehran University of medical sciences (TUMS).

METHODS

A nominal group technique session was conducted with key informants from faculty development program providers to generate and prioritize a list of capacity development indicators.

RESULTS

A list of 26 indicators was generated and five categories were identified: Development and innovation in teaching and learning process, Development and innovation in communication and collaboration at different levels, Development and sustaining faculty development programs, Development of educational leadership and management, Development in scholarship.

CONCLUSIONS

Capacity development for faculty development interventions of health profession educators is a process of engagement within a wider system, including individual and collective action, and involves the socialization of the teachers into suitable roles through professional identity development and participation within the wider system.

Sustained effects of faculty leadership development modules for clinical instructors of core competences education in Taiwan: a four-year explanatory case study

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) core competencies (CC) in general medicine-based primary care are essential for junior medical trainees. In this country, a regular faculty development (FD) program aimed at training faculty in instructing (teaching and assessing) these CC had operated. However, leadership was not emphasized. In a new intervention module, the roles and associated responsibilities of clinical instructors to conduct, design, and lead CC-based education were emphasis.

AIMS

This follow-up explanatory case study compares the effectiveness of intervention module with that of the previous regular module.

METHODS

The regular group (n = 28) comprised clinical instructors who participated in the FD module during the 2013-2014 year while the intervention group (n = 28) was composed of 2015-2016 participants. Prior to the formal (hands-on) training, participants in the intervention group were asked to study the online materials of the regular module. These participants then received a 30-h hands-on training in conducting, designing, and leading skills. Finally, they prepared a 10-h reflective end-of-module presentation of their real-world practices.

RESULTS

Following the training, a higher degree improvement in participants self-reported familiarity with CC education, self-confidence in their ability to deliver CC education and sustained involve CC education were noted among the intervention FD group, compared with the regular FD group. In the intervention group, senior academicians (associate and full professor) are more substantially involved in designing and leading CC-based courses than junior academicians (lecturers and assistant professors). Among non-teaching award winners of in the intervention FD group, the follow-up degree of sustained involvement in delivering, designing and leading CC-based courses was significantly higher than that of the regular group.

CONCLUSIONS

Our study demonstrated that leadership training in the intervention FD modules substantially motivated clinical instructors to become leaders in CC education.

Expanding Faculty Development of Teaching Skills: A National Needs Assessment of Pediatric Critical Care Medicine Faculty

OBJECTIVES

High-quality clinical teaching is an essential element in preparing trainees to become independently competent clinicians. In order to better understand the context-specific faculty development needs of teaching faculty in a specific community, we sought to determine the self-reported teaching skill deficits of pediatric critical care medicine faculty and their preferences and motivations regarding faculty development to enhance their teaching.

DESIGN

Modified Delphi technique was used to create an online survey in which respondents rated their need for education on a variety of teaching skills, their preferred learning modalities, and factors that motivate their participation in faculty development.

SETTING

Pediatric Critical Care Medicine divisions at the 64 sites in the United States with fellowship programs.

SUBJECTS

Five-hundred forty-five Pediatric Critical Care Medicine faculty who teach fellows and other trainees.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Response rate was 40%. Respondents reported a median of 8.5 years (interquartile range, 4-16 yr) as teaching faculty. The median age of faculty was 44.6 years (interquartile range, 38-50 yr). Only 20% of respondents indicated that improving their teaching was a low priority. Thirty-six percent of respondents had not participated in any formal teaching skill development as faculty. The most frequently cited factors motivating engagement in faculty development were education being included as part of regularly attended conferences, resources readily available when needed, and participation promoted by a supervisor. Preferred learning modalities included a brief discussion with a colleague, a 10-minute video, and a regular conference series.

CONCLUSIONS

Pediatric Critical Care Medicine faculty reported they experience challenges in teaching and would benefit from faculty development training aimed at improving their knowledge and skills about being an educator. Preferred learning methods and motivating factors highlight the importance of efficiency in content delivery and endorsement by faculty supervisors. Consideration of these needs and preferences may be useful in creating context-focused, community of practice-based faculty development programs.

Train the trainer course for general practice trainers in ambulatory care: the Berlin model

Objective: Demands for a stronger competence orientation of specialty postgraduate medical training require the expansion of the didactic qualifications of those responsible for postgraduate medical training. In the context of the foundation of the Berlin competence center for postgraduate general practice training, a train the trainer basic seminar was designed together with the Berlin chamber of physicians. The seminar aims to convey formal-legal aspects in close connection with the development of didactic competences of the general practice trainers. This article presents the didactic concept, focal points and the schedule of the one-and-a-half-day seminar to be able to adapt it to one's own context. Methodology: After the seminars, participants filled out an evaluation form. The questionnaire included the subjective experiences of increased competence, the relevance of the contents, and the satisfaction with the structure and methods of the seminar. The data were analyzed descriptively. Results: Since June 2018, 46 general practice trainers have participated in one of three train the trainer seminars. 97.6% of the participants were very satisfied or satisfied with the overall seminar and felt that the timeframe was right, 92.7% would recommend the seminar to colleagues. 68.3% fully agreed that by attending the seminar they were able to improve their didactic skills, 90% were confident that they could integrate what they had learned into their work as general practice trainers. 85.4% stated that they had reflected on their role as trainers. In particular, the atmosphere, the high degree of interactivity and the protected framework for collegial exchange were positively emphasized. Conclusion: Together with the Berlin chamber of physicians, we succeeded in designing a train the trainer seminar which, on the one hand, met the needs of the general practice trainers for clarification of formal-legal questions of their further training activities and, on the other hand, allowed the further development of didactic skills. At the moment, a modular program is being planned in order to give general practice trainers the opportunity to expand their didactic competence and regularly exchange ideas with colleagues.

Do it together! Conception and long-term results of the trans-institutional Master of Medical Education (MME) program in Germany

Medical education has the responsibility to react to developments and changing demands in healthcare. This implies the need for experts in the area of medical education as well as nationally coordinated initiatives. An innovative model based on trans-institutional cooperation and nationwide consensus for establishing a master's degree course in Medical Education (MME) and long-term results are presented here to other countries and other programs, facing similar challenges. A MME program with the following goals was implemented at the Medical Faculty of Heidelberg University, Germany, in 2004: Qualification of leaders in medical faculties, professionalization and improvement of teaching quality, promotion of nationwide and international exchange, and stimulation of research in medical education. Since then, 15 cohorts with a total of 380 participants have started their studies, 179 participants have graduated and 90 publications resulted from the master's theses (as at November 2018). Evaluation and survey data revealed a very high degree of satisfaction among the participants and a lasting development to medical education experts. Our concept shows that the bundling of regional expertise into a clearly structured trans-institutional network can be a driving force for nationwide comprehensive changes, in order to address changing demands in healthcare systems and transfer it into medical education programs.

Peer Coaching as a Faculty Development Tool: A Mixed Methods Evaluation

BACKGROUND

In the era of competency-based assessment, medical education faculty are frequently challenged to develop unique teaching approaches. One method to address faculty development needs in a real-time clinical learning environment is peer coaching.

OBJECTIVE

We implemented and evaluated a faculty development program involving peer observation and feedback for attending physicians.

METHODS

Hospital internal medicine faculty assigned to a teaching service were recruited for the study. Participants voluntarily agreed to observe and be observed by a peer attending physician during a 2-week block of teaching rounds. When serving in the coaching role, faculty were asked to observe 4 separate occasions using an observation tool based on the Stanford Faculty Development Program framework to guide feedback. An outside consultant facilitated a focus group and completed a qualitative content analysis to categorize all participants' experiences during the faculty development activity.

RESULTS

Of the 22 eligible faculty, 14 (64%) agreed to participate by committing to 6 to 8 hours observing another faculty member during rounds, 2 feedback sessions, and 90 minutes to provide program feedback during a focus group. The analysis of the focus group revealed favorable reactions to the faculty development program, including (1) observed attending awareness of unrecognized habits; (2) personalized teaching tips for the observed attending to improve teaching quality based on individual style/preferences; and (3) exposure to new teaching techniques.

CONCLUSIONS

An inpatient-based peer-coaching faculty development program was acceptable and feasible for a majority of faculty and may improve individual teaching effectiveness among conventionally trained physicians.

Enhancement of role modelling in clinical educators: A randomized controlled trial

Introduction: Role models have an important impact on the professional behavior of medical students. Previous investigations help us understand how to improve role modelling. However, studies aiming at enhancing role modelling among clinical educators are very limited and generally lack comprehensive evaluations of the designed programs. We intended to gather robust evidence on the effectiveness of a longitudinal program for enhancing role modelling.Methods: Clinical educators were divided into intervention and control groups. The longitudinal program, developed based on the exposure phase of the 'Positive Doctor Role Modelling' framework, was delivered during three months of onsite and online sessions. The effectiveness of the program was assessed in three levels of reaction, learning, and behavior.Results: In the intervention group (N = 18), the mean score of satisfaction was 4.7 (SD = 0.5), and the learning (awareness about role modelling) improved significantly after the program (3.33-4.34), comparing to the control group (3.53-3.63). There was no significant difference in terms of behavior improvement between the two groups, before and after the program.Conclusions: Our findings indicate that our longitudinal faculty development program on role modelling was highly appreciated by clinical educators, and improved their awareness and deliberate role modelling.

Faculty development: From rubies to oak

Introduction: Faculty development has played a significant role in health professions education over the last 40 years. The goal of this perspective is to present a portrait of faculty development in Medical Teacher since its inception and to highlight emerging trends moving forward.Method: All issues of Medical Teacher were reviewed, using the search terms faculty development, staff development, professional development, or in-service training for faculty. The search yielded 286 results of which 145 focused specifically on faculty development initiatives, reviews, or frameworks.Findings: This review demonstrated a significant growth in publications related to faculty development in Medical Teacher over the last 40 years, with a primary focus on teaching improvement and traditional approaches to faculty development, including workshops, short courses and other structured, group activities. The international nature of faculty development was also highlighted.Recommendations: Moving forward, it is suggested that we: broaden the scope of faculty development from teaching to academic development; expand our approaches to faculty development, to include peer coaching, workplace learning and communities of practice; utilize a competency-based framework to guide the development of faculty development curricula; support teachers' professional identities through faculty development; focus on organizational development and change; and rigorously promote research and scholarship in faculty development.

Resources for Educating, Training, and Mentoring All Physicians Providing Palliative Care

This article presents a rapid review of the published literature and available resources for educating Canadian physicians to provide palliative and end-of-life care. Several key messages emerge from the review. First, there are many palliative care educational resources already available for Canadian physicians. Second, the many palliative care education resources are often not used in physician training. Third, we know that some palliative care educational interventions are inexpensive and scalable, while others are costly and time-consuming; we know very little about which palliative care educational interventions impact physician behavior and patient care. Fourth, two palliative care competency areas in particular can be readily taught: symptom management and communication skill (e.g., breaking bad news and advance care planning). Fifth, palliative care educational interventions are undermined by the "hidden curriculum" in medical education; interventions must be accompanied by continuing education and faculty development to create lasting change in physician behavior. Sixth, undergraduate and postgraduate medical training is shifting from a time-based training paradigm to competency-based training and evaluation. Seventh, virtually every physician in Canada should be able to provide basic palliative care; physicians in specialized areas of practice should receive palliative care education that is tailored to their area, rather than generic educational interventions. For each key message, one or more implications are provided, which can serve as recommendations for a framework to improve palliative care as a whole in Canada.

Knowledge Gains and Changing Attitudes from the Anatomy Education Research Institute (AERI 2017): A Mixed Methods Analysis

The inaugural Anatomy Education Research Institute (AERI 2017) was held in Bloomington, Indiana in July of 2017. This workshop style conference paired experienced educational researchers (invited speakers) with individuals interested in learning more about the field (accepted applicants). In 2017, AERI was held over a five-day period and entailed plenary style presentations, break-out sessions, and specific times for small group mentorship. All participants (applicants and invited speakers) completed a pre-conference survey at the beginning of the institute and a post-conference survey at the end of the institute. Both surveys included categorical and Likert scale questions as well as open-ended questions for participant feedback. Quantitative and qualitative analyses indicate that both applicants and speakers increased their knowledge of anatomy education research, but that additional obstacles remain. Funding, time, and a lack of respect for the field remain problematic for faculty that wish to complete educational research. Mentorship and a community of practice also emerged as major themes necessary for educational research to be successful.

Developing Academic Advisors and Competence Committees members: A community approach to developing CBME faculty leaders

INTRODUCTION

Implementing competency-based medical education (CBME) at the institutional level poses many challenges including having to rapidly enable faculty to be facilitators and champions of a new curriculum which utilizes feedback, coaching, and models of programmatic assessment. This study presents the necessary competencies required for Academic Advisors (AA) and Competence Committee (CC) members, as identified in the literature and as perceived by faculty members at Queen's University.

METHODS

This study integrated a review of available literature (n=26) yielding competencies that were reviewed by the authors followed by an external review consisting of CBME experts (n=5). These approved competencies were used in a cross-sectional community consultation survey distributed one year before (n=83) and one year after transitioning to CBME (n=144).

FINDINGS

Our newly identified competencies are a useful template for other institutions. Academic Advisor competencies focused on mentoring and coaching, whereas Competence Committee member's competencies focused on integrating assessments and institutional policies. Competency discrepancies between stakeholder groups existing before the transition had disappeared in the post-implementation sample.

CONCLUSIONS

We found value in taking an active community-based approach to developing and validating faculty leader competencies sooner rather than later when transitioning to CBME. The evolution of Competence Committees members and Academic Advisors requires the investment of specialized professional development and the sustained engagement of a collaborative community with shared concerns.

Peer Observations: Enhancing Bedside Clinical Teaching Behaviors

Background

Medical training relies on direct observations and formative feedback. After residency graduation, opportunities to receive feedback on clinical teaching diminish. Although feedback through learner evaluations is common, these evaluations can be untimely, non-specific, and potentially biased. On the other hand, peer feedback in a small group setting or lecture format has been shown to be beneficial to teaching behaviors, however, little is known if peer observation using a standardized tool followed by feedback results in improved teaching behaviors. Therefore, the objective of this study was to examine if feedback after peer observation results in improved inpatient teaching behaviors.

Methods

This study was conducted at a tertiary care hospital. Academic hospitalists in the Division of Hospital Medicine developed a standardized 28-item peer observation tool based on the Stanford Faculty Development Program to observe their peers during bedside teaching rounds and provide timely feedback after observation. The tool focused on five teaching domains (learning climate, control of session, promotion of understanding and retention, evaluation, and feedback) relevant to the inpatient teaching environment. Teaching hospitalists were observed at the beginning of a two-week teaching rotation, given feedback, and then observed at the end of the rotation. Furthermore, we utilized a post-observation survey to assess the teaching and observing hospitalists’ comfort with observation and the usefulness of the feedback. We used mixed linear models with crossed design to account for correlations between the observations. Models were adjusted for gender, age, and years of experience. We tested the internal validity of the instrument with Cronbach’s alpha.

Results

Seventy (range: one to four observations per faculty) observations were performed involving 27 teaching attendings. A high proportion of teachers were comfortable with the observation (79%) and found the feedback helpful (92%), and useful for their own teaching (88%). Mean scores in teaching behavior domains ranged from 2.1 to 2.7. In unadjusted and adjusted analysis, each teaching observation was followed by higher scores in learning climate (adjusted improvement = 0.09; 95% CI = 0.02-0.15; p = 0.007) and promotion of understanding and retention (adjusted improvement = 0.09; 95% CI = 0.02-0.17; p = 0.01). The standardized observation tool had Cronbach’s alpha of 0.81 showing high internal validity.

Conclusions

Peer observation of bedside teaching followed by feedback using a standardized tool is feasible and results in measured improvements in desirable teaching behaviors. The success of this approach resulted in the expansion of peer observation to other Divisions within the Department of Internal Medicine at our Institution.

Competency-based medical education for the clinician-educator: the coming of Milestones version 2

Competency-based medical education is emphasized by institutions overseeing medical school and postgraduate training worldwide. The high rate of preventable errors in medicine underscores this need. Expanding physician competency beyond the domains of patient care and medical knowledge towards goals that emphasize a more holistic view of the healthcare system is one aspect of this emphasis. The Accreditation Council on Graduate Medical Education (ACGME), which oversees postgraduate training programs in the USA, has recently expanded to oversee training programs internationally. The original ACGME Milestones effort unveiled in 2013 was met with skepticism. Nevertheless, other outcomes-based education programs worldwide, including the CanMEDS framework (Canada), Tomorrow's Doctor (UK), and Scottish Doctor (Scotland), have suggested that milestones do offer advantages. Missing from the milestone rollout, however, was collaborative buy-in from multiple stakeholders such as from clinician-educators. Consequently, Milestones version 2 is in development. Specifically, these will address the need for specialty-specific milestones, and the usage of harmonized milestones. A concise history of the push towards outcomes-based medical education is presented and contextualized for physicians who must embrace the transition from teacher-based to learner-based outcomes.

Development, Implementation, and Evaluation of a Faculty Development Workshop to Enhance Debriefing Skills Among Novice Facilitators

Introduction Effective debriefing during simulation-based training (SBT) is critical to promote learning outcomes. Despite debriefing's central role in learning and various published debriefing methods and techniques, little is known about faculty development structure for debriefing training among novice facilitators. Continuing medical education courses often use simulation-based methods but provide minimal training in debriefing techniques to novice facilitators. We describe the development, implementation, and evaluation of a structured debriefing training workshop for novice facilitators. Methods Designed and conducted by simulation debriefing experts, a debriefing workshop was provided to novice facilitators serving as faculty during the simulation-based Sedation Provider Course (PC) at the 2018 Society of Pediatric Sedation conference. Emphasizing evidence-based key elements of effective debriefing, the workshop was divided into three components: 1) an introductory 30 minute didactic, 2) 75 minutes role modeling of simulated effective and ineffective debriefing 3) 120 minutes repetitive deliberate practice sessions with summative and formative feedback. Effective transfer of learned debriefing skills was assessed during facilitators' PC debriefing using the Objective Structured Assessment of Debriefing (OSAD) tool, facilitators' self-efficacy, and PC student learners' evaluation of facilitator debriefings during the PC. Results Sixteen facilitators participated in the 4-h workshop and the next day served as PC faculty. The median OSAD score was 31 (13-40) for all facilitators. OSAD components with lowest and highest performance were "Establishing Learning Environment" with a median score of 1 (1-5) and "Engagement of Learners," with a median score of 4.75 (2.5-5). Facilitators' self- assessment in debriefing significantly improved on the 5-point Likert scale pre- and post-workshop, respectively. PC student learners' evaluations revealed high degrees of satisfaction with debriefing quality. Conclusions A proposed model integrating full-length debriefing and repetitive practice paired with summative and formative feedback provides a feasible and effective approach for debriefing training of novice facilitators for simulation-based educational courses.

Innovation in Education Research: Creation of an Education Research Core

Within academic medical centers, there is increasing interest among physicians to pursue education as a promotion pathway. Many medical schools and universities offer professional development opportunities for these individuals such as workshops and certificate and advanced degree programs. However, there exists a need for a more personalized support for clinician-educators to be successful in educational scholarship in the health care setting. In 2017, a departmental level educational research community was established within Anesthesiology and Critical Care Medicine at Johns Hopkins University to support faculty, staff, and trainees in creating, completing, and publishing educational scholarship. The research infrastructure includes administrative and institutional review board submission assistance, internal grant support, database management, statistical analysis, and consultation with professional educators. Also, integral to the education core is monthly education lab meetings that allow an opportunity for education researchers to present work in progress, conceive new projects, discuss relevant literature, and cultivate and sustain a community of educational scholars.This innovation in education demonstrates feasibility at a departmental level to successfully support educational research. We have initiated education meetings with a cohort of core education faculty who are interested in an educational promotion track. We present several metrics that can be used to evaluate the effectiveness of the programs similar to this innovation.

Barriers and Solutions to Advancing Emergency Medicine Simulation-based Research: A Call to Action

Simulation technology has successfully improved patient safety and care quality through training and assessment of individuals, teams, and health care systems. Emergency medicine (EM) continues to be a leader and pioneer of simulation, including administration of simulation-based fellowships and training programs. However, EM simulation-based research has been limited by low rates of publication and poor methodologic rigor. The Society for Academic Emergency Medicine (SAEM) Simulation Academy is leading efforts to improve the quality of scholarship generated by the EM simulation community and to foster successful research careers for future generations of EM simulationists. Through a needs assessment survey of our membership and a year-long consensus-based approach, we identified two main clusters of barriers to simulation-based research: lack of protected time and dedicated resources and limited training and mentorship. As a result, we generated four position statements with implications for education, training, and research in EM simulation and as a call to action for the academic EM community. Recommendations include expansion of funding opportunities for simulation-based research, creation of multi-institutional simulation collaboratives, and development of mentorship and training pathways that promote rigor in design and methodology within EM simulation scholarship.

Exploring How the New Entrustable Professional Activity Assessment Tools Affect the Quality of Feedback Given to Medical Oncology Residents

The post-graduate medical programs at Queen's University transitioned to a competency-based medical education framework on July 1, 2017. In advance of this transition, the Medical Oncology program participated in a pilot of six Entrustable Professional Activities (EPAs) focused workplace-based assessment (WBA) tools with faculty and residents. The purpose of this sequential explanatory mixed method study was to determine the extent to which these WBAs provided quality feedback for residents. The WBAs were introduced into daily clinical practice and, once completed, were collected by the research team. A resident focus group (n = 4) and faculty interviews (n = 5) were also conducted. Focus group and interview data were analyzed using an emergent thematic analysis. Data from the completed assessment tools were analyzed using both descriptive statistics and a literature-informed framework developed to assess the quality of feedback. Six main findings emerged: Verbal feedback is preferred over written; providing both written and verbal feedback is important; effective feedback was seen as timely, specific, and actionable; the process was conceptualized as coaching rather than high stakes; there were logistical concerns about the WBAs, and additional clarification about the WBA tools is needed. This study provides insight into faculty and resident perceptions of quality feedback and the potential for WBA tools to assist in providing effective feedback to residents as we shift to competency-based medical education in Canada. Our results suggest the need for additional faculty development around the use of the tools, and their intended role, and the elements of quality feedback.

Micro-feedback skills workshop impacts perceptions and practices of doctoral faculty

BACKGROUND

Doctoral supervision is a distinct form of supervision with clearly defined responsibilities. One of these is the delivery of effective face-to-face feedback to allow supervisees to improve upon their performances. Unfortunately, doctoral supervisors, especially of health sciences, are often not trained in supervisory skills and therefore practice mostly on a trial and error basis. Lack of understanding of the feedback process leads to incongruence in how supervisors and supervisees perceive feedback. However, standardized training practices like microteaching can allow supervisors to acquire effective feedback practices. In this study we employed a schematic approach of microteaching, that is micro-feedback, in a workshop to develop feedback skills of doctoral supervisors, and assessed the overall effectiveness of this training using the Kirkpatrick evaluation framework.

METHODOLOGY

This was a Quasi-experimental study with a repeated measures and a two-group separate sample pre-post test design. A micro-feedback skills workshop was organized to enhance feedback skills of doctoral supervisors using microteaching technique. The first two levels of the Kirkpatrick evaluation model were used to determine the workshop's effectiveness. An informal Objective Structured Teaching Exercise (OSTE) was used to assess feedback skills of the supervisors, both before and after the workshop. A questionnaire was developed to compare pre-and post-workshop perceptions of the supervisors (n = 17) and their corresponding supervisees (n = 34) regarding the ongoing feedback practice.

RESULTS

Despite the hectic schedule, most doctoral supervisors (17 of 24, 71%) were willing to undertake faculty development training. Participants indicated a high level of satisfaction with the workshop. A learning gain of 56% was observed on pre-post OSTE scores. Prior to the workshop, perceptions of how supervisees should be given the feedback differed significantly between supervisors and supervisees with an effect size difference of r = 0.30. After the workshop there was a negligible difference in perceptions between supervisors and supervisees (r = .001). Interestingly, supervisors shifted their perceptions more toward those that were originally held by the supervisees.

CONCLUSIONS

These findings suggest that well-designed and properly assessed structured programs such as micro-feedback workshops can improve how doctoral supervisors provide feedback to their supervisees and align supervisors' perceptions of that feedback with those of their supervisees.

Do it together! Conception and long-term results of the trans-institutional Master of Medical Education (MME) program in Germany

Medical education has the responsibility to react to developments and changing demands in healthcare. This implies the need for experts in the area of medical education as well as nationally coordinated initiatives. An innovative model based on trans-institutional cooperation and nationwide consensus for establishing a master's degree course in Medical Education (MME) and long-term results are presented here to other countries and other programs, facing similar challenges. A MME program with the following goals was implemented at the Medical Faculty of Heidelberg University, Germany, in 2004: Qualification of leaders in medical faculties, professionalization and improvement of teaching quality, promotion of nationwide and international exchange, and stimulation of research in medical education. Since then, 15 cohorts with a total of 380 participants have started their studies, 179 participants have graduated and 90 publications resulted from the master's theses (as at November 2018). Evaluation and survey data revealed a very high degree of satisfaction among the participants and a lasting development to medical education experts. Our concept shows that the bundling of regional expertise into a clearly structured trans-institutional network can be a driving force for nationwide comprehensive changes, in order to address changing demands in healthcare systems and transfer it into medical education programs.