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

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.

The Learning Environment in Surgery Clerkship: What are Faculty Perceptions?

OBJECTIVE

Multiple efforts have sought to improve teaching effectiveness and the learning environment (LE), but prior research has not focused on attending physicians' perceptions of mistreatment or contribution to the LE. The purpose of this study was to assess the perception and role of surgical faculty in the medical student LE.

DESIGN

A semistructured interview guide was developed using a comprehensive approach including extensive literature search and focus groups. Data were audio-recorded and transcribed verbatim. Content analysis was used to identify emergent themes.

SETTING

Beth Israel Deaconess Medical Center, an academic tertiary care facility located in Boston, Massachusetts.

PARTICIPANTS

Fifteen faculty in the Department of Surgery underwent detailed interviews. Participants were selected using purposive-stratified criterion-based sampling.

RESULTS

Multiple themes emerged: (1) The competing demands on medical student's time are a negative factor in the LE; (2) Faculty expectations conflict with the existing curriculum; (3) Faculty are concerned with the possibility of being reported for providing negative feedback; (4) Faculty remain unfamiliar with policies regarding the LE/mistreatment; (5) A motivated medical student makes the educational interaction more productive independent of specialty of choice.

CONCLUSIONS

Faculty identified that the most important factors contributing to a negative LE were a mismatch between expectations of medical students and faculty, and the conflict between the current curriculum and the faculty member's perceived ideal educational framework. Importantly, faculties were largely unfamiliar with LE/mistreatment policies and standards. These findings suggest a need for targeted curricula for faculty to raise awareness of components of a positive LE and tools to teach effectively within the contemporary medical school curriculum.

Immediate knowledge improvement and long-term teaching confidence after general medicine faculty training program

BACKGROUND/PURPOSE

This study analyzed the effects of the General Medicine Faculty Training Program (GMFTP), which was implemented in 2009. The training program includes a 7-hour basic training (BT) to introduce ways of teaching and assessing the 6 core competencies identified by the Accreditation Council for Graduate Medical Education, and a 40-hour clinical training program.

METHODS

Physicians from different hospitals attended the GMFTPs. Since 2010, we have been using quick tests to assess trainees' familiarity of core competencies. Knowledge improvement (KI) was defined as the difference between post-BT and pre-BT test scores. Since 2013, we have been annually mailing questionnaires to assess trainees' teaching confidence (TC) of core competencies. We analyzed the correlations between trainees' characteristics, KIs, and TCs.

RESULTS

Between year 2009 and 2017, a total of 319 attending physicians (257 male, 62 female), with a mean age of 39.1 ± 6.2 years, completed the GMFTPs. Significant KI (32.6-55.4) was noted. There were no correlations between trainees' characteristics and KIs. The mean TCs for the 6 core competences were all above 4.0 (based on a 5-point Likert scale). TCs were positively correlated with age during GMFTP training, age when responding to the questionnaire, and duration between training and the last time responding to the questionnaire. TC showed no correlation with sex, hospitals, departments, or KI.

CONCLUSION

Knowledge of teaching core competencies improved immediately after BT, but KIs did not correlate with TCs in long-term follow-up. After the training program, physicians' teaching confidence increased over time.

Discovering the Benefits of Group Peer Review of Submitted Manuscripts

Problem: Traditionally, journal editors expect individuals to complete peer reviews of submitted manuscripts on their own. Recently, a number of editors of health sciences journals have begun to support, and even espouse, the practice of group peer review (GPR). With GPR, multiple individuals work together to complete the review with permission from the journal editor. Motivated by the idea that GPR could provide a meaningful service learning experience for participants in an interprofessional educational scholarship course, we conducted three such reviews and subsequently reflected on our experience and the lessons we learned. We frame our reflections using guiding principles from the domains of peer review, professional development, and educational scholarship. Intervention: The course director arranged for manuscripts to review with the editors of three health sciences journals. Each GPR occurred during a separate weekly session of the course. Each GPR was completed using a similar set of steps, which included (a) gaining familiarity with review criteria, (b) reading aloud and discussing the manuscript's abstract as a class, (c) reading and critiquing assigned sections as individuals and then small groups, (d) building consensus and sharing notes, (e) having the course director synthesize notes into a single review for submission to the journal. Context: The course on educational scholarship involved 15 faculty representing faculty from the University of Utah's School of Medicine, College of Nursing, College of Pharmacy, College of Health, and School of Dentistry. The course director led three GPR sessions mid-way through the yearlong course. Impact: Participants' reflections indicate that GPR (a) conformed to principles of effective peer review; (b) resulted in a meaningful service learning experience within a formal professional development program, deepening understanding of core concepts of educational scholarship; and (c) represented an authentic example of engaging in educational scholarship (i.e., designing and evaluating an intervention while drawing upon and contributing to a body of shared understanding within a community of practice). Lessons Learned: Our principles-based approach to completing GPR within a professional development course on educational scholarship can serve as a model for others to follow. A rigorous, meaningful group review can occur in 1 hour using a combination of group and individual activities focused on matching review criteria to the submitted manuscript. As a result, we continue to include GPR in future offerings of this interprofessional course on educational scholarship, and we continue to study ways to optimize its value as a service learning experience.

Impact of faculty development programme on self-efficacy, competency and attitude towards medical education in Bhutan: a mixed-methods study

BACKGROUND

Soon after Bhutan's first medical university was established in 2012, Faculty Development Programmes (FDPs) were adopted for efficient delivery of postgraduate medical curriculum. Medical education was an additional responsibility for the clinicians who already had multi-dimensional roles in the healthcare system where there is acute shortage of healthcare professionals. We studied the impact of FDPs on postgraduate medical education in Bhutan.

METHODS

This was a mixed-methods study with a quantitative (cohort study - quasi-experimental with 18 participants) and concurrent explanatory qualitative component (focused group discussion (FGD) with 11 teaching faculty members). The 18 participants were given a structured FDP designed by the University. The FGD assessed teacher self-efficacy and competency using standard tools before and after the FDP. Thematic analysis of the FGD explored the impact of FDPs in the delivery of postgraduate residency programmes.

RESULTS

There were significant increase in the teacher self-efficacy (31 vs 34, p = 0.009) and competency scores (56 vs 64, p = 0.011). There were significant improvements in self-efficacy in the domain of the teaching relevant subject contents and developing creative ways to cope with system constraints. In teaching-learning assessments, there was a significant appreciation of the effectiveness of lectures and tutorials and the use of essay questions. The FGD demonstrated the acceptance of FDPs and its importance in quality improvement of postgraduate medical education, professional development of teachers and improvement of their communication skills. The teachers have now migrated from the conventional methods of teaching to workplace-based teaching and assessment. The FDPs also resulted in review and revision of postgraduate medical curriculum soon after the first batch graduated in 2018. Lack of adequate support from relevant stakeholders and lack of a medical education centre in the University were seen as major challenges.

CONCLUSIONS

The FDPs have brought tangible professionalization of postgraduate medical education at an early stage of the medical university. There is a need for continued efforts to strengthen, sustain and consolidate the gains made thus far.

STEM Is Not a Monolith: A Preliminary Analysis of Variations in STEM Disciplinary Cultures and Implications for Change

Research suggests that science, technology, engineering, and mathematics (STEM) departments are a productive unit of focus for systemic change efforts. In particular, they are relatively coherent units of culture, and cultural changes are critical to creating sustainable improvements. However, the STEM disciplines are often treated as a monolith in change literature, and unique aspects of these different disciplinary cultures-and consequences for change efforts-remain somewhat underdeveloped. This exploratory study focuses on similarities and differences among STEM disciplinary cultures, drawing on data gathered from scholars in discipline-based education research who attended two sessions at the 2017 Transforming Research in Undergraduate STEM Education conference. Our analyses of these data help begin to characterize disciplinary cultures using the theoretical lens of four frames: structures, symbols, power, and people. We find preliminary evidence for both similarities and differences among the cultures of STEM disciplines. Implications for change efforts and future directions for research are discussed.

Interprofessional Musculoskeletal Education: A Review of National Initiatives from the Department of Veterans Affairs

This article reviews several national programs in musculoskeletal education initiated by the Department of Veterans Affairs over the past decade. These programs have become sustained interprofessional opportunities for learners across disciplines and along the continuum of health professions education (HPE) and training pathways. This article also describes opportunities for leaders in rheumatology and other HPE programs to join these efforts and to collaborate in the scholarship that will be necessary in constructing educational programs fit for the purpose of ensuring a well-trained, competent workforce of health care providers.

Is computer-assisted instruction more effective than other educational methods in achieving ECG competence amongst medical students and residents? A systematic review and meta-analysis

OBJECTIVES

It remains unclear whether computer-assisted instruction (CAI) is more effective than other teaching methods in acquiring and retaining ECG competence among medical students and residents.

DESIGN

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Electronic literature searches of PubMed, databases via EBSCOhost, Scopus, Web of Science, Google Scholar and grey literature were conducted on 28 November 2017. We subsequently reviewed the citation indexes for articles identified by the search.

ELIGIBILITY CRITERIA

Studies were included if a comparative research design was used to evaluate the efficacy of CAI versus other methods of ECG instruction, as determined by the acquisition and/or retention of ECG competence of medical students and/or residents.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data from all eligible studies and assessed the risk of bias. After duplicates were removed, 559 papers were screened. Thirteen studies met the eligibility criteria. Eight studies reported sufficient data to be included in the meta-analysis.

RESULTS

In all studies, CAI was compared with face-to-face ECG instruction. There was a wide range of computer-assisted and face-to-face teaching methods. Overall, the meta-analysis found no significant difference in acquired ECG competence between those who received computer-assisted or face-to-face instruction. However, subanalyses showed that CAI in a blended learning context was better than face-to-face teaching alone, especially if trainees had unlimited access to teaching materials and/or deliberate practice with feedback. There was no conclusive evidence that CAI was better than face-to-face teaching for longer-term retention of ECG competence.

CONCLUSION

CAI was not better than face-to-face ECG teaching. However, this meta-analysis was constrained by significant heterogeneity amongst studies. Nevertheless, the finding that blended learning is more effective than face-to-face ECG teaching is important in the era of increased implementation of e-learning.

PROSPERO REGISTRATION NUMBER

CRD42017067054.

Technological Pedagogical Content Knowledge Among Medical Educators: What Is Our Readiness to Teach With Technology?

PURPOSE

This study aimed to empirically assess medical educator knowledge of pedagogy and technology to inform the direction of faculty development efforts.

METHOD

The technological pedagogical content knowledge (TPACK) framework survey is a validated instrument for understanding educators' knowledge of content (CK), pedagogy (PK), and technology (TK) in teaching. A modified version of the TPACK was administered to medical educators (N = 76) at 2 public institutions: University of California, Irvine School of Medicine (UC Irvine); and University of Colorado School of Medicine (CU).

RESULTS

An independent-samples t test compared TK with PK and CK within each institution. The means of TK (UC Irvine: 3.4; CU: 3.4) and both PK for didactic sessions (UC Irvine: 3.9; CU: 4.4) and PK for clinical settings (UC Irvine: 4.0; CU: 4.4) were compared using a t test and statistically different, P < .01. Similarly, the means of TK and CK (UC Irvine: 4.5; CU: 4.7) were statistically different, P < .01. A Wilcoxon rank sum test indicated that the CU PK for a didactic session (mean: 4.4) was greater than the UC Irvine PK for a didactic session (mean: 3.9), P < .01. Similarly, the CU PK for a clinical setting (mean: 4.4) was greater than the UC Irvine PK for a clinical setting (mean: 4.0), P < .01.

CONCLUSIONS

There is a clear need for faculty development programs for medical educators to focus on how to teach with technology if medical schools continue to adopt technology within their curricula.

Curriculum development in final year dentistry to enhance competency and professionalism for contemporary general dental practice

INTRODUCTION

General dentistry is the most common area of practice, and new dentists must have the competency and skills to safely deliver patient care. In New Zealand (NZ), completion of a 5-year Bachelor of Dental Surgery (BDS) degree enables graduates to register with the Dental Council in NZ. This necessitates that the clinical component of the curriculum in final year dentistry (BDS5) transparently delivers learning opportunities and evaluates competency for independent practice. A review of the BDS5 Clinical Practice course was undertaken in 2015 and a revised curriculum introduced in 2016.

CURRICULUM

We present a BDS5 curriculum for a Clinical Practice course that is learner focused with emphasis on comprehensive patient-centred care, competency and professional practice. Learning opportunities and assessment processes are described alongside teacher training. These changes have provided students scaffolding to support clinical and professional development, and accommodate different learning preferences. The outcomes align with the competency requirements of the NZ regulatory body for registration as a general dental practitioner. Since its introduction 3 years ago, ongoing feedback from students and staff has been positive and indicates the curriculum is effective in achieving its objectives.

CONCLUSIONS

This curriculum provides a firm foundation for students transitioning to independent clinical practice in the community and supports the professional development of clinical teachers. It may also be translated to other areas of health education to ensure the delivery of quality holistic patient care.

Developing a Model for Accreditation of Iranian Teaching Hospitals: A Qualitative Study

BACKGROUND

Among different factors, accreditation is being widely used across the world to improve quality and safety in hospitals. Therefore, the purpose of the present study was to develop an accreditation model for teaching hospitals in Iran.

METHODS

This qualitative study was conducted in four phases from January, 2017 to March, 2018. To this end; firstly, existing accreditation models were extracted and reviewed comparatively. Within the second stage, dimensions and components of the accreditation model were extracted through semi-structured interviews. In the third stage, a new instruction was developed via integrating the findings from the first and the second stages. Finally, the model was validated in two phases of Delphi method and a specialized forum in the fourth step. Qualitative findings were then analyzed using content analysis method.

RESULTS

Models of Joint Commission International (JCI) and Word Federation for Medical Education (WFME) in other 6 countries were reviewed and compared with the current Iranian model. Extracted dimensions discovered to complement the present model included learner assessment, continuous reviews and revisions, and educational productivity. The final model was also developed with 12 dimensions and 94 standards. Content validity ratio (CVR) and content validity index (CVI) were also estimated to be 0.40 and 0.80, respectively. As well, the second round of Delphi method could increase the number of model standards to 97. Moreover, Cohen's kappa coefficient was calculated to be at least 0.71.

CONCLUSION

This study led to the development of a comprehensive model for scientific accreditation of teaching hospitals through reviewing documentation, combining and comparing global approaches, as well as integrating them with the views of domestic experts.

Efficacy of a Short Role-Play Training on Breaking Bad News in the Emergency Department

Introduction

Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills.

Methods

Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule.

Results

Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience.

Conclusion

A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.

Peer-supported faculty development and workplace teaching: an integrative review

CONTEXT

The use of peer support as a faculty development technique to improve clinical teaching is uncommon in medical education, despite the benefits of situating learning in the workplace. The authors therefore conducted a broad search seeking theoretical and empirical literature describing peer support strategies for clinical teachers in health care workplaces. This included descriptive and non-experimental studies that are often excluded from reviews. The review aimed to identify and assess existing initiatives and to synthesise key challenges and benefits.

METHODS

An integrative literature review was undertaken (2004-2017), based on searches of eight international electronic databases and targeted manual searches. Key concepts, elements and models were mapped using an iterative, constant comparative method. An evaluative framework, drawing on previous research, informed conclusions regarding the quality of evidence.

RESULTS

From a pool of 5735 papers, 34 met the inclusion criteria. The majority referred to studies conducted in the USA (59%) and in the medical profession (71%). Analysis revealed a trend towards using a collaborative model (56%), voluntary participation (59%), and direct workplace observation by a peer clinician (68%). Design features of the peer support strategy were commonly reported (65%), with half providing outcome measures (56%). Few papers reported on process evaluation (15%) or evidence of programme sustainability (15%). Despite logistical and time-associated challenges, benefits accrued to individuals and the workplace, and included improved teaching practices. Embedding the peer support strategy into routine organisational practice proved effective.

CONCLUSIONS

The results indicated that a workplace-based peer support model is an acceptable and effective faculty development strategy for health care clinical teachers. Conceptualising workplace-based peer support via a sociocultural model that acknowledges the significance of educational design, peers as collaborators and the importance of workplace context and culture is emphasised. Future research should focus on clarification studies informed by contemporary models of faculty development, in which factors impacting the health care workplace are considered.

Assessing Preceptor Use of Cognitive Apprenticeship: Is the Maastricht Clinical Teaching Questionnaire (MCTQ) a Useful Approach?

Construct: The authors investigated the utility of the Maastricht Clinical Teaching Questionnaire (MCTQ) to assess preceptor use of cognitive apprenticeship teaching methods. Background: The MCTQ is an instrument first studied in medical and veterinary education; it was shown to produce valid and reliable data when evaluating how well preceptors engage in cognitive apprenticeship. Additional validity evidence, however, is needed to determine if the MCTQ is useful and applicable in other healthcare professions, such as pharmacy. Approach: Student pharmacists and pharmacy residents at a large academic medical center completed the MCTQ to evaluate pharmacist preceptors. A confirmatory factor analysis (CFA) was used to determine how consistent the data were with the 5-factor structure of the cognitive apprenticeship teaching methods (e.g., modeling, coaching, articulation, exploration, and safe learning environment). A structural equation model (SEM) was used to evaluate the relationship between the 5 factors. Preceptor and student perceptions were also collected to evaluate the response process and potential consequences of using the instrument. Results: Thirty-eight learners (2nd-year and 4th-year student pharmacists and pharmacy residents) submitted 157 evaluations. The CFA showed appreciable fit with the 5-factor structure of the cognitive apprenticeship framework after 2 modifications (removal of 1 item and moving 1 item to a different factor). The SEM had poor model fit compared to previous studies, and an exploratory analysis suggests that there is a complex relationship between the various teaching methods. Preceptors and students highly agreed that the instrument was valuable for providing feedback. Conclusion: The MCTQ has additional validity evidence that supports it as a viable instrument to assess preceptor engagement in teaching methods consistent with the cognitive apprenticeship framework. Additional research is warranted to explore the relationship between components in the cognitive apprenticeship framework to determine how preceptors can best focus their efforts to improve clinical teaching.

Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association

The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.

Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review: BEME Guide No. 56

Background: Clinical teachers often struggle to report unsatisfactory trainee performance, partly because of a lack of evidence-based remediation options. Objectives: To identify interventions for undergraduate (UG) and postgraduate (PG) medical learners experiencing academic difficulties, link them to a theory-based framework and provide literature-based recommendations around their use. Methods: This systematic review searched MEDLINE, CINAHL, EMBASE, ERIC, Education Source and PsycINFO (1990-2016) combining these concepts: medical education, professional competence/difficulty and educational support. Original research/innovation reports describing intervention(s) for UG/PG medical learners with academic difficulties were included. Data extraction employed Michie's Behavior Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraisal used the Mixed Methods Appraisal Tool (MMAT). The authors synthesized extracted evidence by adapting the GRADE approach to formulate recommendations. Results: Sixty-eight articles met the inclusion criteria, most commonly addressing knowledge (66.2%), skills (53.9%) and attitudinal problems (26.2%), or learner personal issues (41.5%). The most common BCTs were Shaping knowledge, Feedback/monitoring, and Repetition/substitution. Quality appraisal was variable (MMAT 0-100%). A thematic content analysis identified 109 interventions (UG: n = 84, PG: n = 58), providing 24 strong, 48 moderate, 26 weak and 11 very weak recommendations. Conclusion: This review provides a repertoire of literature-based interventions for teaching/learning, faculty development, and research purposes.

Professional Development for Clinical Faculty in Academia: Focus on Teaching, Research, and Leadership

Clinical faculty need creative, systematic, and supportive approaches for their success. Academic institutions and departments have a unique opportunity to engage its faculty by sponsoring and creating innovative professional development programs to enhance leadership, research, teaching, and clinical skills. The added benefit of these "homegrown" programs is that clinical faculty members feel more valued, engaged, and supported and will want to better align their priorities with the strategic priorities of the institution. There are excellent national resources to learn from to support and complement local professional development efforts. Each department needs to balance any standard with customized approaches.

A description and opinions of a longitudinal book club for comprehensive pharmacy faculty development

INTRODUCTION

The objectives of this study were to implement a faculty development book club centering on pharmacy education and to evaluate faculty opinions of the process.

METHODS

A year-long pharmacy faculty development book club was conducted. Monthly meetings explored a pharmacy education text. Discussions centered on reflective questions submitted by chapter facilitators. Participants completed pre- and post-surveys regarding attitudes and opinions of faculty development utilizing a book club format. The Kruskal-Wallis, Dunn's multiple comparisons, Mann-Whitney, and Wilcoxon tests were used to analyze results.

RESULTS

Of 48 faculty, 26 and 19 responded to the pre- and post-surveys, respectively; 73% agreed they would like a faculty development book club on the pre-survey, while 86.3% of participants were satisfied or highly satisfied with the book club on the post-survey. On the pre-survey, females and clinical faculty felt they would be more engaged in the book club than in more traditional development programs; the same groups indicated more engagement on the post-survey. Males indicated greater improvement in teaching abilities than females as a result of the book club. Of paired pre- and post-surveys, 12 respondents more strongly agreed that they were able to describe characteristics of a student-centered approach to teaching after the book club.

CONCLUSIONS

Faculty found a comprehensive book club to be an enjoyable and engaging way of developing skills and knowledge as a pharmacy academician. This alternative delivery method for faculty development programming can be replicated by other institutions. Further study is needed to evaluate long-term outcomes.

Learning and Teaching Together to Advance Evidence-Based Clinical Education: A Faculty Learning Community

Clinical teaching is a cornerstone of health sciences education; it is also the most challenging aspect. The University of Pittsburgh Schools of Dental Medicine, Nursing, and Pharmacy developed a new evidence-based interprofessional course framed as a faculty learning community (FLC) around the principles of learning in a clinical environment. The aim of this study was to assess the overall effectiveness of this two-semester FLC at four health professions schools in academic year 2014-15. The assessment included anonymous participant surveys in each session and an anonymous end-of-course survey. Thirty-five faculty members from dental, health and rehabilitation sciences, nursing, and pharmacy enrolled in the FLC, with six to 32 enrollees attending each session. All attendees at each session completed the session evaluation surveys, but the attendance rate at each session ranged from 17.1% to 91.4%. Sixteen participants (46%) completed the end-of-course survey. The results showed overall positive responses to the FLC and changes in the participants' self-reported knowledge. Session surveys showed that the participants found the FLC topics helpful and appreciated the opportunity to learn from each other and the interprofessional nature of the FLC. Responses to the end-of-course survey were in alignment with the individual session surveys and cited specific benefits as being the content, teaching materials, and structured discussions. In additional feedback, participants reported interest to continue as a cohort and to extend the peer-support system beyond the FLC. This outcomes assessment of the first round of the FLC confirmed that this cohort-based faculty development in an interprofessional setting was well received by its participants. Their feedback provided valuable insights for changes to future offerings.

Factors affecting the transfer of training to the workplace after a faculty development programme: What do trainers think?

Objectives

Faculty development plays a pivotal role in developing competent and effective teachers. The eventual goal of faculty development is to transfer newly acquired knowledge, skills, and attitudes to the workplace to positively influence students’ learning. However, the transfer of training skills is a complex phenomenon, and not much has been reported about the factors affecting this process, especially in the health sciences. This study aims to explore the factors hindering or aiding the transfer of training (newly learned competencies) to the workplace.

Methods

This cross-sectional qualitative study employed a purposive sampling technique and incorporated seven programme developers. The data were collected through semi-structured interviews, and then analysed using thematic analysis.

Results

The interviews with programme developers and faculty trainers revealed that the transfer of training to educational practices is a complex and multidimensional process. Primarily, such transfer is influenced by many variables that can be broadly categorised into three groups: trainee characteristics, training design features, and environmental factors.

Conclusion

The current study has implications for understanding learning transfer after a faculty development programme. It provides a brief overview of the individual, programmatic, and environmental factors that influence the transfer of training to an educational setup.

The utilization of peer feedback during collaborative learning in undergraduate medical education: a systematic review

BACKGROUND

Peer evaluation can provide valuable feedback to medical students, and increase student confidence and quality of work. The objective of this systematic review was to examine the utilization, effectiveness, and quality of peer feedback during collaborative learning in medical education.

METHODS

The PRISMA statement for reporting in systematic reviews and meta-analysis was used to guide the process of conducting the systematic review. Evaluation of level of evidence (Colthart) and types of outcomes (Kirkpatrick) were used. Two main authors reviewed articles with a third deciding on conflicting results.

RESULTS

The final review included 31 studies. Problem-based learning and team-based learning were the most common collaborative learning settings. Eleven studies reported that students received instruction on how to provide appropriate peer feedback. No studies provided descriptions on whether or not the quality of feedback was evaluated by faculty. Seventeen studies evaluated the effect of peer feedback on professionalism; 12 of those studies evaluated its effectiveness for assessing professionalism and eight evaluated the use of peer feedback for professional behavior development. Ten studies examined the effect of peer feedback on student learning. Six studies examined the role of peer feedback on team dynamics.

CONCLUSIONS

This systematic review indicates that peer feedback in a collaborative learning environment may be a reliable assessment for professionalism and may aid in the development of professional behavior. The review suggests implications for further research on the impact of peer feedback, including the effectiveness of providing instruction on how to provide appropriate peer feedback.

A study of clinical teachers' attitude to teaching and perceived learning needs in a medical college in Nigeria

BACKGROUND AND PURPOSE

Debates on medical educational reform initiatives in Nigeria have gradually shifted from access to medical colleges to improving learning quality. Understandably, clinical teachers are being encouraged to acquire basic teaching pedagogical knowledge through learning activities. Considering the fact that the concept of faculty development for medical teachers' is still evolving in Sub-Saharan Africa, this study aims to explore clinical teachers' attitude to teaching and perceptions of continuing education in teaching knowledge and skills in a medical college in Nigeria.

METHODS

Using a mixed-method research approach, quantitative data were collected from a sample of teachers through survey questionnaires, and qualitative data were obtained through face-to-face individual semi-structured interviews of teachers from the same institution.

RESULTS

Sixty-one survey questionnaires (response rate of 88%) and 10 interviews were completed and analyzed. Findings revealed that teachers' derived satisfaction from teaching and maintain a strong commitment to teaching. Bedside teachings (64%) and lectures (21%) were reported to be the most frequent mode of teaching. Although four out of every five respondents (80%) reported not having previous training in teaching, a large proportion (97%) self-assessed their teaching abilities to be average or above average, with most indicating that the experience of teaching observed during undergraduate medical training may be sufficient preparation for their teaching roles. The majority of the teachers' were of the opinion that there is a need to improve their individual teaching skill. However, in the absence of formal faculty development programs in the college, most of the teachers indicated that their teaching skills are currently being improved through sporadic informal community of practice involving interested colleagues and modeling identified good teachers.

CONCLUSION

A catalyst of learning by teachers' may come from their belief and self-rating of teaching ability. In this under-resourced context, explicit classifications of existing informal learning opportunities coupled with greater institutional support could improve teaching and teachers' development.

Self-directed learning and practice of Italian osteopathic students during summer break: a cross-sectional survey

Background

Self-directed learning is a student-centered approach based on the students’ evaluation about their own learning needs. Self-directed practice is a component of the self-directed learning which focus on achieving manual and practical skills. Given the abundance of manual skills that students need to develop in the osteopathic curriculum, self-directed practice has become an attractive methodology. Most of the Italian osteopathic educational institutions recognize two types of educational curriculum: T1, for students without a healthcare background; and T2 for students who are already healthcare professionals. The aim of the present study is to investigate the attitudes of Italian osteopathic students toward self-directed practice during the summer break highlighting the possible differences between T1 and T2 students.

Methods

A web-based closed-ended survey was administered to the students attending one of the Italian osteopathic educational institutions which accepted to participate in the research.

Results

Two hundred sixty-eight students on 2549 participated to the survey. 64.92% of the students reported to have performed self-directed practice during the summer break. The main difficulty encountered by students in approaching self-directed practice was ‘lack of people to exercise with’. Most of the students performed self-directed practice between 1 to 5 h per week. The most common clinical condition encountered was Low Back Pain. The anatomical area most approached was lumbar spine. The most commonly simulated tests were the articular mobility tests. The techniques in which students trained the most were muscle energy techniques. Significant difference was found in self-engagement to the self-directed practice between T1 and T2 students (p = 0.026), and in the reasons to perform self-directed practice (p = 0.027).

Conclusions

The results of this study could be useful to reveal some aspects of students’ academic education and future clinical practice. Therefore this paper can be a useful tool for the institutions to develop strategies to overcome the reported problems students have towards self-directed practice. For example it should be discussed the possibility for the students to observe some senior osteopaths during their practice or to plan to maintain an open tutored didactic environment during the summer break as an extracurricular activity.

Educação interprofissional e as ações formativas do eixo do provimento emergencial do Programa Mais Médicos

RESUMO Este artigo objetivou identificar se as ações formativas do eixo do provimento emergencial do Programa Mais Médicos se apoiam em elementos teórico-metodológicos da educação interprofissional, na perspectiva dos participantes do programa. Trata-se de estudo exploratório, desenvolvido em 2016, em Minas Gerais. Os dados foram coletados mediante entrevistas individuais (n=30) e nove grupos focais (n=52) com participantes do programa, e tratados por análise de conteúdo, que produziu três categorias: Os pressupostos da educação interprofissional enunciados nos ciclos formativos do Programa Mais Médicos; As mudanças no processo de trabalho em equipe, na perspectiva dos elementos da educação interprofissional, desencadeadas pelos ciclos formativos; e Dificuldades para a abordagem da educação interprofissional nos ciclos formativos. Entre os elementos enunciados nos processos formativos, estão o aprendizado sobre o papel de cada profissão, o compartilhamento de experiências e a centralidade do cuidado no paciente. Por outra via, o preceito fundamental da educação interprofissional de aprendizado entre duas ou mais profissões não é aplicado sistematicamente. O Mais Médicos se constitui política propícia para o fortalecimento da interprofissionalidade, especialmente porque sua proposta se assenta na lógica da educação permanente, que demanda o estabelecimento de uma relação de mútua influência entre a educação e o trabalho em saúde.

The International Literature on Teaching Faculty Development in English-Language Journals: A Scoping Review and Recommendations for Core Topics

BACKGROUND

With increasing physician mobility, there is interest in how medical schools and postgraduate medical education institutions across the world develop and maintain the competence of medical teachers. Published reviews of faculty development (FD) have predominantly included studies from the United States and Canada.

OBJECTIVE

We synthesized the international FD literature (beyond the US and Canada), focusing on FD type, intended audience, study format, effectiveness, differences among countries, and potential unique features.

METHODS

We identified English-language publications that addressed FD for medical faculty for teaching and related activities, excluding US and Canadian publications.

RESULTS

A search of 4 databases identified 149 publications, including 83 intervention studies. There was significant growth in international FD publications for the most recent decade, and a sizable number of studies were from developing economies and/or resulted from international collaborations. Focal areas echo those in earlier published reviews, suggesting the international FD literature addresses similar faculty needs and organizational concerns.

CONCLUSIONS

The growth in publications in recent years and a higher proportion of reporting on participant reactions, coupled with less frequent reporting of results, transfer to practice, and impact on learners and the organization, suggest this is an evolving field. To enhance international FD, educators and researchers should focus on addressing common needs expressed by faculty, including curriculum design and evaluation, small group teaching, assessing professionalism and providing feedback. Future research should focus on approaches for developing comprehensive institutional FD programs that include communities of learning and practice and evaluating their impact.

Narrative medicine as a medical education tool: A systematic review

Aim: Narrative medicine has been promoted as an innovative and effective means of stimulating medical students' professional development by teaching them to approach their patients' experiences of illness with more understanding and compassion. This systematic literature review aims to answer the following question: what evidence of effect is available in the literature about models for teaching narrative medicine? Methods: We conducted a narrative review of 36 articles and used the Best Evidence in Medical Education (BEME) Global Scale and Kirkpatrick Scale for strength and importance of evidence to categorize reported assessment strategies and to evaluate the effectiveness of their narrative medicine programs. Results: We found evidence that narrative medicine is an effective pedagogic tool with a clear and replicable structure and methodology. We also determined that a positive impact could be measured when pertaining to participation and modification of attitudes, knowledge, and skills. However, unequivocal evidence of the effect of narrative medicine on students' behavior or ongoing interaction with colleagues and patients is still lacking. Conclusion: While many recent publications describe the goals and virtues of a narrative-based approach, more research is needed to determine whether or not there is an ideological consensus undergirding this approach. In addition, it is still unclear whether the long-term impact of narrative medicine classroom interventions are felt by patients, or whether such interventions positively impact patient care.

Stakeholder Groups' Unique Perspectives About the Attending Physician Preceptor Role: A Qualitative Study

BACKGROUND

Attending physician preceptors are accountable to many stakeholder groups, yet stakeholders' views about what the preceptor role entails have not been sufficiently considered.

OBJECTIVE

To explore stakeholder groups' unique perspectives of the preceptor role.

DESIGN

Qualitative study with a constructivist orientation.

PARTICIPANTS

Semi-structured interviews were conducted with 73 participants from two university teaching hospitals between October 2012 and March 2014. Participants included representatives from seven stakeholder groups: patients and their families, allied healthcare providers, bedside nurses, nurse managers, medical students, internal medicine residents, and preceptors.

APPROACH

An inductive thematic analysis was conducted where researchers coded transcripts, abstracted codes into themes, and then mapped themes onto six focus areas: role dimensions, role performance, stressors and rewards, mastery, fulfillment, and impact on others. Two authors then identified "recurrent themes" (emerging in two or more focus areas) and compared them across groups to identify "unique themes" (emerging from a maximum of two stakeholder groups). "Unique thematic emphases" (unique themes that would not have emerged if a stakeholder group was not interviewed) are described.

KEY RESULTS

Patients and their families emphasized preceptors' ultimate authority. Allied healthcare providers described preceptors as engaged collaborators involved in discharge planning and requiring a sense of humor. Bedside nurses highlighted the need for role standardization. Nurse managers stressed preceptors' need for humanism. Medical students highlighted preceptors' emotional labor and their influence on learners' emotional well-being. Residents emphasized preceptors' responsibilities to multiple stakeholders. Preceptors described lifelong learning and exercising control over one's environment.

CONCLUSIONS

Various stakeholder groups hold unique and nuanced views of the attending physician preceptor role. These views could broaden formal role guidance for medical education and patient care. This study generated real-world, practical examples of what stakeholders feel are important preceptor skills. These skills should be practiced, taught, and role modeled in this clinical setting.

Rural competencies in emerging medical practitioners: Beyond clinical skills

PROBLEM

Recruitment and retention of rural doctors remains a challenge in Australia. The Queensland Rural Generalist Program was developed to address this challenge and provides a range of tailored professional development opportunities to support rural medical training, recruitment and retention. The Rural Generalist Vocational Preparation Workshop was developed to maintain connection with trainees during a known attrition risk period and address a gap in training that focused on competencies required for rural practice.

DESIGN

The Rural Generalist Vocational Preparation Workshop, designed using adult learning principles, includes an optimal balance between theory, scenario-based learning and facilitated group discussions. A cross-sectional survey design was employed to evaluate the workshops delivered between 2015 and 2017.

SETTING

The workshops were attended by Queensland Rural Generalist Program trainees in the year prior to undertaking a vocational training position in a rural hospital or general practice. Participants were from 10 Hospital and Health Services in the Queensland public health sector at the time of attendance.

KEY MEASURES FOR IMPROVEMENT

An evaluation survey captured participant feedback about the workshop, its value, impact and their intention to implement changes in practice.

STRATEGIES FOR CHANGE

Fifty-one trainees attended the workshops across four locations.

EFFECTS OF CHANGE

Eight-eight per cent of participants reported intentions to implement changes to practice in: pursuit of career options and enhanced team work, leadership skills and networking.

LESSONS LEARNT

Evaluation results indicated that Rural Generalist Vocational Preparation Workshop was a highly valued opportunity. It provided future rural medical practitioners with professional support and networking opportunities, promoted identity formation and stimulated rural career planning.

Objective structured teaching examination (OSTE): an underused tool developed to assess clinical teaching skills. A narrative review of the literature

BACKGROUND

There are plenty of options for evaluating medical students and medical residents' clinical skills. Objective structured clinical evaluations (OSCEs) have emerged as a powerful and reliable tool for assessing multiple cognition domains of clinical expertise. In the same way as OSCEs have emerged to assess clinical skills, objective structured teaching evaluations (OSTEs) have come to light as promising and unbiased interventions for evaluating the act of clinical teaching.

DESIGN AND SETTING

Narrative review developed at Universidade Federal de Uberlândia, Brazil.

METHODS

We searched the literature regarding OSTEs using the MEDLINE (via PubMed) and LILACS (viaBiblioteca Virtual em Saude) databases. The SciELO library was also searched for Brazilian papers. Systematic reviews, reviews and randomized controlled trials specifically assessing how OSTEs performed in relation to development of academic staff and medical residents were then selected.

RESULTS

Our search retrieved 178 papers, of which 40 were considered eligible for intensive review. Most of the studies selected reported positive effects from OSTE activities. However, there was little quantitative data to gauge the impact of OSTEs on improvement of teaching skills.

CONCLUSIONS

Considering that OSCEs have become a widely used tool for assessing medical students' and residents' clinical skills, it is high time to incorporate OSTEs for evaluating teaching skills in Brazil. Encouraging data to support implementation of this assessment tool in this country is available from abroad. The net benefit from this would possibly encompass medical students, residents and academic staff, through bringing awareness about the importance of excelling in teaching skills.

Barriers and facilitators to writing quality items for medical school assessments - a scoping review

BACKGROUND

Producing a sufficient quantity of quality items for use in medical school examinations is a continuing challenge in medical education. We conducted this scoping review to identify barriers and facilitators to writing good quality items and note gaps in the literature that are yet to be addressed.

METHODS

We conducted searches of three databases (ERIC, Medline and Scopus) as well as Google Scholar for empirical studies on the barriers and facilitators for writing good quality items for medical school examinations.

RESULTS

The initial search yielded 1997 articles. After applying pre-determined criteria, 13 articles were selected for the scoping review. Included studies could be broadly categorised into studies that attempted to directly investigate the barriers and facilitators and studies that provided implicit evidence. Key findings were that faculty development and quality assurance were facilitators of good quality item writing while barriers at both an individual and institutional level include motivation, time constraints and scheduling.

CONCLUSIONS

Although studies identified factors that may improve or negatively impact on the quality of items written by faculty and clinicians, there was limited research investigating the barriers and facilitators for individual item writers. Investigating these challenges could lead to more targeted and effective interventions to improve both the quality and quantity of assessment items.

Designing a Comprehensive Professional Development Program in a Surgery Department: Process, Measures, and Lessons Learned

BACKGROUND

Departments within academic medical centers are typically comprised of clinical and research faculty, administrative staff, residents, and in many instances advance practice providers (APPs). Each member of these groups of people, at 1 point, took time, effort, and money to recruit, hire, and train. It is therefore important to consider ways to increase the "return on investment" of hiring each member of a department as well as maintaining a high level of department vitality. The Department of Surgery at Indiana University has never had a robust professional development program for all of its members. A challenge, therefore, presented itself of how best to increase faculty engagement in faculty development and to initiate opportunities for professional development for APPs and staff.

INTERVENTION

We implemented a professional development program that focused on academic success with emphasis on teaching and leadership and tailored activities to meet the needs of each member. Professional development was promoted by targeting select groups of people within our department to engage rather than have members go to the effort of seeking development on their own.

SETTING

The intervention occurred in the Department of Surgery at Indiana University which is comprised of ∼125 faculty, 100 residents and/or fellows, 60 APPs, and 19 lead business administrators for 6 divisions, all working within 5 downtown hospitals comprising the academic health center.

RESULTS

Great effort has been placed into defining measures for each activity including measures of engagement, completion of deliverables, and tracking new leadership positions obtained by participants. Between 2014 and 2017, the number of faculty development activities that faculty attended has tripled since inception of our professional development program.

CONCLUSIONS

For those looking to enhance or begin a professional development program, appointing a director or vice chair to oversee and champion the initiative is key. From our experience, putting effort first into developing a junior faculty development program to capture internal motivation early on is likely best. For leadership development, selecting faculty to form faculty learning cohorts worked well. Finally, to deal with the barriers of time and competing interests, building in protected time for professional development is essential.

Interprofessional Education: Opportunities and Challenges for Psychology

This manuscript is an outgrowth of an invited panel presentation at the national Association for Psychologists in Academic Health Centers Conference in 2017 on Interprofessional Education (IPE). IPE is a structured and transformative educational strategy designed to provide active learning experiences where trainees from diverse healthcare professions gain shared content knowledge plus collaboration skills as they learn about, from, and with each other. Collaboration skills include understanding professional role distinctions and overlap, effective team-based communication, shared values/ethics and respect for each other's expertise, and teamwork dynamics. It is increasingly important to expand training beyond the intraprofessional activities in which psychology trainees engage to prepare them to participate in interprofessional collaborative care. As healthcare systems move to team-based collaborative practice and value-based reimbursement models, the profession of psychology needs leaders at every academic health center to facilitate the design and/or implementation of IPE activities. The panel of psychologists presented roles that psychologists play in IPE institutional program design and implementation, graduate training programs, and the perspectives of an early career psychologist and psychology trainee. Opportunities and challenges are highlighted, culminating in a call to action. Psychologists must embrace their identity as health professionals and engage their learners in IPE so that the emerging cognitive schemata of healthcare that is developed includes the profession of psychology. Otherwise, healthcare teams and health professionals will not understand the value, roles, or potential contributions of psychologists in enhancing patient care outcomes, ultimately jeopardizing psychologists' referrals, involvement in healthcare delivery, and career opportunities.

Just-in-time faculty development: a mobile application helps clinical teachers verify and describe clinical reasoning difficulties

BACKGROUND

Although clinical teachers can often identify struggling learners readily and reliably, they can be reluctant to act upon their impressions, resulting in failure to fail. In the absence of a clear process for identifying and remediating struggling learners, clinical teachers can be put off by the prospect of navigating the politically and personally charged waters of remediation and potential failing of students.

METHODS

To address this gap, we developed a problem-solving algorithm to support clinical teachers from the identification through the remediation of learners with clinical reasoning difficulties, which have significant implications for patient care. Based on this algorithm, a mobile application (Pdx) was developed and assessed in two emergency departments at a Canadian university, from 2015 to 2016, using interpretive description as our research design. Semi-structured interviews were conducted before and after a three-month trial with the application. Interviews were analysed both deductively, using pre-determined categories, and inductively, using emerging categories.

RESULTS

Twelve clinical teachers were interviewed. Their experience with the application revealed their need to first validate their impressions of difficulties in learners and to find the right words to describe them before difficulties could be addressed. The application was unanimously considered helpful regarding both these aspects, while the mobile format appeared instrumental in allowing clinical teachers to quickly access targeted information during clinical supervision.

CONCLUSIONS

The value placed on verifying impressions and finding the right words to pinpoint difficulties should be further explored in endeavours that aim to address the failure to fail phenomenon. Moreover, just-in-time mobile solutions, which mirror habitual clinical practices, may be used profitably for knowledge transfer in medical education, as an alternative form of faculty development.

Implementation of workplace-based assessment in general practice

Background: Workplace-based assessment (WPBA) is widely accepted, but few studies have investigated implementation issues during general practice (GP) placements. This study explored possible barriers and identified key elements for successful implementation of a WPBA-programme in Danish GP specialist training. Methods: Supervisors had attended a one-day course in WPBA and trainees had received a short introduction. Questionnaires on experiences with implementation of WPBA were distributed to 106 GP supervisors and 110 trainees after the rotation was finished. Results: The response rate was 61/96 (64%) for trainees and 67/94 (71%) for supervisors. Supervisors were generally more positive towards WPBA and saw fewer barriers than trainees. Lack of planning was most often reported as an impediment to WPBA. Supervisors did not identify trainees' uneasiness of being observed as a problem as often as trainees. A total of 34% of trainees reported uneasiness as an obstacle to WPBA. Conclusions: It seems that the education of supervisors positively influenced supervisors' perception and use of WPBA. Adequate planning of WPBA may be just as big a problem as assigning the time. Further investigations on the impact of education on trainees' perception of WPBA are needed.

Longitudinal Outcomes of an Elective Academic and Administrative Advanced Pharmacy Practice Experience

Objective. To evaluate the impact of an academic and administrative advanced pharmacy practice experience (APPE) on participants' career choice and long-term retention of teaching knowledge. Methods. Participants in an academic and administrative APPE from 2009 to 2016 completed a questionnaire about the experience and a 20-item knowledge test covering the five APPE modules. In addition, a retrospective review of graduates from the same timeframe was conducted to determine their faculty and preceptor status. Results. Of the 17 APPE participants, 16 completed the study and 100% reported that the experience helped them understand what it means to be a faculty member and an effective preceptor. The study participants completed the APPE knowledge test over the five modules. Participants passed four of the five module tests, including that for the instructional design module. A greater proportion of participants (75%) obtained faculty positions than did graduates who had not completed the APPE (9%). Seventy-one percent of students became active preceptors compared to 53% of students who did not complete the academic and administrative APPE, but this difference was not significant as the study was not powered to detect a difference. Conclusion. A longitudinal analysis of an academic and administrative APPE found that 75% of participants pursued a faculty position and retained their knowledge over time. A majority of the APPE participants (71%) and nonparticipants (53%) obtained a preceptor license. The outcomes support continued offering of the academic and administrative APPE to fourth-year pharmacy (P4) students. Requiring all P4 students to complete the APPE could help make them "preceptor ready."