Faculty development for hospitalists: structured peer observation of teaching

A novel hospitalist peer observation program to improve educational and operational rounding practices

Academic hospitalists must balance trainee education with operational demands to round efficiently and optimize hospital throughput. Peer observation has been shown to support educator development, however, few hospitalists have formal training to optimize both skill sets. We sought to extend and adapt peer observation programs to equally focus on education and operations-based outcomes. During the 2-year study period, 76 of 98 (78%) eligible faculty participated in a structured, real-time peer observation program. Immediately after observing a peer, 42% of respondents planned to adopt an operations-related rounding behavior. Following program completion, 77% of respondents endorsed the implementation of a new rounding behavior learned from a peer, with a third of these behaviors related to clinical operations. Ninety-five percent of respondents endorsed at least a moderate degree of program satisfaction. High levels of engagement and sustained behavior change following program participation suggest clinical operations are an important addition to peer observation programs and faculty development initiatives.

Twelve tips for creating and sustaining a peer assessment program of clinical faculty

While feedback is essential for learning in the health professions, clinical teachers rarely get feedback on their teaching, and the existing feedback is often non-specific and distant from teaching encounters. To enhance clinical teaching, we created a peer assessment program for clinical faculty. This program has been well-received and sustained for five years despite the challenges of faculty turnover and the pandemic. In this article, we identify twelve tips for creating and sustaining a peer assessment program for clinical faculty based on this experience. These tips focus on how to create a culture that supports peer assessment, on how best to implement a peer assessment program in practical terms, and on how to sustain a peer assessment program long-term. We hope these tips help educators receive better feedback about their clinical teaching and improve the future care delivered by our learners.

A systematic review of faculty development programs based on the Harden teacher's role framework model

BACKGROUND

Despite the changing roles of faculty in the health professions over the past two decades, none of the reviews has been paid enough attention to the impact of the faculty development programs on these roles. The objective of this review is to synthesize the existing evidence that addresses the questions: "What are the types and outcomes of faculty development programs based on the Harden teachers' role framework and which of the areas described by Harden and Crosby are the authors referring to?"

METHODS

This review was conducted according to the guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. In 2020, a literature search was conducted in MEDLINE/PubMed, Scopus, ERIC, ScienceDirect, Google Scholar, Magiran and SID databases. The review included 119 studies (between 1990 and 2020) that met the review criteria. Data were extracted using a modified coding sheet. We used the modified Kirkpatrick model to assess the educational outcomes of faculty development programs.

RESULTS

The majority of faculty development programs were workshops (33.61%) with various durations. Most programs focused on the domain of information provider and coach (76.47%), followed by the facilitator of learning and mentor (53.78%) and assessor and diagnostician (37.81%). Only five faculty development programs focused on the domain of role model. The majority (83.19%) of outcomes reported were at level 2B, level 1 (73.95%) and level 2A (71.42%). Gains in knowledge and skills related to teaching methods and student assessment were frequently noted. Behavior changes included enhanced teaching performance, development of new educational curricula and programs, improved feedback and evaluation processes, new leadership positions, increased academic output and career development. The impact on the organizational practice continued to be underexplored.

CONCLUSION

Based on the review findings, broadening the scope of faculty development programs beyond the traditional roles of the faculty members by utilizing a competency-based framework for developing a comprehensive faculty development program is recommended. Attention to individualized form of faculty development programs and incorporating more informal approaches into the design and delivery of faculty development programs is also needed.

Peer observation of student-led teaching

INTRODUCTION

The use of near-peer teaching in medical schools is increasing internationally. Peer observation of teaching (POT) is a useful and effective method for enhancing teaching experiences and quality, but its use among student peer teachers is not well documented. The aim of the study was to explore medical student perceptions on the value and limitations of POT.

METHODS

Ten medical students were trained as observers. Using a previously developed model, they observed 27 teaching sessions led by other students (observees), with a pre- and post-observation meeting. Observers and observees completed a survey and group interview to explore their experiences. Descriptive analysis of survey data and thematic analysis of qualitative data were conducted.

RESULTS

Observees found feedback valuable in learning about, reflecting on, and increasing confidence in teaching practice. They felt comfortable receiving feedback and reported positively about the observers in terms of: expertise, relatability, non-intimidating presence, and awareness of the target audience. Observers reported learning more about good teaching practice. While most observers found it enjoyable, several found some aspects of giving feedback uncomfortable. Most found it difficult to establish a satisfactory dynamic, citing lack of credibility and difficulty in eliminating hierarchies. Pre-existing friendships were reported by observers as both helping and hindering the dynamic.

DISCUSSION

Both observers and observees gained from the experience of POT. However, observers lacked confidence in their credibility. Further work should address how best to implement POT into the curriculum to improve teaching practice in medical students. Further training or coaching could be considered to overcome observers' concerns.[Box: see text].

Effectiveness of a supervisor training on quality of feedback to internal medicine residents: a controlled longitudinal multicentre study

OBJECTIVES

High-quality feedback on different dimensions of competence is important for resident learning. Supervisors may need additional training and information to fulfil this demanding task. This study aimed to evaluate whether a short and simple training improves the quality of feedback residents receive from their clinical supervisors in daily practice.

DESIGN

Longitudinal quasi-experimental controlled study with a pretest/post-test design. We collected multiple premeasurements and postmeasurements for each supervisor over 2 years. A repeated measurements ANOVA was performed on the data.

SETTING

Internal medicine departments of seven Dutch teaching hospitals.

PARTICIPANTS

Internal medicine supervisors (n=181) and residents (n=192).

INTERVENTION

Half of the supervisors attended a short 2.5-hour training session during which they could practise giving feedback in a simulated setting using video fragments. Highly experienced internal medicine educators guided the group discussions about the feedback. The other half of the supervisors formed the control group and received no feedback training.

OUTCOME MEASURES

Residents rated the quality of supervisors' oral feedback with a previously validated questionnaire. Furthermore, the completeness of the supervisors' written feedback on evaluation forms was analysed.

RESULTS

The data showed a significant increase in the quality of feedback after the training F (1, 87)=6.76, p=0.04. This effect remained significant up to 6 months after the training session.

CONCLUSIONS

A short training session in which supervisors practise giving feedback in a simulated setting increases the quality of their feedback. This is a promising outcome since it is a feasible approach to faculty development.

Teaching Observation as a Faculty Development Tool in Medical Education: A Scoping Review

INTRODUCTION

Health professions education often includes teaching observation to inform faculty development (FD) and indirectly improve student performance. Although these FD approaches are well received by faculty, they remain underused and/or underreported, with limited opportunities to receive feedback in workplace contexts. The goal of our study was to map the depth and breadth of education literature on the use of observation of teaching as a tool of professional development in medical education.

METHODS

Following the methodology by Arksey and O'Malley, we conducted a scoping review and searched four databases for articles published in English (final searches in April 2022).

RESULTS

Of 2080 articles identified, 45 met the inclusion criteria. All observation activities were associated with one of the following FD approaches: peer observation of teaching (23 articles, 51%), peer coaching (12, 27%), peer review (9, 20%), and the critical friends approach (1, 2%). Thirty-three articles (73%) concerned formative versions of the observation model that took place in clinical settings (21, 47%), and they tended to be a voluntary (27, 60%), one-off (18, 40%), in-person intervention (29, 65%), characterized by limited institutional support (13, 29%). Both barriers and challenges of teaching observation were identified.

DISCUSSION

This review identified several challenges and shortcomings associated with teaching observation, such as inadequate methodological quality of research articles, inconsistent terminology, and limited understanding of the factors that promote long-term sustainability within FD programs. Practical strategies to consider when designing an FD program that incorporates teaching observation are outlined.

Peer observation of teaching: A feasible and effective method of physician faculty development

Physician faculty learn teaching skills informally while fighting competing professional obligations. One underutilized proven technique to improve teaching skills is peer observation with feedback. We aimed to understand benefits and challenges of a physician faculty development program based on peer observation of teaching and to develop best practice recommendations for future program development. The authors developed a peer observation-based physician faculty development program from 2015 to 2017. Two interviewers conducted and analyzed qualitative interviews with 13 faculty participants and four non-participants using content analysis to identify themes and subthemes in NVivo©. Participant-identified program benefits included conveyed institutional support for teaching, the opportunity for peer observation with direct and timely feedback, the opportunity for community building, and overall program feasibility. Program challenges included competing scheduling demands, variability in feedback quality, and difficulty maintaining engagement for the program duration. Potential areas for improvement included participation incentives, external faculty involvement, assistance with program logistics and administration, and improvement in the consistency of the feedback experience. While peer observation is a valued approach to physician faculty development of teaching skills, competing demands on physicians may still limit program effectiveness. Program sustainability depends on optimizing feedback quality, boosting motivation for participation, and providing administrative support.

Mission Critical: Reimagining Promotion for Clinician-Educators

Academic clinician-educators who teach health professions trainees and lead educational programs have been penalized by the mismatch between their daily contributions to the academic mission and traditional promotion criteria focused on peer-reviewed publications and external reputation. Despite two decades of incremental approaches, inconsistency and inequity persist in the promotion process for clinician-educators. The authors propose five steps to mark a new approach to academic advancement for clinician-educators: (1) elevate the scholarly approach to teaching over peer-reviewed publications; (2) allow clinician-educators to identify an area of focus; (3) broaden the evidence for educational excellence; (4) prioritize internal referees; and (5) increase clinician-educator representation on promotion committees. Achieving meaningful change requires transforming entrenched traditions and policies at multiple levels. Changes that advance equity are necessary to retain academic faculty members who train the next generation of health professionals.

Beyond the Workshop: Results From a Longitudinal, Interprofessional Teaching Certificate Program

OBJECTIVES

While most hospital-based, healthcare professionals are expected to teach and supervise, few receive training in education. We designed, implemented, and evaluated an interprofessional, hospital-based teaching certificate program based on experiential learning and reflective practice for healthcare professionals with little or no formal training in education.

METHODS

Participants attended educational seminars; incorporated new concepts, skills, and behaviors in their teaching; and submitted written reflections. Participants also met with an education coach, received feedback from a trained observer, and observed a "master teacher." We used descriptive statistics to analyze a survey distributed to the 2017-2019 cohort. We also analyzed written reflections to determine whether participants described a new teaching skill, concept, or behavior, and how they applied these to their teaching.

RESULTS

Survey completion rate was 15/20 (75%). Participants described feeling connected to an educator community, establishing educational alliances with senior educators, and learning teaching strategies from other certificate members outside their own profession. Participants indicated they are more likely to pursue educational innovation, leadership, and scholarship. In the reflections, 88% described incorporating a new concept in their teaching.

CONCLUSION

Participants in an interprofessional teaching certificate program engaged in a curriculum of professional development in education. Graduates of the program reported knowledge gain, behavior change, and establishment of educational alliances and a community of practice.

Participation in a Resident-as-Teacher Rotation: Motivations of and Impacts on Faculty Coaches

PURPOSE

Coaching in medical education is increasingly used for trainee development for a variety of skills, including improving trainee teaching skills through resident-as-teacher programs. Faculty who serve as coaches commit significant effort to the coaching role, often without protected time or support. Little is known about faculty motivations to participate in coaching programs or how the coaching experience affects the faculty. This study explored faculty coaches' motivations to participate as coaches in a resident-as-teacher rotation and the impacts they experienced as a result of their participation.

METHOD

In this qualitative study, authors conducted 14 semistructured interviews in 2019 with faculty coaches from a single resident-as-teacher program in Boston, Massachusetts. Authors analyzed the transcripts using thematic analysis to develop a conceptual framework.

RESULTS

Faculty coaches' motivations for initial participation included a sense of honor; a sense of duty; perception of competence; interest in promoting medical education; and desire for increased connectedness. These motivations all related to a larger theme of educator identity. Coaches identified 3 main impacts from participation: improvement in their own teaching, personal satisfaction from helping others and seeing improvement in their learners, and increased connectedness. These impacts affirmed the coaches' educator identity and led to ongoing motivation to participate. They also contributed to the coaches' well-being at work.

CONCLUSIONS

Faculty were initially motivated to participate as coaches in a resident-as-teacher rotation based on their identity as educators. The benefits achieved-improvement in own teaching, personal satisfaction, and increased connectedness-affirmed their educator identity and led to ongoing participation and increased well-being at work. These motivations and impacts are important to consider as future programs are developed and coaches are recruited for programs across undergraduate, graduate, and continuing medical education settings.

Peer Observation of Teaching Program for the Busy Hospitalist

Background: Peer observation of teaching (POT) is a well-documented faculty development tool, but published research focuses mostly on programs in which participating physicians had protected time in their schedule in which to complete observations. Most programs nationally depend on hospitalists who have minimal, if any, protected time in their schedule and thus in order to complete these observations, will need to figure out a way to schedule these into their regular working day.

Objective: We determined whether a POT program, focused on hospitalists with minimal non-clinical time, scheduled around clinical responsibilities, could be feasible and acceptable.

Methods: Seven hospitalists participated in a POT pilot program from January 2019 to June 2019. Each hospitalist completed three 30-minute observations during this interval. At the completion of the pilot, the hospitalists were surveyed on their experience and results were assessed via open-ended narrative questions, which underwent thematic analysis.

Results: Twenty of the 21 scheduled observations (95%) were completed. Of the completed observations, 100% were completed while the observer was assigned to concomitant clinical duties. The survey response rate was 100%. From free-text responses, the following themes emerged: (1) Acceptable time commitment with minor inconvenience, (2) learning through observing and reflecting for personal growth, and (3) stress-free peer observations.

Conclusions: This study demonstrates the successful development and implementation of a POT program that served as a faculty development initiative focused primarily on hospitalists with minimal protected time.

Frameworks to Guide Faculty Development for Health Professions Education: A Scoping Review

INTRODUCTION

The authors explored the existence of explicit definitions, guiding competency frameworks, and learning theory to inform health professions education faculty development (FD) programs. The authors analyzed identified frameworks based on thematic focus, scope of targeted faculty, and design structure.

METHODS

A scoping review was used to identify health professions education literature between 2005 and 2020. Frameworks were characterized according to the scope of the faculty targeted and design structure, and then, domains were grouped into topical categories for analysis.

RESULTS

Twenty-three articles met the criteria for data extraction, of which only one (4.3%) described the explicit use of a learning theory and three (13%) included an explicit definition of FD. One (4.3%) used a recognized framework, whereas 12 (52.2%) developed a novel framework based on an existing outline. Ten (43.5%) described de novo framework development. Only three (13.0%) used entrustable professional activities or similar constructs. Five (21.7%) programs targeted multiple health professions, 11 (47.8%) targeted a single health profession, and seven (30.5%) targeted a specific specialty within a health profession. Only two frameworks included a developmental component.

DISCUSSION

Few authors describe an explicit definition, learning theory, or use a pre-established framework when framing their FD programs. The use of entrustable professional activities to structurally link competencies to work practices is also uncommon, as well as the use of developmental structures designed to support progressive FD over time.

Seeing is Believing: Inclusion of Biomedical Scientist Educators as Observers on Clinical Rounds

Increasingly, medical school curricula seek to integrate the biomedical and clinical sciences. Inclusion of the basic sciences into the clinical curricula is less robust than including clinical content early in medical school. We describe inclusion of biomedical scientists on patient care rounds to increase the visibility of biomedical sciences, to nurture relationships between clinicians and biomedical scientists, and to identify additional opportunities for integration throughout medical school.

Characteristics, satisfiers, development needs, and barriers to success for early-career academic hospitalists

BACKGROUND

Academic hospitalists engage in many non-clinical domains. Success in these domains requires support, mentorship, protected time, and networks. To address these non-clinical competencies, faculty development programs have been implemented. We aim to describe the demographics, job characteristics, satisfiers, and barriers to success of early-career academic hospitalists who attended the Academic Hospitalist Academic (AHA), a professional development conference from 2009 to 2019.

METHODS

Survey responses from attendees were evaluated; statistical analyses and linear regression were performed for numerical responses and qualitative coding was performed for textual responses.

RESULTS

A total of 965 hospitalists attended the AHA from 2009 to 2019. Of those, 812 (84%) completed the survey. The mean age of participants was 34 years and the mean time in hospitalist practice was 3.2 years. Most hospitalists were satisfied with their job, and teaching and clinical care were identified as the best parts of the job. The proportion of female hospitalists increased from 42.2% in 2009 to 60% in 2019 (p = 0.001). No other demographics or job characteristics significantly changed over the years. Lack of time and confidence in individual skills were the most common barriers identified in both bedside teaching and providing feedback, and providing constructive feedback was an additional challenge identified in giving feedback.

CONCLUSIONS

Though early-career hospitalists reported high levels of job satisfaction driven by teaching and clinical care, barriers to success include time constraints and confidence. Awareness of these factors of satisfaction and barriers to success can help shape faculty development curricula for early-career hospitalists.

Faculty development program for coaching in nursing education: A curriculum development process study

AIM/OBJECTIVE

This study aims to develop a Faculty Development Program for Coaching that can be used in teaching psychomotor skills in nursing education.

BACKGROUND

Knowledge, skills and attitudes of faculty members play a significant role in students acquiring basic nursing psychomotor skills before clinical training.

DESIGN

It is a curriculum development process study.

METHODS

The study sample comprised 149 nursing faculty members in all nursing faculties in Turkey. This study combines the Delphi survey, analysis of psychomotor skills training programs and a literature review with the Triangulation Strategy.

RESULTS

A Faculty Development Program for Coaching consisting of six modules and 34-hours was developed. The program including various teaching strategies. Participant's achievements are assessed by grading individual assignments.

CONCLUSIONS

The Faculty Development Program for Coaching was developed to be used in all nursing faculties. When this faculty development program is implemented, it will enable researchers to make national and international comparisons in this field.

Using Peer Feedback to Promote Clinical Excellence in Hospital Medicine

Hospitalists provide a significant amount of direct clinical care in both academic and community hospitals. Peer feedback is a potentially underutilized and low resource method for improving clinical performance, which lends itself well to the frequent patient care handoffs that occur in the practice of hospital medicine. We review current literature on peer feedback to provide an overview of this performance improvement tool, briefly describe its incorporation into multi-source clinical performance appraisals across disciplines, highlight how peer feedback is currently used in hospital medicine, and present practical steps for hospital medicine programs to implement peer feedback to foster clinical excellence among their clinicians.

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.

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.

Twelve tips for providing feedback to peers about their teaching

When healthcare professionals provide feedback to peers after a teaching observation, there are benefits for both parties. In this article, we outline strategies to use before, during, and after teaching observations to engage in mutually-beneficial conversations that highlight best practices, identify solutions for teaching dilemmas, and initiate teaching relationships. We discuss the importance of choosing words wisely; giving feedback about teaching skills, not the teacher as a person; recognizing how colleagues view their teaching identities; and ensuring peers are emotionally ready for a post-observation conversation. We also explain how to use pronouns, questions, and active listening during feedback conversations. Finally, we explore the impact of biases on observations, how to establish peer observer credibility, and how to make the teaching observation process and feedback discussion valuable experiences for both parties so that it leads to long-lasting partnerships in the quest to improve educational quality.

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.

Assessment of a Faculty and Preceptor Development Intervention to Foster Self-Awareness and Self-Confidence

Objective. To conduct and evaluate the outcomes of a pharmacy faculty and preceptor development program to foster self-awareness and self-confidence. Methods. A faculty and preceptor development intervention was implemented in a multi-campus college of pharmacy to promote and assess for improvements in self-awareness and self-confidence. Faculty members and preceptors were surveyed regarding their self-perceptions and confidence at baseline and following an intervention in which they completed the Birkman Method self-assessment and participated in a training program with an active-learning component. A longitudinal follow-up survey was conducted to assess the long-term impacts of the intervention. Results. Faculty members and preceptors experienced significant improvements in self-awareness from baseline following the development intervention. They also experienced increases in self-confidence related to coaching. A survey evaluating the longitudinal impact of the intervention indicated a positive association between receiving a sufficient level of Birkman Method training and improved ability of both faculty members and preceptors to manage professional relationships. Similarly, a positive association was identified between the sufficiency of training and preceptors' confidence in their ability to manage personal relationships and stress following the intervention. Conclusion. Faculty members and preceptors teach students to be more self-aware and confident, yet both groups often need to grow in these areas themselves. A faculty and preceptor development intervention using the Birkman Method self-assessment is one approach to facilitating growth in these educators' self-awareness and self-confidence.

Current Practices and Perspectives on Peer Observation and Feedback: A National Survey

OBJECTIVE

Peer observation and feedback (POF) is the direct observation of an activity performed by a colleague followed by feedback with the goal of improved performance and professional development. Although well described in the education literature, the use of POF as a tool for development beyond teaching skills has not been explored. We aimed to characterize the practice of POF among pediatric hospitalists to explore the perceived benefits and barriers and to identify preferences regarding POF.

METHODS

We developed a 14-item cross-sectional survey regarding divisional expectations, personal practice, perceived benefits and barriers, and preferences related to POF. We refined the survey based on expert feedback, cognitive interviews, and pilot testing, distributing the final survey to pediatric hospitalists at 12 institutions across the United States.

RESULTS

Of 357 eligible participants, 198 (56%) responded, with 115 (58%) practicing in a freestanding children's hospital. Although 61% had participated in POF, less than one half (42%) reported divisional POF expectation. The most common perceived benefits of POF were identifying areas for improvement (94%) and learning about colleagues' teaching and clinical styles (94%). The greatest perceived barriers were time (51%) and discomfort with receiving feedback from peers (38%), although participation within a POF program reduced perceived barriers. Most (76%) desired formal POF programs focused on improving teaching skills (85%), clinical management (83%), and family-centered rounds (82%).

CONCLUSIONS

Although the majority of faculty desired POF, developing a supportive environment and feasible program is challenging. This study provides considerations for improving and designing POF programs.

Peer Observation of Rounds Leads to Collegial Discussion of Teaching

PROBLEM

Faculty in the Division of Hospital Medicine provide most of the clinical teaching for learners at our institution. The majority of these faculty are Assistant Professors with limited formal instruction in clinical teaching. Previous Divisional strategies to improve clinical teaching ability included discussion of effective teaching behaviors, developing written expectations for teaching faculty, and instituting seminars on effective clinical teaching. Heretofore, the Division had not utilized a direct observation exercise.

INTERVENTION

We developed a direct observation exercise to encourage discussion of teaching techniques and contemplation of change. Using a social learning model, we developed a peer-to-peer observation followed by a nonevaluative discussion. We created a tool for describing teaching behaviors in 5 domains that were similar to or different from the usual behavior of the observing peer: learner presentations, team leadership, bedside teaching, professionalism, and other. After the observation, the observing and observed faculty met to discuss observed teaching behaviors. Both faculty members discussed and then recorded any teaching behaviors that they planned to adopt or change.

CONTEXT

We implemented this intervention in a 22-member Academic Division of Hospital Medicine at a tertiary care medical center in the United States. A high proportion were junior faculty and graduates of our residency program.

OUTCOME

We reviewed records of 28 of 31 observations that were completed during the initial 9-month period of implementation and later surveyed faculty. The exercise resulted in planned changes in teaching behaviors that included instituting new methods to improve teaching team leadership, triaging of patients seen on rounds, faculty behaviors during oral presentations, giving real-time feedback, use of technology and humor, demonstrating physical examination findings, and modeling professional behaviors. Faculty later reported adoption of new teaching behaviors that were important to them.

LESSONS LEARNED

This exercise was easily implemented, resulted in planned changes by both observed and observing peers, and resulted in widespread adoption of some specific teaching behaviors. The most commonly planned change dealt with team leadership or organizational issues. When given the freedom to choose, junior faculty were more likely to observe senior faculty.

A novel peer feedback programme of family-centred rounds

BACKGROUND

Family-centred rounds (FCRs) are becoming standard practice in in-patient paediatrics. Few faculty development programmes to train doctors in how to lead FCRs have been described in the literature, yet recent studies of peer feedback of in-patient rounds in internal medicine suggest benefits to teaching practices. Peer feedback may be useful as a faculty development method for FCRs. The study objective was to describe the experience of paediatric hospitalists participating in a peer feedback programme based on direct observation of FCRs.

METHODS

This was a qualitative study of 13 paediatric hospitalists at an academic centre, who participated in individual semi-structured interviews about their experience with the programme of peer feedback of FCRs. Interviews were transcribed and the data were analysed by coding statements of interest. Like content was categorised into over-arching themes.

RESULTS

The resultant themes included: (1) comfort is key for participation; (2) initial trepidation fades; (3) seniority has an effect; and (4) peer feedback of FCRs has value. Several specific elements of feedback were provided to improve teaching behaviours. Recent studies of peer feedback of in-patient rounds in internal medicine suggest benefits to teaching practices DISCUSSION: This faculty development programme of peer feedback based on direct observation of FCRs was endorsed by participants at our institution. Our findings serve to inform other programmes interested in peer feedback or in faculty development opportunities for FCRs.

A Pilot Study of the Creation and Implementation of a Teaching Development Assessment Tool

BACKGROUND

The importance of effective clinical teaching skills is well established in the literature. However, reliable tools with validity evidence that are able to measure the development of these skills and can effectively be used by nonphysician raters do not exist.

OBJECTIVE

Our initiative had 2 aims: (1) to develop a teaching development assessment tool (TDAT) that allows skill assessment along a continuum, and (2) to determine if trained nonphysicians can assess clinical teachers with this tool.

METHODS

We describe the development of the TDAT, including identification of 6 global teaching domains and observable teaching behaviors along a 3-level continuum (novice/beginner, competent/proficient, expert) and an iterative revision process involving local and national content experts. The TDAT was studied with attending physicians during inpatient rounds with trained physician and nonphysician observers over 6 months.

RESULTS

The TDAT showed emerging evidence of content, construct, and viable validity (the degree to which an assessment tool is practical, affordable, suitable, evaluable, and helpful in the real world) for the evaluation of attending physicians on inpatient rounds. Moderate to near perfect interrater reliability was seen between physician and nonphysician raters for the domains of promotion of clinical reasoning, control of the learning environment, ability to teach to multiple levels of learners, and provision of feedback.

CONCLUSIONS

The TDAT holds potential as a valid and reliable assessment tool for clinical teachers to track the development of each individual's teaching skills along the continuum from early development to mastery.