The teacher simulation exercise: changes in physician teaching emphasis and strategy. The SGIM Task Force on the Medical Interview

Teaching the medical interview: methods and key learning issues in a faculty development course

OBJECTIVE

To describe the American Academy on Communication in Healthcare's (AACH) Faculty Development Course on Teaching the Medical Interview and report a single year's outcomes.

DESIGN

We delivered a Faculty Development course on Teaching the Medical Interview whose theme was relationship-centered care to a national and international audience in 1999. Participants completed a retrospective pre-post assessment of their perceived confidence in performing interview, clinical, teaching, and self-awareness skills.

PARTICIPANTS AND SETTING

A total of 79 participants in the 17th annual AACH national faculty development course at the University of Massachusetts Medical School in June 1999.

INTERVENTION

A 5-day course utilized the principles of learner-centered learning to teach a national and international cohort of medical school faculty about teaching the medical interview.

MEASUREMENTS AND MAIN RESULTS

The course fostered individualized, self-directed learning for participants, under the guidance of AACH faculty. Teaching methods included a plenary session, small groups, workshops, and project groups all designed to aid in the achievement of individual learning goals. Course outcomes of retrospective self-assessed confidence in interview, clinical, teaching, self-awareness, and control variables were measured using a 7-point Likert scale. Participants reported improved confidence in interview, clinical, teaching, and self-awareness variables. After controlling for desirability bias as measured by control variables, only teaching and self-awareness mean change scores were statistically significant (p < .001).

CONCLUSIONS

The AACH Faculty Development course on Teaching the Medical Interview utilized learner-centered teaching methods important to insure learning with experienced course participants. Perceived teaching and self-awareness skills changed the most when compared to other skills.

The impact of the Stanford Faculty Development Program on ambulatory teaching behavior

CONTEXT

Faculty development has received considerable investment of resources from medical institutions, though the impact of these efforts has been infrequently studied.

OBJECTIVE

To measure the impact of the Stanford Faculty Development Program in Clinical Teaching on ambulatory teaching behavior.

DESIGN

Pre-post.

SETTING AND PARTICIPANTS

Eight internal medicine faculty participating in local faculty development.

INTERVENTION

Participants received 7 2-hour sessions of faculty development. Each session included didactic, role-play, and videotaped performance evaluation.

MAIN OUTCOME MEASURE

Before and after the intervention, faculty were video-taped during a case presentation from a standardized learner, who had been trained to portray 3 levels of learners: a third-year medical student, an intern, and a senior medical resident. Teacher and learner utterances (i.e, phrases) were blindly and randomly coded, using the Teacher Learner Interaction Analysis System, into categories that capture both the nature and intent of the utterances. We measured change in teaching behavior as detected through analysis of the coded utterances.

RESULTS

Among the 48 videotaped encounters, there were a total of 7,119 utterances, with 3,203 (45%) by the teacher. Examining only the teacher, the total number of questions asked declined (714 vs 426, P=.02) with an increase in the proportion of higher-level, analytic questions (44% vs 55%, P<.0001). The quality of feedback also improved, with less "minimal" feedback (87% vs 76%, P<.0005) and more specific feedback (13% vs 22%) provided.

CONCLUSIONS

Teaching behaviors improved after participation in this faculty development program, specifically in the quality of questions asked and feedback provided.

Outcomes of a national faculty development program in teaching skills: prospective follow-up of 110 medicine faculty development teams

BACKGROUND

Awareness of the need for ambulatory care teaching skills training for clinician-educators is increasing. A recent Health Resources and Services Administration (HRSA)-funded national initiative trained 110 teams from U.S. teaching hospitals to implement local faculty development (FD) in teaching skills.

OBJECTIVE

To assess the rate of successful implementation of local FD initiatives by these teams.

METHODS

A prospective observational study followed the 110 teams for up to 24 months. Self-reported implementation, our outcome, was defined as the time from the training conference until the team reported that implementation of their FD project was completely accomplished. Factors associated with success were assessed using Kaplan-Meier analysis.

RESULTS

The median follow-up was 18 months. Fifty-nine of the teams (54%) implemented their local FD project and subsequently trained over 1,400 faculty, of whom over 500 were community based. Teams that implemented their FD projects were more likely than those that did not to have the following attributes: met more frequently (P=.001), had less turnover (P=.01), had protected time (P=.01), rated their likelihood of success high (P=.03), had some project or institutional funding for FD (P=.03), and came from institutions with more than 75 department of medicine faculty (P=.03). The cost to the HRSA was $22,033 per successful team and $533 per faculty member trained.

CONCLUSIONS

This national initiative was able to disseminate teaching skills training to large numbers of faculty at modest cost. Smaller teaching hospitals may have limited success without additional support or targeted funding.

The Impact of a Physician Awareness Group and the First Year of Training on Hematology-Oncology Fellows

Purpose: To assess the impact of a Balint-like physician awareness group on hematology-oncology fellows’ attitudes and measure changes in attitudes during the first fellowship year.

Patients and Methods: We used a modified crossover design in which one half of a fellowship class at a time was exposed to the group intervention over a 2-year period (2000 to 2002). Two 14-fellow classes were followed for 1 year each and were given three “attitudes” questionnaires, at the beginning, middle, and end of the academic year.

Results: Forty Balint group sessions were held during the 2-year study period; 82 questionnaires of the 84 administered (98%) were recovered. Instrument content and criterion validity were demonstrated, as was topic domain reliability. Overall, mean attitude scores increased following the group intervention, from 3.6 (95% CI, 3.5 to 3.7) to 3.7 (95% CI, 3.6 to 3.8; P = .09). Within domains, scores increased in a “fellow’s views of him/herself as a physician,” from 3.8 (95% CI, 3.6 to 3.9) to 4.1 (95% CI, 3.9 to 4.2; P = .008) and “comfort dealing with emotional patient/clinical situations,” from 3.5 (95% CI, 3.3 to 3.7) to 3.7 (95% CI, 3.6 to 3.9; P = .11). Changes in responses to individual questions included: an increase in fellows’ comfort with the technical aspects of being an oncologist (P < .03); an increase in fellows’ comfort with discussing the stress of home at work (P < .023); and an increase among fellows in feeling pressed for time to discuss psychosocial issues with patients (P = .035).

Conclusion: A physician awareness group was feasible and enhanced fellows’ development as physicians. Further research is needed to determine how to incorporate such groups into oncology fellowships.

Faculty development for educational leadership and scholarship

The Medical Education Scholars Program (MESP) at the University of Michigan Medical School is designed to develop leaders in medical education. The program's goals are to enable faculty to provide curriculum direction, improved teaching, educational research, and development, and institutional leadership at all levels of medical education. This one-year program uses a variety of educational methods and provides a broad curriculum in educational theory, assessment and evaluation, research design and methods, teaching-skills development, and educational leadership. Faculty are admitted on a competitive basis and one half-day per week of release time is funded as part of the program. Salient outcomes of the program (promotions, educational research and development, curriculum leadership, and educational scholarship) were measured in a pre- and post-program design in which each scholar acted as his or her own control. There were major increases in promotions and educational awards, new educational responsibilities, and new educational programs. A particularly important outcome was the emergence of educational scholarship in the professional portfolios of the program scholars in the form of peer-reviewed presentations and publications and educational grant funding. A cost-outcome analysis indicates that these multi-year outcomes were obtained from a one-time investment of approximately $21,000 per graduating scholar. This evaluation indicates that intensive faculty development programs can have measurable impacts on the careers of the participants and the institutional environment.

Faculty evaluation in departments of family medicine: do our universities measure up?

Family medicine programmes at Canadian universities have expanded dramatically over the past several years. The development of effective means of faculty evaluation is a real concern for these departments as they strive to maintain the high quality of their teaching programmes in the face of rapid change. The literature on faculty evaluation, including reviews and articles discussing the application of faculty evaluations, is reviewed. The current state of faculty evaluation at three Canadian family medicine department has also been surveyed. Student evaluations were found to be valid, accurate and well studied. They are not perfect, however, and require the use of additional methods such as peer review or video review in conjunction in order to provide a comprehensive evaluation of all areas of faculty activity. Faculty evaluation in family medicine teaching units and community-based settings has not been well studied. Our survey of faculty evaluation at three Canadian universities shows much room for improvement, particularly in community-based settings where evaluation is almost non-existent. Expanding the use of faculty evaluations for formative means and linking evaluation to faculty development opportunities are essential if improvements to the currently used systems are to be successful and accepted by faculty. Special consideration must be given to community-based settings where systems designed for use in larger university settings will need to be modified substantially before they can be used effectively. Further research is required in this area.

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

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